Value of indoleamine 2,3-dioxygenase in diagnosis of systemic inflammatory response syndrome after cardiopulmonary bypass in children with congenital heart disease
WANG Xin, LI Zong-Xiao, WEN Yu-Peng, CHANG Cheng
Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin 300134, China
Abstract：Objective To study the value of indoleamine 2,3-dioxygenase (IDO) in the early diagnosis of systemic inflammatory response syndrome (SIRS) after cardiopulmonary bypass in children with congenital heart disease.Methods A total of 90 children with congenital heart disease who underwent cardiopumonary bypass surgery between May 2012 and January 2016 were enrolled. According to the prsence or absence of SIRS after surgery, they were divided into SIRS group (n=43) and control group (n=47). Peripheral blood samples were collected before surgery, during surgery, and after surgery. Serum levels of IDO, C-reactive protein (CRP), and interleukin-6 (IL-6) were measured and compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate their diagnostic efficiency.Results Compared with the control group, the SIRS group had higher serum CRP levels at 72 hours after surgery, higher IL-6 levels during surgery and at 72 hours after surgery, and higher IDO levels at 24 and 72 hours after surgery. IDO had a certain value in the diagnosis of SIRS at 24 hours after surgery with an area under the ROC curve (AUC) of 0.793, a specificity of 100%, and a sensitivity of 58.14%. CRP, IL-6, and IDO had a certain value in the diagnosis of SIRS at 72 hours after surgery. IDO had the highest diagnostic efficiency with an AUC of 0.927, a specificity of 95.74%, and a sensitivity of 76.74% at 72 hours after surgery.Conclusions IL-6, CRP, and IDO have a certain value in the diagnosis of SIRS after surgery for congenital heart disease, and IDO has a higher diagnostic efficiency. IDO can predict the development of SIRS in children after surgery for congenital heart disease earlier.
WANG Xin,LI Zong-Xiao,WEN Yu-Peng et al. Value of indoleamine 2,3-dioxygenase in diagnosis of systemic inflammatory response syndrome after cardiopulmonary bypass in children with congenital heart disease[J]. CJCP, 2018, 20(1): 28-31.
Boehne M, Sasse M, Karch A, et al. Systemic inflammatory response syndrome after pediatric congenital heart surgery:Incidence, risk factors, and clinical outcome[J]. J Card Surg, 2017, 32(2):116-125.
[2]
Durandy Y. Minimizing systemic inflammation during cardiopulmonary bypass in the pediatric population[J]. Artif Organs, 2014, 38(1):11-18.
[3]
Träger KK, Fritzler D, Fischer G, et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption:a case series[J]. Int J Artif Organs, 2016, 39(3):141-146.
[4]
Güvener M, Korun O, Demirtürk OS. Risk factors for systemic inflammatory response after congenital cardiac surgery[J]. J Card Surg, 2015, 30(1):92-96.
[5]
Giannoudis PV, Harwood PJ, Loughenbury P, et al. Correlation between IL-6 levels and the systemic inflammatory response score:can an IL-6 cutoff predict a SIRS state?[J]. J Trauma, 2008, 65(3):646-652.
[6]
Anderson IB, Sudhakar S, Keenan CR, et al. The elusive SIRS diagnosis[J]. J Gen Intern Med, 2013, 28(3):470-474.
[7]
Munn DH, Mellor AL. IDO in the tumor microenvironment:inflammation, counter-regulation, and tolerance[J]. Trends Immunol, 2016, 37(3):193-207.
[8]
Goldstein B, Giroir B, Randolph A, et al. International pediatric sepsis consensus conference:definitions for sepsis and organ dysfunction in pediatrics[J]. Pediatr Crit Care Med, 2005, 6(1):2-8.
[9]
Soares LC, Ribas D, Spring R, et al. Clinical profile of systemic inflammatory response after pediatric cardiac surgery with cardiopulmonary bypass[J]. Arq Bras Cardiol, 2010, 94(1):127-133.
[10]
Balk RA. Systemic inflammatory response syndrome (SIRS):where did it come from and is it still relevant today?[J]. Virulence, 2014, 5(1):20-26.
[11]
Allan CK, Newburger JW, McGrath E, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass[J]. Anesth Analg, 2010, 111(5):1244-1251.
[12]
Punjabi PP, Taylor KM. The science and practice of cardiopulmonary bypass:From cross circulation to ECMO and SIRS[J]. Glob Cardiol Sci Pract, 2013(3):249-260.
