scholarly journals Complement (C3, C4) and C-reactive Protein Responses to Cardiopulmonary Bypass and Protamine Administration

1993 ◽  
Vol 21 (1) ◽  
pp. 50-55 ◽  
Author(s):  
M. Tulunay ◽  
S. Demiralp ◽  
S. Tastan ◽  
H. Akalin ◽  
U. Ozyurda ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Complement System ◽  
Complement Activation ◽  
Heart Surgery ◽  
Tissue Injury ◽  
Open Heart Surgery ◽  
Complement C3 ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Protamine Administration

Complement activation has been deemed responsible for the damaging effects of cardiopulmonary bypass (CPB) in patients undergoing open heart surgery. We studied C3, C4 and C-reactive protein (CRP) in 22 patients undergoing CPB. In Group 1 (11 patients), protamine was given intravenously and in Group 2 (11 patients), via the aortic root after CPB. Significant decreases were observed in C3 and C4 during CPB in both groups indicating complement activation primarily by the classic pathway. Protamine did not lead to further activation of the complement system. In both groups, C3 levels gradually returned toward baseline within 24 hours but C4 levels were still lower than baseline 24 hours postoperatively. CPB and protamine administration did not cause any significant changes in CRP levels, but CRP increased abruptly 24 hours after operation. Although activation of complement system during CPB is expected to invoke an acute phase response, we conclude that this period is not long enough to induce an increased production of CRP in response to tissue injury or inflammation.

Post-operative kinetics of C-reactive protein to distinguish between bacterial infection and systemic inflammation in infants after cardiopulmonary bypass surgery: the early and the late period

2021 ◽  
pp. 1-8
Author(s):  
Hanna Renk ◽  
David Grosse ◽  
Sarah Schober ◽  
Christian Schlensak ◽  
Michael Hofbeck ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Bacterial Infection ◽  
Congenital Heart ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Post Operative Period ◽  
Kinetics Of

Abstract Objectives: Differentiation between post-operative inflammation and bacterial infection remains an important issue in infants following congenital heart surgery. We primarily assessed kinetics and predictive value of C-reactive protein for bacterial infection in the early (days 0–4) and late (days 5–28) period after cardiopulmonary bypass surgery. Secondary objectives were frequency, type, and timing of post-operative infection related to the risk adjustment for congenital heart surgery score. Methods: This 3-year single-centre retrospective cohort study in a paediatric cardiac ICU analysed 191 infants accounting for 235 episodes of CPBP surgery. Primary outcome was kinetics of CRP in the first 28 days after CPBP surgery in infected and non-infected patients. Results: We observed 22 infectious episodes in the early and 34 in the late post-operative period. CRP kinetics in the early post-operative period did not accurately differentiate between infected and non-infected patients. In the late post-operative period, infected infants displayed significantly higher CRP values with a median of 7.91 (1.64–22.02) and 6.92 mg/dl (1.92–19.65) on days 2 and 3 compared to 4.02 (1.99–15.9) and 3.72 mg/dl (1.08–9.72) in the non-infection group. Combining CRP on days 2 and 3 after suspicion of infection revealed a cut-off of 9.47 mg/L with an acceptable predictive accuracy of 76%. Conclusions: In neonates and infants, CRP kinetics is not useful to predict infection in the first 72 hours after CPBP surgery due to the inflammatory response. However, in the late post-operative period, CRP is a valuable adjunctive diagnostic test in conjunction with clinical presentation and microbiological diagnostics.

scholarly journals Monomeric C-reactive protein inhibits renal cell-directed complement activation mediated by properdin

2016 ◽  
Vol 310 (11) ◽  
pp. F1308-F1316 ◽  
Author(s):  
Joseph O'Flynn ◽  
Pieter van der Pol ◽  
Karen O. Dixon ◽  
Zoltán Prohászka ◽  
Mohamed R. Daha ◽  
...  
Keyword(s):  
Complement Activation ◽  
Tissue Injury ◽  
Alternative Pathway ◽  
Fluorescent Microscopy ◽  
Jurkat Cells ◽  
C Reactive Protein ◽  
Tubular Cells ◽  
Reactive Protein ◽  
Renal Tubular Cells ◽  
Renal Tubular

Previous studies have shown that complement activation on renal tubular cells is involved in the induction of interstitial fibrosis and cellular injury. Evidence suggests that the tubular cell damage is initiated by the alternative pathway (AP) of complement with properdin having an instrumental role. Properdin is a positive regulator of the AP, which can bind necrotic cells as well as viable proximal tubular epithelial cells (PTECs), inducing complement activation. Various studies have indicated that in the circulation there is an unidentified inhibitor of properdin. We investigated the ability of C-reactive protein (CRP), both in its monomeric (mCRP) and pentameric (pCRP) form, to inhibit AP activation and injury in vitro on renal tubular cells by fluorescent microscopy, ELISA, and flow cytometry. We demonstrated that preincubation of properdin with normal human serum inhibits properdin binding to viable PTECs. We identified mCRP as a factor able to bind to properdin in solution, thereby inhibiting its binding to PTECs. In contrast, pCRP exhibited no such binding and inhibitory effect. Furthermore, mCRP was able to inhibit properdin-directed C3 and C5b-9 deposition on viable PTECs. The inhibitory ability of mCRP was not unique for viable cells but also demonstrated for binding to necrotic Jurkat cells, a target for properdin binding and complement activation. In summary, mCRP is an inhibitor of properdin in both binding to necrotic cells and viable renal cells, regulating complement activation on the cell surface. We propose that mCRP limits amplification of tissue injury by controlling properdin-directed complement activation by damaged tissue and cells.

scholarly journals A novel case of impaired C-reactive protein response following open-heart surgery: a case report and review of the literature

2021 ◽  
Author(s):  
Erik Wilhelm Vinnes ◽  
Paul Kjetel Soldal Lillemoen ◽  
Robert Matongo Persson ◽  
Klaus Meyer ◽  
Rune Haaverstad ◽  
...  
Keyword(s):  
Case Report ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Review Of The Literature ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Protein Response

Comparison of a Duraflo II-coated cardiopulmonary bypass circuit and a trillium-coated oxygenator during open-heart surgery

Perfusion ◽  
2004 ◽  
Vol 19 (3) ◽  
pp. 177-184 ◽  
Author(s):  
Tom N Hoel ◽  
Vibeke Videm ◽  
Svein T Baksaas ◽  
Tom E Mollnes ◽  
Frank Brosstad ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Complement Activation ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Activation Products ◽  
Risk Patients ◽  
Leukocyte Counts ◽  
Terminal Complement

Background: Cardiopulmonary bypass (CPB) evokes a systemic inflammatory response. In attempting to improve the biocompatibility of the equipment, various methods to coat the inner surfaces of the CPB systems have been developed. The present study compares a Trillium Biopassive surface-coated Affinity oxygenator with a Duraflo II totally heparin-coated CPB system. Methods: Low-risk patients admitted for primary coronary artery bypass grafting or aortic valve replacement were randomized to operation using the Trillium- or the Duraflo II-coated setups. Heparin concentration, complement activation (C3bc activation products and terminal complement complex (TCC)), platelet activation (platelet numbers and beta-thromboglobulin (BTG)), leukocyte activation (leukocyte numbers and myeloperoxidase (MPO)), coagulation (thrombin/antithrombin complexes (TAT)) and fibrinolytic activity (plasmin/a2-antiplasmin complexes (PAP)) were measured during CPB and two hours postoperatively. Results: Platelet counts decreased during CPB, without significant intergroup differences. The median BTG concentration increased moderately in both groups and were slightly higher in the Trillium group during CPB (p B-0.05), but not postoperatively. Complement activation products (C3bc and TCC), leukocyte counts, MPO, TAT and PAP activity showed no differences between the two groups. Conclusions: There were small differences in the inflammatory response between the two extracorporeal circulation devices compared in this study.

Comparison of the effects of centrifugal versus roller pump on the immune response in open-heart surgery

Perfusion ◽  
1995 ◽  
Vol 10 (4) ◽  
pp. 249-256 ◽  
Author(s):  
J. Perttilä ◽  
M. Salo ◽  
O. Peltola
Keyword(s):  
Immune Responses ◽  
Centrifugal Pump ◽  
Coronary Artery Bypass Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Pokeweed Mitogen ◽  
C Reactive Protein ◽  
Roller Pump ◽  
Reactive Protein

We compared the effects of a centrifugal pump with those of a roller pump on immune responses in 26 coronary artery bypass surgery patients during cardiopulmonary bypass (CPB). The patients were randomly allocated into a (Biomedicus) centrifugal pump group and a (Stöckert) twin roller pump group. Leucocyte and differential counts; percentages of lymphocyte subpopulations (CD3-, CD4-, CD8-, CD16-, CD20- and CD25-positive lymphocytes) and monocytes (CD14); phytohaemagglutinin-, concanavalin A-, and pokeweed mitogen-induced and unstimulated proliferation of separated lymphocytes; unstimulated and pokeweed mitogen-stimulated production of IgG, IgM, or IgA; and plasma fibronectin, C-reactive protein and serum albumin concentrations were measured preoperatively, immediately before CPB, immediately before aortic declamping and on the first postoperative morning. Significant changes were seen in these variables, but no differences occurred between the groups.

scholarly journals Postoperative Adiponectin Levels in Pediatric Patients Undergoing Open Heart Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
A. Thaler ◽  
H. Kanety ◽  
T. Avni ◽  
D. Mishali ◽  
R. Hemi ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Time Course ◽  
Inflammatory Process ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Pediatric Intensive Care ◽  
Open Heart ◽  
Endocrine Organ ◽  
Reactive Protein ◽  
Inotropic Score

Background. Adipose tissue is an important endocrine organ that secretes cytokines, including adiponectin, levels of which are negatively correlated with the severity of the inflammatory process.Aim. To assess the time course of adiponectin levels following open heart surgery with cardiopulmonary bypass and its correlation with early postoperative outcomes.Materials and Methods. Blood samples were obtained from 24 children undergoing cardiac surgery and analyzed for adiponectin, C-reactive protein, and other inflammatory markers.Results. Baseline adiponectin levels were negatively correlated with patients’ preoperative weight and age. Postoperative adiponectin levels decreased compared to baseline () and correlated negatively with duration of cardiopulmonary bypass (, ), length of stay in the pediatric intensive care unit (, ), and the inotropic score (, ). Adiponectin levels were positively correlated with sVCAM 1 levels; however, there was no correlation between adiponectin levels and sP selectin, tPA, MCP1, and sCD40.Conclusions. The inflammatory response after open heart surgery with cardiopulmonary bypass is associated with a reduction in adiponectin levels. Prolonged or more complicated surgery induced a more substantial inflammatory process characterized by a significant reduction in adiponectin levels over time and a delayed return to baseline levels.

scholarly journals Dexamethasone Prophylaxis in Pediatric Open Heart Surgery Is Associated with Increased Blood Long Pentraxin PTX3: Potential Clinical Implications

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Franco Lerzo ◽  
Giuseppe Peri ◽  
Andrea Doni ◽  
Paola Bocca ◽  
Fabio Morandi ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Heart Surgery ◽  
Interleukin 1 ◽  
Open Heart Surgery ◽  
Open Heart ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Inflammatory Parameters ◽  
Inflammatory Parameter ◽  
Improve Clinical Outcome

Glucocorticoid administration before cardiopulmonary bypass (CPB) can reduce the systemic inflammatory response and improve clinical outcome. Long pentraxin PTX3 is a novel inflammatory parameter that could play a protective cardiovascular role by regulating inflammation. Twenty-nine children undergoing open heart surgery were enrolled in the study. Fourteen received dexamethasone (1st dose 1.5 mg/Kg i.v. or i.m. the evening before surgery; 2nd dose 1.5 mg/kg i.v. before starting bypass) and fifteen children served as control. Blood PTX3, short pentraxin C-reactive protein (CRP), interleukin-1 receptor II (IL-1RII), fibrinogen and partial thromboplastin time (PTT) were assayed at different times. PTX3 levels significantly increased during CPB in dexamethasone-treated (+D) and dexamethasone-untreated (−D) subjects, but were significantly higher in +D than −D patients. CRP levels significantly increased both in +D and −D patients in the postoperative days, with values significantly higher in −D than +D patients. Fibrinogen and PTT values were significantly higher in −D than +D patients in the 1st postoperative day. IL-1RII plasma levels increased in the postoperative period in both groups. Dexamethasone prophylaxis in pediatric patients undergoing CPB for cardiac surgery is associated with a significant increase of blood PTX3 that could contribute to decreasing inflammatory parameters and improving patient clinical outcome.

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