Preoperative Clinical Factors Are Important Determinants of the Inflammatory State Before and After Heart Surgery

Abstract

Postoperative inflammatory response is common in heart surgery patients, but less is known about variation in the baseline inflammatory state. This study characterizes the preoperative inflammatory profile in a group of high- and low-risk patients (n = 32; male 16, female 16; mean age, 70.3 +/- 1.8) and relates this to postoperative events. Interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, TNF receptors (R1 and R2), and high-sensitivity C-reactive protein were measured before surgery and 4 hours after arrival in the intensive care unit. Considerable variability existed in all preoperative inflammatory mediators before surgery. Patients with an elevated baseline IL-6 level, (IL-6 >10 pg/mL) were older (73.5 +/- 2.2 vs. 67.9 +/- 2.6 years), had a lower ejection fraction (34 +/- 3.8% vs. 44 +/- 2.9%), a higher predicted risk score (10.3 +/- 1.2 vs. 5.9 +/- 1.1), and a higher baseline high-sensitivity C-reactive protein (65 +/- 10 vs. 24 +/- 6 mg/L), p < 0.05 for all. These patients had high morbidity and mortality rates after surgery. In addition, patients judged to be at high risk on clinical criteria were found to have consistent elevations in the baseline inflammatory state. All patients had a surge in inflammatory mediators after surgery, but those who started at a higher baseline reached a higher postoperative level than the others (IL-6 2023 +/- 561 vs. 361 +/- 47 pg/mL, p < 0.05). Many heart surgery patients, especially higher-risk patients, have a significant inflammatory state before surgery. These patients are at risk for high morbidity and mortality rates after surgery.

Preoperative statin is associated with decreased operative mortality in high risk coronary artery bypass patients

“…Nonetheless, a number of hypotheses are generated. Our group [11] and others [12] have recently shown that patients undergoing heart surgery who have elevated risk based on standard preoperative variables (age, left ventricular dysfunction, co-morbid disease) have evidence of ongoing inflammation manifested by elevated levels of inflammatory mediators such as interleukin-6 (IL-6) and C-reactive protein (CRP). Statins have been shown to ameliorate the inflammatory cascade in a number of models and these properties may confer protection from the inflammatory response induced by open heart surgery.…”

No clear clinical benefit of using mini-invasive extracorporeal circulation in coronary artery bypass grafting in low-risk patients

“…Higher concentrations correlate to higher postoperative morbidity and mortality. 17 Its kine� tics while using ECC are well known. In comparison to the effect of mini�systems, there are published materials which confirm significantly lower values of IL� 6 while using mini�ECC.…”

Genetic and clinical risk factors for fluid overload following open-heart surgery

“…The genetic alterations may act together with clinical risk factors causing an altered immune profile preoperatively that primes the immune system and facilitates an enhanced inflammatory and vascular reaction triggered by CPB. [7][8][9] We hypothesised that there exist clinical as well as genetic markers associated with fluid accumulation during and after open-heart surgery. These may be related to alterations in inflammatory and haemodynamic signalling pathways contributing to increased susceptibility to microvascular instability and injury, causing some patients to develop postoperative fluid overload.…”