Perioperative levels of total IgE correlate with outcomes of prolonged mechanical ventilation after cardiopulmonary bypass in pediatric patients.

Abstract:

BACKGROUND:Although cardiopulmonary bypass (CPB) has been previously studied as risking infection and inflammatory responses, few studies evaluate the relationship of preoperative high total immunoglobulin E (tIgE) to outcomes in pediatric patients predisposed to atopy undergoing cardiac surgery with CPB. METHODS:Serum tIgE, tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), IL-4, interferon-γ (IFN-γ), and T-helper type 1/2 (Th1/Th2) ratio were quantified in 104 pediatric patients who underwent surgical repair with CPB. Blood samples were obtained: before operation (T1), at the beginning (T2), and before the completion of CPB (T3), after protamine administration (T4), 4 h after CPB (T5), and on postoperative days 1 and 2 (T6, T7). Data on clinical outcomes were collected prospectively. RESULTS:Compared to 50 cases with normal tIgE, 54 cases with high tIgE were found to have higher TNF-α, IL-10, and IL-4 affected by CPB on the specific timepoints (pTNF-α <  0.001; pIL-10 = 0.035; pIL-4 = 0.001). TIgE levels shifted transiently towards Th2, which may be caused by high tIgE specific to T4. This resulted in the correlation between prolonged duration of mechanical ventilation (IL-4: r = 0.426, p = 0.015; Th1/Th2: r = -0.272, p = 0.043) in patients with high tIgE. CONCLUSIONS:A high preoperative tIgE level predisposes patients to an aggravated Th2 shift after protamine administration during CPB in association with increased risk of prolonged mechanical ventilation and medical intervention.

journal_name

Pediatr Res

journal_title

Pediatric research

authors

Li Y,Zhu L,Chen J,Singson MTG,Rui X,Li N,Zhou L,Liu J

doi

10.1038/s41390-018-0048-2

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

689-695

issue

5

eissn

0031-3998

issn

1530-0447

pii

10.1038/s41390-018-0048-2

journal_volume

84

pub_type

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