Systemic Inflammatory Burden Correlates with Severity and Predicts Outcomes in Patients with Cardiogenic Shock Supported
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ORIGINAL ARTICLE
Systemic Inflammatory Burden Correlates with Severity and Predicts Outcomes in Patients with Cardiogenic Shock Supported by a Percutaneous Mechanical Assist Device Nikolaos A. Diakos 1 & Katherine Thayer 1 & Lija Swain 1 & Maithri Goud 1 & Pankaj Jain 1 & Navin K. Kapur 1,2 Received: 3 July 2020 / Accepted: 4 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract In-hospital mortality associated with cardiogenic shock (CS) remains high despite introduction of mechanical circulatory support. In this study, we aimed to investigate whether systemic inflammation is associated with clinical outcomes in CS. We retrospectively analyzed systemic cytokine levels and the neutrophil-to-lymphocyte ratio (NLR), a marker of low-grade inflammation, among 134 patients with CS supported by VA-ECMO or Impella. Sixty-one percent of patients survived CS and either underwent device explantation or were bridged to LVAD or cardiac transplant. IL6 was the predominant circulating cytokine. IL6 levels were reduced after circulatory support in survivors. NLR pre-device implantation was significantly lower in patients with earlier stages of cardiogenic shock. Compared with non-survivors, survivors had a lower pre-device NLR and NLR was independently predictive of survival after adjusting for other covariates. In summary, NLR is a widely available marker of inflammation and correlates with in-hospital mortality among patients with cardiogenic shock requiring percutaneous mechanical circulatory support. Keywords Cardiogenic shock . Inflammation . Mechanical circulatory support . Heart failure
Abbreviations CS Cardiogenic shock ECMO Extra-corporeal membrane oxygenator EF Ejection fraction HF Heart failure IFN Interferon Associate Editor Marat Fudim oversaw the review of this article Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12265-020-10078-5) contains supplementary material, which is available to authorized users. * Navin K. Kapur [email protected] 1
Division of Cardiology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
2
Department of Medicine/Division of Cardiology, The Cardiovascular Center for Research and Innovation (CVCRI), Acute Circulatory Support Program, Interventional Research Laboratories, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, USA
IL LVAD NLR TNF
Interleukin Left ventricular assist device Neutrophil-to-lymphocyte ratio Tumor necrosis factor
Introduction Despite the introduction of acute mechanical circulatory support, the mortality from cardiogenic shock (CS) remains as high as 50% [1]. Inflammation plays a central role in the pathogenesis of acute and chronic heart failure (HF) and prior studies have shown a correlation between systemic inflammation and adverse HF outcomes [2, 3]. The development of novel anti-inflammatory agents with promising results in the treatment of cardiovascular disease underlines the necessity to further investigate the ro
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