Derivation of sieving coefficients to determine the efficacy of the hemoconcentrator in removal of four inflammatory mediators produced during cardiopulmonary bypass

Cardiopulmonary bypass has been implicated in triggering a multisystem inflammatory response caused by blood contact with the artificial surfaces of the circuit. This leads to increased morbidity levels because of cytotoxic enzymes released from activated neutrophils. Recently, it was discovered that certain inflammatory mediators are permeable to the membrane of the hemoconcentrator. As a result, this study was undertaken to quantitatively characterize the nature of this movement by deriving a sieving coefficient (S) for four inflammatory mediators: myeloperoxidase, elastase, interleukin-6, and lactoferrin. The results show no permeability through the hemoconcentrator for the two neutrophil derived enzymes myeloperoxidase and elastase (S = 0, p > 0.05). Conversely, although larger than the pore size of the hemoconcentrator, lactoferrin sieves through unrestricted (S = 1.030 +/- 0.037, p < 0.0001). Interleukin-6 is removed in concentrations greater than those found in the blood, which yields a sieving coefficient significantly greater than 1.0 (S = 1.246 +/- 0.042, p < 0.0001). In addition to sieving coefficients, this study offers theories as to why these mediators acted as such. One conclusion is that certain mediators are efficaciously removed by the hemoconcentrator and, with additional study, may result in an attenuated inflammatory response.