Study on the relationship of APACHE III and levels of cytokines in patients with systemic inflammatory response syndrome after coronary artery bypass grafting.
The aim of this study was to explore the relationship and interpret the clinical importance of acute physiology and chronic health evaluation III (APACHE III) and levels of cytokines in patients with systemic inflammatory response syndrome (SIRS) after coronary artery bypass grafting (CABG) with or without cardio-pulmonary bypass (CPB) to see if they are beneficial for evaluating the seriousness of SIRS. The data suggested that the APACHE III score and levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1beta), and soluble interleukin-2 receptor (sIL-2R) were significantly higher after conventional CABG (CCABG) than after off-pump coronary artery bypass grafting (OPCAB) (p<0.05). With an increase in the APACHE III score, the levels of IL6, IL8, TNF-alpha, IL-1beta, and sIL-2R and the morbidity of multiple organ dysfunction syndrome (MODS) increased gradually (p<0.01), while the level of IL2 decreased (p<0.01). Stepwise regression analysis showed that IL-1beta, IL6, IL8, and sIL-2R levels had significant influences on the APACHE III score (p<0.05). The APACHE III score and levels of IL6, IL8, TNF-alpha, IL-1beta, and sIL-2R were significantly higher in the MODS group than in the non-MODS group (p<0.05), but the level of IL2 was significantly lower in the MODS group (p = 0.04). In conclusion, despite comparable surgical trauma, we believe that CPB is one of the most important factors responsible for stimulating an inflammatory response. SIRS after OPCAB was clearly mitigated compared with CCABG. Determination of the APACHE III score and plasma IL-1beta, IL6, IL8 and sIL-2R concentrations might be helpful for evaluating the severity of SIRS following CABG and making a prognosis.
Mei
Yun Qing
YQ
Heart-Lung-Blood Vessel Center of Tongji University, Institute of Heart-Lung-Blood Vessel Disease of Tongji University, 389 Xincun Rd., Shanghai 200065, PR China. rabbitmei2000@yahoo.com
Ji
Qiang
Q
Liu
Hua
H
Wang
Xisheng
X
Feng
Jing
J
Long
Cun
C
Cheng
Bangchang
B
Xing
Yan
Y
Li
Jue
J
Hu
Dayi
D
D018806:APACHE; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D016207:Cytokines / Q000097:blood* / Q000145:classification; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000503:physiopathology; D011379:Prognosis; D015375:Receptors, Interleukin-2 / Q000097:blood; D012720:Severity of Illness Index; D016019:Survival Analysis; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left / Q000502:physiology
D016207:Cytokines; D015375:Receptors, Interleukin-2