Preoperative plasma levels of soluble tumor necrosis factor receptor type I (sTNF-RI) predicts adverse events in cardiac surgery.
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.
Gelape
C L
CL
Department of Surgery, Minas Gerais Federal University, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, MG, Brazil. clgelape@uai.com.br
Sanches
M D
MD
Teixeira
A L
AL
Teixeira
M M
MM
Bráulio
R
R
Pinto
I F
IF
Galdino
F
F
Ribeiro
A L
AL
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
D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept