Abstract
Patients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response. Blood transfusion may contribute to disruption of homeostasis in these patients. We sought to evaluate the impact of blood transfusion on serum interleukin-6 (IL-6), hypoxia induced factor-1 alpha (HIF-1α) levels as well as adverse outcomes in patients undergoing adult cardiac surgery. We prospectively enrolled 282 patients undergoing adult cardiac surgery. Serum IL-6 and HIF-1α levels were measured preoperatively and on the first postoperative day. Packed red blood cells were transfused in 26.3% of patients (mean 2.93 ± 3.05 units) by the time of postoperative sampling. Postoperative IL-6 levels increased over 30-fold and were similar in both groups (p = 0.115), whilst HIF-1α levels (0.377 pg/mL vs. 0.784 pg/mL, p = 0.002) decreased significantly in patients who received red blood cell transfusion. Moreover, greater decrease in HIF-1α levels predicted worse in-hospital and 3mo adverse outcome. Red blood cell transfusion was associated with higher risk of major adverse outcomes (stroke, pneumonia, all-cause mortality) during the index hospitalization. Red blood cell transfusion induces blunting of postoperative HIF-1 α response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery.Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03444259.
Highlights
Patients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response
Lower decrease in HIF-1α levels—as an indication for minor blunting—predicted better composite outcome of all-cause mortality, stroke, transient ischemic attack (TIA), pneumonia, mediastinitis, acute dialysis or reoperation for bleeding during index hospitalizaton and at 3mo follow-up in a multivariable logistic regression model including age and gender as covariates in the overall series and in the Propensity score matching (PSM) cohort
The main finding of this study was that red blood cells (RBC) transfusion may significantly reduce the response to hypoxia by inhibiting HIF-1α elevation in the cytokine storm secondary to surgical stress and the use of cardiopulmonary bypass
Summary
Patients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response. We sought to evaluate the impact of blood transfusion on serum interleukin-6 (IL-6), hypoxia induced factor-1 alpha (HIF-1α) levels as well as adverse outcomes in patients undergoing adult cardiac surgery. Red blood cell transfusion was associated with higher risk of major adverse outcomes (stroke, pneumonia, all-cause mortality) during the index hospitalization. Red blood cell transfusion induces blunting of postoperative HIF-1 α response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery. RBC transfusion is associated with higher risk of stroke and all-cause mortality in patients undergoing cardiac surgery[1–4]. We sought to evaluate the systemic inflammatory response, HIF-1α levels and the related clinical outcome in patients undergoing adult cardiac surgery
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