title: Relationship between early inflammatory response and clinical evolution of the severe multiorgan failure in mechanical circulatory support-treated patients.
abstract: BACKGROUND
  The mechanical circulatory support (MCS) is an effective treatment in critically ill patients with end-stage heart failure (ESHF) that, however, may cause a severe multiorgan failure syndrome (MOFS) in these subjects. The impact of altered inflammatory response, associated to MOFS, on clinical evolution of MCS postimplantation patients has not been yet clarified.
  
  
  METHODS
  Circulating cytokines, adhesion molecules, and a marker of monocyte activation (neopterin) were determined in 53 MCS-treated patients, at preimplant and until 2 weeks. MOFS was evaluated by total sequential organ failure assessment score (tSOFA).
  
  
  RESULTS
  During MCS treatment, 32 patients experienced moderate MOFS (tSOFA < 11; A group), while 21 patients experienced severe MOFS (tSOFA ≥ 11) with favorable (B group) or adverse (n = 13, C group) outcomes. At preimplant, higher values of left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were the only parameter independently associated with A group. In C group, during the first postoperative week, high levels of interleukin-8 (IL-8) and tumor necrosis factor (TNF)-α, and an increase of neopterin and adhesion molecules, precede tSOFA worsening and exitus.
  
  
  CONCLUSIONS
  The MCS patients of C group show an excessive release to IL-8 and TNF-α, and monocyte-endothelial activation after surgery, that might contribute to the unfavourable evolution of severe MOFS.
authors.affiliation: CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Raffaele
authors.identifier: 0000-0002-4471-2339
authors.initials: R
authors.lastname: Caruso
authors.affiliation: CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Jonica
authors.initials: J
authors.lastname: Campolo
authors.affiliation: CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Alessandro
authors.identifier: 0000-0003-3917-2355
authors.initials: A
authors.lastname: Verde
authors.affiliation: CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.affiliation: CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Lorena
authors.identifier: 0000-0002-7429-8706
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Parolini
authors.affiliation: CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Milazzo
authors.affiliation: CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Nonini
authors.affiliation: CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.affiliation: CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Paino
authors.affiliation: CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy ; CNR Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marraccini
authors.affiliation: CardioThoracic and Vascular Department, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
authors.forename: Maria
authors.identifier: 0000-0001-9762-1222
authors.initials: M
authors.lastname: Frigerio
mesh_terms: D000328:Adult; D000368:Aged; D015815:Cell Adhesion Molecules / Q000378:metabolism; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000276:immunology*; D006353:Heart-Assist Devices; D006801:Humans; D016753:Interleukin-10 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000276:immunology* / Q000378:metabolism*; D019798:Neopterin / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D055815:Young Adult
chemical_list: D015815:Cell Adhesion Molecules; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D019798:Neopterin