title: Analysis of inflammatory response and utility of N-terminal pro brain-type natriuretic peptide in cardiac surgery with extracorporeal circulation.
abstract: OBJECTIVE
  Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response. During and after cardiac surgery, we examined the pattern of cytokine release of interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-alpha, to investigate inflammatory response. We analyzed N-terminal pro brain-type natriuretic peptide (NT-proBNP) as a marker of ventricular function.
  
  
  METHODS
  Consecutive patients (n = 58) undergoing elective cardiac surgery with extra-corporeal circulation were recruited into the study. Blood samples for analysis of the biochemical markers were taken at seven time points for cytokines and TNF, and three for Nt-proBNP.
  
  
  RESULTS
  All markers increased significantly after CPB. IL-6 and IL-8 levels were higher in men. IL-8 was related to a need for inotropic support. IL-6 was related to the time of CPB (P = 0.004), aortic clamping (P = 0.013), length of stay in intensive care unit (ICU) (P = 0.004) and mechanical ventilation for more than 12 h (P = 0.006). The levels of NT-proBNP were higher in cases of ventricular dysfunction (P = 0.003) and functional class III/IV (P = 0.001). The postoperative values were related to age (P < 0.05), creatinine values (P < 0.001), mechanical ventilation time (P < 0.001) and stay in the ICU (P = 0.001).
  
  
  CONCLUSIONS
  Our data indicate a relationship between cytokine levels and sex, time of CPB and aortic clamping, The increase of cytokines correlates with a need for inotropic support, mechanical ventilation and length of stay in ICU. We confirmed the predictive role, and its utility in the risk stratification of the NT-proBNP, and its importance in early diagnosis of postoperative ventricular dysfunction.
authors.affiliation: Heart Institute (ICICOR), Department of Cardiac Surgery, Spain. salvadiste@gmail.com
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Stefano
authors.forename: Elena
authors.initials: E
authors.lastname: Casquero
authors.forename: Rosa
authors.initials: R
authors.lastname: Bustamante
authors.forename: Juan
authors.initials: J
authors.lastname: Bustamante
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
authors.forename: Enrique
authors.initials: E
authors.lastname: Fulquet
authors.forename: Javier
authors.initials: J
authors.lastname: Gualis
authors.forename: Santiago
authors.initials: S
authors.lastname: Florez
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Echevarria
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Carrascal
authors.forename: Luis
authors.initials: L
authors.lastname: Fiz
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D006348:Cardiac Surgical Procedures; D003422:Critical Care; D017558:Elective Surgical Procedures; D005260:Female; D006323:Heart Arrest; D006801:Humans; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007902:Length of Stay; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012121:Respiration, Artificial; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D016276:Ventricular Function / Q000502:physiology
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D010446:Peptide Fragments; D014409:Tumor Necrosis Factor-alpha; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain