Document Detail

Importance of monocyte deactivation in determining early outcome after ventricular assist device implantation.
MedLine Citation:
PMID:  22461111     Owner:  NLM     Status:  In-Data-Review    
Background: Patients undergoing mechanical circulatory support using ventricular assist devices (VADs) experience a postoperative mixed antagonistic (proinflammatory and antiinflammatory) response syndrome. This response can result in immunoparalysis, exposing VAD recipients to infection and interfering with patient recovery despite adequate hemodynamic support. We undertook the present study to evaluate whether postoperative monocytic human leukocyte antigen-DR (mHLA-DR) expression is of prognostic value for mortality or infection of VAD recipients during their initial intensive care unit (ICU) stay after implantation. Methods: Since 2004, we have monitored postoperative mHLA-DR expression in 50 VAD recipients using flow cytometry. Results: Thirty-seven patients (74%) developed infection, and 22 patients (44%) died during their initial ICU stay. mHLA-DR expression was lowest in the immediate postoperative period (postoperative days [PODs] 1-3) but increased progressively thereafter. Multiple regression analysis showed that preoperative aspartate aminotransferase level was the only significant and independent predictor of the percentage of HLA-DR-positive monocytes on PODs 1-3 (β=-0.726, p=0.0001). ICU death and infection were associated with significantly lower percentages of HLA-DR-positive monocytes on PODs 1-3. ROC curve analysis revealed that the percentage of HLA-DR-positive monocytes on PODs 1-3 had significant discriminative power for ICU death (area under the curve = 0.73, 95% confidence interval, 0.545-0.912, p=0.037), but not for infection. Conclusions: Postoperative mHLA-DR expression was closely related to preoperative hepatic cytolysis. It appeared to be the only early postoperative biological parameter that had some predictive power for death of VAD recipients in the ICU.?
Matthias Kirsch; Bernadette Boval; Thibaud Damy; Soulef Ghendouz; Emmanuelle Vermes; Daniel Loisance; Ludovic Drouet
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The International journal of artificial organs     Volume:  35     ISSN:  1724-6040     ISO Abbreviation:  Int J Artif Organs     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802649     Medline TA:  Int J Artif Organs     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  169-76     Citation Subset:  IM    
Department of Cardiothoracic Surgery, AP-HP, Henri Mondor Hospital, Créteil - France.
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