Early expression of pro- and anti-inflammatory cytokines in left ventricular assist device recipients with multiple organ failure syndrome.
To assess whether the combined evaluation of total Sequential Organ Failure Assessment (t-SOFA) score and pro- and anti-inflammatory cytokine profiles early after left ventricular assist device (LVAD) implant discriminates patients at high risk for multiple organ failure syndrome (MOFS) in the first month post-LVAD, we analyzed plasma interleukin (IL)-6, IL-8, IL-10, IL-1ra, IL-1beta, tumor necrosis factor-alpha (TNF-alpha), and urine neopterin levels before (day 0) and at 4 hours, 1, 3, 7, 14, and 30 days after LVAD implant in 23 recipients. Eight patients died of MOFS between days 7 and 30 (nonsurvivors). At preimplant, only blood urea nitrogen and age were higher in nonsurvivors than survivors. At 4 hours, IL-8, IL-10, and IL1-ra levels were higher in nonsurvivors than in survivors; t-SOFA was also higher and peaked on day 3 in nonsurvivors. Only IL-8 levels on day 1 were significantly associated with a t-SOFA > or =10 on day 3 (odds ratio 1.10, 95% confidence interval 1.01-1.21, p = 0.04). Neopterin, marker of monocyte activation, increased significantly only in nonsurvivors (p < 0.001). These findings suggest that an activated inflammatory system soon after LVAD implant is implicated in MOFS development. Early monitoring of inflammatory mediators and t-SOFA score may be a valuable tool for outcome prediction in LVAD recipients.
Caruso
Raffaele
R
CNR Clinical Physiology Institute-Milan, Milan, Italy.
Trunfio
Salvatore
S
Milazzo
Filippo
F
Campolo
Jonica
J
De Maria
Renata
R
Colombo
Tiziano
T
Parolini
Marina
M
Cannata
Aldo
A
Russo
Claudio
C
Paino
Roberto
R
Frigerio
Maria
M
Martinelli
Luigi
L
Parodi
Oberdan
O
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D016207:Cytokines / Q000097:blood* / Q000276:immunology; D005260:Female; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000276:immunology; D018836:Inflammation Mediators / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000276:immunology; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators