Abstract
Systemic inflammatory response syndrome (SIRS) is a common complication after cardiovascular surgery that in severe cases can lead to multiple organ dysfunction syndrome and even death. We therefore set out to identify reliable early biomarkers for SIRS in a prospective small patient study for timely intervention. 21 Patients scheduled for planned cardiovascular surgery were recruited in the study, monitored for signs of SIRS and blood samples were taken to investigate biomarkers at pre-assigned time points: day of admission, start of surgery, end of surgery, days 1, 2, 3, 5 and 8 post surgery. Stored plasma and cryopreserved blood samples were analyzed for cytokine expression (IL1β, IL2, IL6, IL8, IL10, TNFα, IFNγ), other pro-inflammatory markers (sCD163, sTREM-1, ESM-1) and response to endotoxin. Acute phase proteins CRP, PCT and pro-inflammatory cytokines IL6 and IL8 were significantly increased (p<0.001) at the end of surgery in all patients but could not distinguish between groups. Normalization of samples revealed significant increases in IL1β changes (p<0.05) and decreased responses to endotoxin (p<0.01) in the SIRS group at the end of surgery. Soluble TREM-1 plasma concentrations were significantly increased in patients with SIRS (p<0.01). This small scale patient study could show that common sepsis markers PCT, CRP, IL6 and TNFα had low predictive value for early diagnosis of SIRS after cardiovascular surgery. A combination of normalized IL1β plasma levels, responses to endotoxin and soluble TREM-1 plasma concentrations at the end of surgery are predictive markers of SIRS development in this small scale study and could act as an indicator for starting early therapeutic interventions.
Highlights
Systemic inflammation is a common response in critically ill patients and a known side-effect after surgery [1,2]
Patients undergoing elective cardiovascular surgery were recruited after ethical approval and monitored in addition to the usual medical parameters for signs of Systemic inflammatory response syndrome (SIRS) and early response proteins C-reactive protein (CRP) and procalcitonin (PCT)
At completion of recruitment and sampling, patient data were analyzed for signs of SIRS according to the official guidelines of the ACCP/SCCM Consensus Conference [3]
Summary
Systemic inflammation is a common response in critically ill patients and a known side-effect after surgery [1,2]. In contrast to other elective surgeries, patients undergoing cardiovascular surgery often are elderly and represent with comorbidities and a weakened general condition Those patients are especially at risk of complications such as systemic inflammatory response syndrome (SIRS). This generic term encompasses sterile inflammation as well as sepsis (that is SIRS with confirmed bacteremia) and is defined by meeting two or more of the following criteria: 1) a temperature of above 38°C or below 36°C, 2) a heart rate over 90 beats/min, 3) a respiratory rate above 20 breaths/min or decreased paCO2 below 32 mmHg, 4) white blood cell count of over 12000 cells/mm or under 4000 cells/mm or more than 10% immature neutrophils [3]. In this current paper SIRS is used to describe the state of sterile inflammation without positive blood culture
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