Vandestienne Marie, Braik Rayan, Lavillegrand Jean-Rémi, Hariri Geoffroy, Demailly Zoe, Ben Hamouda Nadine, Tamion Fabienne, Clavier Thomas, Ait-Oufella Hafid
Centre de Recherche Cardiovasculaire de Paris (PARCC), Université de Paris, Inserm U970, Paris, France.
Service de Réanimation Chirurgicale, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpétrière, Institut du Coeur, Paris, France.
Front Cardiovasc Med. 2023 Jul 13;10:1098914. doi: 10.3389/fcvm.2023.1098914. eCollection 2023.
Cardiopulmonary bypass (CPB) during cardiac surgery leads to deleterious systemic inflammation. We hypothesized that TREM-1, a myeloid receptor shed after activation, drives systemic inflammation during CPB.
Prospective observational bi-centric study. Blood analysis (flow cytometry and ELISA) before and at H2 and H24 after CPB. Inclusion of adult patients who underwent elective cardiac surgery with CPB.
TREM-1 expression on neutrophils decreased between H0 and H2 while soluble (s)TREM-1 plasma levels increased. sTREM-1 levels increased at H2 and at H24 ( < 0.001). IL-6, IL-8, G-CSF and TNF-α, but not IL-1β, significantly increased at H2 compared to H0 ( < 0.001), but dropped at H24. Principal component analysis showed a close relationship between sTREM-1 and IL-8. Three patterns of patients were identified: Profile 1 with high baseline sTREM-1 levels and high increase and profile 2/3 with low/moderate baseline sTREM-1 levels and no/moderate increase overtime. Profile 1 patients developed more severe organ failure after CPB, with higher norepinephrine dose, higher SOFA score and more frequently acute kidney injury at both H24 and H48. Acute atrial fibrillation was also more frequent in profile 1 patients at H24 (80% vs. 19.4%, = 0.001). After adjustment on age and duration of CPB, H0, H2 and H24 sTREM-1 levels remained associated with prolonged ICU and hospital length of stay.
Baseline sTREM-1 levels as well as early kinetics after cardiac surgery identified patients at high risk of post-operative complications and prolonged length of stay.
心脏手术期间的体外循环（CPB）会引发有害的全身炎症。我们假设触发受体表达上调分子-1（TREM-1），一种激活后脱落的髓系受体，在CPB期间驱动全身炎症。
前瞻性观察性双中心研究。在CPB前、CPB后2小时（H2）和24小时（H24）进行血液分析（流式细胞术和酶联免疫吸附测定）。纳入接受择期心脏手术并使用CPB的成年患者。
中性粒细胞上TREM-1的表达在H0至H2之间降低，而可溶性（s）TREM-1血浆水平升高。sTREM-一水平在H2和H24时升高（<0.001）。与H0相比，IL-6、IL-8、粒细胞集落刺激因子（G-CSF）和肿瘤坏死因子-α（TNF-α）在H2时显著升高（<0.001），但在H24时下降，而IL-1β则无显著变化。主成分分析显示sTREM-1与IL-8之间存在密切关系。确定了三种患者模式：模式1患者基线sTREM-1水平高且升高幅度大，模式2/3患者基线sTREM-1水平低/中等且随时间无/中等升高。模式1患者在CPB后发生更严重的器官功能衰竭，去甲肾上腺素剂量更高，序贯器官衰竭评估（SOFA）评分更高，在H24和H48时急性肾损伤更频繁。模式1患者在H24时急性心房颤动也更常见（80%对19.4%，P=0.001）。在对年龄和CPB持续时间进行调整后，H0、H2和H24时的sTREM-1水平仍与重症监护病房（ICU）和住院时间延长相关。
心脏手术后的基线sTREM-1水平以及早期动力学可识别出术后并发症风险高和住院时间延长的患者。
