title: Soluble tumor necrosis factor receptor p55 predicts cytokinemia and systemic inflammatory response after cardiopulmonary bypass.
abstract: OBJECTIVE
  To examine the behavior of soluble tumor necrosis factor (TNF) receptors in circulation before and after cardiopulmonary bypass and the relationship to the development of cytokinemia and acute complications comprising systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). The predictive value of soluble TNF receptor is assessed herein.
  
  
  METHODS
  Prospective study comparing prebypass and postbypass levels in patients with and without complications indicative of SIRS and MODS.
  
  
  METHODS
  Cardiac surgical intensive care unit in a tertiary care hospital.
  
  
  METHODS
  A total of 20 pediatric patients who underwent cardiopulmonary bypass during open heart surgery.
  
  
  METHODS
  Blood samples were collected from catheters before and 2 hrs and 24 hrs after the onset of bypass.
  
  
  RESULTS
  We measured plasma levels of soluble TNF receptors by using enzyme-linked immunosorbent assay in 20 patients before and after cardiopulmonary bypass. Clinical data, including duration of bypass and tests or signs indicative of SIRS/MODS, were collected. Soluble TNF receptor I (p55 sR), significantly increased (2241 +/- 312 pg/mL) at 2 hrs after bypass (p <.0005) and remained elevated (2826 +/- 695 pg/mL) at 1 day after bypass (p <.005) when compared with prebypass levels (725 +/- 130 pg/mL). Patients with the acute complications of SIRS/MODS had a higher ratio of postbypass to prebypass p55 sR levels (5.0-fold, p <.001) when compared with patients with no SIRS/MODS (1.75-fold). Remarkably, before surgery, levels of TNF p55 sR predict both cytokinemia (r =.67 to.73, p <.05) and SIRS/MODS (p <.01). The prebypass levels of TNF p55 sR were consistently higher (range, 1000-1400 pg/mL) in patients who subsequently developed SIRS/MODS than the levels (range, 400-570 pg/mL) in patients who did not develop SIRS/MODS. Hypotension, respiratory dysfunctions, and coagulopathy were particularly more prevailing (p <.005) among the complications that were associated with high prebypass levels of TNF p55 sR.
  
  
  CONCLUSIONS
  Soluble TNF receptor p55 can be employed as a predictive marker for cytokinemia and the development of SIRS/MODS that may arise from a major insult to the body such as cardiopulmonary bypass.
authors.affiliation: Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: el-Barbary
authors.forename: Khalid S A
authors.initials: KS
authors.lastname: Khabar
mesh_terms: D015703:Antigens, CD / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D002669:Child Welfare; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D000068800:Etanercept; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007223:Infant; D007229:Infant Welfare; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood; D011183:Postoperative Complications / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D047888:Receptors, Tumor Necrosis Factor, Type I; D013223:Statistics as Topic; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood*
chemical_list: D015703:Antigens, CD; D015415:Biomarkers; D016207:Cytokines; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D047888:Receptors, Tumor Necrosis Factor, Type I; D000068800:Etanercept