| Cytokine profile of Post–cardiopulmonary bypass in children |
Kantara Saelim1 
, Kanokpan Ruangnapa1
, Jirayut Jarutach2
, Pongsanae Duangpakdee3
, Smonrapat Surassombatpattana4
, Pharsai prasertsan1
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1Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
2Division of Cardiovascular, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
3Division of Cardiovascular and Thoracic Surgeon, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
4Division of immunology and virology, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand |
Correspondence:
Pharsai prasertsan, Email: pharsai_16@yahoo.com
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Received: 13 April 2025 • Revised: 11 July 2025 • Accepted: 24 July 2025 |
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| Abstract |
Background
Open cardiac surgery involving cardiopulmonary
bypass (CPB) triggers a systemic inflammatory
response that significantly affects clinical outcomes. However,
the dynamics and specific roles of cytokine release
after CPB in the pediatric population remain unclear.
Purpose
To evaluate the dynamics of cytokine levels
and their association with low cardiac output syndrome
(LCOS)-related outcomes.
Methods
A prospective observational cohort study was
conducted of 32 children who underwent elective open
cardiac surgery with CPB at Songklanagarind Hospital,
Thailand. Levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, and
tumor necrosis factor (TNF)-α were analyzed preoperatively
and immediately (T0), 6, 12, and 24 hours after intensive
care unit admission. LCOS-related outcomes were defined
with at least two of the following criteria being met within
24 hours postoperative: clinical and laboratory parameters,
vasopressor-inotropic score ≥20, ejection fraction
<50% on echocardiography; and requirement for a serious
postoperative intervention. Statistical analyses utilized
linear mixed models and multivariate logistic regression
to identify the independent predictors of LCOS.
Results
The mean patient age was 34.8±34.4 months; 56.2
% were male. Roughly one-third (37.5%) had a history of
previous cardiac surgery, while one-quarter (28.3%) had
a Risk Adjustment for Congenital Heart Surgery score ≥3.
LCOS-related outcomes occurred in 37.5% of patients. IL-
6, IL-8, and TNF-α levels differed significantly between
patients with and without LCOS outcomes. An increase in
IL-8 of >56 pg/mL from baseline to T0 showed the strongest
association with LCOS (odds ratio, 37.34; 95% confidence
interval, 4.53–836.53).
Conclusion
An elevated postoperative IL-8 level is a robust
predictor of LCOS-related outcomes in pediatric patients
undergoing cardiac surgery. These findings emphasize
the importance of monitoring cytokine dynamics to guide
interventions and improve patient outcomes. |
| Key Words:
Biomarkers, Cardiac surgery, Cytokines, Child,
Low cardiac output syndrome |
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