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).