Markers of Innate and Adaptive Immunity and Biochemical Parameters in Patients Undergoing Cardiac Surgery under Artificial Circulation and High-Volume Hemodiafiltration

Introduction. A systemic inflammatory response is one of the complications of cardiac surgery under artificial circulation. It can become an important link in the formation of a critical condition involving multiple organ failure. Controlled continuous high-volume hemodiafiltration was used to eliminate negative consequences in patients undergoing cardiac surgery under artificial circulation. The study of dynamic changes in the parameters of innate and adaptive immunity, biochemical parameters allows assessing the risk of developing a systemic inflammatory response and evaluating the protective effect of hemofiltration.

The aim and objectives of the study were: to measure the parameters of innate and adaptive immunity, biochemical parameters in patients before surgery (on the day of its implementation), in 3 and 10 days after the combined effect of cardiac surgery under artificial circulation using controlled continuous high-volume hemodiafiltration; to evaluate the obtained measurements comparing the immune and biochemical statuses between different study periods and the parameters of healthy donors.

Methods. Phenotypic analysis of lymphoid and phagocytic cells was performed by flow cytometry using monoclonal antibodies (AB) from BD Biosciences, Becton, Dickinson and Co. (USA), labeled with FITC (fluorescein isothiocyanate) or PE (phycoerythrin), on a FACSCalibur flow cytometer (Becton Dickinson, USA). A wide panel of applied monoclonal AB and other markers is presented in Table 1. During the phenotypic analysis, the blood formula was evaluated using a standard approach, biochemical studies were performed on an automatic biochemical analyzer ARCHITECT c4000 (ABBOTT, USA) using reagents from the same company. Statistical analysis of the results was performed using the Prisma 7 program.

Results. The article presents results of 24 patients who underwent surgery for various cardiovascular pathologies under artificial circulation (AC). Controlled continuous high-volume hemodiafiltration was used to eliminate negative consequences in patients undergoing cardiac surgery under artificial circulation. Clinical, biochemical and immune assessment of the health status of patients was carried out in dynamics: before the operation (on the day of its implementation) and in 3 and 10 days. The comparison group consisted of 32 primary donors. Comparative analysis allowed assuming the development of the inflammatory process in patients on the 3rd day after the combined effect of cardiac surgery under AC with the use of controlled continuous high-volume hemodiafiltration. In 10 days after the surgery, the manifestations of inflammation still remained, but the inflammatory reaction was declining, and no generalized systemic inflammatory response developed. The same pattern was observed when analyzing the absolute content of three subpopulations of monocytic cells in patients.

Conclusion. The combined effect of cardiac surgery under AC with the use of controlled continuous high-volume hemodiafiltration allows assuming that the development of a systemic inflammatory response might be prevented; this is apparently due to the eliminated negative effect of CPB.