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Setiadi H, El-Banayosy AM, George S, Schmidtke DW, El-Banayosy A, Horstmanshof DA, Long JW. Oncostatin M: a Potential Biomarker to Predict Infection in Patients with Left Ventricular Assist Devices. ASAIO J 2022; 68:1036-1043. [PMID: 34772849 PMCID: PMC9110559 DOI: 10.1097/mat.0000000000001608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infection is a serious adverse event limiting left ventricular assist device (LVAD) therapy in advanced heart failure patients, but a reliable means to identify patients at increased risk of infection is still lacking. We hypothesized that preoperative elevated levels of plasma Oncostatin M (OSM), a cytokine marker of leukocyte activation and inflammation, would be predictive of subsequent infection. We measured plasma OSM in 41 LVAD patients one day before LVAD implantation and postoperatively over two months. Preoperative plasma OSM levels were normal in 27 patients (group A, 4.9 ± 3.2 pg/ml) but elevated in 14 patients (group B, 1649.0 ± 458.9 pg/ml) ( p = 0.003). Early postoperative levels rose in both groups and declined rapidly in group A, with group B declining slowly over two months. Significantly more infections developed in group B than group A patients over two months postimplantation ( p = 0.004). No other routine clinical assessment or laboratory testing afforded this differentiation. These findings suggest that preoperative plasma OSM levels may assist in identifying patients at increased risk of infections after LVAD implantation.
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Affiliation(s)
- Hendra Setiadi
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Ahmed M. El-Banayosy
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Susan George
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - David W. Schmidtke
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas
| | - Aly El-Banayosy
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Douglas A. Horstmanshof
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - James W. Long
- INTEGRIS Advanced Cardiac Care, Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
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Kozakov K, Philipp A, Lunz D, Lubnow M, Provaznik Z, Keyser A, Rupprecht L, Schmid C, Schopka S. Multi-organ dysfunction syndrome in patients undergoing extracorporeal life support. Artif Organs 2022; 46:1912-1922. [PMID: 35470442 DOI: 10.1111/aor.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/30/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple organ failure is a common complication in patients undergoing ECLS significantly affecting patient outcomes. Gaining knowledge about the mechanisms of onset, clinical course, risk factors, and potential therapeutic targets is highly desirable. METHODS Data of 354 patients undergoing ECLS with one-, two, three-, and four organ failures were retrospectively analyzed. Incidence of multiple organ dysfunction (MODS), its impact on survival, risk factors for its occurrence, and the impact of proinflammatory mediators on the occurrence of MODS in patients undergoing ECLS were investigated. RESULTS The median follow-up was 66 (IQR 6; 820) days. 245 (69.2%) patients could be weaned from ECLS, 30-day survival and 1-year survival were 194 (54.1%) and 157 (44.4%), respectively. The duration of mechanical support was 4 (IQR 2; 7) days in the median. Increasing severity of MODS resulted in significant prolongation of mechanical circulatory support and worsening of the outcome. Liver dysfunction had the strongest impact on patient mortality (OR = 2.5) and survival time (19 vs 367 days). The serum concentration of analyzed interleukins rose significantly with each, additional organ affected by dysfunction (p < 0.001). All analyzed proinflammatory cytokines showed significant predictivity relative to the occurrence of MODS with interleukin 8 serum level prior to ECLS showing the strongest predictive potential for the occurrence of MODS (AUC 0.78). CONCLUSION MODS represents a frequent complication in patients undergoing ECLS with a significant impact on survival. Proinflammatory cytokines show prognostic capacity regarding the occurrence and severity of multi-organ dysfunction.
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Affiliation(s)
- Kostiantyn Kozakov
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Alois Philipp
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Department of Anaesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Leopold Rupprecht
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Diakos NA, Taleb I, Kyriakopoulos CP, Shah KS, Javan H, Richins TJ, Yin MY, Yen C, Dranow E, Bonios MJ, Alharethi R, Koliopoulou AG, Taleb M, Fang JC, Selzman CH, Stellos K, Drakos SG. Circulating and Myocardial Cytokines Predict Cardiac Structural and Functional Improvement in Patients With Heart Failure Undergoing Mechanical Circulatory Support. J Am Heart Assoc 2021; 10:e020238. [PMID: 34595931 PMCID: PMC8751895 DOI: 10.1161/jaha.120.020238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Recent prospective multicenter data from patients with advanced heart failure demonstrated that left ventricular assist device (LVAD) support combined with standard heart failure medications, induced significant cardiac structural and functional improvement, leading to high rates of LVAD weaning in selected patients. We investigated whether preintervention myocardial and systemic inflammatory burden could help identify the subset of patients with advanced heart failure prone to LVAD-mediated cardiac improvement to guide patient selection, treatment, and monitoring. Methods and Results Ninety-three patients requiring durable LVAD were prospectively enrolled. Myocardial tissue and blood were acquired during LVAD implantation, for measurement of inflammatory markers. Cardiac structural and functional improvement was prospectively assessed via serial echocardiography. Eleven percent of the patients showed significant reverse remodeling following LVAD support (ie, responders). Circulating tumor necrosis factor alpha, interleukin (IL)-4, IL-5, IL-6, IL-7, IL-13, and interferon gamma were lower in responders, compared with nonresponders (P<0.05, all comparisons). The myocardial tissue signal transducer and activator of transcription-3, an inflammatory response regulator, was less activated in responders (P=0.037). Guided by our tissue studies and a multivariable dichotomous regression analysis, we identified that low levels of circulating interferon gamma (odds ratio [OR], 0.06; 95% CI, 0.01-0.35) and tumor necrosis factor alpha (OR, 0.05; 95% CI, 0.00-0.43), independently predict cardiac improvement, creating a 2-cytokine model effectively predicting responders (area under the curve, 0.903; P<0.0001). Conclusions Baseline myocardial and systemic inflammatory burden inversely correlates with cardiac improvement following LVAD support. A circulating 2-cytokine model predicting significant reverse remodeling was identified, warranting further investigation as a practical preintervention tool in identifying patients prone to LVAD-mediated cardiac improvement and device weaning.
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Affiliation(s)
- Nikolaos A. Diakos
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT,Present address:
Division of CardiologyColumbia University Medical CenterNew YorkNY
| | - Iosif Taleb
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT,University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Christos P. Kyriakopoulos
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT,University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Kevin S. Shah
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Hadi Javan
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT,University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Tyler J. Richins
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT
| | - Michael Y. Yin
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Chi‐Gang Yen
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Elizabeth Dranow
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Michael J. Bonios
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT,Present address:
Onassis Cardiac Surgery CenterAthensGreece
| | - Rami Alharethi
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Antigone G. Koliopoulou
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT,Present address:
Onassis Cardiac Surgery CenterAthensGreece
| | - Mariam Taleb
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT
| | - James C. Fang
- University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Craig H. Selzman
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT,University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
| | - Konstantinos Stellos
- Cardiovascular Research CentreNewcastle University & Cardiothoracic CentreNewcastle upon Tyne HospitalsNewcastleUK
| | - Stavros G. Drakos
- Nora Eccles Harrison Cardiovascular Research and Training InstituteUniversity of UtahSalt Lake CityUT,University of Utah Health and School of Medicine, Intermountain Medical Center, George E. Wahlen Department of Veterans Affairs Medical CenterU.T.A.H. (Utah Transplant Affiliated Hospitals) Cardiac Transplant ProgramSalt Lake CityUT
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Schaenman JM, Rossetti M, Sidwell T, Groysberg V, Sunga G, Liang E, Vangala S, Chang E, Bakir M, Bondar G, Cadeiras M, Kwon M, Reed EF, Deng M. Association of pro-inflammatory cytokines and monocyte subtypes in older and younger patients on clinical outcomes after mechanical circulatory support device implantation. Hum Immunol 2018; 80:126-134. [PMID: 30445099 DOI: 10.1016/j.humimm.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/29/2018] [Accepted: 11/07/2018] [Indexed: 01/30/2023]
Abstract
Noninvasive immunologic analysis of peripheral blood holds promise for explaining the mechanism of development of adverse clinical outcomes, and may also become a method for patient risk stratification before or after mechanical circulatory support device (MCSD) implantation. Dysregulation of the innate immune system is associated with increased patient age but has yet to be evaluated in the older patient with advanced heart failure undergoing MCSD surgery. Patients pre- and post-MCSD implantation had peripheral blood mononuclear cells (PBMC) and serum isolated. Multiparameter flow cytometry was used to analyze markers of innate cell function, including monocyte subtypes. Multiplex cytokine analysis was performed. MELD-XI and SOFA scores were utilized as surrogate markers of outcomes. Increased levels of pro-inflammatory cytokines including IL-15, TNF-α, and IL-10 were associated with increased MELD-XI and SOFA scores. IL-8, TNF- α, and IL-10 were associated with risk of death after MCSD implantation, even with correction for patient age. Increased frequency of 'classical' monocytes (CD14 + CD16-) were associated with increased MELD-XI and SOFA scores. This suggests that inflammation and innate immune system activation contribute to progression to multiorgan system failure and death after MCSD surgery. Development of noninvasive monitoring of peripheral blood holds promise for biomarker development for candidate selection and patient risk stratification.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States.
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Tiffany Sidwell
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Victoria Groysberg
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Gemalene Sunga
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Emily Liang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Sitaram Vangala
- UCLA Department of Medicine Statistics Core, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Eleanor Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Maral Bakir
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Galyna Bondar
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Martin Cadeiras
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Murray Kwon
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Mario Deng
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA 90095, United States
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Vallet H, Chenevier-Gobeaux C, Villain C, Cohen-Bittan J, Ray P, Epelboin L, Verny M, Riou B, Khiami F, Boddaert J. Prognostic Value of Serum Procalcitonin After Orthopedic Surgery in the Elderly Population. J Gerontol A Biol Sci Med Sci 2017; 72:438-443. [PMID: 27231388 DOI: 10.1093/gerona/glw097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 05/10/2016] [Indexed: 12/21/2022] Open
Abstract
Background Orthopedic surgery is more and more frequent in the older patients and is associated with a high mortality rate. Although serum procalcitonin levels are associated with prognosis in young adults, data are still lacking in the elderly population, and especially after surgery. The main objective of this study was to determine the prognostic value of procalcitonin levels in a large geriatric orthopedic population, and we compared it with clinical variables and biomarkers. Methods This is a prospective study including patients admitted in our dedicated geriatric postoperative unit, after orthopedic surgery with immediate postoperative measured procalcitonin levels. Collected data included age, sex, medical history, functional status (activities of daily living [ADL]), fracture type, Cumulative Illness Rating scale (CIRS), postoperative complications, and biological data. The primary endpoint was the 30-day mortality. Results 436 patients (age 85±6 years) were included. Hip fracture surgery was the most frequent (n = 310; 71%), and the 30-day mortality rate was 6.9%. Compared with C-reactive protein (CRP), albumin, CIRS, and ADL, procalcitonin had the highest area under the receiver operating characteristic curve for predicting 30-day mortality (0.74; 95% CI: 0.70-0.78). Using a cutoff at 1 µg/L, procalcitonin was more specific than CIRS to predict 30-day mortality (92 vs 77%; p < .001). In a multivariable analysis, procalcitonin level higher than 0.39 µg/L is a significant predictor of mortality within 30 days (odds ratio 3.84; 95% CI: 1.61-9.14, p = .002). Conclusion Elevated procalcitonin values were strongly and significantly associated with mortality within 30 days in older patients after orthopedic surgery.
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Affiliation(s)
- Hélène Vallet
- Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,Sorbonne Universités, UPMC Paris 6, Paris, France
| | | | - Cédric Villain
- Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Judith Cohen-Bittan
- Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Patrick Ray
- Sorbonne Universités, UPMC Paris 6, Paris, France.,Department of Emergency Medicine, Groupe Hospitalo-Universitaire de l'Est parisien, site Tenon, APHP, Paris, France
| | - Loïc Epelboin
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Université de la Guyane, Institut Pasteur de La Guyane et Centre d'Investigation Clinique CIC Antilles-Guyane Inserm 1424, Guyane Française, France
| | - Marc Verny
- Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,Sorbonne Universités, UPMC Paris 6, Paris, France.,UMR CNRS 8256, Paris, France
| | - Bruno Riou
- Sorbonne Universités, UPMC Paris 6, Paris, France.,Department of Emergency Medicine and Surgery, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France.,UMR INSERM 1166, IHU ICAN, Paris, France
| | - Frédéric Khiami
- Sorbonne Universités, UPMC Paris 6, Paris, France.,Department of Orthopedic Surgery and Trauma, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, APHP, Paris, France
| | - Jacques Boddaert
- Unit of Peri-Operative Geriatric Care, Department of Geriatrics, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix. DHU FAST, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,Sorbonne Universités, UPMC Paris 6, Paris, France.,UMR CNRS 8256, Paris, France
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