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Observational Study
. 2018 Oct;5(5):920-930.
doi: 10.1002/ehf2.12327. Epub 2018 Jul 17.

Systemic inflammation in acute cardiorenal syndrome: an observational pilot study

Christoph Linhart  1 , Christof Ulrich  1 , Daniel Greinert  1 , Stefanie Dambeck  2 , Andreas Wienke  3 , Matthias Girndt  1 , Rainer U Pliquett  1
Affiliations
Observational Study

Systemic inflammation in acute cardiorenal syndrome: an observational pilot study

Christoph Linhart et al. ESC Heart Fail. 2018 Oct.

Abstract

Aims: Acute cardiorenal syndrome (CRS) with and without consideration of the volume state was assessed with regard to inflammatory parameters.

Methods and results: Blood samples from patients with acute CRS (Ronco type 1 or 3, Group 1, n = 15), end-stage renal disease (Group 2, n = 12), hypertension (Group 3, n = 15), and, in a second cohort, with acute CRS and hypervolemia (Group 4, n = 9) and hypertension (Group 5, n = 10) were analysed with regard to lipopolysaccharide-binding protein (LBP), interleukins (ILs), and monocyte function (flow cytometry) both on admission (all groups) and on discharge (Groups 1 and 4). By discharge, one Group 1 patient died. LBP (ANOVA for Groups 1-3: P = 0.001) and IL-6 (Kruskal-Wallis for Groups 1-3: P < 0.0001) were higher in Group 1 (LBP: 11.7 ± 2.0 μg/mL; IL-6: 15.0 ± 6.1 pg/mL) and in Group 2 (LBP: 10.4 ± 1.4 μg/mL; IL-6: 14.6 ± 3.8 pg/mL) than in Group 3 (LBP: 5.8 ± 0.4 μg/mL; IL-6: 1.8 ± 0.4 pg/mL). In a direct comparison, the proportion of activated monocytes (CD14 and CD16 positive) was higher in Group 1 (6.9% ± 0.7%) vs. Group 3 (5.1% ± 0.6%; P = 0.018). Group 4 patients had higher IL-6 plasma levels (34.2 ± 10.1 pg/mL) than Group 1 patients (15.0 ± 6.1 pg/mL; P = 0.03). All other findings obtained in CRS groups (Groups 1 and 4) were comparable.

Conclusions: In acute CRS, a state of systemic inflammation was found, which is comparable with the end-stage renal disease situation. In comparison with hypertensive controls, a monocytic activation was found in acute CRS regardless of volume state.

Keywords: Cardiorenal syndrome; Heart failure; Inflammation; Monocyte function.

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Figures

Figure 1
Figure 1
Study flow of study participants of Group 1 (cardiorenal syndrome patients, type 1 or 31), Group 2 (end‐stage renal disease patients), and Group 3 (hypertensive patients). FACS, fluorescence‐activated cell scanning.
Figure 2
Figure 2
Study flow of study participants of Group 4 (cardiorenal syndrome patients, type 1 or 31 with hypervolemia) and Group 5 (hypertensive patients). FACS, fluorescence‐activated cell sorting.
Figure 3
Figure 3
Box plot analysis of interleukin‐6 (IL‐6), C‐reactive protein (CRP), and lipopolysaccharide‐binding protein (LBP) plasma levels in patients with acute cardiorenal syndrome (CRS) (Ronco type 1 or 3) either without (Group 1, left panel) or with consideration of hypervolemic state on admission (Group 5, right panel) in comparison with patients with end‐stage renal disease (ESRD, Group 2) and hypertension (Groups 3 and 5).
Figure 4
Figure 4
Take‐home figure: typical clinical findings and suggested interventions in acute cardiorenal syndrome (CRS) accompanied by hypervolemia or hypovolemia.
See this image and copyright information in PMC

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