Cardiac surgery modulates leucocyte subsets and inflammatory mediators

Leucocytes regulate the immune response through multiple pathways including cytokine release, which is critical for mediating host defences. Coronary artery bypass grafting (CABG) initiates a systemic inflammatory response that may contribute to adverse patient outcomes. Full blood counts (FBC) provide insight into patient's haematological status, however FBC don't provide comprehensive analysis of leucocyte subsets. We investigated the impact of CABG on circulating leucocyte subsets and plasma cytokine levels. Whole blood was collected from CABG patients (n = 75) at five time-points (admission, intra-operative, ICU, day three (D3), day five (D5)). The absolute count of monocytes, natural killer (NK) cells, B-cells, T-cell subsets, and dendritic cell (DC) subsets were assessed using Trucount tubes. A full blood count was performed on each patient sample and used to calculate the lymphocyte monocyte ratio and neutrophil lymphocyte ratio. Cytokine levels in patient plasma were measured via cytometric bead array. The relationship between CABG-associated immunomodulation and patient outcomes (atrial fibrillation (AF) and ICU length of stay (LOS)) was also explored. Compared to admission, patient monocyte numbers increased, and T-cell numbers decreased from the ICU period. B-cell numbers initially decreased during CABG surgery before increasing from D3. During the CABG procedure, classical DC numbers decreased, while plasmacytoid DC numbers increased. CABG also increased plasma levels of IL-6, MCP-10 and IP-10. Modulation of DC subsets, DC subset activation markers and T-cell subsets were associated with AF and ICU LOS. This study demonstrates the utility of comprehensive leucocyte subset and ratio analyses in CABG patients and provides further insight into cardiac immunobiology. Detailed assessment of the patient haematological status could be used as a clinical tool to guide post-operative management.