Plasma-soluble E-selectin after cardiopulmonary bypass in children: Is it a marker of the postoperative course?

Objective: To investigate the relationship and possible role of soluble adh esion molecule E-selectin in the postoperative course in children undergoin g cardiopulmonary bypass (CPB). Design: Prospective cohort study. Setting:Pediatric intensive care unit of a university hospital. Participants: Thirteen children who were candidates for cardiac surgery. Interventions: None. Measurements and Main Results: Serial blood samples of 13 CPB patients were collected from the arterial catheter or from the bypass circuits preoperat ively; on initiation of CPB; on termination of CPB; and 1, 2, 4, 8,12, 18, 24, and 48 hours postoperatively. Plasma was recovered immediately, aliquot ed, and frozen at -70 degrees C until use. Circulating soluble selectin mol ecules were measured with a sandwich enzyme-linked immunosorbent assay tech nique. There were significant changes in plasma levels of soluble E-selecti ns in patients after CPB, and these levels were associated with patient cha racteristics, operative variables, and postoperative course. Soluble E-sele ctin correlated significantly with inotropic support and the use of anti-in flammatory drugs. There was a significant association between the developme nt of postoperative sepsis and soluble E-selectin levels. No correlation wa s found between soluble E-selectins and duration of CPB, aortic cross-clamp ing, or hemodynamic variables, including heart rate and mean systemic arter ial pressure. Conclusion: These results suggest a relationship between CPB-induced mediat ors and early and late clinical effects. Although the mechanism for the inc rease of soluble E-selectin remains to be elucidated, the upregulation of s oluble E-selectin indicates neutrophil activation, and its inhibition may r epresent a target for reducing the inflammatory response associated with CP B. Copyright (C) 2000 by W.B. Saunders Company.