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.

Background:There is growing evidence that cytokines are the key elements in the initiation,evolution,and,ultimately,the resolution of inflammatory bowel disease (IBD).Ahns:To investigate the differences of cytokine expressions in intestinal mucosa between IBD patients and normal controls.Methods:Thirty cases of colonoscopic or enteroscopic biopsied mucosal tissue were collected from 7 normal subjects,12 ulcerative colitis (UC),and 11 definite or suspicious Crohn's disease (CD) during Jan.2014 to Dec.2014 at Shanghai East Hospital South Branch.Using the suspension chip technology,expressions of 27 cytokines in mucosal tissues were detected.Results:Most of the cytokines in intestinal mucosa of patients with IBD were decreased as compared with the normal controls,whereas the expressions of interleukin-5 (IL-5) and IL-7 were increased.Among the 27 cytokines,statistically significant differences were seen in expressions of IL-1β,IL-2,IL-15,interferon-γ-induced protein-10 (IP-10),monocyte chemoattractant protein-1 (MCP-1),macrophage inflammatory protein-1α (MIP-1α) and MIP-1β between UC,CD and normal controls (P ＜ 0.05);in addition,significant differences were seen in expressions of IL-8 and platelet-derived growth factor-BB (PDGF-BB) between CD and normal controls (P ＜ 0.05).No significant differences were observed in expressions of all 27 cytokines between UC and CD (P ＞ 0.05),as well as between active and remission stages of IBD (P ＞ 0.05).Conclusions:Expressions of IL-1β,IL-2,IL-15,IP-10,MCP-1,MIP-1α and MIP-1β are significantly down-regulated in intestinal mucosa of IBD patients.It may help to further explore the role of cytokines in IBD.