Study On Characteristics Of Early Postoperative Cytokine Storm In Patients Undergoing Cardiac Surgery

Objective:The purpose of this study was to investigate the characteristics of cytokine storm in patients undergoing cardiac surgery in the early postoperative period,and to observe its correlation with the severity of the illness.Methods: This study included patients with multiple organ dysfunction after cardiac surgery from April 28,2019 to December 31,2019,and were transferred to the critical care department of Dalian Central Hospital for treatment of severe diseases’ patients(severely ill group).Inclusion criteria: Patients with a Sequential Organ Failure Assessment(SOFA)score greater than or equal to 10 and with 2 or more organ dysfunctions.Exclusion criteria: Patients aged 18 years or over 80 years,those who used immunosuppressants within six months,recent infections,and incomplete clinical data collection which would affect the outcome determination.In addition,patients with only one type or no organ dysfunction during the same period were included as the mildly ill control group;and 10 ordinary healthy persons aged between 18 and 80 years old were included as the healthy control group.This study was approved by the Ethics Committee of Dalian Central Hospital,and its registration number was Chi CTR1900021351 in the China Clinical Trial Registry.All the above-mentioned included populations obtained informed consent.Taking the time after the start of surgery as the starting point for monitoring the expression of cytokines,blood samples were collected at 0,3,6,12,24,and 48 hours,and one sample was taken from the healthy control group.A total of 10 cytokine concentrations(Tumor Necrosis Factor,[TNF]-α,Monocyte Chemotactic Protein,[MCP]-1,Interleukin,[IL]-6,IL-8,IL-10,IL-12p70,IL-1β,IL-4,Interferon,[IFN]-γ,IL-16)in blood samples were detected by Luminex technology.And record the general situation of patients in the severely ill group and the mildly ill control group(age,gender,surgical method,operation time,intensive care unit[ICU] length of stay,SOFA score,mortality rate,lactic acid,creatinine,urine volume,etc.),hemodynamic parameters,vasopressors dosage used,and other clinical objective data.The measurement data of normal distribution are expressed as mean ± standard deviation,and comparison is made by repeated measurement analysis of variance.Measurement data for non-normal distributions are expressed as median(quartile),using the Kruskal-Wallis H test.Some general characteristic data of severely ill group,mildly ill control group,and healthy control group were compared by T test.The count data were expressed as cases or percentages,p <0.05 was statistically significant.Principal component analysis was used to count the weights of 10 cytokines and make a cytokine storm intensity curve to calculate the maximum value of Vasoactive-Inotropic Score(VIS)at the early stage of cardiac surgery in patients with severely ill group.The intensity was compared with the vasoactive drug score and the SOFA score..Results: A total of 29 patients were included in this experiment.Among them,14 patients(10 males and 4 females)with multiple organ dysfunction were included as the severely ill group.15 patients(11males and 4 females)with stable disease without mltiple organ dysfunction after surgery were included as the mildly ill control group.There were no significant differences in age and gender between the groups.The cytokine concentration in the severely ill group increased significantly,and the cytokine concentration in the mildly ill control group was between the severely ill group and the healthy control group.The concentrations of most cytokines in the three groups were significantly different(p<0.05).The highest concentration of IL-10 in the severely ill group is close to 200 times the normal value,the peak concentration of IL-6 exceeds 400 times the normal value,the highest concentration of IL-16 is more than 500 times the normal value,and the highest concentration of MCP-1 is 1,000 times the normal value.Based on the cytokine storm intensity curve integrated with 10 kinds of cytokines,the dynamic change trend of cytokine storm in the early period after cardiac surgery was obtained.It was found that the intensity of the storm in the severely ill group was always significantly higher than that in the mildly ill control group and the healthy control group representing normal levels.The peak of the cytokine storm in the severely ill group was concentrated during the operation,which was earlier than the time when the maximum value of vasoactive drug score and SOFA score appeared.Conclusions: 1.Cytokine storm occur during cardiac surgery and early postoperative period,the intensity of which is closely related to the severity of the disease;2.The peak of the cytokine storm occurs earlier than the most severe time,suggesting that the cytokine storm may be one of the important mechanisms of multiple organ dysfunction after cardiac surgery;3.The time and intensity of cytokine storms after cardiac surgery can be monitored by measuring the concentration of representative biomarkers(such as IL-6,MCP-1,etc.);4.Intervention for cytokine storm should be started as early as possible during cardiopulmonary bypass or early after the cardiac surgery,and preventive measures can also be carried out before surgery.