Plasma levels of alarmin HNPs 1–3 associate with lung dysfunction after cardiac surgery in children

Abstract

BackgroundEarly onset of lung injury is considerable common after cardiac surgery and is associated with increasing in morbidity and mortality, but current clinical predictors for the occurrence of this complication always have limited positive warning value. This study aimed to evaluate whether elevated plasma levels of human neutrophil peptides (HNPs) 1–3 herald impaired lung function in infants and young children after cardiac surgery necessitating cardiopulmonary bypass (CPB).MethodsConsecutive children younger than 3 years old who underwent cardiac surgery were prospectively enrolled. Plasma concentrations of HNPs 1–3 and inflammatory cytokines were measured before, and immediately after CPB, as well as at 1 h, 12 h, and 24 h after CPB.ResultsThirty patients were enrolled, 18 (60%) of whom were infants. Plasma levels of HNPs 1–3 and the pro-inflammatory cytokine interleukin-6 (IL-6) significantly increased immediately after CPB (P < 0.001), while IL-8 increased 1 h after the CPB operation (P = 0.002). The anti-inflammatory cytokine IL-10 levels were also significantly elevated immediately after CPB compared with the baseline (P < 0.001). The stepwise multiple linear regression analysis showed that the plasma HNPs 1–3 levels immediately after CPB was independent correlated with the declined lung function, as reflected by the PaO2/FiO2 ratio on the first 2 days after operation (for the first day: OR, −1.067, 95% CI, −0.548 to −1.574; P < 0.001; for the second day: OR, −0.667, 95% CI, −0.183 to −1.148; P = 0.009) and prolonged mechanical ventilation time (OR, 0.039, 95% CI, 0.005 to 0.056; P = 0.011). Plasma levels of HNPs 1–3 and IL-10 returned to the baseline values, while IL-6 and IL-8 levels remained significantly higher than baseline 24 h after CPB (P ≤ 0.01).ConclusionsElevated HNPs 1–3 levels immediately after CPB correlate with impaired lung function, and HNPs 1–3 could serve as a quantifiable early alarmin biomarker for onset of lung injury in infants and young children undergoing cardiac surgery with CPB.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0558-4) contains supplementary material, which is available to authorized users.

Plasma Cold-Inducible RNA-Binding Protein Predicts Lung Dysfunction After Cardiovascular Surgery Following Cardiopulmonary Bypass: A Prospective Observational Study

“…Considering that CIRP participates in the dysfunction of endothelial cells via activation of the NLRP3 inflammasome [21], we speculated that CIRP is correlated with lung injury induced by cardiovascular surgery with CPB. As expected, after adjusting other factors, multiple linear regression analysis indicated that CIRP levels were independently associated with PaO 2 /FiO 2 and reflect the severity of lung injury [28]. These findings strengthen the conclusion that CIRP is a predictor for lung injury after cardiovascular surgery with CPB.…”

Lactoferrin and Human Neutrophil Protein (HNP) 1–3 Levels During the Neonatal Period in Preterm Infants

“…However, HNP 1–3 was elevated in infants diagnosed with another inflammation-mediated disease, BPD, comparable to serum concentrations of several cytokines ( 27 ). Interestingly, previous studies found an elevation of serum HNP in children with poor pulmonary outcome ( 15 ), assuming its function as an alarmin may be of use as a prognostic marker of the inflammation mediating the lung disease. This aspect needs to be confirmed in prospective trials in order to evaluate whether HNP adds information within the multifactorial risk profile for BPD.…”

“…In preterm infants, infection and inflammation may influence systemic levels of APPs ( 6 , 7 , 13 – 15 ). In line with that, LF has been proposed to have a beneficial effect by counter-regulating systemic inflammation in neonatal sepsis ( 16 ), which was not confirmed by other investigators ( 17 ).…”

Serum level of calpains product as a novel biomarker of acute lung injury following cardiopulmonary bypass

“…If severe cases evolve into acute respiratory distress syndrome (ARDS), the mortality rate is close to 30% (4,5). According to clinical experience, the earlier lung damage is detected, the more successful the treatment will be (6)(7)(8). Therefore, in-depth study of the mechanism of CPB-related lung injury, discovery, and validation of certain alarming biomarker of CPB-related lung injury in cardiac surgery patients will greatly contribute to early diagnosis and effective treatment decisions making.…”