Do S100β protein level increases due to inflammation during cardiopulmonary bypass occur without any neurological deficit?

Abstract

Purpose: S100β protein level correlates with the duration of cardiopulmonary bypass (CPB) and aortic crossclamp times, but is different during pulsatile and nonpulsatile CPB. In this study, we investigated the time course of the release of S100β protein during and after pulsatile and nonpulsatile CPB.

Patients and methods: This is a prospective study. Twenty patients had open-heart surgery with pulsatile flow and 20 with nonpulsatile flow. We compared complement proteins, interleukins, white blood cells and S100β protein before the initiation of CPB, immediately prior to aortic crossclamping, following unclamping, and at postoperative 1st and 24th hours.

Results: In the pulsatile CPB group following aortic unclamping, S100β protein ( p = 0.028) and C3a ( p = 0.011) levels were significantly lower than those of the nonpulsatile group. In the pulsatile CPB group at postoperative first hour, C3a level ( p = 0.018) and absolute neutrophil count ( p = 0.034) were significantly lower than those of the nonpulsatile group. None of the patients developed a neurological deficit and all of the patients survived after the operation and were discharged from the hospital.

Conclusion: During CPB, serum S100β protein level increases and this increase is higher in the nonpulsatile group. High serum level of S100β protein is associated with increased levels of serum inflammatory mediators and systemic inflammatory response.

Get full access to this article

View all access options for this article.

References

Blauth CI , Cosgrove DM , Webb BW et al. Atheroembolism from the ascending aorta . J Thorac Cardiovasc Surg 1992; 103: 1104-1112 .

Gardner TJ , Horneffer PJ , Manolio TA et al. Stroke following coronary artery bypass grafting: a ten year study . Ann Thorac Surg 1985; 40: 574-581 .

McKhann GM , Goldsborough MA , Borowicz LMJ et al. Predictors of stroke risk in coronary artery bypass patients . Ann Thorac Surg 1997; 63: 516-521 .

Ali MS , Harmer M , Vaughan R. Serum S100 protein as a marker of cerebral damage during cardiac surgery . Br J Anaesth 2000; 85: 287-298 (Review).

Aurell A , Rosengren LE , Karlsson B et al. Determination of S-100 and glial fibrillary acidic concentrations in cerebrospinal fluid after brain infarction . Stroke 1999; 22: 1254-1258 .

Gao F , Harris DN , Sapsed-Byrne S et al. Sangtec 100 release with hypothermic and normothermic bypass . Perfusion 1997; 12: 45-46 .

Jankovic BD , Djordjijevic D. Differential appearance of autoantibodies to human brain S100 protein, neuron specific enolase and myelin basic protein in psychiatric patients . Int J Neurosci 1991; 60: 119-127 .

Persson L , Hardemark HG , Gustafsson G et al. S-100 protein and neuron-specific enolase in cerebrospinal fluid and serum: markers of cell damage in human central nervous system . Stroke 1987; 18: 911-918 .

Johnsson P , Lundqvist C , Lindgren A et al. Cerebral complications after cardiac surgery assessed by S-100 and NSE levels in blood . J Cardiothorac Vasc Anesth 1995; 9: 694-699 .

10.

Blomquist S , Johnsson P , Luhrs C et al. The appearance of S-100 protein in serum during and immediately after cardiopulmonary bypass surgery: a possible marker for cerebral injury . J Cardiothorac Vasc Anesth 1997; 11: 699-703 .

11.

Westaby S , Johnsson P , Parry AJ et al. Serum S-100 protein, a potential marker for cerebral events during cardiopulmonary bypass . Ann Thorac Surg 1996; 61: 88-92 .

12.

Grocott HP , Croughwell ND , Verkerk GC et al. Serum S100 as a predictor of neurological and neurocognitive outcomes after cardiac surgery . Anaesth Analg 1998; 86: 65-65 .

13.

Jönsson H , Johnsson P , Alling C et al. Significance of serum S-100 release after coronary artery bypass grafting . Ann Thorac Surg 1998; 65: 1639-1644 .

14.

Jönsson H. S100 as a diagnostic tool for brain damage after cardiac surgery. In Baykut D , Krian A eds. Current perspectives of the extracorporeal circulation. New York: Springer , 2000: 91-101.

15.

Ashraf S , Bhattacharya K , Tian Y , Watterson K. Cytokine and S100B levels in paediatric patients undergoing corrective cardiac surgery with or without total circulatory arrest . Eur J Cardiothorac Surg 1999; 16: 32-37 .

16.

Hill GE , Whitten CW , Landers DF. The influence of cardiopulmonary bypass on cytokines and cell -cell communication . J Cardiothorac Vasc Anesth 1997; 11: 367-375 .

17.

Grocott HP , Croughwell ND , Amory DW et al. Cerebral emboli and serum S100B during cardiac operations . Ann Thorac Surg 1998; 65: 1645-1650 .

18.

Gillinov AM , Davis EA , Curtis WE et al. Cardiopulmo-nary bypass and the blood barrier: an experimental study . J Thorac Cardiovasc Surg 1991; 104: 1110-1115 .

19.

Boyle EM , Pohlman TH , Johnson MC et al. Endothelial cell injury in cardiovascular surgery: the systemic inflammatory response . Ann Thorac Surg 1997; 63: 277-284 .

20.

Lindberg L , Olsson AK , Anderson K et al. Serum S-100 protein levels after pediatric cardiac operations: a possible new marker for postoperative cerebral injury . J Thorac Cardiovasc Surg 1998; 116: 281-285 .

21.

Knudsen F , Pederson JO , Johl O et al. Complement and leukocytes during cardiopulmonary bypass: effects on plasma C3d and C5a, leukocyte count, release of granulocyte elastase and granulocyte chemotaxis . J Cardiothorac Anesth 1988; 2: 164-170 .

22.

Hammerschmidt DE , Stroncek DF , Bowers TK. Complement activation and neutropenia occurring during cardiopulmonary bypass . J Thorac Cardiovasc Surg 1981; 81: 370-377 .