Plasma concentrations of soluble tumor necrosis factor receptor I and tumor necrosis factor during cardiopulmonary bypass

Background. Tumor necrosis factor-cw (TNF) has been implicated in the devel opment of postoperative morbidity after cardiopulmonary bypass for myocardi al revascularization. Despite their postulated roles as modulators of TNF b ioavailability, soluble TNF receptors have not been characterized in patien ts undergoing this procedure and is the focus of this study. Methods. Soluble tumor necrosis factor receptor I (sTNFRI) and TNF were mea sured by immunoassay in plasma samples collected from 36 patients at events before, during, and after cardiopulmonary bypass. Results. Plasma concentrations of sTNFRI averaged 1.39 ng/mL at the start o f the operation. Preoperative sTNFRI concentrations were found to significa ntly correlate with a preoperative morbidity assessment score, age, duratio n of bypass, duration of supplemental oxygen, and length of hospital stay. Plasma sTNFRI increased in all of the patients during the procedure. Plasma concentrations of sTNFRI and TNF did not correlate at any time. Conclusions. Preoperative measurement of sTNFRI could potentially serve as a reliable indicator for prophylactic treatment with an anti-TNF therapy. S uch a therapeutic approach might help attenuate inflammatory processes thou ght to underlie postoperative morbidity associated with cardiopulmonary byp ass. (C) 2000 by The Society of Thoracic Surgeons.