Diagnostic usefulness of inflammatory markers in acute cellular rejection after heart transplantation.
BACKGROUND
Acute cellular rejection (ACR) affects early morbidity and mortality after heart transplantation. The diagnostic technique of choice is endomyocardial biopsy. Our aim was to evaluate the diagnostic usefulness of inflammatory markers as a noninvasive method to monitor cellular rejection.


METHODS
We prospectively analyzed 73 cardiac transplant patients by determining the serum levels of protein fibrinogen (fgpro), functional fibrinogen (fgfun), C-reactive protein (CRP), and sialic acid (SA) coinciding with an endomyocardial biopsy (5.1 revisions/patient). The statistical methods were chi(2), Student's t-test, and ROC curves.


RESULTS
Of the 373 controls, significant rejection was detected in 19%. Analysis of the relationship between ACR and the markers showed significantly elevated levels of fgpro (345 +/- 90 versus 307 +/- 74 mg/dL; P = .03), fgfun (361 +/- 101 versus 318 +/- 89 mg/dL; P = .04), and SA (74 +/- 22 versus 66 +/- 15 mg/dL; P = .02), but not CRP (19 +/- 29 versus 10 +/- 21 mg/dL; P = .07). SA displayed a better diagnostic utility (area under the curve 0.7; P < .01), 35% sensitivity, 85% specificity, and 82% negative predictive value for a cutoff point of 80 mg/dL.


CONCLUSIONS
Among the inflammatory markers increased in ACR, SA was the most useful noninvasive tool for screening.
Sánchez-Soriano
R M
RM
Cardiac Failure and Transplant Unit, La Fe University Hospital, Valencia, Spain. rusansor@yahoo.es
Almenar
L
L
Martínez-Dolz
L
L
Reganon
E
E
Martínez-Sales
V
V
Chamorro
C I
CI
Vila
V
V
Martín-Pastor
J
J
Villa
P
P
Salvador
A
A
D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism*; D006084:Graft Rejection / Q000097:blood*; D016027:Heart Transplantation / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008875:Middle Aged; D019158:N-Acetylneuraminic Acid / Q000097:blood*; D011183:Postoperative Complications / Q000145:classification; D011446:Prospective Studies; D012372:ROC Curve
D015415:Biomarkers; D005340:Fibrinogen; D002097:C-Reactive Protein; D019158:N-Acetylneuraminic Acid