Michael Bernhard1, Konrad-Martin Schultz1, Stefan Hofer1, Christian Hainer1, Vassil Gegouskov2, Eike Martin1, Matthias Karck2, Johann Motsch1, Markus A. Weigand1,4, Steffen P. Luntz3, Christoph Lichtenstern1,4
1Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany; 2Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany; 3Coordination Centre for Clinical Trials (KKS), Heidelberg, Germany; 4Department of Anesthesiology and Intensive Care Medicine, University of Gießen, Gießen, Germany
[Applied Cardiopulmonary Pathophysiology 14: 115-123, 2010]
Background: Cardiac surgery under extracorporeal circulation (ECC) is associated with a complex physiological response that is clinically manifested as a systemic inflammatory response syndrome. Perioperative levels of human intercellular adhesion molecule 1 (sICAM-1), macrophage migration inhibitory factor (MIF), and other cytokines (IL-6, IL-8) could potentially predict postoperative outcome.
Methods: In this prospective study, serum levels of sICAM-1, IL-6, IL-8, and MIF from patients undergoing cardiac surgery under ECC were analyzed at eight time points in the perioperative setting using enzyme-linked immunosorbent assays. The results were compared with patient characteristics, past medical history, present surgical intervention, postoperative complications, and length of stay in the ICU (ICU-LOS).
Results: Serum levels of sICAM-1, IL-6, IL-8, and MIF from 73 patients were investigated. IL-6, IL-8, and MIF had a peak upon admission to the ICU or 6 h after ECC (p<0.05) and decreased in the following 7 days after cardiac surgery. sICAM-1 initially showed a significant decrease from the pre-op level to the time point directly before start of the ECC and admission to the ICU. Thereafter, sICAM-1 levels increased significantly up to the seventh day after cardiac surgery (p<0.05). No correlation was found between the levels of sICAM-1, IL-6, and IL-8 with the parameters duration of ventilation, ICU-LOS, or duration of ECC. However, the peak level of MIF in the perioperative course correlates with ICU-LOS (r=0.35, p<0.01). The higher the maximum level of MIF, the longer the stay in the ICU was.
Conclusions: sICAM-1, IL-6, IL-8, and MIF are influenced by ECC. No correlation was found between level of sICAM-1, IL-6, or IL-8 with duration of ventilation, ICU-LOS or duration of ECC.
Key words: macrophage migration inhibitor factor, sICAM, cardiac surgery, systemic inflammatory response
Prof. Markus A. Weigand, M.D.
Department of Anesthesiology and Intensive Care Medicine