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Therapeutic plasma exchange decreases levels of routinely used cardiac and inflammatory biomarkers.

Tutarel O, Golla P, Beutel G, Bauersachs J, David S, Schmidt BM, Lichtinghagen R, Kielstein JT - PLoS ONE (2012)

Bottom Line: The procedure reduced plasma levels of the examined biomarkers: 23% for NT-proBNP (pre vs. post: 4637±10234 ng/l to 3565±8295 ng/l, p<0.001), 64% for CRP (21.9±47.0 mg/l vs. 7.8±15.8 mg/l, p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l vs. 0.27±0.72 µg/l, p=0.004).TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l vs. 52.2±141.3 ng/l), however this difference was not statistical significant (p=0.95).TPE significantly reduces plasma levels of inflammatory and cardiac biomarkers.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.

ABSTRACT

Background: Therapeutic plasma exchange (TPE) plays a key role in the management of various diseases, from thrombotic thrombocytopenic purpura and Goodpasture's syndrome to cardiac allograft rejection. In many of these disease states cardiac and inflammatory involvement is common and biomarkers are routinely used for diagnosis or assessment of therapeutic success. The effect of TPE on biomarkers used in the clinical routine has not been investigated.

Methods: TPE was initiated for established clinical conditions in 21 patients. Troponin T, NT-proBNP, C-reactive protein, procalcitonin and routine chemistry were drawn before and after TPE, as well as before and after the 2(nd) TPE. The total amount of these markers in the waste bag was also analyzed.

Results: In 21 patients 42 TPEs were performed. The procedure reduced plasma levels of the examined biomarkers: 23% for NT-proBNP (pre vs. post: 4637±10234 ng/l to 3565±8295 ng/l, p<0.001), 64% for CRP (21.9±47.0 mg/l vs. 7.8±15.8 mg/l, p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l vs. 0.27±0.72 µg/l, p=0.004). TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l vs. 52.2±141.3 ng/l), however this difference was not statistical significant (p=0.95). There was a significant correlation between the difference of pre TPE levels to post TPE levels of all examined biomarkers and the total amount of the removed biomarker in the collected removed plasma.

Conclusions: TPE significantly reduces plasma levels of inflammatory and cardiac biomarkers. Therefore, post TPE levels of cardiac and inflammatory biomarkers should be viewed with caution.

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Related in: MedlinePlus

Plasma levels of cardiac biomarkers.Pre and post TPE (left axis) and total amount in the waste bag (right axis). A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T.
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pone-0038573-g001: Plasma levels of cardiac biomarkers.Pre and post TPE (left axis) and total amount in the waste bag (right axis). A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T.

Mentions: The reduction of the examined biomarkers comparing pre TPE and post TPE plasma levels was 23% for N-terminal-pro-brain natriuretic peptide (NT-proBNP) (pre TPE vs. post TPE: 4637±10234 ng/l (median 310 ng/l, IQR 1569 ng/l) to 3565±8295 ng/l (median 219 ng/l, IQR 1168 ng/l), p<0.001), 64% for C-reactive protein (CRP) (21.9±47.0 mg/l (median 5.7 mg/l, IQR 13.25 mg/l) vs. 7.8±15.8 mg/l (median 1.9 mg/l, 5.6 IQR mg/l), p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l (median 0.08 µg/l, IQR 0.12 µg/l) vs. 0.27±0.72 µg/l (median 0.08 µg/l, IQR 0.07 µg/l), p=0.004). TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l (median 13.7 ng/l, IQR 33.0 ng/l) vs. 52.2±141.3 ng/l (median 14.2 ng/l, IQR 23.6 ng/l), however this difference was not statistical significant (p=0.95) (Figure1and2).


Therapeutic plasma exchange decreases levels of routinely used cardiac and inflammatory biomarkers.

Tutarel O, Golla P, Beutel G, Bauersachs J, David S, Schmidt BM, Lichtinghagen R, Kielstein JT - PLoS ONE (2012)

Plasma levels of cardiac biomarkers.Pre and post TPE (left axis) and total amount in the waste bag (right axis). A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369845&req=5

pone-0038573-g001: Plasma levels of cardiac biomarkers.Pre and post TPE (left axis) and total amount in the waste bag (right axis). A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T.
Mentions: The reduction of the examined biomarkers comparing pre TPE and post TPE plasma levels was 23% for N-terminal-pro-brain natriuretic peptide (NT-proBNP) (pre TPE vs. post TPE: 4637±10234 ng/l (median 310 ng/l, IQR 1569 ng/l) to 3565±8295 ng/l (median 219 ng/l, IQR 1168 ng/l), p<0.001), 64% for C-reactive protein (CRP) (21.9±47.0 mg/l (median 5.7 mg/l, IQR 13.25 mg/l) vs. 7.8±15.8 mg/l (median 1.9 mg/l, 5.6 IQR mg/l), p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l (median 0.08 µg/l, IQR 0.12 µg/l) vs. 0.27±0.72 µg/l (median 0.08 µg/l, IQR 0.07 µg/l), p=0.004). TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l (median 13.7 ng/l, IQR 33.0 ng/l) vs. 52.2±141.3 ng/l (median 14.2 ng/l, IQR 23.6 ng/l), however this difference was not statistical significant (p=0.95) (Figure1and2).

Bottom Line: The procedure reduced plasma levels of the examined biomarkers: 23% for NT-proBNP (pre vs. post: 4637±10234 ng/l to 3565±8295 ng/l, p<0.001), 64% for CRP (21.9±47.0 mg/l vs. 7.8±15.8 mg/l, p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l vs. 0.27±0.72 µg/l, p=0.004).TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l vs. 52.2±141.3 ng/l), however this difference was not statistical significant (p=0.95).TPE significantly reduces plasma levels of inflammatory and cardiac biomarkers.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.

ABSTRACT

Background: Therapeutic plasma exchange (TPE) plays a key role in the management of various diseases, from thrombotic thrombocytopenic purpura and Goodpasture's syndrome to cardiac allograft rejection. In many of these disease states cardiac and inflammatory involvement is common and biomarkers are routinely used for diagnosis or assessment of therapeutic success. The effect of TPE on biomarkers used in the clinical routine has not been investigated.

Methods: TPE was initiated for established clinical conditions in 21 patients. Troponin T, NT-proBNP, C-reactive protein, procalcitonin and routine chemistry were drawn before and after TPE, as well as before and after the 2(nd) TPE. The total amount of these markers in the waste bag was also analyzed.

Results: In 21 patients 42 TPEs were performed. The procedure reduced plasma levels of the examined biomarkers: 23% for NT-proBNP (pre vs. post: 4637±10234 ng/l to 3565±8295 ng/l, p<0.001), 64% for CRP (21.9±47.0 mg/l vs. 7.8±15.8 mg/l, p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l vs. 0.27±0.72 µg/l, p=0.004). TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l vs. 52.2±141.3 ng/l), however this difference was not statistical significant (p=0.95). There was a significant correlation between the difference of pre TPE levels to post TPE levels of all examined biomarkers and the total amount of the removed biomarker in the collected removed plasma.

Conclusions: TPE significantly reduces plasma levels of inflammatory and cardiac biomarkers. Therefore, post TPE levels of cardiac and inflammatory biomarkers should be viewed with caution.

Show MeSH
Related in: MedlinePlus