Standardized immune monitoring for the prediction of infections after cardiopulmonary bypass surgery in risk patients

• Published in: Cytometry. Part B, Clinical cytometry Vol. 53B; no. 1; pp. 54 - 62
• Main Authors: Strohmeyer, Jens‐Christian, Blume, Christian, Meisel, Christian, Doecke, Wolf‐Dietrich, Hummel, Manfred, Hoeflich, Conny, Thiele, Kathi, Unbehaun, Axel, Hetzer, Roland, Volk, Hans‐Dieter
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.05.2003
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers; Cardiopulmonary Bypass; cardiopulmonary bypass surgery; CD11b; CD64; Coronary Disease - surgery; ex vivo elastase secretion; ex vivo TNF‐α secretion; Female; Granulocytes - immunology; HLA‐DR monocytes; Humans; IL‐10; immune monitoring; Immunocompetence; Infection - epidemiology; Infection - immunology; Infection - pathology; Male; Middle Aged; Monocytes - immunology; Postoperative Complications - epidemiology; Postoperative Complications - immunology; Postoperative Complications - pathology; prediction of infection; Predictive Value of Tests; Risk Factors
• ISSN: 1552-4949; 1552-4957
• DOI: 10.1002/cyto.b.10031

Background Infections are the most common cause of late complications in cardiopulmonary bypass (CPB) surgery patients, and are difficult to predict. Here we studied the diagnostic value of a standardized immune monitoring program based on recent advances in flow cytometry (exact quantification of surface‐marker expression) and cytokine determination (semiautomatic systems). Methods CPB patients (56) at risk for complications (age >70 years and/or preoperative left‐ventricular ejection fraction < 25 %) were classified into three groups: without (33), with suspected (14), and with confirmed (9) infection. Applying the Quantibrite™‐system, we daily quantified the expression of CD11b, CD64, CD71, CD86, and HLA‐DR on monocytes/granulocytes. Furthermore, the ex vivo secretion of tumor necrosis factor (TNF)‐α as well as the plasma interleukin (IL)‐10 levels were determined by a semiautomatic system. Ex vivo elastase release was measured by enzyme‐linked immunosorbent assay (ELISA). Results All patients showed signs of granulocyte activation and monocyte deactivation. Monocytic HLA‐DR and plasma IL‐10 were the best markers to discriminate patients with infection from those without as early as day 1. Using a cutoff of 5792 HLA‐DR molecules per cell, both sensitivity and negative predictive value for patients who developed microbiologically confirmed infection was 1.0, and the area under the curve (AUC) was 0.85. Conclusions Our data suggest that a standardized immune monitoring at day 1 might be useful for early discrimination of patients at elevated risk for infections. Cytometry Part B (Clin. Cytometry) 53B:54–62, 2003. © 2003 Wiley‐Liss, Inc.