The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions

Abstract

Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1beta, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocardial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1beta) and PCT were significantly elevated in MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response.

A Comparison of Monocyte Counts and Ex Vivo and In Vitro Monocyte Cytokine Production After Major Surgical Trauma

“…These findings confirm previous studies that investigated these parameters under similar conditions [6 -8, 15, 17]. The increase in leukocyte counts is considered to be part of the systemic inflammatory response syndrome [18,19]. Our results show that the number of peripheral blood CD14ϩ MOs increased to a level similar to that of other leukocytes.…”

Pro-inflammatory cytokines after different kinds of cardio-thoracic surgical procedures: is what we see what we know?

“…They peaked on dxC and remained slightly elevated until d5. IL-8 plays a major role in the recruitment and activation of leucocytes during post-operative (multi-)organ dysfunction syndrome (MODS) [6,10]. The selective increase in IL-8 following CS with or without CPB thus requires further attention.…”

Redox regulation of neutrophil apoptosis and the systemic inflammatory response syndrome

“…cytokines) into the circulation [16,17]. Secondly, activation of leucocytes [18], platelets [19], complement [20,21], clotting cascades [22] and other inflammatory mediators [23][24][25][26] may occur following the direct contact of blood with the extracorporeal bypass circuit. Finally, relative hypoperfusion of the splanchnic bed, both intra-and post-operatively, may lead to gut wall ischaemia, an increase in villous capillary permeability and translocation of enteral flora into the systemic circulation [27].…”