Journal Article

Red blood cell transfusion induces abnormal HIF-1α response to cytokine storm after adult cardiac surgery

Kiviniemi, Tuomas O., Jalkanen, Juho, Airaksinen, K. E. Juhani, Viikinkoski, Emma, Hollmén, Maija, Jalkanen, Sirpa, Vasankari, Tuija, Valtonen, Mika, Biancari, Fausto, Gunn, Jarmo, Lehto, Joonas

2021

Overview

Patients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response. Blood transfusion may contribute to disruption of homeostasis in these patients. We sought to evaluate the impact of blood transfusion on serum interleukin-6 (IL-6), hypoxia induced factor-1 alpha (HIF-1α) levels as well as adverse outcomes in patients undergoing adult cardiac surgery. We prospectively enrolled 282 patients undergoing adult cardiac surgery. Serum IL-6 and HIF-1α levels were measured preoperatively and on the first postoperative day. Packed red blood cells were transfused in 26.3% of patients (mean 2.93 ± 3.05 units) by the time of postoperative sampling. Postoperative IL-6 levels increased over 30-fold and were similar in both groups (p = 0.115), whilst HIF-1α levels (0.377 pg/mL vs. 0.784 pg/mL, p = 0.002) decreased significantly in patients who received red blood cell transfusion. Moreover, greater decrease in HIF-1α levels predicted worse in-hospital and 3mo adverse outcome. Red blood cell transfusion was associated with higher risk of major adverse outcomes (stroke, pneumonia, all-cause mortality) during the index hospitalization. Red blood cell transfusion induces blunting of postoperative HIF-1 α response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03444259.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 631/250/127/1213 / 692/53/2423 / Adverse events / Aged / Aged, 80 and over / Biomarkers / Blood / Blood transfusion / Blood transfusions / Cardiac Surgical Procedures - adverse effects / Critical Care / Cytokine Release Syndrome - diagnosis / Cytokine Release Syndrome - etiology / Cytokine Release Syndrome - metabolism / Cytokine storm / Cytokines - blood / Cytokines - metabolism / Disease Susceptibility / Erythrocyte Transfusion - adverse effects / Erythrocytes / Female / Heart / Heart surgery / Homeostasis / Hospitalization / Humanities and Social Sciences / Humans / Hypoxia / Hypoxia-Inducible Factor 1, alpha Subunit - blood / Hypoxia-Inducible Factor 1, alpha Subunit - metabolism / Hypoxia-inducible factor 1a / Inflammation / Interleukin 6 / Male / multidisciplinary / NCT / NCT03444259 / Patient Outcome Assessment / Patients / Postoperative Complications / Science / Science (multidisciplinary)