Results:
Five patients (10%) died during first 30 POD - the reasons were fatal
sepsis in one case (9th POD), multiorgan dysfunction
syndrome (MODS) due to sepsis with right ventricular failure
(2nd and 22nd POD) in two cases, and
MODS without infection (1st and 4thPOD) in other two cases.
PCT levels were low before surgery in all patients – actually in a
normal range (0.16, 0.10-0.34). They raised significantly on
1st (5.49, 2.52-18.42; p<0.001) and
2nd (5.65, 2.47-19.53; p<0.001) POD. On
30th POD we observed decrease of PCT back to the
baseline values (0.09, 0.07-0.19) – figure 1. PSEP levels were mildly
elevated before LVAD implantation (543, 340-882), raised significantly
on 1st (892, 557-1362, p=0.002) and
2nd (1015, 659-1494, p<0.001) POD and
decreased on 14th (838, 505-1620) and
30th (566, 420-867) POD – figure 2.
IC occurred after LVAD implantation in 11 of 50 patients (22%). There
were 4 cases of sepsis (defined according to the current guidelines)
with fatal outcome in one case, pneumonia in 4 cases, urinary infection
in one case, and Clostridium difficile colitis in two cases. There was
no significant difference in PCT or PSEP levels between patients with or
without IC during entire follow-up – see figures 3 and 4.
Twenty subjects (40%) had acute renal failure (ARF) defined as injury,
failure or loss of kidney function by RIFLE
criteria14. Seventeen of them needed renal replacement
therapy (RRT) initiated between 1st and
7th POD. Patients with ARF had significantly higher
PCT levels 2 days after surgery and further (day 2 – 24.15, 4.28-76.7
vs. 3.3, 2.21-9.03, p=0.045, day 14 – 0.68, 0.24-2.25 vs. 0.13,
0.09-0.28, p<0.001, day 30 – 0.21, 0.12-0.34 vs. 0.08,
0.04-0.12, p=0.005) – figure 5. ARF increased PSEP levels significantly
only 14 days after LVAD implantation (1926, 838-5936, vs. 688, 430-1181,
p=0.005) – see figure 6.
Right ventricular assist device (RVAD; CentriMagTMCirculatory Support System, Abbott, Abbott Park, IL, USA) had to be
implanted in 7 patients (14%) due to right heart failure. Subjects with
RVAD had also higher PCT and PSEP values. However, this difference
reached the significance only for PCT assessed 14 days after surgery
(8.02, 0.37-31.95 vs. 0.17, 0.1-0.37, p=0.018) – figures 7 and 8.
During 1-year follow-up, 10/50 (20%) patients died. Non-survivors
presented with higher levels of both PCP and PSEP before LVAD
implantation and during 30-day post-operative period, but this
difference did not reach statistical significance (figures 9 and 10).