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Ann Thorac Surg 2003;75:981-985
© 2003 The Society of Thoracic Surgeons

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Original article: general thoracic

Complement activation and cytokine and chemokines release during mediastinitis

^a Department of Thoracic and Cardiovascular Surgery, Oslo, Norway
^b Research Institute for Internal Medicine, Oslo, Norway
^c Section of Endocrinology, Oslo, Norway
^d Institute of Immunology, Oslo, Norway
^e Section of Clinical Immunology and Infectious Diseases, Rikshospitalet, University of Oslo, Oslo, Norway

Accepted for publication September 28, 2002.

^* Address reprint requests to Dr Risnes, Department of Thoracic and Cardiovascular Surgery, Rikshospitalet N-0027, Oslo, Norway.
e-mail: ivar.risnes{at}rikshospitalet.no

BACKGROUND: Mediastinitis after open heart operation is an infrequent, but life-threatening complication with a reported incidence rate between 1% and 4%. Hospital mortality is estimated at 10% to 35%. The aim of the present work was to study the systemic inflammatory reaction as judged by complement activation and cytokine and chemokines release in patients with mediastinitis after open heart operation.

METHODS: Seven patients with clinical signs of mediastinitis were included. Three patients had undergone coronary artery bypass grafting, whereas 4 patients had combined coronary artery bypass grafting, valve replacement, or valvuloplasty. Blood samples were drawn before induction of anesthesia and at the time of reoperation, and thereafter daily during the hospital stay. Controls comprised similar patients with an uneventful postoperative course.

RESULTS: The terminal SC5b-9 complement complex concentration in the mediastinitis patients was substantially higher compared with the controls (p < 0.001), and the terminal SC5b-9 complement complex values showed no overlap between the two groups. Interleukin-8, stromal cell-derived factor-1 and IL-6 concentrations were also significantly higher in the mediastinitis group than in the control group (p < 0.001), but with considerable overlap between the groups. Interleukin-1ß, interleukin-10, and monocyte chemoattractant protein-1 concentrations were slightly higher in the mediastinitis group, and no differences were seen for the tumor necrosis factor-.

CONCLUSIONS: During mediastinitis, the complement is activated and the cytokines and chemokines, interleukin-6, interleukin-8, and stromal cell-derived factor -1 are released. These proteins may be involved in the pathogenesis of this complication. Terminal SC5b-9 complement complex may be an indicator to discriminate mediastinitis patients from those with uneventful course.

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