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CARDIOVASCULAR ANESTHESIA

Increased Interleukin-6 After Cardiac Surgery Predicts Infection

Departments of Anesthesiology and Intensive Care Medicine, and Cardiovascular Surgery, University Hospital Charité, Campus Charité Mitte/Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin, Germany; Department of Anesthesiology, St. Mary’s Medical Center, San Francisco, California

Address correspondence and reprint requests to Michael Sander, MD, Department of Anesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Charité Campus Mitte, Schumannstr. 20/21, 10117 Berlin, Germany. Address e-mail to michael.sander{at}charite.de.

Early diagnosis and treatment of infection after cardiac surgery with cardiopulmonary bypass (CPB) improves outcome. Conventional laboratory tests, such as C-reactive protein and white blood cell count can not distinguish patients with early infection from those with systemic inflammatory response syndrome but without infection. After CPB, there is a systemic release of proinflammatory and antiinflammatory cytokines, including tumor necrosis factor-, interleukin (IL)-6, and IL-10. We investigated the predictive ability of these variables for infection after cardiac surgery. Forty-six patients with impaired left ventricular ejection fraction (<60%), scheduled for cardiac surgery, were included. Plasma samples were drawn 1 day before and immediately before surgery, on admission to the intensive care unit, and on days 1, 3, and 7 after surgery. Infection was identified according to the criteria of the Centers for Disease Control and Prevention. After surgery 13 patients developed an infection. In patients with infection, confirmed a median of 4 days after surgery, all measurements of IL-6, and IL-10 on postoperative day 3 were significantly increased. Tumor necrosis factor-, leukocytes, and C-reactive protein were not increased in these patients. Immediately after surgery blood glucose was significantly increased in patients with infection. Increased IL-6 after CPB is predictive of infection after cardiac surgery in patients with impaired left ventricular function.

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