Preoperative prediction of pediatric patients with effusions and edema following cardiopulmonary bypass surgery by serological and routine laboratory data.
OBJECTIVE
Postoperative effusions and edema and capillary leak syndrome in children after cardiac surgery with cardiopulmonary bypass constitute considerable clinical problems. Overshooting immune response is held to be the cause. In a prospective study we investigated whether preoperative immune status differences exist in patients at risk for postsurgical effusions and edema, and to what extent these differences permit prediction of the postoperative outcome.


METHODS
One-day preoperative serum levels of immunoglobulins, complement, cytokines and chemokines, soluble adhesion molecules and receptors as well as clinical chemistry parameters such as differential counts, creatinine, blood coagulation status (altogether 56 parameters) were analyzed in peripheral blood samples of 75 children (aged 3-18 years) undergoing cardiopulmonary bypass surgery (29 with postoperative effusions and edema within the first postoperative week).


RESULTS
Preoperative elevation of the serum level of C3 and C5 complement components, tumor necrosis factor-alpha, percentage of leukocytes that are neutrophils, body weight and decreased percentage of lymphocytes (all P < 0.03) occurred in children developing postoperative effusions and edema. While single parameters did not predict individual outcome, >86% of the patients with postoperative effusions and oedema were correctly predicted using two different classification algorithms. Data mining by both methods selected nine partially overlapping parameters. The prediction quality was independent of the congenital heart defect.


CONCLUSIONS
Indicators of inflammation were selected as risk indicators by explorative data analysis. This suggests that preoperative differences in the immune system and capillary permeability status exist in patients at risk for postoperative effusions. These differences are suitable for preoperative risk assessment and may be used for the benefit of the patient and to improve cost effectiveness.
Pediatric Cardiology, Heart Center Leipzig GmbH, University of Leipzig, Germany.
József
J
Bocsi
Jörg
J
Hambsch
Pavel
P
Osmancik
Peter
P
Schneider
Günter
G
Valet
Attila
A
Tárnok
D000293:Adolescent; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003176:Complement C3 / Q000378:metabolism; D003182:Complement C5 / Q000378:metabolism; D016002:Discriminant Analysis; D004487:Edema / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D006098:Granulocytes / Q000378:metabolism; D006400:Hematocrit; D006801:Humans; D019041:L-Selectin / Q000097:blood; D015999:Multivariate Analysis; D009504:Neutrophils / Q000378:metabolism; D010490:Pericardial Effusion / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D010996:Pleural Effusion / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D011183:Postoperative Complications / Q000378:metabolism / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D003176:Complement C3; D003182:Complement C5; D014409:Tumor Necrosis Factor-alpha; D019041:L-Selectin