Cytokine balance in infants undergoing cardiac operation.
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.
Hövels-Gürich
Hedwig H
HH
Department of Pediatric Cardiology, Aachen University of Technology, Germany. hhoevels-guerich@ukaachen.de
Schumacher
Kathrin
K
Vazquez-Jimenez
Jaime F
JF
Qing
Ma
M
Hüffmeier
Ulrike
U
Buding
Brigitte
B
Messmer
Bruno J
BJ
von Bernuth
Götz
G
Seghaye
Marie-Christine
MC
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*
D000209:Acute-Phase Proteins; D016207:Cytokines