Identification of Predictive Early Biomarkers for Sterile-SIRS after Cardiovascular Surgery

Stoppelkamp, Sandra; Veseli, Kujtim; Stang, Katharina; Schlensak, Christian; Wendel, Hans Peter; Walker, Tobias

doi:10.1371/journal.pone.0135527

Cited by 43 publications

(30 citation statements)

References 79 publications

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“…Sepsis may benefit from early identification (1), thus many biomarkers and screening strategies to identify patients with sepsis have been investigated (22,23). The reference standard used in these studies was defined in the ACCP/SCCM, 2001 SCCM/ESICM/ACCP/ATS/SIS and 2012 SSC guidelines.…”

Section: Early Identification Of Sepsismentioning

confidence: 99%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for

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Section: Early Identification Of Sepsismentioning

confidence: 99%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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“…It is a marker of neonatal sepsis 11 and predicts shock and death. 12 sTREM-1 and its gene polymorphisms are also associated with sepsis prognosis 13 and high sTREM-1 is predictive of Systemic Inflammatory Response Syndrome (SIRS) 14 after surgery. TREM-1 and its soluble form are therefore potential diagnostic markers for infectious and chronic inflammatory diseases and also potential future targets for therapeutic manipulation.…”

Section: Introductionmentioning

confidence: 99%

Reversal of TREM-1 ectodomain shedding and improved bacterial clearance by intranasal metalloproteinase inhibitors

et al. 2017

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Triggering receptor expressed on myeloid cells-1 (TREM-1) is expressed on neutrophils and monocyte/macrophages and amplifies Toll-like receptor-mediated inflammation during infection. TREM-1 also exists in an antagonistic soluble form (sTREM-1) that has been used as a peripheral biomarker in sepsis, though the mechanisms of its release are not entirely clear. The requirement of TREM-1 in single microbial infections is controversial, with some studies showing a protective role and others a contribution to immunopathology. Furthermore, the role of membrane-bound and sTREM-1 in polygenic infections is currently unknown. In a mouse co-infection model where preceding viral infection greatly enhances bacteria co-infection, we now determine a mechanisms for the striking increase in sTREM-1 and the loss of TREM-1 on surface of neutrophils. We identified a matrix metalloproteinase (MMP)-9 cleavage site in TREM-1 and that the increase of MMP-9 in bronchoalveolar lavage fluid mirrors sTREM-1 release. In vitro studies with neutrophils and MMP-9 and the reduction of sTREM-1 in vivo after MMP-9 inhibition verifies that this enzyme cleaves TREM-1. Intriguingly, MMP-9 inhibition significantly reduces bacterial load and ensuing immunopathology in a co-infection model. This highlights MMP-9 inhibition as a potential therapeutic via blocking cleavage of TREM-1.

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“…Despite all recent advances in optimizing myocardial protection, cardiopulmonary bypass, and the use of minimally invasive approaches, heart surgeries still require extracorporeal circulation, myocardial protection from injury during aortic crossclamping and cardioplegic cardiac arrest by injecting cardioplegic solutions in the coronary bed. It leads to myocardial ischemia-reperfusion injury which remains the primary cause of acute heart failure during the restoration of spontaneous circulation and results in the onset of post-perfusion multiple organ dysfunction syndrome (MODS) [3][4][5][6]. The presence of comorbidities may also complicate the course of the postoperative period in patients with CVD following surgical repair.…”

Section: Introductionmentioning

confidence: 99%

Immunosuppression as a Component of Multiple Organ Dysfunction Syndrome Following Cardiac Surgery

Grigoryev

Шукевич

Матвеева

et al. 2018

Kompleks. probl. serdečno-sosud. zabol.

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Aim. To defne the role of myeloid-derived suppressor cells in the development of persistent multiple organ dysfunction followed cardiac surgeries with cardiopulmonary bypass.Methods. 40 patients who have undergone cardiac surgery were included in the study. Granulocyte myeloid-derived suppressor cells (G-MDSC) were defned as cells with the HLA-DR– / CD11β+ / CD15+ / CD33+ phenotype, and monocytic MDSC (M-MDSC) as cells with the HLA-DR– / CD11β+ / CD14+ / CD33+ phenotype using ﬂow cytometry. Levels of cytokines, IL-1β, IL-6, TNF-α, and IL-10 were measured with an enzyme immunoassay. All patients were assigned to three groups: Group 1 – patients with the uncomplicated postoperative period (n = 14), Group 2 – patients with non-persistent MODS and its early resolution (n = 16), and Group 3 – patients with persistent MODS at day 7.Results. We observed an increase in M-MDSCs and G-MDSC at day 1 following cardiac surgery. The most pronounced increase was found in monocytic-myeloid derived suppressor cells, i.e. an 8-fold increase in M-MDSCs in all study groups at day 1 after surgery. The number of M-MDSCs remained high in patients with persistent MODS at day 7 after cardiac surgery. Levels of IL-6 and IL-10 increased at day 1 after surgery. IL-6 reached its peak level, signifcantly exceeding baseline levels. By day 7, blood levels of all cytokines have decreased, except IL-10 levels, which remained above the baseline in patients with persistent MODS.Conclusion. An increase in M-MDSCs and elevated serum levels of the anti-inﬂammatory cytokine IL-10 have been found in patients regardless of the presence or absence of the complications in the early postoperative period after cardiac surgery with cardiopulmonary bypass. Persistent MODS with the SOFA scoring > 5 scores at day 7 after cardiac surgery, is associated with an increase in M-MDSCs and elevated levels of the anti-inﬂammatory cytokine IL-10, related to higher rate of hospital infections, prolonged intensive care unit stay and higher mortality.

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Identification of Predictive Early Biomarkers for Sterile-SIRS after Cardiovascular Surgery

Cited by 43 publications

References 79 publications

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Reversal of TREM-1 ectodomain shedding and improved bacterial clearance by intranasal metalloproteinase inhibitors

Immunosuppression as a Component of Multiple Organ Dysfunction Syndrome Following Cardiac Surgery

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