The Clinical Significance Of Plasma B7-H3 Levels In Pediatric Patients Under Surgical Stress

Objective Surgical stress may impair immunity, making the patients more susceptible to microbial pathogens and leading to an increase in post-operative complications and mortality. B7-H3, a co-stimulatory molecule, produces immune-regulatory effect. This study aims to evaluate the clinical significance of plasma B7-H3 levels in pediatric patients under degrees of surgical stress.Methods 48 children were chosen in this study, 20 with general surgery and 28 with cardiac surgery. With their surgical stress scored on the Anand and Aynsley-Green scale, the children were divided into moderate stress(n=14) and severe stress(n=34) groups. Peripheral blood samples were collected respectively before surgery, immediately after surgery, and at day 1, day 3, and day 7 after surgery to assess plasma B7-H3 levels. Correlations between plasma B7-H3 levels at different points and surgical stress scores on the Anand and Aynsley-Green scale as well as post-operative complications were also examined.Results Plasma B7-H3 levels of all the 48 pediatric patients were significantly lower after surgery than before surgery(p<0.01). Children with general surgery showed significant decreases in plasma B7-H3 levels at all points after surgery(p<0.01 for immediately-after-surgery and post-operativeday 3 samples, p<0.05 for post-operative day 1 and day 7 samples). Children with cardiac surgery showed reduced plasma B7-H3 levels immediately after surgery and at day 3 after surgery(p<0.05) compared with those before surgery. The cardiac surgery group showed significantly reduced plasma B7-H3 levels at day 1(p<0.05) and day 3(p<0.01) after surgery, compared with the general surgery group. The severe stress group showed significantly lowered plasma B7-H3 levels at day 1, day 3, and day 7 after surgery(p<0.05) compared with the moderate stress group. Furthermore, the children’s plasma B7-H3 levels at day 1(p=0.010) and day 3(p=0.025) after surgery correlated negatively with their surgical stress scores.Conclusions The significant decrease in the plasma B7-H3 levels of the children undergoing general and cardiac surgery 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 scores suggests that plasma B7-H3 might be a useful biomarker for monitoring stress intensity during pediatric surgery.