Cardiac surgery using cardiopulmonary bypass (CPB) is commonly associated with a systemic inflammatory response. This is the first conducted study use the modified prognostic scoring models, and assesses inflammatory cytokines to predict inflammation during operation and early postoperative periods. The aim of this study was to assess production of inflammatory cytokines related to the performance of the modified prognostic scoring, and to identify clinical outcomes, which predict further systemic inflammation in peri-operative cardiac patients.Methods
This is a prospective observational design study. The study was approved by Khon Kaen University Human Ethics Committee (HE number 531033). Thirty-four consecutive adult patients who underwent elective cardiac surgery with CPB were enrolled into two groups (a) coronary artery bypass graft, and (b) valvular replacement at Queen Sirikit Heart Center of the Northeast, Khon Kaen University, Thailand. Plasma concentrations of interleukin (IL)-6, IL-8, and IL-10, and leukocyte counts were measured sequentially at 0, 0.5, 4, 12, and 24 hours after CPB. Data for the modified Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) and Multi-organ Dysfunction (MOD) scoring systems were collected at the same time-points. In addition, peri-operative clinical outcomes were collected.Results and Discussion
The absolute neutrophil counts increased over time in all patients. IL-6 and IL-8 levels rose at 4 hours after CPB and were still significantly increased at 24 hours, while IL-10 levels increased maximally at 4 hours and then declined to near normal levels. The modified APACHE II, SOFA, and MOD scores showed similar patterns at all time-points. Outcomes of all correlations between cytokines and modified prognostic scoring systems were similar, but the correlation of IL-6 and the modified SOFA score was the strongest (r2 = 0.710, p < 0.0001. Therefore, the modified SOFA score, which is simpler than other scoring systems, might be a good candidate to predict serious outcome after cardiac surgery.Conclusions
Early detection of systemic inflammation, as indicated by high and extended pro-inflammatory cytokine (IL-6) level and modified SOFA scoring, predicts onset of serious clinical outcomes (e.g., anemia, atrial fibrillation, low ejection fraction, and electrolyte imbalances).