What does this research mean for the field?

Cardiac surgeries elicit distinct inflammatory, stress, and cardiac marker responses, with early changes in markers like resistin and CRP predicting short-term clinical outcomes such as transfusion needs and inotrope use. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

April 30, 2020Open Access

The association of systemic inflammatory markers with indicators of stress and cardiac necrosis in patients undergoing aortic valve replacement and revascularization surgeries

ASAndrea SaračevićUniversity Hospital Centre Zagreb IMIvan MedvedUniversity Hospital Centre Zagreb SVSunčana VlahHealth Center

Structured PICO

Do different types of open heart surgeries (on-pump, off-pump, valve replacement) cause different changes in inflammatory, stress, and cardiac markers, and can these markers predict short-term outcomes?

Population

90 patients undergoing open heart surgeries (divided into 3 groups of 30: on-pump revascularization, off-pump revascularization, and valve replacement)

Intervention

Off-pump revascularization or valve replacement

Comparator

On-pump revascularization

Outcome

Changes in inflammatory, stress, and cardiac markers (complete blood count, CRP, IL-6, IL-10, leptin, resistin, MCP-1, cortisol, CK, hsTnT) up to 5 days after the proceduresurrogate

Cardiac surgeries cause an increase in inflammatory, stress, and cardiac markers, with specific marker trajectories predicting short-term outcomes like transfusion needs and vasopressor use.

Abstract

The aim was to investigate: changes of inflammatory, stress and cardiac response in patients undergoing open heart surgeries up to five days after the procedure; the association between inflammatory, stress and cardiac response and whether changes in a certain marker can predict short-term patient outcome. Ninety patients were divided into three groups, 30 participants each (on-pump,off-pump revascularization and valve replacement group). The following markers were measured:complete blood count, CRP, IL-6, IL-10, leptin, resistin, monocyte chemoattractant protein-1 (MCP-1), cortisol, CK and hsTnT in 5 points. Resistin increased in all three groups. Lower IL-10 levels were found after the surgery and higher levels of leptin and MCP-1 in the off-pump than in the on-pump group. Off-pump group had higher values of IL-6, IL-10, leptin, resistin and MCP-1 and lower levels of CK and hsTnT 24 after surgery than the on-pump group. We found significant correlation between MCP-1 and resistin. The difference between resistin at time points 2 and 3 significantly predicted transfusion needs; while the difference between CRP and resistin before and at the end of the surgery together with the difference between leukocytes at the end and 24 hours after the surgery predicted the use of inotropic agents/vasopressors. Cardiac surgeries cause an increase of inflammatory, stress and cardiac markers. Only resistin correlated with MCP-1 which confirms the link between resistin secreted form infiltrated macrophages and enhanced release of MCP-1.

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