Perioperative immune dynamics and clinical outcomes in patients undergoing on-pump cardiac surgery
10.13303/j.cjbt.issn.1004-549x.2026.01.005
- VernacularTitle:体外循环心脏手术患者免疫特征动态变化与预后的研究
- Author:
Zhiyuan CHENG
1
;
Xinyi LIAO
1
;
Juan WU
2
;
Ping YANG
3
;
Tingting WANG
4
;
Qinjuan WU
5
;
Wentong MENG
6
;
Zongcheng TANG
1
;
Jiayi SUN
7
;
Jia TAN
1
;
Jing LIN
1
;
Dan LUO
1
;
Hao WANG
1
;
Chaonan LIU
8
;
Jiyue XIONG
1
;
Liqin LING
8
;
Jing ZHOU
8
;
Lei DU
1
Author Information
1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
2. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Anesthesiology, Sichuan Cancer Hospital, Chengdu 610041, China
3. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Anesthesiology, Chongqing University Three Gorges Hospital, Chongqing 404100, China
4. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
5. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Anesthesiology, The Second People's Hospital of Chengdu, Affiliated to Sichuan University, Chengdu 610041, China
6. Laboratory of Stem Cell Biology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
7. Department of Applied Biology and Biotechnology, The Hong Kong Polytechnic University, Ho Man Tin 99907, China
8. Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- Publication Type:Journal Article
- Keywords:
cardiovascular surgery;
cardiopulmonary bypass;
sequential organ failure assessment;
systemic inflammatory response;
immune cell phenotypes
- From:
Chinese Journal of Blood Transfusion
2026;39(1):31-43
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10
/L vs preoperative 3.07×10
/L, P<0.001), with significant upregulation of CD11b (7.30×10
/L vs preoperative 3.05×10
/L, P<0.001) and CD54 (7.15×10
/L vs preoperative 2.99×10
/L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10
/L vs preoperative 1.12×10
/L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10
/L vs preoperative 1.12×10
/L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.
