Exhaustion, immuno-inflammation, and pathogen burden after cardiac surgery: An exploratory study

Pamela S. Miller, Lorraine Evangelista, Joyce Newman Giger, Otoniel Martinez-Maza, Teresita Corvera-Tindel, Larry Magpantay, Guadalupe Pena, Lynn V. Doering

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Exhaustion, a consequence of prolonged stress characterized by unusual fatigue, is associated with increased risk of cardiac morbidity and mortality. In patients recovering from coronary artery bypass (CABG), little is known about the relationship of 1) immune-mediated inflammation and resultant endothelial activation, and 2) cumulative exposure to infectious pathogens (pathogen burden (PB)) implicated in coronary atherosclerosis to exhaustion. Aim: The aim of this exploratory study was to investigate the association of PB, inflammatory markers (interleukin (IL)-6, IL-10) and a marker of endothelial activation (soluble intercellular adhesion molecule-1 (sICAM-1)) to exhaustion. Methods: One to two months post-CABG, 42 individuals who met inclusion criteria were assessed for exhaustion using the Maastricht Interview for Vital Exhaustion. Serum IgG antibodies to herpes simplex virus (HSV)-1, HSV-2, cytomegalovirus, Epstein Barr virus, and inflammatory and endothelial activation markers were measured by enzymelinked immunosorbent assay. Pathogen burden was defined as the total number of seropositive exposures: low (0-1), moderate (2-3), and high (4). Results: Prevalence of exhaustion was 40.5%. Relative to non-exhausted patients, exhausted patients demonstrated a higher frequency of moderate PB (h=0.73, p=0.04) but lower frequency of high PB (h=1.05, p=0.03). Exhaustion showed a non-significant trend for positive correlations with IL-6 and sICAM-1 levels, and inverse relation to PB. In subgroup analysis, exhausted patients had stronger correlations with IL-6 and IL-6:IL-10 and a tendency towards higher serum IL-10 concentrations compared with their non-exhausted counterparts. Conclusion: This hypothesis-generating study provides preliminary evidence that elevated post-CABG exhaustion may be associated with PB, inflammation, and endothelial activation.

Original languageEnglish (US)
Pages (from-to)211-220
Number of pages10
JournalEuropean Journal of Cardiovascular Nursing
Volume13
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Thoracic Surgery
Interleukin-6
Interleukin-10
Inflammation
Intercellular Adhesion Molecule-1
Immunosorbents
Human Herpesvirus 2
Human Herpesvirus 1
Serum
Cytomegalovirus
Human Herpesvirus 4
Coronary Artery Bypass
Fatigue
Coronary Artery Disease
Immunoglobulin G
Interviews
Morbidity
Mortality
Antibodies

Keywords

  • Coronary heart disease
  • cytokines
  • herpesviruses
  • inflammation
  • pathogen burden
  • vital exhaustion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing
  • Medical–Surgical
  • Medicine(all)

Cite this

Miller, P. S., Evangelista, L., Giger, J. N., Martinez-Maza, O., Corvera-Tindel, T., Magpantay, L., ... Doering, L. V. (2014). Exhaustion, immuno-inflammation, and pathogen burden after cardiac surgery: An exploratory study. European Journal of Cardiovascular Nursing, 13(3), 211-220. https://doi.org/10.1177/1474515113482805

Exhaustion, immuno-inflammation, and pathogen burden after cardiac surgery : An exploratory study. / Miller, Pamela S.; Evangelista, Lorraine; Giger, Joyce Newman; Martinez-Maza, Otoniel; Corvera-Tindel, Teresita; Magpantay, Larry; Pena, Guadalupe; Doering, Lynn V.

In: European Journal of Cardiovascular Nursing, Vol. 13, No. 3, 01.01.2014, p. 211-220.

Research output: Contribution to journalArticle

Miller, PS, Evangelista, L, Giger, JN, Martinez-Maza, O, Corvera-Tindel, T, Magpantay, L, Pena, G & Doering, LV 2014, 'Exhaustion, immuno-inflammation, and pathogen burden after cardiac surgery: An exploratory study', European Journal of Cardiovascular Nursing, vol. 13, no. 3, pp. 211-220. https://doi.org/10.1177/1474515113482805
Miller, Pamela S. ; Evangelista, Lorraine ; Giger, Joyce Newman ; Martinez-Maza, Otoniel ; Corvera-Tindel, Teresita ; Magpantay, Larry ; Pena, Guadalupe ; Doering, Lynn V. / Exhaustion, immuno-inflammation, and pathogen burden after cardiac surgery : An exploratory study. In: European Journal of Cardiovascular Nursing. 2014 ; Vol. 13, No. 3. pp. 211-220.
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abstract = "Background: Exhaustion, a consequence of prolonged stress characterized by unusual fatigue, is associated with increased risk of cardiac morbidity and mortality. In patients recovering from coronary artery bypass (CABG), little is known about the relationship of 1) immune-mediated inflammation and resultant endothelial activation, and 2) cumulative exposure to infectious pathogens (pathogen burden (PB)) implicated in coronary atherosclerosis to exhaustion. Aim: The aim of this exploratory study was to investigate the association of PB, inflammatory markers (interleukin (IL)-6, IL-10) and a marker of endothelial activation (soluble intercellular adhesion molecule-1 (sICAM-1)) to exhaustion. Methods: One to two months post-CABG, 42 individuals who met inclusion criteria were assessed for exhaustion using the Maastricht Interview for Vital Exhaustion. Serum IgG antibodies to herpes simplex virus (HSV)-1, HSV-2, cytomegalovirus, Epstein Barr virus, and inflammatory and endothelial activation markers were measured by enzymelinked immunosorbent assay. Pathogen burden was defined as the total number of seropositive exposures: low (0-1), moderate (2-3), and high (4). Results: Prevalence of exhaustion was 40.5{\%}. Relative to non-exhausted patients, exhausted patients demonstrated a higher frequency of moderate PB (h=0.73, p=0.04) but lower frequency of high PB (h=1.05, p=0.03). Exhaustion showed a non-significant trend for positive correlations with IL-6 and sICAM-1 levels, and inverse relation to PB. In subgroup analysis, exhausted patients had stronger correlations with IL-6 and IL-6:IL-10 and a tendency towards higher serum IL-10 concentrations compared with their non-exhausted counterparts. Conclusion: This hypothesis-generating study provides preliminary evidence that elevated post-CABG exhaustion may be associated with PB, inflammation, and endothelial activation.",
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