Soluble TREM-1 plasma levels are associated with acute kidney injury, acute atrial fibrillation and prolonged ICU stay after cardiac surgery- a proof-concept study

Marie Vandestienne; Rayan Braik; Jean-Rémi Lavillegrand; Geoffroy Hariri; Zoe Demailly; Nadine Ben Hamouda; Fabienne Tamion; Thomas Clavier; Hafid Ait-Oufella

doi:10.3389/fcvm.2023.1098914

Soluble TREM-1 plasma levels are associated with acute kidney injury, acute atrial fibrillation and prolonged ICU stay after cardiac surgery- a proof-concept study

Front Cardiovasc Med. 2023 Jul 13:10:1098914. doi: 10.3389/fcvm.2023.1098914. eCollection 2023.

Authors

Marie Vandestienne^#¹, Rayan Braik^#¹, Jean-Rémi Lavillegrand^#¹, Geoffroy Hariri², Zoe Demailly^{3

4}, Nadine Ben Hamouda⁵, Fabienne Tamion^{3

6}, Thomas Clavier^{3

4}, Hafid Ait-Oufella^{1

7

8}

Affiliations

¹ Centre de Recherche Cardiovasculaire de Paris (PARCC), Université de Paris, Inserm U970, Paris, France.
² Service de Réanimation Chirurgicale, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpétrière, Institut du Coeur, Paris, France.
³ Université de Normandie, UNIROUEN, Inserm U1096, FHU REMOD-VHF, Rouen, France.
⁴ Service D'anesthésie-Réanimation Chirurgicale, CHU De Rouen, Rouen, France.
⁵ Service D'Immunologie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.
⁶ Service de Médecine Intensive-Réanimation, CHU De Rouen, Rouen, France.
⁷ Service de Médecine Intensive-Réanimation, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
⁸ Hôpital Saint-Antoine, Sorbonne Université, Paris, France.

^# Contributed equally.

Abstract

Background: Cardiopulmonary bypass (CPB) during cardiac surgery leads to deleterious systemic inflammation. We hypothesized that TREM-1, a myeloid receptor shed after activation, drives systemic inflammation during CPB.

Methods: Prospective observational bi-centric study. Blood analysis (flow cytometry and ELISA) before and at H2 and H24 after CPB. Inclusion of adult patients who underwent elective cardiac surgery with CPB.

Results: TREM-1 expression on neutrophils decreased between H0 and H2 while soluble (s)TREM-1 plasma levels increased. sTREM-1 levels increased at H2 and at H24 (p < 0.001). IL-6, IL-8, G-CSF and TNF-α, but not IL-1β, significantly increased at H2 compared to H0 (p < 0.001), but dropped at H24. Principal component analysis showed a close relationship between sTREM-1 and IL-8. Three patterns of patients were identified: Profile 1 with high baseline sTREM-1 levels and high increase and profile 2/3 with low/moderate baseline sTREM-1 levels and no/moderate increase overtime. Profile 1 patients developed more severe organ failure after CPB, with higher norepinephrine dose, higher SOFA score and more frequently acute kidney injury at both H24 and H48. Acute atrial fibrillation was also more frequent in profile 1 patients at H24 (80% vs. 19.4%, p = 0.001). After adjustment on age and duration of CPB, H0, H2 and H24 sTREM-1 levels remained associated with prolonged ICU and hospital length of stay.

Conclusions: Baseline sTREM-1 levels as well as early kinetics after cardiac surgery identified patients at high risk of post-operative complications and prolonged length of stay.

Keywords: TREM-1; cardiopulmonary bypass; cytokine; inflammation; outcome.