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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

Longitudinal kinetics of the investigated biomarkers.A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T; C. C-reactive protein (CRP); D. procalcitonin.
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pone-0038573-g003: Longitudinal kinetics of the investigated biomarkers.A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T; C. C-reactive protein (CRP); D. procalcitonin.

Mentions: The kinetics of the biomarkers were analyzed via a comparison between pre TPE (pre TPE1) and post TPE (post TPE 1) levels for the first TPE with the pre TPE levels before the second TPE (pre TPE 2). The second TPE was performed 25±5 hours after the first. While NT-proBNP increased 1 day after the first TPE (pre TPE 2 vs. post TPE 1 (4270±10097 ng/l (median 284 ng/l, IQR 1470 ng/l) to 3839±8746 ng/l (median 227 ng/l, IQR 1586 ng/l)), it was still significantly reduced compared to pre TPE 1 levels (5003±10606 ng/l (median 336 ng/l, IQR 2336 ng/l), p=0.04) (Figure3). A different effect was seen for CRP. Pre TPE 2 levels were higher than post TPE 1 levels (15.3±28.8 mg/l (median 6.6 mg/l, IQR 9.8 mg/l) vs. 9.3±18.2 mg/l (median 1.5 mg/l, IQR 9.45 mg/l), p=0.004) and statistically not significant lower than pre TPE 1 levels (28.5±60.0 mg/l (median 3.9 mg/l, IQR 23.6 mg/l), p=0.211) (Figure3). For procalcitonin and troponin T no significant difference was observed in the longitudinal analysis (pre TPE 1 vs. post TPE 1 vs. pre TPE2 for procalcitonin 0.42±1.29 µg/l (median 0.08 µg/l, 0.15 IQR µg/l) vs. 0.30±0.79 (median 0.07 µg/l, 0.11 IQR µg/l) vs. 0.35±0.91 µg/l (median 0.09 µg/l, IQR 0.12 µg/l), and for troponin T 62.3±186.4 ng/l (median 13.8 ng/l, IQR 30.0 ng/l) vs. 55.1±154.6 (median 14.8 ng/l, IQR 21.3 ng/l) vs. 59.1±168.6 ng/l (median 13.6 ng/l, IQR 34.4 ng/l) (Figure3).


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)

Longitudinal kinetics of the investigated biomarkers.A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T; C. C-reactive protein (CRP); D. procalcitonin.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0038573-g003: Longitudinal kinetics of the investigated biomarkers.A. N-terminal-pro-brain natriuretic peptide (NT-proBNP); B. troponin T; C. C-reactive protein (CRP); D. procalcitonin.
Mentions: The kinetics of the biomarkers were analyzed via a comparison between pre TPE (pre TPE1) and post TPE (post TPE 1) levels for the first TPE with the pre TPE levels before the second TPE (pre TPE 2). The second TPE was performed 25±5 hours after the first. While NT-proBNP increased 1 day after the first TPE (pre TPE 2 vs. post TPE 1 (4270±10097 ng/l (median 284 ng/l, IQR 1470 ng/l) to 3839±8746 ng/l (median 227 ng/l, IQR 1586 ng/l)), it was still significantly reduced compared to pre TPE 1 levels (5003±10606 ng/l (median 336 ng/l, IQR 2336 ng/l), p=0.04) (Figure3). A different effect was seen for CRP. Pre TPE 2 levels were higher than post TPE 1 levels (15.3±28.8 mg/l (median 6.6 mg/l, IQR 9.8 mg/l) vs. 9.3±18.2 mg/l (median 1.5 mg/l, IQR 9.45 mg/l), p=0.004) and statistically not significant lower than pre TPE 1 levels (28.5±60.0 mg/l (median 3.9 mg/l, IQR 23.6 mg/l), p=0.211) (Figure3). For procalcitonin and troponin T no significant difference was observed in the longitudinal analysis (pre TPE 1 vs. post TPE 1 vs. pre TPE2 for procalcitonin 0.42±1.29 µg/l (median 0.08 µg/l, 0.15 IQR µg/l) vs. 0.30±0.79 (median 0.07 µg/l, 0.11 IQR µg/l) vs. 0.35±0.91 µg/l (median 0.09 µg/l, IQR 0.12 µg/l), and for troponin T 62.3±186.4 ng/l (median 13.8 ng/l, IQR 30.0 ng/l) vs. 55.1±154.6 (median 14.8 ng/l, IQR 21.3 ng/l) vs. 59.1±168.6 ng/l (median 13.6 ng/l, IQR 34.4 ng/l) (Figure3).

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