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Monocyte subset distribution is associated with outcome in patients after cardiac arrest

Session ACVC Essentials 4 You - ePublications

Speaker Konstantin A Krychtiuk

Event : ACVC Essentials 4 You 2020

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care – Resuscitation
  • Session type : ePublication

Authors : KA Krychtiuk (Vienna,AT), M Lenz (Vienna,AT), K Huber (Vienna,AT), C Hengstenberg (Vienna,AT), J Wojta (Vienna,AT), G Heinz (Vienna,AT), WS Speidl (Vienna,AT)

Authors:
KA Krychtiuk1 , M Lenz1 , K Huber2 , C Hengstenberg1 , J Wojta1 , G Heinz1 , WS Speidl1 , 1Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology - Vienna - Austria , 2Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine - Vienna - Austria ,

Citation:

Background

After cardiac arrest and successful cardiopulmonary resuscitation with return of spontaneous circulation (ROSC), many patients show signs of an overactive immune activation. As key regulators of innate immunity, monocytes may be crucially involved in the development of this systemic inflammatory response. Monocytes can be distinguished into three subsets: classical monocytes (CM; CD14++CD16-); intermediate monocytes (IM; CD14++CD16+CCR2+) and non-classical monocytes (NCM; CD14+CD16++CCR2-).

Purpose

The aim of this prospective, observational study was to analyze whether monocyte subset distribution is associated with 30-day survival in patients after cardiac arrest.

Methods

We included 50 patients admitted to our medical cardiovascular ICU after cardiac arrest. Flow cytometry data was available in 43 patients. Blood was taken on admission and monocyte subset distribution was analyzed by flow cytometry.

Results

Median age was 65 (IQR 50-74) years, 75.5% of patients were male and 30-day mortality was 47%. Of interest, monocyte subset distribution upon admission to the ICU did not differ according to 30-day mortality. However, patients that died within 30 days showed a strong increase in the pro-inflammatory subset of intermediate monocytes (9.4% (IQR 3.8-14.6) vs 4.1% (IQR: 1.7-8.3); p=0.049) and a decrease of classical monocytes (87.2% (IQR 76.6-89) vs 90.8% (IQR 85-92.4); p=0.035) 72 hours after admission.

Discussion

A strong increase in the intermediate subset of monocytes 72 hours after admission to the ICU after cardiac arrest is strongly associated with 30-day mortality. This suggests that activation of the innate immune system as evidenced by monocyte subset distribution may play a significant role in patient outcome after cardiac arrest.

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