title: Cytokine balance in infants undergoing cardiac operation.
abstract: BACKGROUND
  The control of the systemic inflammatory response taking place during cardiac operations depends on adequate antiinflammatory reaction. In this prospective study we tested the hypothesis that cytokine balance during pediatric cardiac surgical procedures would be influenced by the patients' preoperative clinical condition, defined as hypoxemia or heart failure.
  
  
  METHODS
  Twenty infants (median age, 8 months) with hypoxemia owing to intracardiac right-to-left shunt (group 1, n = 10) or with heart failure because of intracardiac left-to-right shunt (group 2, n = 10), scheduled for elective primary corrective operation, were enrolled. Plasma levels of the proinflammatory cytokine interleukin (IL) 6, the natural antiinflammatory cytokine IL-10, and the markers of the acute-phase response, C-reactive protein and procalcitonin, were sequentially measured before, during, and after cardiac operation up to the 10th postoperative day. The ratio of IL-10 to IL-6 levels served as a marker for the individual's antiinflammatory cytokine balance.
  
  
  RESULTS
  Group 1 showed higher preoperative IL-6 (p < 0.001), lower IL-10 levels (p < 0.02), and lower ratio of IL-10 to IL-6 levels (p < 0.001) than group 2. Preoperative C-reactive protein and procalcitonin were not detectable. In group 1, preoperative IL-6 levels inversely correlated with preoperative oxygen saturation (Spearman correlation coefficient, -0.74, p < 0.02). During cardiopulmonary bypass, IL-6 levels were higher, whereas IL-10 and ratio of IL-10 to IL-6 levels were lower in group 1 than in group 2. In all patients, postoperative IL-6 levels were positively correlated with duration of inotropic support and serum creatinine value and inversely correlated with oxygenation index and diuresis.
  
  
  CONCLUSIONS
  Infants with hypoxemia show a preoperative inflammatory state with low antiinflammatory cytokine balance in contrast to those with heart failure. This in turn is associated with lower perioperative antiinflammatory cytokine balance and might contribute to postoperative morbidity.
authors.affiliation: Department of Pediatric Cardiology, Aachen University of Technology, Germany. hhoevels-guerich@ukaachen.de
authors.forename: Hedwig H
authors.initials: HH
authors.lastname: Hövels-Gürich
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schumacher
authors.forename: Jaime F
authors.initials: JF
authors.lastname: Vazquez-Jimenez
authors.forename: Ma
authors.initials: M
authors.lastname: Qing
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hüffmeier
authors.forename: Brigitte
authors.initials: B
authors.lastname: Buding
authors.forename: Bruno J
authors.initials: BJ
authors.lastname: Messmer
authors.forename: Götz
authors.initials: G
authors.lastname: von Bernuth
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Seghaye
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D016207:Cytokines / Q000097:blood*; D005260:Female; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000276:immunology / Q000601:surgery*; D006333:Heart Failure / Q000276:immunology / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000276:immunology / Q000601:surgery; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000276:immunology*; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology*
chemical_list: D000209:Acute-Phase Proteins; D016207:Cytokines