may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the.
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Perfusion 2002; 17
The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions Armin Sablotzki1, Ivar Friedrich1, Jo ¨rg Mu ¨ hling2, Marius G Dehne2, Jan Spillner1, Rolf E Silber1 and 3 Elke Czeslik 1
Clinic of Cardiothoracic Surgery, University of Halle, Halle an der Saale, Germany; Department of Anesthesiology and Intensive Care Medicine, University of Giessen, Germany; 3 Clinic of Anesthesiology and Intensive Care Medicine, University of Halle, Halle an der Saale, Germany 2
Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1B, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocardial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1B) and PCT were significantly elevated in
MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response. Perfusion (2002) 17
Introduction The systemic inflammatory response syndrome (SIRS) is a marked, generalized response to a wide variety of injuries, which has been defined by the Society of Critical Care Medicine and the American College of Chest Physicians.1 Especially after exposure of blood to artificial surfaces of extracorporeal circulation, the activation of cascade systems leads to an inflammatory response, described by Kirklin et al.2 as ‘whole body inflammation syndrome,’ which may be associated with severe organ dysfunctions. The presence of elevated levels of circulating cytokines has been found in patients with documented bacteremia or with signs of sepsis,3 – 5 just as in patients after uncomplicated cardiopulmonary bypass surgery.6,7
Address for correspondence: Dr Armin Sablotzki, Clinic of Cardiothoracic Surgery, Martin Luther University Halle/Wittenberg, Ernst Grube Str. 40, Halle an der Saale 06120, Germany.
D Arnold 2002
Due to the fact that only a few of the cardiovascular patients with SIRS develop severe complications and organ failure, it seems especially necessary to investigate the inflammatory response in those patients. Helpful for an early clinical evaluation of the severity of SIRS may be the APACHE-II score.8 Pilz et al.9 demonstrated that patients with an APACHE-II score > 24 points at the first postoperative day following cardiac surgery showed a high risk of developing severe organ dysfunction. These findings were confirmed by Kuhn et al.10 in a recently published paper. A large number of previous studies on this issue have reported different changes of immunological parameters during and after cardiovascular surgery. Most of these studies have looked only at patients with an uncomplicated postoperative course.11 – 14 Due to the high mortality of escalating systemic inflammation after cardiac surgery, and in order to obtain new therapeutic concepts, it is very important 10.1191/0267659102pf543oa
Systemic inflammatory response syndrome A Sablotzki et al.
2
to understand the pathophysiology of severe SIRS. In the present study, we investigated proinflammatory cytokines (IL-1b, IL-6, IL-8, IL-12) and procalcitonin (PCT) in patients with two or more SIRS criteria, two or more organ dysfunctions, and an APACHE-II score >24.
0,5
IL-1 pg/ml
SIRS-group MODS-group
0,4
0,3
0,2
0,1
Materials and methods 0,0
After approval by the Ethics Committee of our hospital, 12 adult male patients with signs of multiple organ dysfunction syndrome (MODS) in the morning of the first postoperative day were included in the study. According to the American College of Chest Physicians and the Society of Critical Care Medicine, diagnosis of SIRS has been based upon two or more of the following criteria: body temperature 38C, tachycardia >90/min, tachypnea >20/min or paCO2
