Opfermann Philipp, Simader Elisabeth, Felli Alessia, Bevilacqua Michele, Holaubek Caroline, Dworschak Martin, Mouhieddine Mohamed, Zimpfer Daniel, Ankersmit Jan Hendrik, Steinlechner Barbara
Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
Department of Surgery, Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
J Immunol Res. 2020 Dec 26;2020:5826176. doi: 10.1155/2020/5826176. eCollection 2020.
The use of left ventricular assist device (LVAD) has increased considerably over the past decade; however, there is limited literature to assist in patient selection and monitoring. The frequency of adverse events remains high. We examined the early expression of circulating soluble ST2 (sST2), a biomarker with immunosuppressive and profibrotic activity, and assessed the risk of death at 1 year in patients receiving LVAD implant.
We prospectively enrolled 20 heart failure patients and measured sST2, IL-33, and IL-6 serum concentrations over three weeks after LVAD implantation. We compared the kinetics of IL-6, sST2, and IL-33 release in survivors with those of nonsurvivors using mixed model two-way analysis of variance for repeated measures. We also collected data on hemodynamic parameters (i.e., cardiac output) and frequency of infections during the hospital stay.
LVAD therapy led to an immediate and significant improvement of the hemodynamic parameters in 1-year survivors and nonsurvivors alike. The 1-year survival rate was 65%. IL-6 concentrations showed a significant ( = 0.03) peak at admission to the intensive care unit following LVAD implantation, whereas sST2 levels were massively increased ( < 0.0003) on day 1. While 1-year survivors had persistently lower sST2 values compared to nonsurvivors during the first 3 weeks after LVAD implantation ( = 0.012), no differences were observed in the temporal pattern of IL-6 or IL-33. The odds of detecting species in the bronchoalveolar lavage fluid were 14 times higher in nonsurvivors than in survivors (OR 13.7, CI 1.4-127, = 0.02).
In patients implanted with LVAD, circulating sST2 levels and frequency of colonisation were associated with higher mortality. Awareness of this early immune response can guide physicians in risk-benefit analysis.
在过去十年中，左心室辅助装置（LVAD）的使用显著增加；然而，有助于患者选择和监测的文献有限。不良事件的发生率仍然很高。我们研究了具有免疫抑制和促纤维化活性的生物标志物循环可溶性ST2（sST2）的早期表达，并评估了接受LVAD植入的患者1年时的死亡风险。
我们前瞻性地纳入了20例心力衰竭患者，并在LVAD植入后三周内测量了sST2、IL-33和IL-6的血清浓度。我们使用重复测量的混合模型双向方差分析比较了幸存者和非幸存者中IL-6、sST2和IL-33释放的动力学。我们还收集了住院期间的血流动力学参数（即心输出量）和感染频率的数据。
LVAD治疗使1年幸存者和非幸存者的血流动力学参数立即得到显著改善。1年生存率为65%。IL-6浓度在LVAD植入后入住重症监护病房时出现显著（=0.03）峰值，而sST2水平在第1天大幅升高（<0.0003）。虽然在LVAD植入后的前3周内，1年幸存者的sST2值持续低于非幸存者（=0.012），但在IL-6或IL-33的时间模式上未观察到差异。非幸存者在支气管肺泡灌洗液中检测到菌种的几率比幸存者高14倍（OR 13.7，CI 1.4-127,=0.02）。
在植入LVAD的患者中，循环sST2水平和菌种定植频率与较高的死亡率相关。认识到这种早期免疫反应可以指导医生进行风险效益分析。
