CIRCULATING ENDOTOXIN AND CYTOKINES AFTER CARDIOPULMONARY BYPASS - DIFFERENTIAL CORRELATION WITH DURATION OF BYPASS AND SYSTEMIC INFLAMMATORY RESPONSE MULTIPLE ORGAN DYSFUNCTION SYNDROMES

Cardiopulmonary bypass constitutes an injury that may cause postoperat ive pathophysiological changes due to systemic inflammatory response s yndrome (SIRS) and multiple organ dysfunction syndrome (MODS). These c omplications include caogulopathy, hypotension, capillary leakage, and multiple organ injury. To investigate the role of endotoxin and cytok ines in the response to bypass injury, we measured plasma levels of en dotoxin and proinflammatory cytokines in 20 pediatric patients before and after bypass, Clinical data, including duration of injury and test s indicative of SIRS/ MODS, were collected. Levels of endotoxin, TNF-a lpha, IL-6, and IL-8 but not IL-1 beta were significantly increased af ter bypass, Most of the cytokines have been found to correlate with ea ch other. Endotoxin did not correlate with duration of bypass, cytokin es, or SIRS/MODS. In contrast, TNF-alpha and IL-8 correlated with dura tion of bypass and were associated with SIRS/MODS, Certain clinical co mplications were associated with specific cytokines. Understanding the role of cytokinemia in SIRS/MODS may lead to better prognostic assess ment and therapeutic modalities. (C) 1997 Academic Press.