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. 2012;7(6):e38573.
doi: 10.1371/journal.pone.0038573. Epub 2012 Jun 7.

Therapeutic plasma exchange decreases levels of routinely used cardiac and inflammatory biomarkers

Oktay Tutarel  1 , Paulina Golla, Gernot Beutel, Johann Bauersachs, Sascha David, Bernhard M W Schmidt, Ralf Lichtinghagen, Jan T Kielstein
Affiliations

Therapeutic plasma exchange decreases levels of routinely used cardiac and inflammatory biomarkers

Oktay Tutarel et al. PLoS One. 2012.

Abstract

Background: Therapeutic plasma exchange (TPE) plays a key role in the management of various diseases, from thrombotic thrombocytopenic purpura and Goodpasture's syndrome to cardiac allograft rejection. In many of these disease states cardiac and inflammatory involvement is common and biomarkers are routinely used for diagnosis or assessment of therapeutic success. The effect of TPE on biomarkers used in the clinical routine has not been investigated.

Methods: TPE was initiated for established clinical conditions in 21 patients. Troponin T, NT-proBNP, C-reactive protein, procalcitonin and routine chemistry were drawn before and after TPE, as well as before and after the 2(nd) TPE. The total amount of these markers in the waste bag was also analyzed.

Results: In 21 patients 42 TPEs were performed. The procedure reduced plasma levels of the examined biomarkers: 23% for NT-proBNP (pre vs. post: 4637±10234 ng/l to 3565±8295 ng/l, p<0.001), 64% for CRP (21.9±47.0 mg/l vs. 7.8±15.8 mg/l, p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l vs. 0.27±0.72 µg/l, p=0.004). TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l vs. 52.2±141.3 ng/l), however this difference was not statistical significant (p=0.95). There was a significant correlation between the difference of pre TPE levels to post TPE levels of all examined biomarkers and the total amount of the removed biomarker in the collected removed plasma.

Conclusions: TPE significantly reduces plasma levels of inflammatory and cardiac biomarkers. Therefore, post TPE levels of cardiac and inflammatory biomarkers should be viewed with caution.

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Conflict of interest statement

Competing Interests: JTK has received research funding from Caridian BCT for an investigator-initiated study with unrestricted research support, i.e. no influence on the current study. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. There are no other competing interests.

Figures

Figure 1
Figure 1. Plasma levels of cardiac biomarkers.
Pre and post TPE (left axis) and total amount in the waste bag (right axis). A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T.
Figure 2
Figure 2. Plasma levels of inflammatory biomarkers.
Pre and post TPE (left axis) and total amount in the waste bag (right axis). A. C-reactive protein (CRP); B. procalcitonin.
Figure 3
Figure 3. Longitudinal kinetics of the investigated biomarkers.
A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T; C. C-reactive protein (CRP); D. procalcitonin.
See this image and copyright information in PMC

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