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Monocyte subset distribution is associated with mortality of critically ill patients

Session Inflammation and atherothrombosis in ACS

Speaker Konstantin A Krychtiuk

Event : Acute Cardiovascular Care 2015

  • Topic : basic science
  • Sub-topic : Basic Science
  • Session type : Symposium

Authors : KA Krychtiuk (Vienna,AT), M Lenz (Vienna,AT), L Wutzlhofer (Vienna,AT), K Huber (Vienna,AT), G Maurer (Vienna,AT), G Heinz (Vienna,AT), J Wojta (Vienna,AT), WS Speidl (Vienna,AT)

KA Krychtiuk1 , M Lenz1 , L Wutzlhofer1 , K Huber2 , G Maurer1 , G Heinz1 , J Wojta1 , 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 ,

European Heart Journal: Acute Cardiovascular Care ( 2015 ) 4 ( Supplement 5 ), S140

Purpose: Despite the fact that patients admitted to an ICU suffer from various pathologies, many develop a systemic inflammatory response syndrome (SIRS). As key regulators of innate immunity, monocytes may be crucially involved in SIRS development. Monocytes can be distinguished into three subsets: Classical monocytes (CD14++CD16-; CM), non-classical monocytes (CD14+CD16++; NCM) and intermediate monocytes (CD14++CD16+; IM), the latter shown to be particularly pro-inflammatory. The aim of our present study was to analyze whether monocyte subset distribution at admission or 72 hours after admission in critically ill patients is associated with 30-day survival.
Methods: In this prospective, observational study, 195 consecutive patients admitted to a cardiac ICU at a tertiary care center were enrolled. Blood was taken at admission and after 72 hours. Distribution of monocyte subsets was analyzed by flow-cytometry.
Results: Mean Apache II score was 19.5±8.1 and 30-day mortality was 25.4%. At admission, NCM were significantly lower in non-survivors as compared to survivors [2.65 (0.42-5.53) vs. 4.36 (0.67-7.66) %; p=0.010] whereas CM and IM did not differ according to 30-day survival. In contrast, 72 hours after admission, monocyte subset distribution shifted towards an increased proportion of IM [9.4 (3.8-13.1) vs. 4.3 (2.3-8.1); p=0.005] with a concomitant decrease of CM [86.8 (78.5-89.3) vs. 89.6 (84.9-93.1); p=0.009] in non-survivors versus survivors, respectively. NCM at day 3 were not associated with death at 30 days. Kaplan Meier analysis revealed that NCM at admission below the median predicted early mortality (day 0 to day 10; p<0.001), whereas CM and IM at day 3 were associated with late mortality (CM: p=0.036; IM: p=0.003).
Conlusions: Circulating monocyte subsets are associated with 30-day mortality in critically ill patients. The innate immune system as reflected by monocyte subset distribution plays a major role in ICU outcome despite varying admittance pathologies.

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