• Francesco Onorati, Antonino S Rubino, Aldo Cuda, Daniela Foti, Vincenzo Sica, Francesco Santini, Elio Gulletta, and Attilio Renzulli.
• Cardiac Surgery Unit, Division of Cardiac Surgery, University of Verona, Verona, Italy. frankono@libero.it
• Int J Artif Organs. 2011 Jun 1; 34 (6): 469-80.

PurposeAltered endothelial response has been described in diabetics after cardiac surgery. Infections and inflammatory organ damage often complicate the postoperative course. We evaluated endothelial/cytokine response (ECR) after cardiac surgery and its role on infective/inflammatory complications of type II diabetic patients.MethodsPerioperative ECR of 60 diabetic patients (Group A) undergoing cardiopulmonary bypass was compared to that of 60 non-diabetics (Group B). Hemodynamics, endothelial markers [vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1)], pro-inflammatory (IL-2, IL-6, IL-8) and anti-inflammatory cytokines (IL-10) were analyzed preoperatively (T0), at time of aortic declamping (T1), at ITU admission (T2), at 12 h (T3) and 24 h (T4) postoperatively. Postoperative infective/inflammatory complications were registered, and the related ECR was analyzed.ResultsHemodynamics were comparable. No differences were found in perioperative IL-6 (p = 0.776) and IL-8 (p=0.660) between the 2 groups. However, the diabetics showed significantly higher endothelial activation (VEGF p = 0.0001, p = 0.0001 since T1 to T3; MCP-1 p = 0.0001, p<0.007 at T1, T3 and T4) with lower IL-10 (p = 0.0001, p<0.05 at T2, T3, T4) and lower IL-2 secretion (p = 0.0001, p < 0.0001 at T1, T2). Infections developed in 23.3% of the diabetics; inflammatory complications in 13.3%. Those developing infections showed significantly lower IL-2 (p = 0.042; p = .021 at T1 and T2) than patients without infections, whereas those with complicated inflammatory lung or renal injury had higher MCP-1 leakage (p = 0.006) with lower IL-10 (p = 0.005).ConclusionsThe diabetics showed higher endothelial activation and lower antiinflammatory response to CPB compared to non-diabetics. Infections in diabetic patients correlated with depressed IL-2, while inflammatory complications correlated to higher endothelial activation and lower anti-inflammatory cytokine secretion.

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