Postoperative complications in cardiovascular surgery remain an important unresolved problem, in particular in patients with aortic aneurysm. The role of the altered microbiota in such patients is of great interest. The aim of this pilot study was to determine whether the development of postoperative complications in patients with aortic aneurysm is related with initial or acquired disorders of microbiota metabolism by monitoring the level of some aromatic microbial metabolites (AMMs) circulating in the blood before the surgery and in the early postoperative period. The study comprised patients with aortic aneurysm (n = 79), including patients without complications (n = 36) and patients with all types of complications (n = 43). The serum samples from the patients were collected before and 6 h after the end of the surgery. The most significant results were obtained for the sum of three sepsis-associated AMMs. This level was higher before the surgery in comparison with that of healthy volunteers (n = 48), p < 0.001, and it was also higher in the early postoperative period in patients with all types of complications compared to those without complications, p = 0.001; the area under the ROC curve, the cut-off value, and the odds ratio were 0.7; 2.9 µmol/L, and 5.5, respectively. Impaired microbiota metabolism is important in the development of complications after complex reconstructive aortic surgery, which is the basis for the search for a new prevention strategy.

INTRODUCTION: Hematological indices are available, universal predictors and markers of infectious and non-infectious pathological conditions. OBJECTIVE: To determine the predictive ability of hematological indices in relation to the development of postoperative complications in patients undergoing reconstructive interventions on the aorta. MATERIALS AND METHODS: A prospective, observational, single-center study included 79 patients who underwent elective aortic surgery under cardiopulmonary bypass. Age of participants 57 (46.5; 64) years, Charlson comorbidity index 4 (2; 5), cardiopulmonary bypass duration 123 (101; 160) minutes, myocardial ischemia 91 (66; 115) minutes. The patients were divided into two groups: I — without complications, II — with complications. RESULTS: Neutrophil to lymphocyte ratio (NLR) on day 3 in group I was 6.17 (4.1; 8.7), in group II — 9.56 (6.68; 12.46), p = 0.002. NLR on day 6 in group I was 3.79 (2.77; 5.1), in group II — 6.0 (4.3; 9.1), p = 0.001. NLR > 7.5 on day 3 was a predictor of complications in the postoperative period, OR = 4.6 (95 % CI 1.8–11.9, p = 0.002). NLR on day 6 > 5.0 also showed a predictive ability: OR = 4.9 (95 % CI 1.9–12.7, p = 0.001). Platelet to lymphocyte ratio (PLR) on day 3 in group I was 103.88 (78.87; 133.57), by day 6 it increased to 117.5 (104.63; 160.78); in group II, there was practically no increase in PLR: from 122 (88.46; 160.25) to 127.06 (108.40; 154.14). Differences between the indicators in groups were not statistically significant. CONCLUSIONS: Hematological indices can be used as predictors of complications in patients after surgery on the aorta and its branches. Patients with NLR > 7.5 on day 3 and > 5.0 on day 6, regardless of comorbidities and age, may represent a previously unrecognized subgroup of patients with an increased risk of postoperative complications.

Aim. To identify biomarkers for prediction and early diagnosis of infectious and inflammatory complications in patients after aortic surgery.Materials and methods. The study included 57 patients who underwent surgical procedures on the aorta and its branches under cardiopulmonary bypass and myocardial ischemia. The cohort was divided into two groups: patients with an uneventful postoperative period (group 1, N=35) and patients with local infectious and inflammatory complications after surgery (group 2, N=22). Serum levels of procalcitonin (PCT), interleukins (IL-6 and IL-10), and aromatic microbial metabolites (AMM) were measured before surgery, upon admission, and six hours after admission to the ICU. On postoperative days 3 and 6 neutrophil, lymphocyte, and platelet counts were assessed, and neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated.Results. There were no significant differences in sex, age, or comorbidities between groups 1 and 2. Patients in group 2 had a more severe intraoperative period and required a longer ICU stay. Predictive markers of complications included IL-6143.35 pg/mL at ICU admission (sensitivity 42.9%, specificity 90.9%, AUC 0.789, 95% CI 0.669–0.909, P0.001); PCT0.12 ng/mL 6 hours after ICU admission (sensitivity 90.9%, specificity 54.3%, AUC 0.762, 95% CI 0.634–0.891, P0. 001); NLR 7.8 on postoperative day 3 (sensitivity 72.7%, specificity 68.6%, AUC 0.710, 95% CI 0.571–0.850, P=0.003); and AMM (before and after surgery) 0.185 (sensitivity 77.3%, specificity 71.4%, AUC 0.780, 95% CI 0.651–0.909, P0.001).Conclusion. Values of IL-6, PCT, NLR, and AMM reflect different features of the inflammation and can be used for prediction and early diagnosis of infectious and inflammatory complications in cardiac surgery patients.

Коррекция эндотоксемии и профилактика шока с помощью многократной сорбции липополисахарида: описание клинического случая и анализ данных литературы

Sepsis is a heterogeneous and life-threatening condition caused by a dysregulated immune response to infection. The most severe form of sepsis is septic shock, characterized by arterial hypotension, impaired tissue perfusion, and hypoxia. Despite new findings in antimicrobial and intensive care therapy, the incidence and mortality rates of sepsis remain high, which underscores the relevance of further studies on its pathogenesis. In recent years, the research has shifted from clinical signs to analysis of immunological and molecular mechanisms, which allowed to identify specific phenotypes and endotypes of the disease. Sepsis phenotypes are based on clinical manifestations and biomarkers, whereas its endotypes are defined by molecular mechanisms, including immune gene expression patterns. This article reviews key aspects of the innate and adaptive immune responses in sepsis, including activation of proinflammatory cytokines, development of coagulopathies, deterioration of endothelial integrity and microvascular regulation. Moreover, the potential mechanisms, e.g., hyperinflammation, simultaneous development of immunosuppression, and functional exhaustion of immunocompetent cells are highlighted. Thus, immunological biomarkers are considered a promising tool for patient‘s stratification, prognosis prediction and personalized therapy. Current immunodiagnostic methods are also discussed in this article, including quantitative analysis of cytokine levels and assessment of innate immune dysfunction markers. Hence, current understanding of sepsis as an immunologically heterogeneous syndrome enables researchers to expand existing concepts of its pathogenesis. In contrast to classical concept based on a shift from inflammation to immune suppression, the novel results suggest a simultaneous presence of both processes in the same patient, making it necessary to reconsider the existing diagnostic and therapeutic approaches.

INTRODUCTION: Microbiota metabolism disturbance, assessed by the dynamics of clinically significant aromatic metabolites in the blood, plays an important role in the development of complications after cardiac surgery, which is the basis for the search for a new prevention strategy. OBJECTIVES: To evaluate the feasibility of microbial metabolism modulation using antibiotics-inhibitors of protein synthesis in bacterial cell for prevention of infectious-inflammatory complications after cardiac surgery. MATERIAL AND METHODS: A randomized prospective interventional study was conducted, including patients (n = 58) who underwent planned surgical intervention on the heart and main vessels under artificial circulation and were divided into group I — main group — patients with microbial metabolism modulation using antibiotics-inhibitors of protein synthesis (n = 30), group II — control group — patients without microbial metabolism modulation (n = 28). Blood serum samples from patients were taken before surgery, on the 3rd and 6th days of the postoperative period, in which clinical blood parameters, biomarkers, and concentrations of clinically significant aromatic acids were determined. RESULTS: In groups I and II postoperative complications were observed in 6 and 8 patients, respectively. Groups I and II differed significantly in the frequency of pneumonia (0 vs. 5 patients, respectively, p = 0.016). The spectrum of microorganisms determined in group II was significantly wider. In group I there was a more significant decrease in 4-hydroxyphenylacetic acid (p-HPhAA) concentration between baseline and postoperative values on the 3rd and 6th day, compared to group II (p = 0.016 and p = 0.005, respectively). The sum of aromatic metabolites on the 3rd day and p-HPhAA on the 6th day had a good predictor significance in relation to the complication development (sensitivity 100 % in both cases; specificity 81.5 % and 92.6 %, respectively). CONCLUSIONS: Prophylactic use of antibiotics-inhibitors of microbial protein synthesis allows to reliably reduce the degree of microbiota metabolism dysfunction and the frequency of pneumonia development in the early postoperative period.