Standardized immune monitoring for the prediction of infections after cardiopulmonary bypass surgery in risk patients.
BACKGROUND
Infections are the most common cause of late complications in cardiopulmonary bypass (CPB) surgery patients, and are difficult to predict. Here we studied the diagnostic value of a standardized immune monitoring program based on recent advances in flow cytometry (exact quantification of surface-marker expression) and cytokine determination (semiautomatic systems).


METHODS
CPB patients (56) at risk for complications (age >70 years and/or preoperative left-ventricular ejection fraction < 25 %) were classified into three groups: without (33), with suspected (14), and with confirmed (9) infection. Applying the Quantibrite trade mark -system, we daily quantified the expression of CD11b, CD64, CD71, CD86, and HLA-DR on monocytes/granulocytes. Furthermore, the ex vivo secretion of tumor necrosis factor (TNF)-alpha as well as the plasma interleukin (IL)-10 levels were determined by a semiautomatic system. Ex vivo elastase release was measured by enzyme-linked immunosorbent assay (ELISA).


RESULTS
All patients showed signs of granulocyte activation and monocyte deactivation. Monocytic HLA-DR and plasma IL-10 were the best markers to discriminate patients with infection from those without as early as day 1. Using a cutoff of 5792 HLA-DR molecules per cell, both sensitivity and negative predictive value for patients who developed microbiologically confirmed infection was 1.0, and the area under the curve (AUC) was 0.85.


CONCLUSIONS
Our data suggest that a standardized immune monitoring at day 1 might be useful for early discrimination of patients at elevated risk for infections.
Strohmeyer
Jens-Christian
JC
Institute for Medical Immunology, Charité-Campus Mitte, Berlin, Germany.
Blume
Christian
C
Meisel
Christian
C
Doecke
Wolf-Dietrich
WD
Hummel
Manfred
M
Hoeflich
Conny
C
Thiele
Kathi
K
Unbehaun
Axel
A
Hetzer
Roland
R
Volk
Hans-Dieter
HD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002315:Cardiopulmonary Bypass; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006098:Granulocytes / Q000276:immunology; D006801:Humans; D007121:Immunocompetence; D007239:Infections / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D011237:Predictive Value of Tests; D012307:Risk Factors
D015415:Biomarkers