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Cytokine profile of Post-cardiopulmonary bypass in children
Kantara Saelim1, Kanokpan Ruangnapa1, Jirayut Jarutach2
1Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Insights
Elevated postoperative interleukin-8 (IL-8) levels strongly predict low cardiac output syndrome (LCOS) in children after heart surgery. Monitoring these cytokine dynamics is crucial for guiding interventions and improving outcomes.
Area of Science:
- Pediatric cardiac surgery
- Inflammatory response
- Cytokine dynamics
Background:
- Open cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic inflammatory response impacting outcomes.
- Cytokine release dynamics post-CPB in pediatric patients are not well understood.
Purpose of the Study:
- To investigate the temporal changes in cytokine levels after CPB.
- To determine the association between cytokine levels and low cardiac output syndrome (LCOS)-related outcomes in pediatric cardiac surgery patients.
Main Methods:
- Prospective observational cohort study of 32 children undergoing open cardiac surgery with CPB.
- Measurement of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α preoperatively and at 6, 12, and 24 hours post-ICU admission.
- LCOS defined by clinical criteria, vasopressor-inotropic score, ejection fraction, and need for intervention.
Main Results:
- LCOS-related outcomes occurred in 37.5% of patients.
- Significant differences in IL-6, IL-8, and TNF-α levels were observed between patients with and without LCOS.
- A >56 pg/mL increase in IL-8 from baseline to T0 was strongly associated with LCOS (OR 37.34).
Conclusions:
- Elevated postoperative IL-8 is a significant predictor of LCOS in pediatric cardiac surgery.
- Monitoring cytokine profiles, particularly IL-8, can aid in identifying at-risk patients.
- These findings support targeted interventions based on inflammatory marker dynamics to improve pediatric cardiac surgery outcomes.
Background:
Open cardiac surgery involving cardiopulmonary bypass (CPB) triggers a systemic inflammatory response that significantly affects clinical outcomes. However, the dynamics and specific roles of cytokine release after CPB in the pediatric population remain unclear.
Purpose:
To evaluate the dynamics of cytokine levels and their association with low cardiac output syndrome (LCOS)-related outcomes.
Methods:
A prospective observational cohort study was conducted of 32 children who underwent elective open cardiac surgery with CPB at Songklanagarind Hospital, Thailand. Levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α were analyzed preoperatively and immediately (T0), 6, 12, and 24 hours after intensive care unit admission. LCOS-related outcomes were defined with at least two of the following criteria being met within 24 hours postoperative: clinical and laboratory parameters, vasopressor-inotropic score ≥20, ejection fraction <50% on echocardiography; and requirement for a serious postoperative intervention. Statistical analyses utilized linear mixed models and multivariate logistic regression to identify the independent predictors of LCOS.
Results:
The mean patient age was 34.8±34.4 months; 56.2 % were male. Roughly one-third (37.5%) had a history of previous cardiac surgery, while one-quarter (28.3%) had a Risk Adjustment for Congenital Heart Surgery score ≥3. LCOS-related outcomes occurred in 37.5% of patients. IL-6, IL-8, and TNF-α levels differed significantly between patients with and without LCOS outcomes. An increase in IL-8 of >56 pg/mL from baseline to T0 showed the strongest association with LCOS (odds ratio, 37.34; 95% confidence interval, 4.53-836.53).
Conclusion:
An elevated postoperative IL-8 level is a robust predictor of LCOS-related outcomes in pediatric patients undergoing cardiac surgery. These findings emphasize the importance of monitoring cytokine dynamics to guide interventions and improve patient outcomes.
