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Case-control study on the interplay between immunoparalysis and delirium after cardiac surgery
Shokoufeh CheheiliSobbi1,2, Annemieke M Peters van Ton3, Esther M Wesselink4
1Department of Intensive Care Medicine, IP 707, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Insights
Post-cardiothoracic surgery, immune suppression (immunoparalysis) was similar in patients who developed delirium and those who did not. This suggests immunoparalysis does not explain the link between infection and delirium after surgery.
Area of Science:
- Immunology
- Critical Care Medicine
- Infectious Disease
Background:
- Delirium is common after cardiothoracic surgery, with infection as a key risk factor.
- Cardiothoracic surgery and cardiopulmonary bypass can cause immune suppression, termed immunoparalysis.
- This study investigated if immunoparalysis is more severe in patients who develop delirium post-surgery.
Purpose of the Study:
- To determine if delirious patients exhibit more pronounced immunoparalysis after cardiothoracic surgery compared to non-delirious patients.
- To explore the association between delirium, infection, and immune response following cardiothoracic surgery.
Main Methods:
- A prospective matched case-control study was conducted in two university hospitals.
- Cytokine production (TNF-α, IL-6, IL-8, IL-10) was measured from lipopolysaccharide-stimulated whole blood pre- and post-surgery (up to 3 days).
- Delirium was assessed using validated scales and chart review.
Main Results:
- Both delirious and non-delirious patients showed severe suppression of cytokine production post-surgery.
- The degree of cytokine suppression (immunoparalysis) was comparable between patients with and without delirium.
- No significant difference in the attenuation of TNF-α, IL-6, IL-8, and IL-10 production was observed between the groups.
Conclusions:
- Post-operative immunoparalysis is similar in patients who develop delirium and those who remain delirium-free after cardiothoracic surgery.
- These findings indicate that more pronounced immunoparalysis is unlikely to be the reason for delirium in these patients.
- The study does not support immunoparalysis as a direct explanation for the delirium-infection association in cardiothoracic surgery patients.
Background:
Delirium occurs frequently following cardiothoracic surgery, and infectious disease is an important risk factor for delirium. Surgery and cardiopulmonary bypass induce suppression of the immune response known as immunoparalysis. We aimed to investigate whether delirious patients had more pronounced immunoparalysis following cardiothoracic surgery than patients without delirium, to explain this delirium-infection association.
Methods:
A prospective matched case-control study was performed in two university hospitals. Cytokine production (tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and IL-10) of ex vivo lipopolysaccharide (LPS)-stimulated whole blood was analyzed in on-pump cardiothoracic surgery patients preoperatively, and at 5 timepoints up to 3 days after cardiothoracic surgery. Delirium was assessed by trained staff using two validated delirium scales and chart review.
Results:
A total of 89 patients were screened of whom 14 delirious and 52 non-delirious patients were included. Ex vivo-stimulated production of TNF-α, IL-6, IL-8, and IL-10 was severely suppressed following cardiothoracic surgery compared to pre-surgery. Postoperative release of cytokines in non-delirious patients was attenuated by 84% [IQR: 13-93] for TNF-α, 95% [IQR: 78-98] for IL-6, and 69% [IQR: 55-81] for IL-10. The attenuation in ex vivo-stimulated production of these cytokines was not significantly different in patients with delirium compared to non-delirious patients (p > 0.10 for all cytokines).
Conclusions:
The post-operative attenuation of ex vivo-stimulated production of pro- and anti-inflammatory cytokines was comparable between patients that developed delirium and those who remained delirium-free after on-pump cardiothoracic surgery. This finding suggests that immunoparalysis is not more common in cardiothoracic surgery patients with delirium compared to those without.
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