[ABSTRAK Latar Belakang: Pada anak dengan penyakit jantung bawaan (PJB) yangmenjalani operasi jantung terbuka, sepsis merupakan salah satu komplikasipascaoperasi. Lama prosedur pintas jantung paru, usia, status gizi, timektomi, danvariasi genetik, seperti polimorfisme toll-like receptor (TLR) 2 dan tollinteractingprotein (TOLLIP) dapat memengaruhi respons imun. Informasimengenai peran faktor tersebut terhadap kejadian sepsis dan respons imunpascaoperasi jantung terbuka masih terbatas.Tujuan: Mengetahui peran polimorfisme TLR2, TOLLIP, dan faktor lainnyaterhadap kejadian sepsis dan respons imun pascaoperasi jantung terbuka untukmemperoleh strategi paling tepat dalam penanganan kasus bedah jantung padaanak.Metodologi: Studi longitudinal dengan non-probability consecutive samplingdilakukan pada anak <1 tahun yang menjalani operasi jantung terbuka.Pemeriksaan polimorfisme TLR2 Arg677Trp, TLR2 N199N, TOLLIP rs5743867,sel CD4 dan CD8 yang menyekresikan IFN-γ intraselular, sel Dendritik yangmengekspresikan TLR2, dan sel NK. Pasien menjalani operasi jantung terbuka.Setelah operasi, pasien dimonitor untuk menilai sepsis dan respons imunpascaoperasi.Hasil: Dari 108 subjek yang terlibat, 21,3% diantaranya mengalami sepsis.Seluruh subjek adalah mutan TLR2 Arg677Trp, 92,6% pasien adalah mutan TLR2N199N, dan 52,8% pasien adalah mutan TOLLIP rs5743867. Polimorfisme TLR2N199N dan timektomi total tidak diikutkan dalam model analisis multivariat.Polimorfisme TOLLIP rs5743867 (p = 0,358) menurunkan resiko sepsis, lamaprosedur pintas jantung paru ≥90 menit (p = 0,002), usia neonatus (p = 0,032), dangizi buruk (p = 0,558) meningkatkan risiko sepsis pascaoperasi. Jumlah responsimun bervariasi antara kategori, namun secara umum komponen respons imunlebih rendah pada pasien yang mengalami sepsis dibanding pada pasien yang tidakmengalami sepsis.Simpulan: Lama prosedur pintas jantung paru dan usia neonatus secara signifikanmemengaruhi risiko dan kecepatan sepsis pascaoperasi. Peran polimorfisme TLR2N199N dan TOLLIP rs5743867 terhadap kejadian sepsis dan respons imunpascaoperasi memerlukan studi komprehensif lebih lanjut. ABSTRACT Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery, Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response’s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery] |