Interleukin-6 and interleukin-8 concentrations as predictors of outcome in ventricular assist device patients before heart transplantation

Abstract

Objective To determine whether the serum concentrations of some circulating cytokines (as highly sensitive markers of inflammation) are of value in predicting the outcome of patients with cardiogenic shock and end-stage heart disease, who undergo ventricular assist device implantation until heart transplantation. Design Cohort study. Setting University teaching hospitals. Patients Twenty patients with cardiogenic shock or end-stage heart disease were consecutively selected for this study, if assist device implantation was performed as a bridge to heart transplantation. Measurements and Main Results The circulating concentrations of the cytokines inter-leukin (IL)-1 β, IL-6, IL-8 and tumor necrosis factor (TNF)-α were monitored from the beginning to the end of assist device support two to three times a week, using commercial enzyme-linked immunosorbent assays (ELISA). In all patients, circulating IL-6 and IL-8 values were increased shortly after assist device implantation. In patients with uncomplicated courses, IL-6 and IL-8 concentrations decreased after an initial increase and were low at the time of transplantation, whereas serum cytokine concentrations increased and remained increased in the nonsurvivors (survivors vs. nonsurvivors, p < .001). Circulating IL-1β and TNF-α concentrations were rarely detectable. Conclusions Monitoring of IL-6 and IL-8 values during ventricular assist device support provides a means of early identification of highrisk patients that may allow optimization of antimicrobial therapy and selection of the appropriate time for transplantation. (Crit Care Med 1994; 22:448–454)