Perioperative serum levels of tumour-necrosis-factor alpha (TNF-α), IL-1β, IL-6, IL-10 and soluble IL-2 receptor in patients undergoing cardiac surgery with cardiopulmonary bypass without and with correction for haemodilution

Abstract

SUMMARYCardiac surgery with cardiopulmonary bypass (CPB) leads to a systemic inflammatory response with secretion of cytokines. Alterations in the serum concentrations of cytokines have important prognostic significance. Reports on cytokine release during cardiac surgery with CPB have yielded conflicting results. Haemodilution occurs with the onset of CPB resulting in large fluid shifts during the perioperative course of cardiac procedures. In the present study we compare the perioperative course of serum concentrations of TNF-a, IL-1b, IL-6, IL-10 and sIL-2R with and without correction for haemodilution in patients undergoing coronary artery bypass grafting (CABG) surgery. Twenty male patients undergoing elective CABG surgery with CPB and general anaesthesia using a balanced technique with sufentanil, isoflurane and midazolam were enrolled into the study. Serum levels of TNFa, IL-1b, IL-6, IL-10 and sIL-2R were measured using commercially available ELISA kits. Simultaneous haematocrit values were obtained at all sample times. Statistical analysis was performed by nonparametric analysis of variance and t-tests for data corrected for haemodilution and data that were not corrected for haemodilution. Adjusted significance level was P < 0·01. Intra-operatively, up to the second post-operative day PCV values were significantly decreased compared with preoperative values. Cytokine measurements not corrected for haemodilution were significantly lower than the corrected values. The perioperative haemodilution and decrease in PCV may lead to an underestimation of the cytokine secretion in post-operative patients. We conclude that cytokine measurements were significantly influenced by the perioperative haemodilution and the subsequent decrease in PCV and may in part account for the varying results reported in the literature regarding cytokine release in patients undergoing CABG surgery.

The Origin of Multiple Molecular Forms in Urine of HNL/NGAL

“…We found the cytokine IL-1␤ to be the most potent stimulus, which is compatible with the work of others using a lung epithelial cell line (A549) (30). High levels of neutrophil secretory proteins and cytokines such as IL-1␤ and TNF-␣ have been observed during and after cardiac surgery by many previous studies (31,32).…”

60 YEARS OF NEUROENDOCRINOLOGY: Glucocorticoid dynamics: insights from mathematical, experimental and clinical studies

“…It is also noteworthy to point out that, because a delay between the beginning of the surgery and the onset of the ACTH response was observed, it is likely that the HPA axis response in these patients may not be induced by the anesthesia or the surgical procedure itself, but other factors may be involved in the robust hormonal response observed. For example, the time of the ACTH response in these patients is consistent with the time of increase in circulating inflammatory mediators (including TNF, IL1 and IL6) that also remain elevated for about 24 h before returning to normal levels (Lahat et al 1992, Roth-Isigkeit et al 1999, de Mendonca-Filho et al 2006. It is known that circulating cytokines can activate CORT secretion not only via inducing hypothalamic CRH and pituitary ACTH release but also by acting directly at the level of the adrenal gland (Engstrom et al 2008).…”

Rhythms Within Rhythms: The Importance of Oscillations for Glucocorticoid Hormones

“…2), we found an initial surge in both ACTH and CORT, followed by a fall in ACTH back to baseline levels but maintenance of the high levels of CORT, with continued but amplified ultradian responses of CORT to small changes in basal ACTH (Gibbison et al 2014). The initial rise in both hormones was delayed after the actual surgery itself, suggesting it was the result of inflammatory cytokine production (from the sternotomy), which is known to go up at this time (Lahat et al 1992;Roth-Isigkeit et al 1999;de Mendonca-Filho et al 2006). Therefore, in a reverse translation approach, we used a model of severe stress both with (LPS) and without (depot ACTH) associated systemic inflammation.…”