Exhaustion, Immuno-inflammation, and Pathogen Burden After Cardiac Surgery: an Exploratory Study

Overview

Journal Eur J Cardiovasc Nurs

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Nursing

Date 2013 Mar 26

PMID 23524631

Citations 2

Authors

Pamela S Miller

Lorraine S Evangelista

Joyce Newman Giger

Otoniel Martinez-Maza

Teresita Corvera-Tindel

Larry Magpantay

Guadalupe Pena

Lynn V Doering

Affiliations

Soon will be listed here.

Abstract

Background: Exhaustion, a consequence of prolonged stress characterized by unusual fatigue, is associated with increased risk of cardiac morbidity and mortality. In patients recovering from coronary artery bypass (CABG), little is known about the relationship of 1) immune-mediated inflammation and resultant endothelial activation, and 2) cumulative exposure to infectious pathogens (pathogen burden (PB)) implicated in coronary atherosclerosis to exhaustion.

Aim: The aim of this exploratory study was to investigate the association of PB, inflammatory markers (interleukin (IL)-6, IL-10) and a marker of endothelial activation (soluble intercellular adhesion molecule-1 (sICAM-1)) to exhaustion.

Methods: One to two months post-CABG, 42 individuals who met inclusion criteria were assessed for exhaustion using the Maastricht Interview for Vital Exhaustion. Serum IgG antibodies to herpes simplex virus (HSV)-1, HSV-2, cytomegalovirus, Epstein Barr virus, and inflammatory and endothelial activation markers were measured by enzyme-linked immunosorbent assay. Pathogen burden was defined as the total number of seropositive exposures: low (0-1), moderate (2-3), and high (4).

Results: Prevalence of exhaustion was 40.5%. Relative to non-exhausted patients, exhausted patients demonstrated a higher frequency of moderate PB (h=0.73, p=0.04) but lower frequency of high PB (h=1.05, p=0.03). Exhaustion showed a non-significant trend for positive correlations with IL-6 and sICAM-1 levels, and inverse relation to PB. In subgroup analysis, exhausted patients had stronger correlations with IL-6 and IL-6:IL-10 and a tendency towards higher serum IL-10 concentrations compared with their non-exhausted counterparts.

Conclusion: This hypothesis-generating study provides preliminary evidence that elevated post-CABG exhaustion may be associated with PB, inflammation, and endothelial activation.

Citing Articles

Psychosomatic syndromes are associated with IL-6 pro-inflammatory cytokine in heart failure patients.

Altamura M, DAndrea G, Angelini E, Tortorelli F, Balzotti A, Porcelli P PLoS One. 2022; 17(3):e0265282.

PMID: 35271674 PMC: 8912235. DOI: 10.1371/journal.pone.0265282.

Reporter Cell Assessment of TLR4-Induced NF-κB Responses to Cell-Free Hemoglobin and the Influence of Biliverdin.

Sharma J, Boyd T, Alvarado C, Gunn E, Adams J, Ness T Biomedicines. 2019; 7(2).

PMID: 31163699 PMC: 6630411. DOI: 10.3390/biomedicines7020041.

References

Smith D, IRVING S, Sheldon J, Cole D, Kaski J . Serum levels of the antiinflammatory cytokine interleukin-10 are decreased in patients with unstable angina. Circulation. 2001; 104(7):746-9. DOI: 10.1161/hc3201.094973. View

Appels A, Bar F, Bar J, Bruggeman C, De Baets M . Inflammation, depressive symptomtology, and coronary artery disease. Psychosom Med. 2000; 62(5):601-5. DOI: 10.1097/00006842-200009000-00001. View

Prasad A, Zhu J, Halcox J, Waclawiw M, Epstein S, Quyyumi A . Predisposition to atherosclerosis by infections: role of endothelial dysfunction. Circulation. 2002; 106(2):184-90. DOI: 10.1161/01.cir.0000021125.83697.21. View

Kudielka B, Bellingrath S, Hellhammer D . Cortisol in burnout and vital exhaustion: an overview. G Ital Med Lav Ergon. 2008; 28(1 Suppl 1):34-42. View

Igna C, Julkunen J, Vanhanen H . Vital exhaustion, depressive symptoms and serum triglyceride levels in high-risk middle-aged men. Psychiatry Res. 2010; 187(3):363-9. DOI: 10.1016/j.psychres.2010.10.016. View

Miller G, Freedland K, Duntley S, Carney R . Relation of depressive symptoms to C-reactive protein and pathogen burden (cytomegalovirus, herpes simplex virus, Epstein-Barr virus) in patients with earlier acute coronary syndromes. Am J Cardiol. 2005; 95(3):317-21. DOI: 10.1016/j.amjcard.2004.09.026. View

Perry T, Muehlschlegel J, Liu K, Fox A, Collard C, Body S . Preoperative C-reactive protein predicts long-term mortality and hospital length of stay after primary, nonemergent coronary artery bypass grafting. Anesthesiology. 2010; 112(3):607-13. PMC: 3000538. DOI: 10.1097/ALN.0b013e3181cea3b5. View

Steptoe A, Shamaei-Tousi A, Gylfe A, Henderson B, Bergstrom S, Marmot M . Socioeconomic status, pathogen burden and cardiovascular disease risk. Heart. 2007; 93(12):1567-70. PMC: 2095775. DOI: 10.1136/hrt.2006.113993. View

Eschen O, Christensen J, Johnsen S, Dethlefsen C, Schmidt E . Adhesion molecules and C-reactive protein are associated to adverse events in angina pectoris. Scand Cardiovasc J. 2010; 44(3):153-60. DOI: 10.3109/14017431003615634. View

10.

Zhu J, Nieto F, Horne B, Anderson J, Muhlestein J, Epstein S . Prospective study of pathogen burden and risk of myocardial infarction or death. Circulation. 2001; 103(1):45-51. DOI: 10.1161/01.cir.103.1.45. View

11.

Andrie R, Bauriedel G, Tuleta I, Braun P, Nickenig G, Skowasch D . Impact of intimal pathogen burden in acute coronary syndromes--correlation with inflammation, thrombosis, and autoimmunity. Cardiovasc Pathol. 2009; 19(6):e205-10. DOI: 10.1016/j.carpath.2009.09.009. View

12.

Ray K, Morrow D, Shui A, Rifai N, Cannon C . Relation between soluble intercellular adhesion molecule-1, statin therapy, and long-term risk of clinical cardiovascular events in patients with previous acute coronary syndrome (from PROVE IT-TIMI 22). Am J Cardiol. 2006; 98(7):861-5. DOI: 10.1016/j.amjcard.2006.04.024. View

13.

Scheller J, Chalaris A, Schmidt-Arras D, Rose-John S . The pro- and anti-inflammatory properties of the cytokine interleukin-6. Biochim Biophys Acta. 2011; 1813(5):878-88. DOI: 10.1016/j.bbamcr.2011.01.034. View

14.

Aiello A, Diez-Roux A, Noone A, Ranjit N, Cushman M, Tsai M . Socioeconomic and psychosocial gradients in cardiovascular pathogen burden and immune response: the multi-ethnic study of atherosclerosis. Brain Behav Immun. 2009; 23(5):663-71. PMC: 2694852. DOI: 10.1016/j.bbi.2008.12.006. View

15.

Lubbock L, Goh A, Ali S, Ritchie J, Whooley M . Relation of low socioeconomic status to C-reactive protein in patients with coronary heart disease (from the heart and soul study). Am J Cardiol. 2005; 96(11):1506-11. PMC: 2776677. DOI: 10.1016/j.amjcard.2005.07.059. View

16.

Appels A, Mulder P . Excess fatigue as a precursor of myocardial infarction. Eur Heart J. 1988; 9(7):758-64. DOI: 10.1093/eurheartj/9.7.758. View

17.

Howren M, Lamkin D, Suls J . Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009; 71(2):171-86. DOI: 10.1097/PSY.0b013e3181907c1b. View

18.

Cavusoglu E, Marmur J, Hojjati M, Chopra V, Butala M, Subnani R . Plasma interleukin-10 levels and adverse outcomes in acute coronary syndrome. Am J Med. 2011; 124(8):724-30. DOI: 10.1016/j.amjmed.2011.02.040. View

19.

Heeschen C, Dimmeler S, Hamm C, Fichtlscherer S, Boersma E, Simoons M . Serum level of the antiinflammatory cytokine interleukin-10 is an important prognostic determinant in patients with acute coronary syndromes. Circulation. 2003; 107(16):2109-14. DOI: 10.1161/01.CIR.0000065232.57371.25. View

20.

Epstein S, Zhu J, Najafi A, Burnett M . Insights into the role of infection in atherogenesis and in plaque rupture. Circulation. 2009; 119(24):3133-41. DOI: 10.1161/CIRCULATIONAHA.109.849455. View