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.

Association of pro-inflammatory cytokines and monocyte subtypes in older and younger patients on clinical outcomes after mechanical circulatory support device implantation

“…As a single center study, we are able to include patients receiving similar medical care with similar waiting time for transplantation. In addition, our work confirms previous studies that have also identified IL-6, IL-8, TNF-a, and MDC as associated with heart failure and MCSD implantation [6,29,32,33]. Future multicenter studies will be important to validate our pilot findings and evaluate whether pre-implant as well as post-implant assessment is associated with clinical outcomes.…”

“…Inflammation is know to play a role in adverse outcomes in older patients, however, less is known about the role of pro-inflammatory monocytes and cytokines in the setting of MCSD implantation. Previously assessed markers such as C-reactive protein and procalcitonin have not added significantly to prediction of adverse outcomes after MCSD, suggesting the need for more immunologically oriented assessment [29,30]. In this analysis of MCSD recipients, we found that despite similar etiologies of heart failure and types of interventions, older patients demonstrated increased frequency of the pro-inflammatory CD14++/CD16− classical monocyte.…”

Oncostatin M: a Potential Biomarker to Predict Infection in Patients with Left Ventricular Assist Devices

“…2–5 Predictors for risk of infection in LVAD recipients have been sought but to date remain unreliable. 6,7…”

“…Given that, we hypothesized that an increase in plasma OSM levels could serve as a more sensitive predictor of infection risk than previously proposed biomarkers. 6,7…”

“…Given that, we hypothesized that an increase in plasma OSM levels could serve as a more sensitive predictor of infection risk than previously proposed biomarkers. 6,7 To test this hypothesis, we performed serial measurements of plasma OSM levels before LVAD implantation and for two months following. We then studied the relationship between OSM levels and the development of postoperative infection.…”