Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

T-cell lymphopenia is associated with an increased infecting risk in children after cardiopulmonary bypass

Pediatric Research volume 95, pages 227–232 (2024)Cite this article

Abstract

Background

children who undergo CPB operations are at an elevated risk of infection due to immunosuppression. This study aims to investigate the association between lymphopenia following CPB and early postoperative infection in children.

Methods

A retrospective analysis including 41 children under 2 years old underwent CPB. Among them, 9 subjects had an early postoperative infection, and 32 subjects were period-matched without infection. Inflammatory cytokines, serum CRP and PCT values were measured in plasma, additionally, circulating total leucocyte and lymphocyte subpopulations were counted.

Results

Infected subjects exhibited significantly higher levels of inflammatory cytokines, including IL-6, IL-8, IL-10, IL-1β and TNF-α, than non-infected subjects after CPB. Additionally, lower absolute number of lymphocyte and their subpopulations CD3+ T cells, CD4+ T-helper cells and CD8+cytotoxic T-cells, were observed in infected subjects. The impairment of T-cells Immune was found to be associated with higher levels of inflammatory cytokines IL-10. The ROC demonstrated that the absolute number of CD3+ T-cells <1934/ul, CD4+ T helper cells <1203/ul and CD8+cytotoxic T-cells <327/ul were associated with early postoperative infection.

Conclusion

Higher levels of inflammatory cytokines resulted in T-cells lymphopenia after CPB, which significantly increasing the risk of postoperative infection in infants and young children.

Impact

  • Infection complications after cardiopulmonary bypass (CPB) in pediatric CHD patients are serious issues, identifing the infection from after CPB remains a challenging.

  • CPB can release numerous inflammatory cytokines associated with T cells lymphopenia, which increases the risk of postoperative infection after surgery.

  • Monitoring T cells lymphopenia maybe more beneficial to predict early postoperative infection than C-reactive protein and procalcitonin.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Impact of CPB on inflammatory cytokines levels in the infected subject and non-infected subjects.
Fig. 2: Impact of CPB on Lymphocyte subsets in the infected subject and non-infected subjects.

Similar content being viewed by others

Data availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Fowler, V. G. et al. Clinical predictors of major infections after cardiac surgery. Circulation 112, I358–I365 (2005).

    Article  PubMed  Google Scholar 

  2. Grisaru‐Soen, G. et al. Nosocomial infections in pediatric cardiovascular surgery patients: a 4‐ year survey. Pediatr. Crit. Care Med 10, 202–206 (2009).

    Article  PubMed  Google Scholar 

  3. Taylor, R. S. & Shekerdemian, L. S. Avoidance of hospital‐acquired infections in pediatric cardiac surgical patients. Pediatr. Crit. Care Med 17, S279–S286 (2016).

    Article  PubMed  Google Scholar 

  4. Wang Y. C., Wu H. Y., Luo C. Y., Lin T. W. Cardiopulmonary bypass time predicts early postoperative enterobacteriaceas bloodstream infection. Ann Thorac Surg. 107, 1333–1341 (2019).

  5. Bronicki, R. A. & Hall, M. Cardiopulmonary bypass-induced inflammatory response: pathophysiology and treatment. Pediatr. Crit. Care Med. 17, S272–S278. (2016).

    Article  PubMed  Google Scholar 

  6. Ward, N. S., Casserly, B. & Ayala, A. The compensatory anti-inflammatory response syndrome (CARS) in critically ill patients. Clin. Chest Med. 29, 617–625 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Liu, C. H., Huang, Z. H., Huang, S. C. & Jou, T. S. Endocytosis of peroxiredoxin 1 links sterile inflammation to immunoparalysis in pediatric patients following cardiopulmonary bypass. Redox Biol. 46, 102086 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Habermehl, P. et al. Changes in lymphocyte subsets after cardiac surgery in children. Eur. J. Pediatr. 162, 15–21 (2003).

    Article  PubMed  Google Scholar 

  9. Engelman, R. R. et al. The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. Ann. Thorac. Surg. 83, 1569–1576 (2007).

    Article  PubMed  Google Scholar 

  10. Warren, O. J. et al. The inflammatory response to cardiopulmonary bypass: Part 1—Mechanisms of pathogenesis. J. Cardiothorac. Vasc. Anesth. 23, 223–231 (2009).

    Article  PubMed  Google Scholar 

  11. Li, Y. P. et al. The compromised inflammatory response to bacterial components after pediatric cardiac surgery is associated with cardiopulmonary bypass–suppressed Toll-like receptor signal transduction pathways. J. Crit. Care 29, 312.e7–13 (2014).

    Article  CAS  PubMed  Google Scholar 

  12. Suleiman, M. S., Zacharowski, K. & Angelina, G. D. Inflammatory response and cardioprotection during open heart surgery; the importance of anaesthetics. Br. J. Pharm. 153, 21–33. 2 (2008).

    Article  CAS  Google Scholar 

  13. Laffey, J. G., Boylan, J. F. & Cheng, D. C. The systemic inflammatory response to cardiac surgery: implications for the anesthesi- ologist. Anesthesiology 97, 215–252 (2002).

    Article  CAS  PubMed  Google Scholar 

  14. Tárnok, A. & Schneider, P. Pediatric cardiac surgery with cardiopulmonary bypass: pathways contributing to transient systemic immune suppression. Shock 16, 24–32 (2001).

    Article  PubMed  Google Scholar 

  15. Martin, M. D., Badovinac, V. P. & Griffith, T. S. CD4 T. Cell responses and the sepsis induced immunoparalysis state. Front Immunol. 11, 1364 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Allen, M. L. et al. Early postoperative monocyte deactivation predicts systemic inflammation and prolonged stay in pediatric cardiac intensive care. Crit. Care Med. 30, 1140–1145 (2002).

    Article  PubMed  Google Scholar 

  17. Cornell, T. T. et al. Clinical implications and molecular mechanisms of immunoparalysis after cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg. 143, 1160–1166 (2012).

    Article  CAS  PubMed  Google Scholar 

  18. Allen, M. L. et al. Interleukin-10 and its role in clinical immunoparalysis following pediatric cardiac surgery. Crit. Care Med 34, 2658–2665 (2006).

    Article  CAS  PubMed  Google Scholar 

  19. Claeys, R. et al. Plasma procalcitonin and C-reactive protein in acute septic shock: Clinical and biological correlates. Crit. Care Med 30, 757–776 (2002).

    Article  CAS  PubMed  Google Scholar 

  20. McMaster, P. et al. Procalcitonin versus C-reactive protein and immature-to-total neutrophil ratio as markers of infection after cardiopulmonary bypass in children. Pediatr. Crit. Care Med 10, 217–221 (2009).

    Article  PubMed  Google Scholar 

  21. Silvetti, S. et al. Procalcitonin and early postoperative infection after pediatric cardiopulmonary bypass surgery. J. Cardiothorac. Vasc. Anesth. 35, 3688–3693 (2021 Dec).

    Article  CAS  PubMed  Google Scholar 

  22. Levy, I. et al. Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J. Hosp. Infect. 53, 111–116 (2003).

    Article  CAS  PubMed  Google Scholar 

  23. Frazier, W. J. & Hall, M. W. Immunoparalysis and adverse outcomes from critical illness. Pediatr. Clin. 55, 647–668 (2008).

    Google Scholar 

Download references

Acknowledgements

We thank all the members at the Department of pediatric cardiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine for supporting.

Funding

This work was supported by Xinhua Hospital&Shanghai Jiao Tong University Joint Project (Grant number: 21XJMR04).

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Xinhua Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China

    Wen-Juan Li, Yong-Xuan Peng, Li-Qing Zhao, Hui-Ying Wang, Wei Liu, Kai Bai, Sun Chen, Ya-nan Lu & Ji-hong Huang

Authors
  1. Wen-Juan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong-Xuan Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li-Qing Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hui-Ying Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kai Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sun Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ya-nan Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ji-hong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

W.L. was involved in gathering data, formal analysis and writing original draft, J.H. conceived the study and revised manuscript, H.W., W.S. and J.X. supported gathering data, ongxuan Peng and W.L. contributed to analyzing and interpreting data, Y.L., K.B. and S.C. revised the manuscript.

Corresponding author

Correspondence to Ji-hong Huang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics

This work was approved by the Xinhua Hospital Ethics Committee (approval number: XHEC-QT-2021-042). All procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975. Informed consent was not required in the present study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, WJ., Peng, YX., Zhao, LQ. et al. T-cell lymphopenia is associated with an increased infecting risk in children after cardiopulmonary bypass. Pediatr Res 95, 227–232 (2024). https://doi.org/10.1038/s41390-023-02765-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-023-02765-1

Search

Advanced search

Quick links