Expansion of CD14+CD16+Monocytes in Critically Ill Cardiac Surgery Patients

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Abstract
We have asked whether critically ill cardiac valve surgery patients identified by a high APACHE II score exhibit an increase in the number of proin-flammatory CD14+ CD16+ monocytes. A group of 12 patients was studied over a period of 5 days post cardiac valve surgery for changes in blood monocyte populations. Patients were selected on day 1 post surgery to either be in good clinical condition (APACHE II Score of ≤14; N = 9) or to be critically ill (APACHE II score of ≥24; N = 3). The ≤14 patients had an uneventful course and could leave the ICU after 2–3 days. Among the ≥24 patients two showed a decrease of the score to ≤14 within the 5 days of observation and they could leave the ICU thereafter. One ≥24 patient (patient #2) had a persistently high score and finally died on day 28. Analysis of blood monocytes on day 1 post surgery revealed that the ≤14 patients had normal values of CD14+CD16+ monocytes (44 ± 9/μl). By contrast the ≥24 patients had increased values of these cells with 243 ± 106 cells per μ1 on day 1. The numbers of CD14+CD16+ monocytes returned to the control range over the 5 days of observation in 2 of the ≥24 patients concomitant with the improvement of the APACHE II score. CD14+CD16+ monocytes remained, however, at a high level in patient #2, the patient with persistently high APACHE II score.