title: Importance of monocyte deactivation in determining early outcome after ventricular assist device implantation.
abstract: BACKGROUND
  Patients undergoing mechanical circulatory support using ventricular assist devices (VADs) experience a postoperative mixed antagonistic (proinflammatory and antiinflammatory) response syndrome. This response can result in immunoparalysis, exposing VAD recipients to infection and interfering with patient recovery despite adequate hemodynamic support. We undertook the present study to evaluate whether postoperative monocytic human leukocyte antigen-DR (mHLA-DR) expression is of prognostic value for mortality or infection of VAD recipients during their initial intensive care unit (ICU) stay after implantation.
  
  
  METHODS
  Since 2004, we have monitored postoperative mHLA-DR expression in 50 VAD recipients using flow cytometry.
  
  
  RESULTS
  Thirty-seven patients (74%) developed infection, and 22 patients (44%) died during their initial ICU stay. mHLA-DR expression was lowest in the immediate postoperative period (postoperative days [PODs] 1-3) but increased progressively thereafter. Multiple regression analysis showed that preoperative aspartate aminotransferase level was the only significant and independent predictor of the percentage of HLA-DR-positive monocytes on PODs 1-3 (β = -0.726, p = 0.0001). ICU death and infection were associated with significantly lower percentages of HLA-DR-positive monocytes on PODs 1-3. ROC curve analysis revealed that the percentage of HLA-DR-positive monocytes on PODs 1-3 had significant discriminative power for ICU death (area under the curve = 0.73, 95% confidence interval, 0.545-0.912, p = 0.037), but not for infection.
  
  
  CONCLUSIONS
  Postoperative mHLA-DR expression was closely related to preoperative hepatic cytolysis. It appeared to be the only early postoperative biological parameter that had some predictive power for death of VAD recipients in the ICU.
authors.affiliation: Department of Cardiothoracic Surgery, AP-HP, Henri Mondor Hospital, Créteil, France. matthias.kirsch@psl.aphp.fr
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boval
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
authors.forename: Soulef
authors.initials: S
authors.lastname: Ghendouz
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Vermes
authors.forename: Daniel
authors.initials: D
authors.lastname: Loisance
authors.forename: Ludovic
authors.initials: L
authors.lastname: Drouet
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006684:HLA-DR Antigens / Q000276:immunology*; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D011184:Postoperative Period; D011379:Prognosis; D013530:Surgical Wound Infection / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D006684:HLA-DR Antigens