title: The influence of the preoperative immune response on blood transfusion requirements in patients undergoing cardiac surgery.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the influence of preoperative type I and II immune responses on blood transfusion requirements.
  
  
  METHODS
  A prospective and observational trial.
  
  
  METHODS
  A postcardiac surgery unit of a university hospital.
  
  
  METHODS
  Seventy-one consecutive patients undergoing elective cardiac surgery.
  
  
  METHODS
  Blood samples drawn for laboratory analysis and immunologic study.
  
  
  RESULTS
  Patients were divided into 2 groups according to blood transfusion requirements: < or = 2 units (n = 35) and >2 units of red blood cells (n = 36). The preoperative immune response was assessed by flow cytometry, measuring the proportion of CD4+ T helper cells producing cytokines, including Th1 response (interferon-gamma and tumor necrosis factor-alpha [TNF-alpha]) and Th2 response (interleukin 4 and 10). Two logistic regression analyses (including and not including immunologic variables) were used to select and weight perioperative variables associated with an increased risk of transfusion. Three variables were found to be independent predictors of transfusion requirements when immunologic variables were not included: preoperative platelet count, preoperative hemoglobin, and hypertension. When all the variables were included, preoperative hemoglobin, cardiopulmonary bypass time, and the preoperative proportion of CD4+ T cells producing TNF-alpha were associated with an increased risk of transfusion (Hosmer-Lemeshow, 0.33; c-index, 0.93), but preoperative platelet count and hypertension were not.
  
  
  CONCLUSIONS
  A low preoperative Th1 immune response, as assessed by the proportion of CD4+ T-helper-producing TNF-alpha, was associated with a higher blood transfusion rate.
authors.affiliation: Critical Care Division, Preventive Medicine and Health Public, University of Seville, Seville, Spain. srleal@telefonica.net
authors.forename: Santiago R
authors.initials: SR
authors.lastname: Leal-Noval
authors.forename: Victoria
authors.initials: V
authors.lastname: Arellano
authors.forename: Alejandro
authors.initials: A
authors.lastname: Vallejo
authors.forename: Ana
authors.initials: A
authors.lastname: Hernández
authors.forename: Antonio
authors.initials: A
authors.lastname: Ordóñez
authors.forename: Rafael
authors.initials: R
authors.lastname: Hinojosa
authors.forename: Juan
authors.initials: J
authors.lastname: Polo
authors.forename: Manuel
authors.initials: M
authors.lastname: Múñoz
authors.forename: Manuel
authors.initials: M
authors.lastname: Leal
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000379:methods*; D018791:CD4 Lymphocyte Count; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007371:Interferon-gamma / Q000096:biosynthesis; D016753:Interleukin-10 / Q000096:biosynthesis; D015847:Interleukin-4 / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D018417:Th1 Cells / Q000276:immunology / Q000378:metabolism; D018418:Th2 Cells / Q000276:immunology / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
chemical_list: C508609:IL10 protein, human; C508598:IL4 protein, human; D018836:Inflammation Mediators; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015847:Interleukin-4; D007371:Interferon-gamma