Preoperative prediction of postoperative edema and effusion in pediatric cardiac surgery by altered antigen expression patterns on granulocytes and monocytes

Abstract

Postoperative edema and effusion (POEE) following cardiopulmonary bypass (CPB) surgery in children retards recovery and may aggravate postpericardiotomy (PPS), capillary leak syndrome (CLS), or multiorgan failure (MOF). Compared with complication-free children, POEE affected children have different preoperative serum levels of circulating cytokines and adhesion molecules. These levels may be used preoperatively to assess POEE, but their determination is time consuming, costly, and a substantial blood volume is required. Altered serum levels of cytokines and adhesion molecules also may be reflected in altered antigen expression on circulating blood leukocytes. The predictive potential of flow cytometric (FCM) leukocyte immunophenotyping was explored as a sensitive and fast method that required small blood samples. Blood samples taken 24 h preoperatively from 49 patients (3-18 years old) were stained with monoclonal antibodies for adhesion molecules (ICAM-1, LFA-1, Mac-1) or constitutive/activation markers (CD4, CD14, CD16, CD25, CD54, CD69, HLA-DR) and measured on a microbead calibrated FCM. Neutrophils, monocytes, and eosinophils from POEE patients express higher preoperative levels of LFA-1, monocytes, HLA-DR, and other activation markers (all P < 0.03). Over 89% of the patients were classified correctly by using two discriminant analysis methods (sensitivity, >76%; specificity, >86%; positive prediction, >80%; negative prediction, >83%). Granulocytes and monocytes of postoperative POEE patients exhibit significant preoperative immune activation, suggesting an increased risk for patients with atopic/allergic predisposition. Surgical trauma and CPB cause additional immune activation, leading to POEE by a summative response. Most patients at risk for POEE can be identified preoperatively by using data pattern analysis on FCM-derived parameters. Cytometry (Comm. Clin. Cytometry) 46:247-253, 2001.

Patient-Specific Immune States Before Surgery Are Strong Correlates of Surgical Recovery

“…8 Current results dovetail with a large body of work implicating a critical role of monocyte subsets and dendritic cells in the immune response to traumatic injury and surgical recovery. [20][21][22][23][24][25][26][27] The findings integrate with the well-established role of the TLR4 signaling pathway in the innate immune response to traumatic injury. 28 MAPKAPK2 is a component of the p38 MAP kinase pathway, which mediates TLR4 priming in injury.…”

Monitoring of monocyte functional state after extracorporeal circulation: A flow cytometry study

“…A prolonged activation of immune system can lead to postoperative complications (2). This acute phase response depends on contact of blood with the foreign surfaces of the bypass apparatus, on release of tissue damage products as consequence of postischemic reperfusion (3), and on priming solutions and medications (4,5).…”

Apoptosis of circulating lymphocytes during pediatric cardiac surgery

“…These findings indicated that pre-operative (allergic or inflammatory) predisposition of POEE risk patients may exist 10,11 . These individual phenotypes would allow for predictive medicine and individualized therapy 16 .…”

“…This device is necessary for oxygenation, blood circulation, body cooling and re-warming but is associated with extensive blood contact with foreign materials and increases trauma. Patients who undergo CPB surgery frequently develop a systemic inflammatory response syndrome (SIRS) ranging from mild complications as pericardial, pleural and or abdominal effusion, liver enlargement and edema formation to massive generalized edema, acute respiratory distress syndrome or even multiple organ failure [9][10][11] . Surgical trauma is associated with elevated apoptosis rate of circulating leukocytes 12 .…”