Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid gelatin in patients undergoing coronary surgery
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Objectives: Compare the effects on inflammatory (TNF-alpha, IL-6, IL-8 and IL-10) and immunologic (CD3(+), CD4(+), CD8(+), CD11b(+), CD16(+)/56(+) T cells and total lymphocyte concentration) variables of hydroxyethyl starch 130/0.4, 4% modified fluid gelatin, or crystalloid when used as volume replacement fluids for acute normovolemic hemodilution (a blood conservation technique) in coronary artery bypass graft patients. Methods: Thirty patients undergoing coronary artery bypass graft surgery were randomized to receive Isolyte S (R) (Group ISO), 6% hydroxyethyl starch 130/0.4 (Group HES) or 4% modified gelatin solution (Group GEL) for acute normovolemic hemodilution. Blood samples were taken immediately after induction of anaesthesia (T0), and 2 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) after separation from cardiopulmonary bypass. TNF-alpha, IL-6, IL-8 and IL-10 levels were determined with commercially available ELISA kits. CD3(+) (mature T cells), CD4(+) (T helper cells), CD8(+) (suppressor cytotoxic T cells), CD16(+)/56(+) (natural killer lymphocytes), and CD11b(+) (Mac-1, adhesion receptor) levels were measured using flow-cytometry reagents. The CD4(+):CD8(+) ratio was calculated. Results: Between-group comparisons showed significantly higher levels of TNF-alpha at T1 (2 h after weaning from cardiopulmonary bypass) in Group HES compared to Group ISO (p = 0.003). IL-8 was significantly lower in Group HES than Group GEL at T1 (p = 0.0005). IL-10 was significantly higher in Group HES than in Group GEL at T1 (p = 0.0001). The CD4(+):CD8(+) ratio in Group ISO was significantly lower than that in Group HES at T2 (p = 0.003). CD11b(+) levels in Group HES were also higher than those in Group GEL and group ISO at T2, but not significantly. CD16/56(+) levels in Group HES were higher than those in Group GEL at T2 (p < 0.003). No excessive hemorrhage occurred in any patient. Mediastinal drainage during the first 24 h after surgery in Group HES (347 +/- 207 mL) was not significantly different from that of Group GEL (272 +/- 177 mL) or Group ISO (247 +/- 109) (p > 0.05). Conclusion: Hydroxyethyl starch 130/0.4 reduced pro-inflammatory responses and increased anti-inflammatory responses to a greater degree than gelatin solution and isolyte S (R). The use of hydroxyethyl starch, compared to gelatin solution and isolyte S (R), resulted in less decrease in the CD4(+):CD8(+) ratio, suggesting less immunosuppression. (C) 2014 Elsevier Ltd. All rights reserved.