title: Preoperative plasma levels of soluble tumor necrosis factor receptor type I (sTNF-RI) predicts adverse events in cardiac surgery.
abstract: OBJECTIVE
  The objective was to estimate the sTNF-RI preoperative measure in the identification of patients with bad outcome and death.
  
  
  METHODS
  We assessed prospectively sixty-two patients submitted electively to myocardial revascularization with ECC or heart valve surgery. The sTNF-RI levels were determined by the Sandwich-Type ELISA method before anesthetic induction. Clinical, surgical characteristics and sTNF-RI levels were compared among patients with good (group I, n=46) or bad outcome (group II, n=16--length of stay in the ICU for over 72 h or death).
  
  
  RESULTS
  No difference was found between the verified mortality (6.4%) and the predicted by EuroSCORE (3.0%), p=0.48. The sTNF-RI levels were higher in group II (1322) than group I (748) p=0.009 (levels >954, 69% sensitivity and 70% specificity for good outcome, 44% positive predicted value and 85% negative). The sTNF-RI levels were higher in patients who died (1556) versus (759) p=0.029, (levels >1230, 79% sensitivity, 75% specificity, 20% positive predicted value and 98% negative). In the multivariate logistic regression model sTNF-RI (OR=1.002, IC95% 1.000-1.005, p=0.014) and age (OR=1.083, IC95% 1.010-1.161, p=0.025) were independently related to the risk of bad outcome.
  
  
  CONCLUSIONS
  Basal levels of sTNF-RI yield prognostic information in patients who undergo heart surgery.
authors.affiliation: Department of Surgery, Minas Gerais Federal University, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, MG, Brazil. clgelape@uai.com.br
authors.forename: C L
authors.initials: CL
authors.lastname: Gelape
authors.forename: M D
authors.initials: MD
authors.lastname: Sanches
authors.forename: A L
authors.initials: AL
authors.lastname: Teixeira
authors.forename: M M
authors.initials: MM
authors.lastname: Teixeira
authors.forename: R
authors.initials: R
authors.lastname: Bráulio
authors.forename: I F
authors.initials: IF
authors.lastname: Pinto
authors.forename: F
authors.initials: F
authors.lastname: Galdino
authors.forename: A L
authors.initials: AL
authors.lastname: Ribeiro
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D000068800:Etanercept; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept