Analysis on the application and prognosis of intraoperative blood salvage in infective endocarditis / 国际外科学杂志

ABSTRACT

Objective:To explore the effect of intraoperative blood salvage (IBS) in the operation of infective endocarditis (IE) and the risk factors of death within half a year after operation.Methods:Used retrospective research methods, a total of 61 patients who were diagnosed as IE and received surgical treatment in Department of Cardiovascular and Large Vascular Surgery, Huizhou Central People′s Hospital from April 2017 to November 2020 were selected as subjects. The patients were divided into autologous group ( n=30) and allogeneic group ( n=31) according to different blood transfusion methods. Patients in the autogenous group received IBS, and patients in the allogeneic group received allogeneic blood transfusion. The indexes of coagulation function [activated partial thromboplastin time(APTT), thrombin tim(TT), prothrombin time(PT), D-dimmer(D-D), fibrinogen degradation product(FDP)], immune reaction (CD3 + CD4 + T cells, CD3 + CD8 + T cells, CD16 + CD56 + NK cells, TLR2 + cells, TLR4 + cells) and inflammatory reaction [soluble CD40 ligand(sCD40L), neutrophil chemokine -1(CINC-1), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)] were compared between the autologous group and the allogeneic group, as well as the incidence of postoperative adverse reactions. The end event was death half a year after operation, and the subjects were divided into death group ( n=15) and survival group ( n=46). The clinical data of the death group and the survival group were compared. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; Chi-square test was used for comparison of enumeration data between groups, and the IBS variables were included and excluded to establish the prediction models of death half a year after operation, respectively. The model was evaluated by the receiver operating characteristic curve (ROC), and the model was internally verified by the method of Bootstrap repeated sampling. IBS was included and removed to establish the prediction model of death within half a year after surgery, and ROC was used to evaluate the model. Bootstrap repeated sampling was used to verify the model internally. Results:Cardiac insufficiency, hypotension, IBS, multivalvular disease and age were independent risk factors for postoperative death ( P<0.05). The model with IBS variables has higher predictive value. 5 days after operation, there were significant differences in the indexes of immune reaction [CD3 + CD4 + T cells (37.49±5.74)% vs (31.68±4.46)%, CD3 + CD8 + T cells (23.07±3.24)% vs (17.82±2.29)%, CD16 + CD56 + NK cells (1.61±0.18)% vs (1.02±0.15)%, TLR2 + cells (9.24±1.15)% vs (18.40±2.21)%, TLR4 + cells (7.79±0.82)% vs (12.33±1.57)%] and inflammatory reaction [sCD40L (59.21±7.80) pg/mL vs (84.33±9.35) pg/mL, CINC-1 (40.27±5.83) pg/mL vs (72.86±9.35) pg/mL, TNF-α (10.86±1.26) ng/mL vs (17.03±2.20) ng/mL and IL-6 (6.32±0.77) ng/mL vs (11.35±1.74) ng/mL] between autologous group and allogeneic group ( P<0.01). Intra-group comparison of patients in autologous group, before and 5 days after operation, there were significant differences in the indexes of immune response [CD3 + CD4 + T cells (48.55±6.67)% vs (37.49±5.74)%, CD3 + CD8 + T cells (30.38±4.69)% vs (23.07±3.24)%, CD16 + CD56 + NK cells (2.53±0.44)% vs (1.61±0.18)%, TLR2 + cells (6.50±0.61)% vs (9.24±1.15)%, TLR4 + cells (4.02±0.63)% vs (7.79±0.82)%] and inflammatory response [sCD40L (38.64±6.75) pg/mL vs (59.21±7.80) pg/mL, CINC-1 (31.65±5.68) pg/mL vs (40.27±5.83) pg/mL, TNF-α (7.59±0.85) ng/mL vs (10.86±1.26) ng/mL and IL-6 (5.10±0.63) ng/mL vs (6.32±0.77) ng/mL] ( P<0.01). Intra-group comparison of patients in allogeneic group, before and 5 days after operation, there were significant differences in the indexes of immune reaction [CD3 + CD4 + T cells (49.13±6.82)% vs (31.68±4.46)%, CD3 + CD8 + T cells (30.65±4.91)% vs (17.82±2.29)%, CD16 + CD56 + NK cells (2.51±0.26)% vs (1.02±0.15)%, TLR2 + cells (6.36±0.66)% vs (18.40±2.21)%, TLR4 + cells (4.08±0.56)% vs (12.33±1.57)%] and inflammatory response [sCD40L (39.14±6.03) pg/mL vs (84.33±9.35) pg/mL, CINC-1 (31.24±5.77) pg/mL vs (72.86±9.35) pg/mL, TNF-α (7.64±0.76) ng/mL vs (17.03±2.20) ng/mL and IL-6 (5.04±0.82) ng/mL vs (11.3±1.74) ng/mL] ( P<0.01). There were 3 cases of hypoproteinemia, 2 cases of incision infection and 1 case of cardiac adverse event in the autologous group; 4 cases of hypoproteinemia, 3 cases of incision infection and 1 case of cardiac adverse event in the allogeneic group. There was no significant difference in the incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:The predictive model included in IBS can better predict the mortality of within half a year after IE. The use of IBS in IE surgery will not significantly affect the blood coagulation function and the incidence of postoperative adverse reactions, but can improve immune function and inhibit inflammatory reaction.