Inflammation is an amplifier of lung congestion by high lv filling pressure in hemodialysis patients: a longitudinal study.
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Torino Claudia, Gargani Luna, Sicari Rosa, Letachowicz Krzysztof, Ekart Robert, Fliser Danilo, Covic Adrian, Siamopoulos Kostas, Stavroulopoulos Aristeidis, Massy Ziad A, Fiaccadori Enrico, Regolisti Giuseppe, Bachelet Thomas, Slotki Itzchak, Martinez-Castelao Alberto, Coudert-Krier Marie-Jeanne, Rossignol Patrick, Hannedouche Thierry, Wiecek Andrzej, Sarafidis Pantelis, Battaglia Yuri, Prohić Nejra, Klinger Marian, Hojs Radovan, Seiler-Mußler Sarah, Lizzi Fabio, Siriopol Dimitrie, Balafa Olga, Shavit Linda, Loutradis Charalampos, Seidowsky Alexandre, Tripepi Rocco, Mallamaci Francesca, Tripepi Giovanni, Picano Eugenio, London Gérard Michel, Zoccali Carmine
Аннотация
OBJECTIVE AND METHODS: We investigated the effect modification by systemic inflammation (serum CRP) on the relationship between a surrogate of the filling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantified by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model.
RESULTS: At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r = 0.23, P < 0.001) and serum CRP was a robust modifier of this relationship (P < 0.001). Similarly, in fully adjusted longitudinal analyses US-B lines associated with simultaneous estimates of LAVI (P = 0.002) and again CRP was a strong modifier of this relationship in adjusted analyses (P ≤ 0.01). Overall, at comparable LAVI levels, lung congestion was more pronounced in inflamed than in non-inflamed patients.
CONCLUSION: In ESKD systemic inflammation is a modifier of the relationship between LAVI, an integrate measure of LV filling pressure, and lung water. For any given pressure, lung water is increased with higher CRP levels, likely reflecting a higher permeability of the alveolar-capillary barrier.