Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany.
Eur Heart J. 2012 Jun;33(12):1459-68. doi: 10.1093/eurheartj/ehs002. Epub 2012 Jan 26.
The outcome of patients undergoing surgical or interventional therapy is unfavourably influenced by severe systemic inflammation. We assessed the impact of a systemic inflammatory response syndrome (SIRS) on the outcome after transcatheter aortic valve implantation (TAVI).
One hundred and fifty-two high-risk patients (mean age: 80.5 ± 6.5 years, mean logistic EuroSCORE: 30.4 ± 8.1%) with symptomatic severe aortic stenosis underwent TAVI. Proinflammatory cytokines [interleukin-6 (IL-6) and interleukin-8 (IL-8)], and acute phase reactants [C-reactive protein (CRP) and procalcitonin (PCT)] were measured at baseline and 1, 4, 24, 48, 72 h, and 7 days after TAVI. Sixty-one of 152 patients developed SIRS during the first 48 h after TAVI. Systemic inflammatory response syndrome patients were characterized by leucocytosis ≥12 × 10(9)/L (83.6 vs. 12.1%; P < 0.001), hyperventilation (80.3 vs. 35.2%; P < 0.001), tachycardia (37.7 vs. 9.9%; P < 0.001), and fever (31.1 vs. 3.3%; P < 0.001) compared with patients without SIRS. Furthermore, the occurrence of SIRS was characterized by a significantly elevated release of IL-6 and IL-8 with subsequent increase in the leucocyte count, CRP, and PCT. Major vascular complications [odds ratio (OR) 5.1, 95% confidence interval (CI): 1.3-19.6; P = 0.018] and the number of ventricular pacing runs (OR 1.7, 95% CI: 1.1-2.8; P = 0.025) were independent predictors of SIRS. The occurrence of SIRS was related to 30-day and 1-year mortality (18.0 vs. 1.1% and 52.5 vs. 9.9%, respectively; P < 0.001) and independently predicted 1-year mortality risk (hazard ratio: 4.3, 95% CI: 1.9-9.9; P < 0.001).
SIRS may occur after TAVI and is a strong predictor of mortality. The development of SIRS could be easily identified by a significant increase in the leucocyte count shortly after TAVI.
严重全身炎症会对接受手术或介入治疗的患者的预后产生不利影响。我们评估了全身炎症反应综合征（SIRS）对经导管主动脉瓣植入（TAVI）后结局的影响。
152 名高危患者（平均年龄：80.5±6.5 岁，平均 logistic EuroSCORE：30.4±8.1%）因有症状的严重主动脉瓣狭窄而行 TAVI 治疗。在 TAVI 后 1、4、24、48、72 小时和 7 天，测量促炎细胞因子[白细胞介素-6（IL-6）和白细胞介素-8（IL-8）]和急性相反应物[C 反应蛋白（CRP）和降钙素原（PCT）]。在 TAVI 后 48 小时内，61 名 152 名患者出现 SIRS。与无 SIRS 患者相比，全身炎症反应综合征患者的特征为白细胞计数≥12×10(9)/L（83.6% vs. 12.1%；P＜0.001）、过度通气（80.3% vs. 35.2%；P＜0.001）、心动过速（37.7% vs. 9.9%；P＜0.001）和发热（31.1% vs. 3.3%；P＜0.001）。此外，SIRS 的发生特征是白细胞介素-6 和白细胞介素-8 的释放显著增加，随后白细胞计数、CRP 和 PCT 增加。主要血管并发症[比值比（OR）5.1，95%置信区间（CI）：1.3-19.6；P=0.018]和心室起搏次数[OR 1.7，95% CI：1.1-2.8；P=0.025]是 SIRS 的独立预测因子。SIRS 的发生与 30 天和 1 年死亡率相关（18.0% vs. 1.1%和 52.5% vs. 9.9%；P＜0.001），并独立预测 1 年死亡率风险（风险比：4.3，95% CI：1.9-9.9；P＜0.001）。
SIRS 可能在 TAVI 后发生，是死亡率的一个强有力的预测因子。SIRS 的发生可以通过 TAVI 后不久白细胞计数的显著增加来轻松识别。
