Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid gelatin in patients undergoing coronary surgery
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Date
2015
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Abstract
Objectives: Compare the effects on inflammatory (TNF-α, 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® (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 2h (T1), 12h (T2), 24h (T3), and 48h (T4) after separation from cardiopulmonary bypass. TNF-α, 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-α at T1 (2h 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 24h after surgery in Group HES (347±207mL) was not significantly different from that of Group GEL (272±177mL) 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®. The use of hydroxyethyl starch, compared to gelatin solution and isolyte S®, resulted in less decrease in the CD4+:CD8+ ratio, suggesting less immunosuppression. © 2014 Elsevier Ltd.
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Keywords
Aged , Coronary Artery Bypass , Female , Gelatin , Hemodilution , Humans , Hydroxyethyl Starch Derivatives , Immunosuppression , Inflammation , Interleukin-10 , Interleukin-6 , Interleukin-8 , Male , Middle Aged , T-Lymphocytes , Tumor Necrosis Factor-alpha , acetic acid plus gluconate sodium plus glucose plus magnesium chloride plus potassium chloride plus sodium chloride , CD11b antigen , CD16 antigen , CD56 antigen , gelatin , hetastarch , interleukin 10 , interleukin 6 , interleukin 8 , tumor necrosis factor alpha , gelatin , HES 130-0.4 , hetastarch derivative , IL10 protein, human , interleukin 10 , interleukin 6 , interleukin 8 , modified fluid gelatins , TNF protein, human , tumor necrosis factor , adult , blood conservation , blood volume , cardiopulmonary bypass , CD3+ T lymphocyte , CD4+ T lymphocyte , CD8+ T lymphocyte , clinical article , controlled study , coronary artery bypass graft , crystalloid , enzyme linked immunosorbent assay , female , flow cytometry , fluid therapy , hemodilution , human , immune deficiency , inflammation , male , natural killer cell , operative blood loss , postoperative period , priority journal , prospective study , randomized controlled trial , Review , aged , blood , drug effects , immunology , immunosuppressive treatment , middle aged , T lymphocyte