The Perioperative Change And Clinical Significance Of Extracellular Histones And Effect Of Ulinastatin In Congenital Cardiac Surgery

Objectives To investigate the perioperative change of extracellular histones and its predictive value for clinical outcomes,and evaluate the efficacy of ulinastatin for attenuating organ injury and the release of inflammatory cytokines due to cardiopulmonary bypass(CPB)during congenital cardiac surgery.Methods One hundred and twenty children diagnosed with congenital heart disease,undergoing corrective procedure with CPB,were prospectively enrolled in this study and divided into cyanosis group(group A,n=24),non-cyanosis group(group B,n=24),test group(group T,n=48)and control group(group C,n=24).Ulinastatin was given to group T,equal amount of saline solution was given to group C.Extracellular histones,Nterminal pro-brain natriuretic peptide(NT-pro BNP),procalcitonin(PCT),C-reactive protein(CRP),IL-6,IL-8,IL-10 and TNF-? were measured in each group at pre-OP(operation)(T0),post-OP hour 0(T1),post-OP hour 24(T2),post-OP hour 48(T3)and post-OP hour 72(T4).Perioperative clinical parameters and complications were recorded.The relationships between histones and other biomarkers as well as clinical parameters were analyzed.Results The extracellular histones level peaked at T1,earlier than NT-pro BNP,PCT and CRP.The peak histones level was statistically correlated with peak NT-pro BNP,PCT and CRP levels as well as CPB time,cross-clamp time,ventilation time,and ICU time.Receiver operating characteristic(ROC)curves analysis showed that,peak histones level has predictive values for bi-antibiotic management and ICU time >3 days post operatively.Post-operative extracellular histones,NT-Pro BNP and CRP levels and post-OP 48 h vasoactive-inotropic score(VIS)in group T were significantly lower than that in group C at T3,whereas PCT,IL-6,IL-8,IL-10 and TNF-? were not different between the groups post-operatively.Conclusion Extracellular histones reached peak level more rapidly than NT-pro BNP,PCT and CRP,and peak histones level had statistically correlation with other biomarkers and clinical parameters postoperatively.Extracellular histones can be potentially a rapid prognostic indicator for children after cardiac surgery with CPB.Ulinastatin can attenuate heart injury but can't inhibit the release of inflammatory cytokines after cardiac surgery with CPB.