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EXHAUSTION AND IMMUNOPATHOGENESIS POST-CORONARY ARTERY BYPASS GRAFT SURGERY
PS Miller, JN Giger, LS Evangelista, LV Doering... - 2011 - EXHAUSTION AND IMMUNOPATHOGENESIS POST-CORONARY ARTERY BYPASS GRAFT SURGERY Conference Sponsor: Western Institute of Nursing Conference Year: 2010 Author: Miller, Pamela S., Ph D, RN PI Institution Name: University of California, Los ...
BACKGROUND: Vital exhaustion (VE), characterized by fatigue, irritability and demoralization, is an independent risk factor for coronary artery disease (CAD) and future cardiac events. The associations among inflammatory biomarkers, cumulative seropositivity to infectious pathogens (pathogen burden [PB]) and atherosclerosis augment risk of CAD progression, plaque destabilization, and thrombotic sequelae after revascularization. Biological mechanisms linking VE with CAD remain unclear. PURPOSE: To examine the relationships among PB of herpesviruses, immuno-inflammation and VE in adults after coronary artery bypass graft (CABG) surgery. METHODS: In a prospective, cross-sectional design, serum levels of the inflammatory cytokine interleukin (IL)-6, anti-inflammatory cytokine IL-l0, endothelial inflammatory protein s ICAM-1, and Ig G antibodies to Herpes Simplex Virus (HSV)-1, HSV-2, Cytomegalovirus and Epstein Barr Virus were determined by ELISA in subjects one to two months after CABG surgery. Pathogen burden was defined by cumulative seropositivity: low (0 - 1), moderate (2 - 3), and high (4). Using Maastricht Interview scores, subjects were categorized as exhausted (equal to or greater than 7) or non-exhausted (< 7). Exclusion criteria were: current smoking, depression (assessed by the Patient Health Questionnaire-2), malignancy, autoimmune disease, or infection. RESULTS: Of the total sample (n = 42; 90.5 % male, age 67.5 +/- 12.6 years, 66.7 % Caucasian, 3.12 +/- 1.3 grafts), 40.5% were exhausted. Considering covariates, a moderate, positive correlation was observed between IL-6 and s ICAM-1 (r = 0.449; p < 0.05). No significant relationships were observed between IL-6, IL-10, IL-6:IL-10 ratio, or s ICAM-1 concentrations and PB. Non-exhausted subjects tended to present with low serum IL-10 concentrations (< 0.781 pg/m L; p = 0.06). Exhausted subjects tended to have less Ig G seropositivity to HSV-2 (p = 0.08). Comparisons of PB levels with exhaustion status revealed that non-exhausted subjects had higher frequencies of both high PB (6 [25 %] vs. 0 [0 %], p = 0.03) and moderate PB (16 [66.7 %] vs. 15 [93.8 %], p = 0.04). In multivariate analyses, increases in s ICAM-1 (OR = 111.99, 95% CI 1.26 - 9926.59, p = 0.04) and presence of moderate PB (OR = 54.35, 95% CI 2.31 - 1277.95, p = 0.01) were independent correlates of exhaustion status. IMPLICATIONS: Vital exhaustion is associated with increased exposure to herpesviruses and advanced PB. Moderate PB and s ICAM-1 are independent predictors of VE in post-CABG subjects, which suggest that inflammation may mediate the relationship of VE to cardiac events. In the post-CABG population, low levels of anti-inflammatory IL-10 supports the role of atherogenic pro-inflammation. Further study is needed to elucidate these relationships.
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EXHAUSTION AND IMMUNOPATHOGENESIS POST-CORONARY ARTERY BYPASS GRAFT SURGERY |
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