Complement activation and cytokine and chemokines release during mediastinitis.
BACKGROUND
Mediastinitis after open heart operation is an infrequent, but life-threatening complication with a reported incidence rate between 1% and 4%. Hospital mortality is estimated at 10% to 35%. The aim of the present work was to study the systemic inflammatory reaction as judged by complement activation and cytokine and chemokines release in patients with mediastinitis after open heart operation.


METHODS
Seven patients with clinical signs of mediastinitis were included. Three patients had undergone coronary artery bypass grafting, whereas 4 patients had combined coronary artery bypass grafting, valve replacement, or valvuloplasty. Blood samples were drawn before induction of anesthesia and at the time of reoperation, and thereafter daily during the hospital stay. Controls comprised similar patients with an uneventful postoperative course.


RESULTS
The terminal SC5b-9 complement complex concentration in the mediastinitis patients was substantially higher compared with the controls (p < 0.001), and the terminal SC5b-9 complement complex values showed no overlap between the two groups. Interleukin-8, stromal cell-derived factor-1alpha and IL-6 concentrations were also significantly higher in the mediastinitis group than in the control group (p < 0.001), but with considerable overlap between the groups. Interleukin-1beta, interleukin-10, and monocyte chemoattractant protein-1 concentrations were slightly higher in the mediastinitis group, and no differences were seen for the tumor necrosis factor-alpha.


CONCLUSIONS
During mediastinitis, the complement is activated and the cytokines and chemokines, interleukin-6, interleukin-8, and stromal cell-derived factor-1alpha are released. These proteins may be involved in the pathogenesis of this complication. Terminal SC5b-9 complement complex may be an indicator to discriminate mediastinitis patients from those with uneventful course.
Risnes
Ivar
I
Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, University of Oslo, Oslo, Norway. ivar.risnes@rikshospitalet.no
Ueland
Thor
T
Aukrust
Pål
P
Lundblad
Runar
R
Baksaas
Svein Tore
ST
Mollnes
Tom Eirik
TE
Svennevig
Jan L
JL
D000368:Aged; D000900:Anti-Bacterial Agents; D054377:Chemokine CXCL12; D018925:Chemokines / Q000097:blood*; D019743:Chemokines, CXC / Q000097:blood; D003167:Complement Activation / Q000276:immunology*; D015938:Complement Membrane Attack Complex; D003165:Complement System Proteins; D001026:Coronary Artery Bypass; D016207:Cytokines / Q000097:blood*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006023:Glycoproteins / Q000097:blood; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000276:immunology / Q000601:surgery
D000900:Anti-Bacterial Agents; C515255:CXCL12 protein, human; D054377:Chemokine CXCL12; D018925:Chemokines; D019743:Chemokines, CXC; D015938:Complement Membrane Attack Complex; D016207:Cytokines; D006023:Glycoproteins; D015850:Interleukin-6; D016209:Interleukin-8; C047610:SC5b-9 protein complex; D003165:Complement System Proteins