Could Pentraxin 3 Be a New Diagnostic Marker for Excessive Inflammatory Response in Cardiac Surgery?

Abstract

Background The aim of this study was to compare the dynamics of two inflammatory response biomarkers pentraxin 3 (PTX3) and C-reactive protein (CRP) after cardiac surgery with particular regard to different postoperative clinical manifestation of inflammatory response.

Patients and Methods In this study, 42 patients undergoing open heart surgery with the use of cardiopulmonary bypass were included and divided in two groups according to the extent of clinical manifestation of inflammatory response: Group A (n = 21)—patients with different severity of systemic inflammatory response syndrome (SIRS) and Group B (n = 21)—patients with uneventful postoperative period (no SIRS). The serum levels of PTX3 and CRP were evaluated and compared at the following time points: before and at the end of surgery, 6 hours, 1st, 3rd, and 7th day after surgery.

Results The dynamics of CRP levels were comparable between both groups and showed the classical characteristics after cardiac surgery with a peak on the 3rd postoperative day (113 vs. 132 mg/L). In contrast, the dynamics of PTX3 showed an earlier increase of serum levels with the peak on the 1st postoperative day in both groups (36.3 vs. 42.7 ng/mL). Importantly, a significant difference of PTX3 levels was found on the 3rd postoperative day (31.1 vs. 7.0 ng/mL; p < 0.006) between the two groups showing significantly delayed decrease of PTX3 levels in patients with SIRS (Group A).

Conclusion This study demonstrates considerably different dynamics of PTX3 levels after cardiac surgery in patients with SIRS and patients without SIRS, thus it may be indicative to start the appropriate therapy.

Keywords

SIRS - postoperative care and complications - cardiac surgery

Note

This article was presented at the 32nd Cardiovascular Surgical Symposium—CSS, Zürs, Austria, March 22–29, 2014.

• References

• 1 Partrick DA, Moore EE, Fullerton DA, Barnett Jr CC, Meldrum DR, Silliman CC. Cardiopulmonary bypass renders patients at risk for multiple organ failure via early neutrophil priming and late neutrophil disability. J Surg Res 1999; 86 (1) 42-49
• 2 Svitek V, Lonsky V, Anjum F. Pathophysiological aspects of cardiotomy suction usage. Perfusion 2010; 25 (3) 147-152
• 3 Chew MS, Brandslund I, Brix-Christensen V , et al. Tissue injury and the inflammatory response to pediatric cardiac surgery with cardiopulmonary bypass: a descriptive study. Anesthesiology 2001; 94 (5) 745-753
• 4 Chowdhury UK, Malik V, Yadav R , et al. Myocardial injury in coronary artery bypass grafting: on-pump versus off-pump comparison by measuring high-sensitivity C-reactive protein, cardiac troponin I, heart-type fatty acid-binding protein, creatine kinase-MB, and myoglobin release. J Thorac Cardiovasc Surg 2008; 135 (5) 1110-1119 , e1–e10
• 5 Bical OM, Fromes Y, Gaillard D , et al. Comparison of the inflammatory response between miniaturized and standard CPB circuits in aortic valve surgery. Eur J Cardiothorac Surg 2006; 29 (5) 699-702
• 6 Kunes P, Mandak J, Holubcova Z, Kolackova M, Krejsek J. The long pentraxin PTX3: a candidate anti-inflammatory mediator in cardiac surgery. Perfusion 2013; 28 (5) 377-389
• 7 Iwasaki A, Medzhitov R. Regulation of adaptive immunity by the innate immune system. Science 2010; 327 (5963) 291-295
• 8 Holmskov U, Thiel S, Jensenius JC. Collections and ficolins: humoral lectins of the innate immune defense. Annu Rev Immunol 2003; 21: 547-578
• 9 Bottazzi B, Garlanda C, Salvatori G, Jeannin P, Manfredi A, Mantovani A. Pentraxins as a key component of innate immunity. Curr Opin Immunol 2006; 18 (1) 10-15
• 10 Deban L, Jaillon S, Garlanda C, Bottazzi B, Mantovani A. Pentraxins in innate immunity: lessons from PTX3. Cell Tissue Res 2011; 343 (1) 237-249
• 11 Garlanda C, Bottazzi B, Bastone A, Mantovani A. Pentraxins at the crossroads between innate immunity, inflammation, matrix deposition, and female fertility. Annu Rev Immunol 2005; 23: 337-366
• 12 Steel DM, Whitehead AS. The major acute phase reactants: C-reactive protein, serum amyloid P component and serum amyloid A protein. Immunol Today 1994; 15 (2) 81-88
• 13 Yamasaki K, Kurimura M, Kasai T, Sagara M, Kodama T, Inoue K. Determination of physiological plasma pentraxin 3 (PTX3) levels in healthy populations. Clin Chem Lab Med 2009; 47 (4) 471-477
• 14 Muller B, Peri G, Doni A , et al. Circulating levels of the long pentraxin PTX3 correlate with severity of infection in critically ill patients. Crit Care Med 2001; 29 (7) 1404-1407
• 15 Balk RA. Systemic inflammatory response syndrome (SIRS): where did it come from and is it still relevant today?. Virulence 2014; 5 (1) 20-26
• 16 Kunes P, Lonsky V, Mandak J , et al. The long pentraxin 3 in cardiac surgery: distinct responses in “on-pump” and “off-pump” patients. Scand Cardiovasc J 2007; 41 (3) 171-179
• 17 Salio M, Chimenti S, De Angelis N , et al. Cardioprotective function of the long pentraxin PTX3 in acute myocardial infarction. Circulation 2008; 117 (8) 1055-1064
• 18 Peri G, Introna M, Corradi D , et al. PTX3, A prototypical long pentraxin, is an early indicator of acute myocardial infarction in humans. Circulation 2000; 102 (6) 636-641
• 19 Latini R, Maggioni AP, Peri G , et al; Lipid Assessment Trial Italian Network (LATIN) Investigators. Prognostic significance of the long pentraxin PTX3 in acute myocardial infarction. Circulation 2004; 110 (16) 2349-2354
• 20 Hudzik B, Szkodzinski J, Pietka-Rzycka A , et al. Plasma pentraxin 3 may be a more sensitive marker of inflammatory response than high-sensitivity C-reactive protein after bare-metal stent compared to drug-eluting stent implantation. J Interferon Cytokine Res 2013; 33 (5) 280-284
• 21 Rastan AJ, Bittner HB, Gummert JF , et al. On-pump beating heart versus off-pump coronary artery bypass surgery-evidence of pump-induced myocardial injury. Eur J Cardiothorac Surg 2005; 27 (6) 1057-1064
• 22 Doni A, Mantovani G, Porta C , et al. Cell-specific regulation of PTX3 by glucocorticoid hormones in hematopoietic and nonhematopoietic cells. J Biol Chem 2008; 283 (44) 29983-29992