title: Systemic inflammatory response syndrome predicts increased mortality in patients after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The outcome of patients undergoing surgical or interventional therapy is unfavourably influenced by severe systemic inflammation. We assessed the impact of a systemic inflammatory response syndrome (SIRS) on the outcome after transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  One hundred and fifty-two high-risk patients (mean age: 80.5 ± 6.5 years, mean logistic EuroSCORE: 30.4 ± 8.1%) with symptomatic severe aortic stenosis underwent TAVI. Proinflammatory cytokines [interleukin-6 (IL-6) and interleukin-8 (IL-8)], and acute phase reactants [C-reactive protein (CRP) and procalcitonin (PCT)] were measured at baseline and 1, 4, 24, 48, 72 h, and 7 days after TAVI. Sixty-one of 152 patients developed SIRS during the first 48 h after TAVI. Systemic inflammatory response syndrome patients were characterized by leucocytosis ≥12 × 10(9)/L (83.6 vs. 12.1%; P < 0.001), hyperventilation (80.3 vs. 35.2%; P < 0.001), tachycardia (37.7 vs. 9.9%; P < 0.001), and fever (31.1 vs. 3.3%; P < 0.001) compared with patients without SIRS. Furthermore, the occurrence of SIRS was characterized by a significantly elevated release of IL-6 and IL-8 with subsequent increase in the leucocyte count, CRP, and PCT. Major vascular complications [odds ratio (OR) 5.1, 95% confidence interval (CI): 1.3-19.6; P = 0.018] and the number of ventricular pacing runs (OR 1.7, 95% CI: 1.1-2.8; P = 0.025) were independent predictors of SIRS. The occurrence of SIRS was related to 30-day and 1-year mortality (18.0 vs. 1.1% and 52.5 vs. 9.9%, respectively; P < 0.001) and independently predicted 1-year mortality risk (hazard ratio: 4.3, 95% CI: 1.9-9.9; P < 0.001).
  
  
  CONCLUSIONS
  SIRS may occur after TAVI and is a strong predictor of mortality. The development of SIRS could be easily identified by a significant increase in the leucocyte count shortly after TAVI.
authors.affiliation: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.forename: Anne-Cathérine
authors.initials: AC
authors.lastname: Scheer
authors.forename: Viktoria
authors.initials: V
authors.lastname: Adenauer
authors.forename: Alexander
authors.initials: A
authors.lastname: Ghanem
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: Robert
authors.initials: R
authors.lastname: Schueler
authors.forename: Cornelius
authors.initials: C
authors.lastname: Müller
authors.forename: Mariuca
authors.initials: M
authors.lastname: Vasa-Nicotera
authors.forename: Eberhard
authors.initials: E
authors.lastname: Grube
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood / Q000401:mortality / Q000601:surgery*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism; D015740:Calcitonin Gene-Related Peptide; D006328:Cardiac Catheterization / Q000401:mortality*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality*; D011498:Protein Precursors / Q000378:metabolism; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000401:mortality*
chemical_list: C000606589:CALCA protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide