Changes in Sepsis Biomarkers after Immunosuppressant Administration in Transplant Patients.

Sepsis biomarkers change continuously during the postoperative period. We aimed to demonstrate the influence of immunosuppressants after transplantation (Tx) on presepsin, procalcitonin, CRP, white blood cells, and IL-6. A group of 140 patients after major surgery (86 non-Tx, 54 Tx) without any signs of sepsis or infectious complications was followed for 7 days. The changes in biomarkers were analyzed with respect to the type of surgery, organ, and induction immunosuppressant used (antithymocyte globulin, corticosteroids, or basiliximab/rituximab). Concentrations (95th percentiles) of presepsin and procalcitonin were higher in the Tx group (presepsin: Tx < 2380 vs. non-Tx < 1368 ng/L, p < 0.05; procalcitonin: <28.0 vs. 3.49 µg/L, p < 0.05). In contrast, CRP and IL-6 were lower in the Tx group (CRP: Tx < 84.2 vs. non-Tx < 229 mg/L, p < 0.05; IL-6: <71.2 vs. 317 ng/L, p < 0.05). Decreases in CRP and IL-6 were found for all immunosuppressants, and procalcitonin was increased after antithymocyte globulin and corticosteroids. Negligible changes were found for white blood cells. Different responses of presepsin, procalcitonin, CRP, and IL-6 were therefore found in patients without any infectious complications after major surgery or transplantation. Immunosuppression decreased significantly IL-6 and CRP in comparison to non-Tx patients, while procalcitonin was increased after corticosteroids and antithymocyte globulin only. Cautious interpretation of sepsis biomarkers is needed in the early posttransplant period. This work was conducted as a noninterventional (nonregistered) study.

Prophylactic application of levosimendan in cardiac surgical patients with severe left ventricle dysfunction.

BACKGROUND: Levosimendan improves myocardial contractility, and increases systemic, pulmonary and coronary vasodilation. The present study investigates the perioperative hemodynamic effects of a prophylactic infusion of levosimendan in high-risk cardiac surgery patients with severe left ventricle dysfunction, and compares short-term clinical outcomes with a historical control group in which dobutamine and milrinone were used. PATIENTS AND METHODS: A retrospective, observational study was performed in 10 adult patients with EuroSCOREs greater than six and severe left ventricle dysfunction. In the study group, prophylactic levosimendan infusion was started after the induction of general anesthesia (bolus 24 mug/kg over 10 min; continuous infusion 0.1 mug/kg/min over the next 24 h). The historical control group (12 patients) was treated with dobutamine and milrinone. The hemodynamic measurements were performed at eight predetermined time points. Short-term clinical outcomes recorded in both groups were the length of intensive care unit stay, the need for dialysis, the length of hospital stay, predicted mortality (logistic EuroSCORE) and 30-day mortality. RESULTS: Hemodynamic measurements performed in the study group revealed an increase in cardiac index 30 min after levosimendan infusion was started. Cardiac performance was sufficient throughout the entire perioperative period. The length of intensive care unit stay was not different between the groups, but the length of hospital stay (10.4+/-5.0 versus 26.6+/-17.6 days; P=0.01) and 30-day mortality (0% versus 41.7%; P=0.04) were significantly lower in levosimendan-treated patients. CONCLUSIONS: Levosimendan seemed to be an effective choice for preventing left ventricle failure in high-risk cardiac surgical patients with severe left ventricle dysfunction compared with patients receiving dobutamine and milrinone.

IL-10 and TNF-beta gene polymorphisms have no major influence on lactate levels after cardiac surgery.

OBJECTIVE: Lactate levels after cardiac surgery are influenced by different proinflammatory (TNF, IL-6, IL-8) and anti-inflammatory (IL-10) cytokines. The goal of the study was to determine the relationship between polymorphism in the IL-10 (-1082G/A) and TNF-beta (+252G/A) genes and lactate levels in patients after cardiac surgery. METHODS: We performed prospective observational study in 168 consecutive adult patients without left ventricle dysfunction undergoing elective coronary artery bypass grafting. Lactic acid levels were documented at five different time points: 10 min after beginning of cardiopulmonary bypass, 40 min after cardiopulmonary bypass termination, and 30 min, 8h, and 16 h after the surgery. Genetic analysis for polymorphism was performed by mismatched polymerase chain reaction and restriction analysis. RESULTS: No association was found between single polymorphism in IL-10 or TNF-beta gene and lactate levels, but the carriers of IL-10/TNF-beta genotype combination +A/GG had significantly different course of lactate levels in time with decrease in lactate (in comparison with increase in other groups) at 8h after the surgery. CONCLUSIONS: IL-10 (-1082G/A) and TNF-beta (+252G/A) gene polymorphisms have a little, yet measurable influence on the time course of changes in lactate levels after cardiac surgery.

Two sporadic infected cardiac myxomas in 1 patient.

Infected cardiac myxoma is a rare cause of endocarditis. The finding of coexisting infected cardiac myxomas is highly unusual. Herein, we present the case of a 58-year-old woman with a low-grade fever. Laboratory findings strongly indicated inflammation, and blood cultures detected Staphylococcus species. Echocardiograms revealed mobile masses in the area of the mitral valve. Transesophageal echocardiograms showed 2 formations that arose from opposite sides of the mitral annulus and protruded into the left ventricle during systole. During emergency surgery, 2 abnormal growths with numerous vegetations were completely excised. The diagnosis of myxoma was confirmed upon histologic evaluation. Microbiological and polymerase chain reaction analysis of the myxomas detected the bacterial strain Enterococcus faecalis. Five months postoperatively, the patient showed no signs of recurrent infection and had a normal echocardiographic appearance.This report is the first of an infected cardiac myxoma in the Czech population and one of approximately 60 reports in the medical literature from 1956 to the present. In addition to the case of our patient, we discuss the discrepancy between the bacteriologic findings.