title: The profile of the systemic inflammatory response in children undergoing ventricular assist device support.
abstract: OBJECTIVE
  Serum C-reactive protein (CRP) has been used as a systemic inflammatory response (SIR) marker in the critical ill, including children after cardiopulmonary bypass surgery. Ventricular assist devices (VAD) have been increasingly used as a bridge support to heart transplantation in children. We aimed to examine the profiles of CRP in children receiving VAD support.
  
  
  METHODS
  Charts of 13 children receiving Berlin Heart EXCOR(®) from 2005 to 2009 were reviewed. The data obtained prior to and during VAD support included: CRP, white blood cells, inotropes and steroid use, VAD mode and duration of VAD support. Ten patients received left VAD (LVAD) and 3 biventricular VAD (BiVAD).
  
  
  RESULTS
  The median duration of VAD support was 59 days (ranged 3-678 days). Pre-VAD CRP was 35 ± 51 mg/l and increased to 109 ± 59 mg/l on days 1-3 after the VAD implantation (P = 0.01), then gradually decreased to 28 ± 28 mg/l by 4 months and normalized by 5 months (P < 0.0001). CRP was higher in BiVAD than in LVAD patients throughout the study period (P = 0.003). CRP positively correlated with the doses of the epinephrine and norepinephrine and the monocyte counts, and negatively correlated with the lymphocyte count. The lymphocyte count was 2.5 ± 0.4 x 10(9)/l prior to implantation, and decreased to 2.1 ± 1.3 x 10(9)/l on days 1-3 (P = 0.5) and then to 0.6 ± 0.1 x 10(9)/l by 6 months (P = 0.08). It tended to be lower in BiVAD patients (P = 0.06).
  
  
  CONCLUSIONS
  SIR exists in children prior to VAD support. VAD implantation is associated with a significant and prolonged increase in CRP and a decrease in lymphocyte count, indicating a suppressed immune function, being more pronounced in BiVAD patients.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics,  Stollery Children's Hospital, University of Alberta, Edmonton, AB,  Canada.
authors.forename: Xiaoyang
authors.initials: X
authors.lastname: Yu
authors.forename: Bodil
authors.initials: B
authors.lastname: Larsen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rutledge
authors.forename: Lori
authors.initials: L
authors.lastname: West
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
authors.forename: Holger
authors.initials: H
authors.lastname: Buchholz
authors.forename: Jia
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D002097:C-Reactive Protein / Q000378:metabolism*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018655:Lymphocyte Count; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000209:etiology
chemical_list: D002097:C-Reactive Protein