Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications
Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications
复制标题
DOI：
10.1097/ccm.0b013e3181c0de7b
复制
发表时间：
2010-02-01
影响因子：
8.8
通讯作者：
Brand, Anneke
中科院分区：
文献类型：
--
作者：
Bilgin, Yavuz M.;van de Watering, Leo M. G.;Brand, Anneke
目的：研究心脏手术中输注含白细胞的红细胞后术后并发症的发生率是否与炎症介质有关。设计：分析参与一项随机试验的患者的炎症标志物白细胞介素-6、白细胞介素-10、白细胞介素-12和降钙素原，比较去白细胞与含白细胞、去血沉棕黄层的红细胞。两所大学附属医院在Netherlands.Subjects：共346例患者接受心脏瓣膜手术与一个完整的系列前和术后的血液samples. Measures和主要结果：有两个研究组之间的细胞因子和降钙素原浓度没有差异时，患者到达重症监护室。在亚组中，接受0 - 3次红细胞输注的患者在两个研究组中显示出相似的细胞因子浓度，而接受≥ 4次红细胞输注的患者在含白细胞、血沉棕黄层去除的红细胞组中具有显著更高的白细胞介素-6浓度。发生术后感染和多器官功能障碍综合征的患者分别显示白细胞、血沉棕黄层去除的红细胞组中白细胞介素-6和白细胞介素-12浓度升高。这些亚组的相互作用试验显示白细胞、血沉棕黄层去除的红细胞组中白细胞介素-6和白细胞介素-12的反应模式显著不同。去白细胞红细胞组与去白细胞红细胞组比较白细胞介素-6和白细胞介素-12。多变量分析显示，高浓度的白细胞介素-6与多器官功能障碍综合征和高浓度的白细胞介素-6和白细胞介素-10与住院mortality.Conclusions：异基因含白细胞的输血与白细胞耗竭输血相比，诱导剂量依赖性显着较高浓度的促炎介质在心脏手术后立即术后期间。高浓度的白细胞介素-6是多器官功能障碍综合征发展的强预测因子，而白细胞介素-6和白细胞介素-10均与住院死亡率相关。这些发现表明，含白细胞的红细胞干扰术后促炎反应之间的平衡，这可能进一步影响心脏手术后并发症的发展。(Crit Care Med 2010; 38：546-552）
Objective: To investigate whether the higher prevalence of postoperative complications in cardiac surgery after transfusion of leukocyte-containing red blood cells can be related to inflammatory mediators.Design: Analysis of inflammatory markers interleukin-6, interleukin-10, interleukin-12, and procalcitonin in patients participating in a randomized trial comparing leukocyte-depleted with leukocyte-containing, buffy-coat-depleted red blood cells.Setting: Two university-affiliated hospitals in the Netherlands.Subjects: A total of 346 patients undergoing cardiac valve surgery with a complete series of pre- and postoperative blood samples.Measurements and Main Results: There were no differences in the cytokines and procalcitonin concentrations between both study arms when the patients arrived in the intensive care unit. In subgroups, patients who received zero to three red blood cell transfusions showed similar cytokine concentrations in both study arms, whereas patients with >= 4 red blood cell transfusions had significantly higher interleukin-6 concentrations in the leukocyte-containing, buffy-coat-depleted red blood cell group. Patients who developed postoperative infections and multiple organ dysfunction syndrome showed, respectively, increased concentrations of interleukin-6 and interleukin-12 in the leukocyte-containing, buffy-coat-depleted, red blood cell group, The interaction tests in these subgroups showed significantly different reaction patterns in the leukocyte-containing, buffy-coat-depleted red blood cell group compared with leukocyte-depleted red blood cell group for interleukin-6 and interleukin-12. Multivariate analysis showed a high interleukin-6 concentration with multiple organ dysfunction syndrome and both high interleukin-6 and interleukin-10 concentrations with hospital mortality.Conclusions: Allogeneic leukocyte-containing blood transfusions compared with leukocyte-depleted blood transfusions induce dose-dependent significantly higher concentrations of proinflammatory mediators in the immediate postoperative period after cardiac surgery. High concentrations of interleukin-6 are strong predictors for development of multiple organ dysfunction syndrome, whereas both interleukin-6 and interleukin-10 are associated with hospital mortality. These findings suggest that leukocyte-containing red blood cells interfere with the balance between postoperative proinflammatory response, which may further affect the development of complications after cardiac surgery. (Crit Care Med 2010; 38:546-552)