Abstract
BackgroundSurgical stress initiates a series of host hormone, metabolism and immune responses, which predominantly affect the homeostatic mechanism of patients with major surgery. B7-H3 is a co-stimulatory molecule and has been shown to participate in both adaptive and innate immune responses. In this study we evaluated the clinical significance of plasma B7-H3 levels in pediatric patients with different types of operation and degrees of surgical stress.MethodsA total of 48 children received pediatric general and cardiac surgery were recruited into this study. Based on the surgical stress scoring, children were divided into moderate stress (n = 14) and severe stress (n = 34) groups. Plasma B7-H3 levels were assessed at selected time points: before surgery, immediately after surgery, at day 1, day 3, and day 7 after surgery. Correlations between plasma B7-H3 levels and surgical stress scores were also examined.ResultsPlasma B7-H3 levels were significantly decreased in all 48 pediatric patients after surgery compared to the B7-H3 level before surgery (p < 0.01). Children with general surgery showed significant decreases in plasma B7-H3 immediately after surgery, and at day 3 and day 7 after surgery (p < 0.05, p < 0.01), whereas children with cardiac surgery showed reduced plasma B7-H3 immediately after surgery and at day 3 after surgery (p < 0.05). Plasma B7-H3 in cardiac surgery group was dropped much lower than that in general surgery group at day 1 (p < 0.05) and day 3 (p < 0.01) after surgery. Significantly reduced plasma B7-H3 was observed in the severe stress group, but not in the moderate stress group, immediately after surgery and at day 3 after surgery (p < 0.05), and severe stress group had significantly lower plasma B7-H3 levels than moderate stress group at day 1, day 3, and day 7 after surgery (p < 0.05). Furthermore, plasma B7-H3 levels at day 1 (p = 0.01) and day 3 (p = 0.025) after surgery correlated negatively with surgical stress scores.ConclusionsPlasma B7-H3 levels were decreased significantly in children subjected to pediatric general and cardiac surgery, which is closely associated with the severity of surgical stress. The negative correlation of plasma B7-H3 levels at day 1 and day 3 after surgery with surgical stress scoring implicates that the plasma B7-H3 level might be a useful biomarker for monitoring stress intensity during pediatric surgery.
Highlights
Surgical stress initiates a series of host hormone, metabolism and immune responses, which predominantly affect the homeostatic mechanism of patients with major surgery
There were more cases with cardiac surgery but less cases with general surgery in severe stress group compared to moderate stress group (p < 0.01)
Reduced plasma B7-H3 levels after surgery As shown in Fig. 1, soluble B7-H3 concentrations in the circulation were significantly decreased in all 48 pediatric patients after general and cardiac surgery compared to the B7-H3 level before surgery (p < 0.05, p < 0.01)
Summary
Surgical stress initiates a series of host hormone, metabolism and immune responses, which predominantly affect the homeostatic mechanism of patients with major surgery. It has long been demonstrated for the past several decades that surgical procedures can activate the hypothalamic–pituitary–adrenal (HPA) axis, thereby causing an elevated systemic glucocorticoid level [1]. IL-6 functions as a representative proinflammatory mediator to upregulate the acute inflammatory reaction, whereas IL-10 serves as a typical anti-inflammatory cytokine to inhibit the proinflammatory response. The imbalance between these cytokines could lead to systemic inflammatory response syndrome (SIRS) or compensatory anti-inflammatory response syndrome (CARS), and even multiple-organ dysfunction syndrome (MODS) [2]
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