title: Association of pre-operative interleukin-6 levels with Interagency Registry for Mechanically Assisted Circulatory Support profiles and intensive care unit stay in left ventricular assist device patients.
abstract: BACKGROUND
  Inflammatory mechanisms are associated with worse prognosis in end-stage heart failure (ESHF) patients who require left ventricular assist device (LVAD) support. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles describe patient condition at pre-implant and outcome. This study assessed the relationship among inflammation patterns and INTERMACS profiles in LVAD recipients.
  
  
  METHODS
  Thirty ESHF patients undergoing LVAD implantation as bridge to transplant were enrolled. Blood and urine samples were collected pre-operatively and serially up to 2 weeks post-operatively for assessment of inflammatory markers (plasma levels of interleukin [IL]-6, IL-8, IL-10, and osteopontin, a cardiac inflammatory-remodeling marker; and the urine neopterin/creatinine ratio, a monocyte activation marker). Multiorgan function was evaluated by the total sequential organ failure assessment (tSOFA) score. Outcomes of interest were early survival, post-LVAD tSOFA score, and intensive care unit (ICU) length of stay.
  
  
  RESULTS
  Fifteen patients had INTERMACS profiles 1 or 2 (Group A), and 15 had profiles 3 or 4 (Group B). At pre-implant, only IL-6 levels and the IL-6/IL-10 ratio were higher in Group A vs B. After LVAD implantation, neopterin/creatinine ratio and IL-8 levels increased more in Group A vs B. Osteopontin levels increased significantly only in Group B. The tSOFA score at 2 weeks post-LVAD and ICU duration were related with pre-implant IL-6 levels.
  
  
  CONCLUSIONS
  The INTERMACS profiles reflect the severity of the pre-operative inflammatory activation and the post-implant inflammatory response, affecting post-operative tSOFA score and ICU stay. Therefore, inflammation may contribute to poor outcome in patients with severe INTERMACS profile.
authors.affiliation: CNR Clinical Physiology Institute, Cardiovascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, Milan, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Caruso
authors.forename: Alessandro
authors.initials: A
authors.lastname: Verde
authors.forename: Manuela
authors.initials: M
authors.lastname: Cabiati
authors.forename: Filippo
authors.initials: F
authors.lastname: Milazzo
authors.forename: Chiara
authors.initials: C
authors.lastname: Boroni
authors.forename: Silvia
authors.initials: S
authors.lastname: Del Ry
authors.forename: Marina
authors.initials: M
authors.lastname: Parolini
authors.forename: Claudia
authors.initials: C
authors.lastname: Vittori
authors.forename: Roberto
authors.initials: R
authors.lastname: Paino
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Daniela
authors.initials: D
authors.lastname: Giannessi
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
authors.forename: Oberdan
authors.initials: O
authors.lastname: Parodi
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007249:Inflammation / Q000097:blood*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D053495:Osteopontin / Q000097:blood; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D053495:Osteopontin; D016753:Interleukin-10