Pre-operative interleukin-6 levels and pronounced postoperative inflammatory response are associated to INTERMACS profile before left ventricular assist device implantation

Aim. Risk stratification for left ventricular assist device (LVAD) support applying Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles has emerged as an important tool in patient selection and outcome assessment. Activation of inflammatory mechanisms are known to be associated with worse prognosis in end-stage heart failure (ESHF) supported by LVAD. Aim of the study was to assess the relationship between INTERMACS profiles and inflammation in LVAD patients. Material and Method. Thirty ESHF-patients submitted to LVAD implantation as bridge-to-transplant were enrolled. Blood and urine samples were collected at pre-implant (4-24 hours before surgery) and serially up to 2 weeks post-LVAD for assessment of pro-inflammatory profiles [plasma levels of interleukin (IL)-6, IL-8, and urine neopterin/creatinine ratio (Neo/Cr), a monocyte activation marker]. Multi-organ function was evaluated by total sequential organ failure assessment (tSOFA)-score. The outcomes of interest were t-SOFA score during early mechanical support and length of Intensive Care Unit (ICU) stay. Results. At pre-implant, 15 pts had an INTERMACS 1 or 2 profiles (cardiogenic shock and inotrope dependent patients, group A), and 15 had 3 or 4 profiles (ambulatory advanced heart failure, group B). Among the assessed inflammatory markers, only IL-6 levels were higher in A- vs B-groups [24.6 (3.8, 45.0) vs 9.8 (2.4, 18.2) pg/mL, respectively; P = .033]. IL-8 and Neo/Cr levels were increased significantly at 2 post-LVAD week only in A-group [11.3 (5.8, 16.3) and 27.6 (11.5, 53.3) pg/mL of IL-8, respectively, P = 0.019; 0.395 (0.279, 0.741) and 1.394 (0.762, 2.294) µmol/mmol of Neo/Cr, respectively, P = 0.016]. Pre-implant IL-6 levels were related with t-SOFA score at 2 post-LVAD weeks (R = 0.53, P = 0.007) and ICU stay (R = 0.60, P = 0.001). Conclusions. In patients undergoing LVAD implant, the more severe INTERMACS profiles are associated to higher IL-6 levels with more adverse inflammatory response following device implantation, affecting postoperative tSOFA score and ICU stay. These data suggest that inflammation may contribute to poor outcome despite similar hemodynamic improvement in patients with severe INTERMACS profiles.