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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 1008-1016, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JB Steinberg, DP Kapelanski, JD Olson and JM Weiler
Patients undergoing cardiopulmonary bypass are known to develop whole body
inflammation that often results in a characteristic syndrome early
postoperatively. This phenomenon has been attributed to complement
activation caused by exposure of blood to the foreign surfaces of the
cardiopulmonary bypass circuit. It has been unknown if cytokines are
involved. Plasma levels of complement activation products (C3a, C4a, C5a,
and C5b-9), interleukins (IL-1 beta, IL-2, IL-4, and IL-6), and tumor
necrosis factor-alpha were measured at multiple time points before, during,
and after cardiopulmonary bypass in 29 patients. No significant increase
over preinduction levels was seen in the cytokines except for IL-6, which
was significantly increased during cardiopulmonary bypass (p < 0.001),
reaching a maximum 3 hours after cardiopulmonary bypass. C3a, C4a, and
C5b-9 levels were significantly elevated during cardiopulmonary bypass (p
< 0.001), with maximum C5b-9 levels preceding the IL-6 elevation.
Heparin coating of the cardiopulmonary bypass circuit was not demonstrated
to have an effect on activation of complement or cytokine production. There
was no statistically significant correlation among hemodynamic variables or
pulmonary function and complement, interleukin, or tumor necrosis
factor-alpha levels. These results confirm the presence of complement
activation and demonstrate the production of IL-6 after the generation of
C5b-9 in patients undergoing cardiopulmonary bypass. IL-6 may contribute to
adverse systemic reactions associated with cardiopulmonary bypass.
ARTICLES
Cytokine and complement levels in patients undergoing cardiopulmonary bypass
Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics.
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