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

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

Publisher: Nature Publishing Group

: 2021

: Scientific Reports

: SCIENTIFIC REPORTS

: SCI REP-UK

: ARTN 22230

: 11

: 9

: 2045-2322

DOI: https://doi.org/10.1038/s41598-021-01695-4

: https://doi.org/10.1038/s41598-021-01695-4

: https://research.utu.fi/converis/portal/detail/Publication/68024560

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-1 alpha) 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-1 alpha 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-1 alpha 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-1 alpha 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 alpha response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery.

s41598-021-01695-4.pdf