The balance of pro- and anti-inflammatory cytokines in cardiac surgery

McBride, W. T.; McBride, S.J.

doi:10.1097/00001503-199802000-00004

Cited by 33 publications

(29 citation statements)

References 58 publications

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“…It may exercise its cytotoxic effect through induction of the nitric oxide synthase in the cells of the renal tubules and thus production of the nitric oxide [37,38]. Moreover, some authors postulate that, in exercising their effect, the pro-inflammatory cytokines that underwent glomerular filtration are not inhibited by the anti-inflammatory cytokines since the later have higher molecular weight and thus are not filtrated through the undamaged basal membrane of the renal glomeruli [39]. It is assumed that, in diabetic patients, the production of the anti-inflammatory cytokines is probably insufficient to reduce significantly the neurotoxic effect of the pro-inflammatory cytokines.…”

Section: Discussionmentioning

confidence: 99%

The activity of N-acetyl-beta-d-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children

Myśliwiec

Zorena

Balcerska

et al. 2006

Clinical Biochemistry

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Section: Discussionmentioning

confidence: 99%

The activity of N-acetyl-beta-d-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children

Myśliwiec

Zorena

Balcerska

et al. 2006

Clinical Biochemistry

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“…1,2 During CPB, interaction of blood with nonbiological surfaces or nondependent material factors (ischaemia -reperfusion of the heart and lungs, shed blood) triggers a strong inflammatory response, as reflected by increased levels of cytokines and leukocyte activation. [3][4][5][6][7][8][9][10][11][12] Moreover, allogeneic blood transfusion or intraoperative autotransfusion is sometimes required, contributing to further increased inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit

et al. 2002

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Intraoperative blood salvage devices allowing a reinfusion of red blood cells (RBCs) after processing of shed blood and stagnant blood in the mediastinal cavity are more and more used to reduce homologous blood requirements in cardiac surgery with cardiopulmonary bypass (CPB). As the proinflammatory activity of the shed blood also contributes to morbidity during CPB, we conducted a prospective study in order to examine the quality of autologous blood before and after processing with five different devices [BRAT2, Sequestra, Compact Advanced, Cell Saver 5 (CS5), Continuous Autologous Transfusion System (CATS)]. All systems resulted in an excellent haemoconcentration, ranging from 53.7% (Compact) to 68.9% (CATS). The concentrations and elimination rates of several inflammatory markers [IL-1beta, IL-2, IL-8, TNFalpha, myeloperoxidase (MPO), elastase] were examined. Except for the Sequestra, an important increase in concentration of IL-1beta (between 30% and 220%) has been observed after processing with each device. In contrast, the attenuation rate of IL-6 and TNFalpha (95%) was optimal for all investigated blood salvages systems. Regarding IL-8, only the CATS and CS5 systems were able to attenuate this biological parameter with an excellent efficacy. The rate of attenuation in MPO and elastase, as markers of leukocyte activation, was higher than 80% for all devices. In conclusion, the different RBC washing systems tested in this study resulted in a significant attenuation of the inflammatory response. Increased levels of IL-1beta after processing remained, however, unclear. According to the type of protocol, based on inlet haematocrit, fill and wash speeds, and wash volumes, small variations in reducing the inflammatory response have been observed from one device to another.

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“…The mechanism whereby transfusion influences adverse outcome has not been obviously understood. The systemic inflammatory response may play role in the negative impact of transfusion on outcome [19]. Patients undergoing cardiac surgery manifest a noninfectious inflammatory response reflected by increased concentrations of inflammatory mediators [20].…”

Section: Discussionmentioning

confidence: 99%

Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

et al. 2009

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AbstractTransfusion after cardiac surgery is very common. This rate varies between institutions and has remained high despite established transfusion guidelines. We analyzed our database of patients who underwent isolated CABG (Coronary Artery Bypass Graft) to determine the predictive factors of homologous transfusion and associated postoperative morbidity, mortality and resource utilization. All 14,152 patients who underwent first-time isolated CABG, with or without cardiopulmonary bypass (CPB) who had postoperative homologous transfusion between February 2002 and March 2008 in Tehran Heart Center, were evaluated retrospectively. Overall, 16.5% of patients received transfusion. Transfused patients demonstrated a significantly higher incidence of postoperative complications (cardiac, infectious, ischemic, reoperation) and mortality (p<0.001). Homologous blood transfusion effect on mortality, morbidity and resource utilization. By Multivariable logistic regression analysis adjusted for confounders: Homologous blood transfusion effect on Mortality (30-days) (OR=3.976, p<0.0001), Prolonged ventilation hours (OR=4.755, p<0.0001), Total ICU hours (β =14.599, p<0.0001), Hospital length of stay (β =1.141, p<0.0001), Post surgery length of stay (β =0.955, p<0.0001). We conclude that the isolated CABG patients receiving blood transfusion have significantly higher mortality, morbidity and resource utilization. Homologous blood transfusion is an independent factor of increased resource utilization, morbidity and mortality.

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The balance of pro- and anti-inflammatory cytokines in cardiac surgery

Cited by 33 publications

References 58 publications

The activity of N-acetyl-beta-d-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children

The activity of N-acetyl-beta-d-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children

Levels of inflammatory markers in the blood processed by autotransfusion devices during cardiac surgery associated with cardiopulmonary bypass circuit

Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery

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