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. 2021 Aug 23;16(1):239.
doi: 10.1186/s13019-021-01627-3.

Case-control study on the interplay between immunoparalysis and delirium after cardiac surgery

Shokoufeh CheheiliSobbi  1   2 , Annemieke M Peters van Ton  3 , Esther M Wesselink  4 , Marjolein F Looije  4 , Jelle Gerretsen  3 , Wim J Morshuis  2 , Arjen J C Slooter  4 , Wilson F Abdo  3 , Peter Pickkers  3 , Mark van den Boogaard  5
Affiliations

Case-control study on the interplay between immunoparalysis and delirium after cardiac surgery

Shokoufeh CheheiliSobbi et al. J Cardiothorac Surg. .

Abstract

Background: Delirium occurs frequently following cardiothoracic surgery, and infectious disease is an important risk factor for delirium. Surgery and cardiopulmonary bypass induce suppression of the immune response known as immunoparalysis. We aimed to investigate whether delirious patients had more pronounced immunoparalysis following cardiothoracic surgery than patients without delirium, to explain this delirium-infection association.

Methods: A prospective matched case-control study was performed in two university hospitals. Cytokine production (tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and IL-10) of ex vivo lipopolysaccharide (LPS)-stimulated whole blood was analyzed in on-pump cardiothoracic surgery patients preoperatively, and at 5 timepoints up to 3 days after cardiothoracic surgery. Delirium was assessed by trained staff using two validated delirium scales and chart review.

Results: A total of 89 patients were screened of whom 14 delirious and 52 non-delirious patients were included. Ex vivo-stimulated production of TNF-α, IL-6, IL-8, and IL-10 was severely suppressed following cardiothoracic surgery compared to pre-surgery. Postoperative release of cytokines in non-delirious patients was attenuated by 84% [IQR: 13-93] for TNF-α, 95% [IQR: 78-98] for IL-6, and 69% [IQR: 55-81] for IL-10. The attenuation in ex vivo-stimulated production of these cytokines was not significantly different in patients with delirium compared to non-delirious patients (p > 0.10 for all cytokines).

Conclusions: The post-operative attenuation of ex vivo-stimulated production of pro- and anti-inflammatory cytokines was comparable between patients that developed delirium and those who remained delirium-free after on-pump cardiothoracic surgery. This finding suggests that immunoparalysis is not more common in cardiothoracic surgery patients with delirium compared to those without.

Keywords: Cardiothoracic surgery; Cytokines; Delirium; Immunity; Intensive care medicine.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Cytokine producing capacity in delirious and non-delirious patients, after whole blood ex vivo-stimulation with bacterial lipopolysaccharide. A Tumor necrosis factor-α (TNF-α). B Interleukin-6 (IL-6). C IL-8. D IL-10. Data are expressed as median concentration per 106 monocytes [interquartile range]. The blue dotted rectangles illustrate the duration of surgery. *p < 0.05; **p < 0.01; ***p < 0.001, NS: no significant change from baseline, according to linear mixed model analysis (LMM) with time of sampling and delirium occurrence as fixed variables, and subject ID as random effect. The p-values above each graph indicate no significant differences in the trajectories of ex vivo cytokine production between patients with and without postoperative delirium based on the LMM analysis, described above
See this image and copyright information in PMC

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