Case-control study on the interplay between immunoparalysis and delirium after cardiac surgery

Autor: Arjen J. C. Slooter, Jelle Gerretsen, Wilson F. Abdo, Shokoufeh CheheiliSobbi, Annemieke M. Peters van Ton, Marjolein F Looije, Mark van den Boogaard, Wim J. Morshuis, E. M. Wesselink, Peter Pickkers
Přispěvatelé: Clinical sciences, Neuroprotection & Neuromodulation
Rok vydání: 2021
Předmět:
Pulmonary and Respiratory Medicine
medicine.medical_specialty
RD1-811
medicine.medical_treatment
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
Case-control studies
law.invention
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
All institutes and research themes of the Radboud University Medical Center
Anesthesiology
law
mental disorders
Cardiopulmonary bypass
Humans
Medicine
RD78.3-87.3
Intensive care medicine
Delirium/etiology
Prospective Studies
Cardiac Surgical Procedures
Risk factor
Tumor Necrosis Factor-alpha
business.industry
Immunity
Case-control study
Delirium
Cardiothoracic surgery
General Medicine
Cardiac Surgical Procedures/adverse effects
Cardiac surgery
Cytokine
Anesthesia
Cytokines
Surgery
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Ex vivo
Research Article
Zdroj: Journal of Cardiothoracic Surgery, 16
Journal of Cardiothoracic Surgery, 16, 1
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-6 (2021)
ISSN: 1749-8090
Popis: Background Delirium occurs frequently following cardiothoracic surgery, and infectious disease is an important risk factor for delirium. Surgery and cardiopulmonary bypass induce suppression of the immune response known as immunoparalysis. We aimed to investigate whether delirious patients had more pronounced immunoparalysis following cardiothoracic surgery than patients without delirium, to explain this delirium-infection association. Methods A prospective matched case–control study was performed in two university hospitals. Cytokine production (tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and IL-10) of ex vivo lipopolysaccharide (LPS)-stimulated whole blood was analyzed in on-pump cardiothoracic surgery patients preoperatively, and at 5 timepoints up to 3 days after cardiothoracic surgery. Delirium was assessed by trained staff using two validated delirium scales and chart review. Results A total of 89 patients were screened of whom 14 delirious and 52 non-delirious patients were included. Ex vivo-stimulated production of TNF-α, IL-6, IL-8, and IL-10 was severely suppressed following cardiothoracic surgery compared to pre-surgery. Postoperative release of cytokines in non-delirious patients was attenuated by 84% [IQR: 13–93] for TNF-α, 95% [IQR: 78–98] for IL-6, and 69% [IQR: 55–81] for IL-10. The attenuation in ex vivo-stimulated production of these cytokines was not significantly different in patients with delirium compared to non-delirious patients (p > 0.10 for all cytokines). Conclusions The post-operative attenuation of ex vivo-stimulated production of pro- and anti-inflammatory cytokines was comparable between patients that developed delirium and those who remained delirium-free after on-pump cardiothoracic surgery. This finding suggests that immunoparalysis is not more common in cardiothoracic surgery patients with delirium compared to those without.
Databáze: OpenAIRE
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