Claudia Torino1, Luna Gargani2, Rosa Sicari2, Krzysztof Letachowicz3, Robert Ekart4, Danilo Fliser5, Adrian Covic6, Kostas Siamopoulos7, Aristeidis Stavroulopoulos8, Ziad A Massy9, Enrico Fiaccadori10, Giuseppe Regolisti10, Thomas Bachelet11, Itzchak Slotki12, Alberto Martinez-Castelao13, Marie-Jeanne Coudert-Krier14, Patrick Rossignol14,15, Thierry Hannedouche16,15, Andrzej Wiecek17, Pantelis Sarafidis18, Yuri Battaglia19, Nejra Prohić20, Marian Klinger21, Radovan Hojs4, Sarah Seiler-Mußler5, Fabio Lizzi5, Dimitrie Siriopol6, Olga Balafa7, Linda Shavit12, Charalampos Loutradis18, Alexandre Seidowsky9, Rocco Tripepi1, Francesca Mallamaci1, Giovanni Tripepi1, Eugenio Picano2, Gérard Michel London22,15, Carmine Zoccali23,24. 1. Institute of Clinical Physiology-Reggio Cal Unit, National Research Council, Reggio Calabria, Italy. 2. Institute of Clinical Physiology-Pisa, National Research Council, Pisa, Italy. 3. Medical University, Wroclaw, Poland. 4. University Clinical Centre Maribor, Maribor, Slovenia. 5. Saarland University Hospital, Homburg, Germany. 6. Dr. C.I.Parhon Hospital, Iasi, Romania. 7. University Hospital of Ioannina, Ioannina, Greece. 8. IASIO Hospital-General Clinic of Kallithea, Kallithea, Greece. 9. Ambroise Pare University Hospital, APHP, Paris-Ile-de France-Ouest University (UVSQ), INSERM U1018, Boulogne Billancourt, Paris, France. 10. Dipartiment of Medicine and Surgery and Nephrology Unit, University Hospital Parma, Parma, Italy. 11. C.T.M.R. Saint-Augustin, Bordeaux, France. 12. Shaare Zedek Medical Center, Jerusalem, Israel. 13. Bellvitge's University Hospital-Hospitalet, Barcelona, REDinREN Instituto Salud Carlos III, Madrid, Spain. 14. Centre D'Investigation Clinique Plurithématique Pierre Drouin-INSERM-CHRU de Nancy-Université de Lorraine and Institute Lorrain du Coeur Et de Vaisseaux Louis Mathieu, Vandœuvre-lès-Nancy, France. 15. FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) Network, Nancy, France. 16. University Hospital Strasbourg, Strasbourg, France. 17. University of Silesia in Katowice, Katowice, Poland. 18. Aristotle University, Thessaloniki, Greece. 19. Università Di Ferrara, Ferrara, Italy. 20. Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina. 21. University of Opole, Opole, Poland. 22. Centre Hospitalier F.H. Manhès, Fleury-Mérogis, France. 23. Institute of Clinical Physiology-Reggio Cal Unit, National Research Council, Reggio Calabria, Italy. carmine.zoccali@tin.it. 24. CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, 89124, Reggio Calabria, Italy. carmine.zoccali@tin.it.
Abstract
INTRODUCTION: Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. 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.
INTRODUCTION: Since inflammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifier of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. 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 ESKDpatients. 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.
Authors: Krzysztof Letachowicz; Anna Królicka; Andrzej Tukiendorf; Mirosław Banasik; Dorota Kamińska; Tomasz Gołębiowski; Magdalena Kuriata-Kordek; Katarzyna Madziarska; Oktawia Mazanowska; Magdalena Krajewska Journal: J Clin Med Date: 2022-02-05 Impact factor: 4.241