Progression of Inflammatory Biomarkers Early after Cardiovascular Implantable Electronic Device Placement

Yıl 2020, Cilt: 6 Sayı: 2, 133 - 137, 05.06.2020

Kamil Gülşen Levent Cerit Burak Ayça Hatice Kemal Cenk Conkbayır Flora Özkalaycı Onur Akpınar Hamza Duygu

https://doi.org/10.30934/kusbed.643919

Öz

Objective: There is a lack of data in the current literature regarding the spontaneous progression of inflammatory biomarkers early after cardiovascular implantable electronic device (CIED) placement. In our study we aimed to detect C-reactive protein (CRP) and white blood cell count (WBC) trends in the 5 days following CIED implantation.
Methods: We retrospectively investigated a total of 235 patients who received CIEDs between 2012 and 2016 in our heart center. The levels of CRP and WBC for one day before and for the following 5 days after the procedure were noted in 4 serial measurements. The longitudinal course of CRP and WBC and their association with various parameters were analyzed with linear mix model of repeated measurements.
Results: Totally 235 patients were screened; 36 patients excluded due to lack of serial CRP and WBC measurements, 44 patients excluded due to occurrence of a factor that may potentially affect CRP and WBC level. Finally 153 patients with a median age of 67 (IQR 58-74), 41 (26.8%) of whom were female, were included in the study. CRP values indicated a significant trend and made a peak in the second estimation (between 48-72 hours) after the procedure (Beta[β]: 0.208; Standard Error [S.E]: 0.015; p< 0.001). Age and procedure duration longer than 1 hour emerged as leading factors for high level of CRP (β:0.004; S.E: 0.002; p=0.05 and β: 0.208; S.E: 0.015; p= 0.02, respectively). The relation between time and WBC count was not statically significant (β: -0.129; S.E: 0.06; p=0.06).
Conclusion: Progression of CRP after CIED implantation demonstrates a significant trend. Age and procedure duration longer than 1 hour are leading factors for high levels of CRP. There is statistically non-significant relation between WBC levels and time in 5 days of procedure. 

Anahtar Kelimeler

Pacemaker, implantable defibrillators, C-reaktive protein, inflammation, biomarkers

Teşekkür

The authors thank Ibrahim Halil Tanboga (Hisar Intercontinental Hospital, Istanbul) for statistical analysis

Kardiyovasküler İmplante Edilen Elektronik Cihaz Takılması Sonrası Erken Dönem İnflamatuar Biyo-Belirteçlerin Seyri

Öz

Amaç: Güncel literatürde kardiyovasküler implante edilen elektronik cihaz (KİEC) takılması sonrası inflamatuar biyo-belirteçlerin seyri ile ilgili yeterli veri yoktur. Çalışmamızda KİEC takılması sonrası 5 gün içerisinde C- reaktif protein (CRP)ve beyaz kan hücresi (BKH) değişimlerini ortaya çıkarmayı amaçladık
Yöntem: Kalp merkezimizde 2012-2016 yılları arasında KİEC takılan toplam 235 hastayı geriye dönük olarak araştırdık. CRP ve BKH sayımı düzeylerinin işlemden 1 gün önce ve işlemden sonraki 5 gün içerisindeki toplamda 4 seri ölçümleri not edildi. CRP ve BKH’nin zaman içerisindeki seyri ve farklı değişkenler ile olan ilişkisi tekrarlayan ölçümler için linear mix model yöntemi kullanılarak analiz edildi.
Bulgular: Toplamda 235 hasta tarandı; 36 hasta işlem sonrası seri CRP ve WBC düzeyleri olamaması, 44 hasta CRP ve WBC düzeylerini etkileyebilecek potansiyel bir neden olması sebebiyle çalışma dışı bırakıldı. Sonuç olarak çalışmaya median yaşı 67 (IQR 58-74) 41’i (%26,8) kadın olan toplamda 153 hasta dahil edildi. CRP düzeyleri belirgin değişim gösterdi ve işlem sonrası ikinci ölçümde (48-72 saatler arası) en yüksek değerine ulaştı (Beta[β]: 0,208; Standart Hata [S.H] 0,015; p<0,001). Yaş ve işlem süresinin 1 saatten uzun olması yüksek CRP düzeylerine neden olan faktörler olarak ortaya çıktı (sırası ile β: 0,004; S.H 0,002; p=0,05 ve β:0,208; S.E:0,015; p= 0,02). Zaman ve BKH arasında istatistiksel anlamlı bir ilişki saptanmadı. (β: -0,129; S.E: 0,06; p=0,06).
Sonuç: KIEC takılması sonrası CRP seyri anlamlı bir değişim gösterir. Yaş ve işlem süresinin 1 saatten uzun olması yüksek CRP düzeylerine neden olan faktörlerdir. İşlem sonrası 5 gün içerisinde zaman ve BKH arasında istatistiksel olarak anlamlı olmayan bir ilişki vardır. 

Anahtar Kelimeler

Kalp pili, implante edilen defibrillator, c-reaktif protein, inflamasyon, biyo-marker

Kaynakça

• Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754.
• Grimm RH, Jr., Neaton JD, Ludwig W. Prognostic importance of the white blood cell count for coronary, cancer, and all-cause mortality. Jama. 1985;254(14):1932-1937.
• Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace. 2015;17(5):767-777.
• F Des, Miracapillo G, Cresti A, Severi S, Airaksinen KE. Pocket Hematoma: A Call for Definition. Pacing Clin Electrophysiol. 2015;38(8):909-913.
• Verhagen DW, Hermanides J, Korevaar JC, et al. Prognostic value of serial C-reactive protein measurements in left-sided native valve endocarditis. Arch Intern Med. 2008;168(3):302-307.
• Sandoe JA, Barlow G, Chambers JB, et al. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother. 2015;70(2):325-359.
• Olsen T, Jorgensen OD, Nielsen JC, Thogersen AM, Philbert BT, Johansen JB. Incidence of device-related infection in 97 750 patients: clinical data from the complete Danish device-cohort (1982-2018). Eur Heart J. 2019;40(23):1862-1869.
• Klug D, Wallet F, Lacroix D, et al. Local symptoms at the site of pacemaker implantation indicate latent systemic infection. Heart. 2004;90(8):882-886.
• Traykov V, Bongiorni MG, Boriani G, et al. Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association. Europace. 2019.
• Zabek A, Ulman M, Holcman K, et al. Inflammatory markers in the diagnostic workup of pacemaker- and defibrillatorrelated infections in patients referred for transvenous lead extraction. Kardiol Pol. 2019;77(10):918-925.
• Santonocito C, De Loecker I, Donadello K, et al. C-reactive protein kinetics after major surgery. Anesth Analg. 2014;119(3):624-629
• Tompkins C, Cheng A, Brinker JA, et al. Significance of leukocytosis after cardiac device implantation. Am J Cardiol. 2013;111(11):1608-1612.
• Kumar DS, Tompkins CM, Veenhuyzen GD, Henrikson CA. Significance of leukocytosis prior to cardiac device implantation. Pacing Clin Electrophysiol. 2018;41(9):1197-1200.
• Pinti M, Appay V, Campisi J, et al. Aging of the immune system: Focus on inflammation and vaccination. Eur J Immunol. 2016;46(10):2286-2301.
• Liu A, Bui T, Van Nguyen H, Ong B, Shen Q, Kamalasena D. Serum C-reactive protein as a biomarker for early detection of bacterial infection in the older patient. Age Ageing. 2010;39(5):559-565
• Nichols CI, Vose JG. Incidence of Bleeding-Related Complications During Primary Implantation and Replacement of Cardiac Implantable Electronic Devices. J Am Heart Assoc. 2017;6(1).
• Barold SS, Giudici M, Herweg B. Uninterrupted warfarin therapy for the implantation of cardiac rhythm devices. Pacing Clin Electrophysiol. 2013;36(5):537-540.