Patterns and prognostic value of troponin, interleukin-6, and leptin after pediatric open-heart surgery.
OBJECTIVE
Leptin and interleukin-6 (IL-6) are inversely correlated and associated with decreased survival in critically ill patients. We investigated changes in leptin, IL-6, and troponin in children undergoing open-heart surgery, hypothesizing that IL-6 and troponin will increase after cardiopulmonary bypass (CPB) and will be negatively correlated with leptin.


METHODS
Serial blood samples were collected from 21 patients 24 hours before and up to 48 hours after surgery.


RESULTS
Leptin levels decreased by 50% during CPB (P < .001), then gradually increased, reaching baseline levels 12 hours after surgery. The IL-6 levels increased (P < .001) during CPB, peaking 2 hours after surgery and remaining slightly elevated at 24 hours after surgery (P < .001). Leptin and IL-6 were negatively correlated (R = -0.448, P < .001). Troponin levels increased during CPB (P < .001). Postoperative leptin and troponin were inversely correlated (r = -0.535, P < .001). Patients with modest elevations in troponin levels (<20 microg/L) had a shorter aortic clamp and CPB time (P < .01), lower IL-6 peak levels (P = .03), and shorter duration of ventilation and inotropic support compared with patients with peak troponin levels greater than 20 microg/L.


CONCLUSIONS
Lower leptin and higher IL-6 levels correlated with troponin, a marker of myocardial injury. Because leptin may have cardioprotective effects, the postoperative drop in its levels may further contribute to myocardial dysfunction.
Pediatric Endocrinology Unit, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. dmodan@sheba.health.gov.il
Dalit
D
Modan-Moses
Anat
A
Prince
Hannah
H
Kanety
Clara
C
Pariente
Ovdi
O
Dagan
Milton
M
Roller
Tali
T
Vishne
Ori
O
Efrati
Gideon
G
Paret
D015415:Biomarkers; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016638:Critical Illness; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D015850:Interleukin-6 / Q000097:blood*; D020738:Leptin / Q000097:blood*; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D014336:Troponin / Q000097:blood*
D015415:Biomarkers; D015850:Interleukin-6; D020738:Leptin; D014336:Troponin