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González-Montelongo MDC, Egea-Guerrero JJ, Murillo-Cabezas F, González-Montelongo R, Ruiz de Azúa-López Z, Rodríguez-Rodríguez A, Vilches-Arenas A, Castellano A, Ureña J. Relation of RhoA in Peripheral Blood Mononuclear Cells With Severity of Aneurysmal Subarachnoid Hemorrhage and Vasospasm. Stroke 2018; 49:1507-1510. [DOI: 10.1161/strokeaha.117.020311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022]
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Gil-Salazar T, Egea-Guerrero JJ, Martin-Villen L, Ruiz de Azua-López Z. Organ donor management: Common recommendations that deserve evidence. Med Intensiva 2018; 42:513. [PMID: 29622462 DOI: 10.1016/j.medin.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
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Toapanta Gaibor NG, González-Roncero FM, Cintra Cabrera M, Suñer Poblet M, Bernal Blanco G, Suarez Benjumea A, Pérez-Valdivia MA, Egea-Guerrero JJ, Rocha Castilla JL, Gentil Govantes MA. Survival and Evolution of Renal Function in Kidney Transplant Recipients From Type II Asystolic Donations: A Single-center Experience. Transplant Proc 2018; 50:565-568. [PMID: 29579853 DOI: 10.1016/j.transproceed.2017.11.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/19/2017] [Accepted: 11/11/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND In recent years, stagnation in the number of kidneys from after brain-dead donors (DBD) has stimulated the use of non-heart beating donors (NHBDs). Herein we present our 5-year experience with type II Maastricht NHBDs in renal transplantation. METHODS All patients (n = 50) in this study received type II Maastricht NHBD kidneys (March 2012 to February 2017), with a median follow-up of 33 months. RESULTS Mean donor age was 39 ± 12 years, mean creatinine 1.24 ± 0.2 mg/dL, and the most frequently observed blood group (donors and recipients) was type A (64%). Recipients were slightly younger (51 ± 11 years old), with mean time on dialysis of 30 ± 24 months. Almost all were primary transplants. Pre-transplant panel-reactive antibodies (PRA) were <25%; initial immunosuppression was thymoglobulin, corticosteroids, mycophenolate mofetil, and delayed introduction of tacrolimus. Six percent were nonfunctioning kidneys; 79.6% presented with delayed renal function (mean duration 14 ± 9 days). Acute rejection was seen in 6% of patients. Mean creatinine at month 3 was 1.7 ± 0.8 mg/dL, and 1.5 ± 0.8 mg/dL in the first year. The last available mean creatinine was 1.54 ± 0.7 mg/dL. Proteinuria in the third month, first year, and third year was 0.70, 0.41, and 0.26 g/d, respectively. Recipient survival at the first, third, and fifth year was 100%, 100%, and 86%, and when graft-censored for death was 94%, 91%, and 91%, respectively. The incidence of acute rejection during first year was 6%, and 2% in the second year. Exitus incidence was 4% and cytomegalovirus infection was 21.3%. BK viremia between 1000 and 10,000 copies/mL was seen in 4.3%, and reached >10,000 copies/mL in 2.1%. CONCLUSIONS Type II NHBD has shown limited frequency of nonfunctioning kidney and high functional delay. The results in survival and renal function are very acceptable, comparable with levels seen in donation after brain death.
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Egea-Guerrero JJ, Martín-Villén L, Ruiz de Azúa-López Zaida Z, Bonilla-Quintero Francisco F, Pérez-López Enrique E, Marín-Andrés R, Correa-Chamorro E, Vilches-Arenas Á. Short-term Results From a Training Program to Improve Organ Donation in Uncontrolled Donation After Circulatory Death. Transplant Proc 2018; 50:530-532. [PMID: 29579843 DOI: 10.1016/j.transproceed.2017.09.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In all organ transplantation programs, election of the proper protocol relies primarily on the professionals involved in the detection of potential donors. The objective of our study was to assess the impact of a series of prehospital training sessions, as well as to develop several positive feedback strategies within the uncontrolled organ donation after circulatory death (uDCD) program in our city. METHODS A before-after intervention study was carried out in 3 steps. First, professionals enrolled in the Emergency Health Services Agency-061 (EPES-061) program underwent specific training to identify potential donors. Second, a specific logotype was designed to alert emergency health care professionals that in cases where cardiopulmonary resuscitation was ineffective and after treatment of all potentially reversible causes, the "chain of survival" should be considered a "chain of opportunities." Third, a positive feedback strategy was put in place, whereby each time a donation was procured, the EPES-061 personnel that had identified the potential donor were notified by phone and in a personal letter. RESULTS The mean age for donors was 50.5 years of age (interquartile range 37-52.5), and 89.5% of all donations came from male subjects. Positive feedback letters and phone calls, including information on final outcome, were provided to the appropriate personnel in 100% of the cases. Postintervention information showed an increase in both eligible and utilized donors. CONCLUSIONS Interventions outside the hospital setting that facilitate optimal implementation of the uDCD program are an essential part of this strategy to increase the donor pool and make the wait shorter for transplant patients.
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Roldán-Reina AJ, Martín-Villén L, Palomo-López N, Hannon V, Cuenca-Apolo DX, Adriaensens-Pérez M, Porras-López M, Ruiz de Azúa-López Z, Corcia-Palomo Y, Egea-Guerrero JJ. Living Donor in Renal Transplantation: Minimizing Risks. Transplant Proc 2018; 50:543-545. [PMID: 29579847 DOI: 10.1016/j.transproceed.2017.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/21/2017] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Abstract
In recent years, the broadening of indications for renal transplantation, together with the progressive reduction of donations following brain stem death, has led to living donation being considered in increasing numbers of cases for renal transplantation. To investigate this further, it is necessary to assess the impact it has on the postoperative outcomes in the intensive care unit (ICU). Our group conducted a retrospective, observational, single-center study from 2013 to 2016 to evaluate differences in outcomes between living and cadaveric kidney donation both during ICU admission and total hospitalization. We compared differences in characteristics between living and deceased graft recipients including demographics, comorbidities, analytical data, radioisotope imaging test results, complications, ICU and hospital ward length of stay, and mortality. In all, 387 patients were eligible for analysis, and 13% received living donor grafts. Our results demonstrate that this group had significantly fewer complications, shorter length of hospital stay, and reduced mortality in comparison with recipients of cadaveric donor grafts. The better postoperative outcomes from living donor grafts could result from careful selection of the donor and less inflammatory injury, minimizing risk in the postoperative period.
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Palomo-López N, Martín-Villén L, Roldán-Reina ÁJ, Ruiz de Azúa-López Z, Cuenca-Apolo DX, Adriaensens-Pérez M, Corcia-Palomo Y, Egea-Guerrero JJ. Results of Controlled Donation After Circulatory Death in a Third-Level Hospital. Transplant Proc 2018; 50:536-538. [PMID: 29579845 DOI: 10.1016/j.transproceed.2017.11.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/09/2017] [Accepted: 11/11/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the characteristics and evolution of controlled donation after circulatory death (DCD) type III. MATERIALS AND METHODS Observational and retrospective study of controlled DCD type III of donors conducted from 2014 to 2016. Clinical data, intensive care unit (ICU) stay, cause of death, warm ischemia time, and total time were collected. Delayed graft function (DGF) and survival of renal transplant were also registered. Qualitative variables are described as frequencies and absolute values and quantitative variables as medians and interquartile ranges. RESULTS A total of 21 donors were collected; 71% (15) were males, median age was 55 years (interquartile range [IR] 48-72), and median ICU stay was 7 days (IR 4-12). The main cause of death was anoxic encephalopathy (57%, 12), followed by intracerebral hemorrhage (28%, 6). In 48%, withdrawal of life support occurred in the operating room, and 98% of donors were preserved by abdominal super-rapid cannulation technique. Average warm ischemia time was 20 minutes (IR 16-24), and total ischemia time was 26 minutes (IR 23-34). Of the donations, 57% were livers and 90% were kidneys. Out of 42 kidneys donated, 54% (23) of them were valid. Median renal transplant hospital stay was 18 days (IR 6-24), and 46% develop DGF. Survival at discharge was 100%. CONCLUSION DCD type III ensures a source of organs. The main cause of death was anoxic encephalopathy. Most donors were able to donate some solid organ.
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Lagerstedt L, Egea-Guerrero JJ, Rodríguez-Rodríguez A, Bustamante A, Montaner J, El Rahal A, Andereggen E, Rinaldi L, Sarrafzadeh A, Schaller K, Sanchez JC. Early measurement of interleukin-10 predicts the absence of CT scan lesions in mild traumatic brain injury. PLoS One 2018; 13:e0193278. [PMID: 29466474 PMCID: PMC5821397 DOI: 10.1371/journal.pone.0193278] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/07/2018] [Indexed: 12/26/2022] Open
Abstract
Traumatic brain injury is a common event where 70%-90% will be classified as mild TBI (mTBI). Among these, only 10% will have a brain lesion visible via CT scan. A triage biomarker would help clinicians to identify patients with mTBI who are at risk of developing a brain lesion and require a CT scan. The brain cells damaged by the shearing, tearing and stretching of a TBI event set off inflammation cascades. These cause altered concentrations of a high number of both pro-inflammatory and anti-inflammatory proteins. This study aimed to discover a novel diagnostic biomarker of mTBI by investigating a broad panel of inflammation biomarkers and their capacity to correctly identify CT-positive and CT-negative patients. Patients enrolled in this study had been diagnosed with mTBI, had a GCS score of 15 and suffered from at least one clinical symptom. There were nine patients in the discovery group, 45 for verification, and 133 mTBI patients from two different European sites in the validation cohort. All patients gave blood samples, underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. The ability of each protein to classify patients was evaluated with sensitivity set at 100%. Three of the 92 inflammation proteins screened-MCP-1, MIP-1alpha and IL-10 -were further investigated in the verification group, and at 100% sensitivity their specificities reached 7%, 0% and 31%, respectively. IL-10 was validated on a larger cohort in comparison to the most studied mTBI diagnostic triage protein to date, S100B. Levels of both proteins were significantly higher in CT-positive than in CT-negative patients (p < 0.001). S100B's specificity at 100% sensitivity was 18% (95% CI 10.8-25.2), whereas IL-10 reached a specificity of 27% (95% CI 18.9-35.1). These results showed that IL-10 might be an interesting and clinically useful diagnostic tool, capable of differentiating between CT-positive and CT-negative mTBI patients.
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Egea-Guerrero JJ, Rodríguez-Rodríguez A, Quintana-Díaz M, Freire-Aragón MD, Raya-Collados D, Hernández-García C, Ortiz-Manzano Á, Vilches-Arenas Á, Díez-Naz A, Guerrero JM, Murillo-Cabezas F. Validation of S100B use in a cohort of Spanish patients with mild traumatic brain injury: a multicentre study. Brain Inj 2018; 32:459-463. [PMID: 29355397 DOI: 10.1080/02699052.2018.1429019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The aim of this study was to validate the S100B protein as a diagnostic tool for ruling out the presence of intracranial lesion (IL) after mild traumatic brain injury (mTBI). Subjects with a Glasgow Coma Scale (GCS) score of 15 and at least one neurological symptom post-trauma were selected from a large Spanish cohort. METHODS A number of 260 patients with mTBI were enrolled. Blood samples were extracted within 6 h and CT scan performed within 24 h post-injury. Blood samples were also drawn from 18 healthy subjects. RESULTS CT scan revealed the presence of IL in 22 patients (8.5%). Patients with mTBI had higher S100B serum levels (p = 0.008) than the healthy subjects (p < 0.001). The ROC analysis of S100B discriminated between patients with and without IL (AUC: 0.671; 95%CI: 0.574-0.769; p = 0.008). The multivariate analysis identified male gender (OR: 5.39; 95%CI: 1.45-20.10; p = 0.012), age > 65 (OR: 2.97; 95%CI: 1.04-8.44; p = 0.041) and S100B level >0.10 µg/L (OR: 7.93; 95%CI: 1.03-60.76; p = 0.046) as independent risk factors for IL in patients with mTBI. CONCLUSION Measurement of S100B within 6 h of mTBI accurately predicts risk of IL in patients with a GCS score of 15 and at least one neurological symptom.
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Roldán-Reina AJ, Egea-Guerrero JJ, Palomo-López N, Cuenca-Apolo DX, Adriaensens-Pérez M, Martín-Villén L. Kidney transplantation in the Intensive Care Unit: Graft evaluation using imaging tests. Med Intensiva 2017; 43:384-386. [PMID: 29110916 DOI: 10.1016/j.medin.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/20/2017] [Accepted: 09/04/2017] [Indexed: 11/19/2022]
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Rodríguez-Rodríguez A, Egea-Guerrero JJ, Vilches-Arenas Á, Gordillo-Escobar E, Ruiz de Azúa-López Z, Murillo-Cabezas F. Prognostic value of total antioxidant capacity to predict functional outcome in traumatic brain injury patients. Clin Chem Lab Med 2017; 55:e265-e267. [PMID: 28412718 DOI: 10.1515/cclm-2017-0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/20/2017] [Indexed: 11/15/2022]
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Freire-Aragón MD, Rodríguez-Rodríguez A, Egea-Guerrero JJ. Update in mild traumatic brain injury. Med Clin (Barc) 2017; 149:122-127. [PMID: 28571951 DOI: 10.1016/j.medcli.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/01/2017] [Indexed: 01/15/2023]
Abstract
There has been concern for many years regarding the identification of patients with mild traumatic brain injury (TBI) at high risk of developing an intracranial lesion (IL) that would require neurosurgical intervention. The small percentage of patients with these characteristics and the exceptional mortality associated with mild TBI with IL have led to the high use of resources such as computerised tomography (CT) being reconsidered. The various protocols developed for the management of mild TBI are based on the identification of risk factors for IL, which ultimately allows more selective indication or discarding both the CT application and the hospital stay for neurological monitoring. Finally, progress in the study of brain injury biomarkers with prognostic utility in different clinical categories of TBI has recently been incorporated by several clinical practice guidelines, which has allowed, together with clinical assessment, a more accurate prognostic approach for these patients to be established.
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Ruiz de Azúa-López Z, Martín-Villén L, Egea-Guerrero JJ. Decisions after irreversible cardiopulmonary arrest: ends and opportunities. Med Intensiva 2017. [PMID: 28647129 DOI: 10.1016/j.medin.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rodríguez-Rodríguez A, Egea-Guerrero JJ, Vilches-Arenas Á, Quintanilla-Vázquez MJ, Murillo-Cabezas F, Muñoz-Sánchez MÁ. Comparison of two competitive enzyme immunoassay kits for quantification of plasma Urotensin-II in rats. J Immunoassay Immunochem 2017; 38:247-256. [DOI: 10.1080/15321819.2016.1250772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Egea-Guerrero JJ, Martín-Villén L, Ruiz de Azúa-López Z. El proceso de donación tras reanimación cardiopulmonar fallida. Med Clin (Barc) 2017; 148:430. [DOI: 10.1016/j.medcli.2016.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022]
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de-Bonilla-Damiá Á, Fernández-López R, Capote-Huelva FJ, de la Cruz-Vicente F, Egea-Guerrero JJ, Borrego-Dorado I. Role of 18F-FDG PET/CT in primary brain lymphoma. Rev Esp Med Nucl Imagen Mol 2017; 36:298-303. [PMID: 28438519 DOI: 10.1016/j.remn.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study the usefulness of 18F-FDG PET/CT in the initial evaluation and in the response assessment in primary brain lymphoma. MATERIAL AND METHODS A retrospective analysis was carried out on 18 patients diagnosed with primary brain lymphoma, a histological subtype of diffuse large B-cell lymphoma, on whom an initial 18F-FDG PET/CT and MRI was performed, with 7 of the cases being analysed after the completion of treatment in order to assess response and clinical follow up. RESULTS Initial 18F-FDG PET/CT showed 26 hypermetabolic foci, whereas 46 lesions were detected by MRI. The average SUV maximum of the lesions was 17.56 with T/N 3.55. The concordance of both tests for identifying the same number of lesions was moderate, obtaining a kappa index of 0.395 (P<.001). In the evaluation of treatment, MRI identified 16 lesions compared to 7 pathological accumulations observed by 18F-FDG PET/CT. The concordance of both tests to assess type of response to treatment was moderate (kappa index 0.41) (P=.04). In both the initial evaluation and the assessment of the response to treatment, PET/CT led to a change strategy in 22% of patients who had lesions outside the cerebral parenchyma. CONCLUSIONS MRI appears to be the method of choice for detecting brain disease in patients with primary brain lymphoma, whereas 18F-FDG PET/CT seems to play a relevant role in the assessment of extra-cerebral disease.
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Lagerstedt L, Egea-Guerrero JJ, Bustamante A, Montaner J, Rodríguez-Rodríguez A, El Rahal A, Turck N, Quintana M, García-Armengol R, Prica CM, Andereggen E, Rinaldi L, Sarrafzadeh A, Schaller K, Sanchez JC. H-FABP: A new biomarker to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury. PLoS One 2017; 12:e0175572. [PMID: 28419114 PMCID: PMC5395174 DOI: 10.1371/journal.pone.0175572] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022] Open
Abstract
The majority of patients with mild traumatic brain injury (mTBI) will have normal Glasgow coma scale (GCS) of 15. Furthermore, only 5%-8% of them will be CT-positive for an mTBI. Having a useful biomarker would help clinicians evaluate a patient's risk of developing intracranial lesions. The S100B protein is currently the most studied and promising biomarker for this purpose. Heart fatty-acid binding protein (H-FABP) has been highlighted in brain injury models and investigated as a biomarker for stroke and severe TBI, for example. Here, we evaluate the performances of S100B and H-FABP for differentiating between CT-positive and CT-negative patients. A total of 261 patients with a GCS score of 15 and at least one clinical symptom of mTBI were recruited at three different European sites. Blood samples from 172 of them were collected ≤ 6 h after trauma. Patients underwent a CT scan and were dichotomised into CT-positive and CT-negative groups for statistical analyses. H-FABP and S100B levels were measured using commercial kits, and their capacities to detect all CT-positive scans were evaluated, with sensitivity set to 100%. For patients recruited ≤ 6 h after trauma, the CT-positive group demonstrated significantly higher levels of both H-FABP (p = 0.004) and S100B (p = 0.003) than the CT-negative group. At 100% sensitivity, specificity reached 6% (95% CI 2.8-10.7) for S100B and 29% (95% CI 21.4-37.1) for H-FABP. Similar results were obtained when including all the patients recruited, i.e. hospital arrival within 24 h of trauma onset. H-FABP out-performed S100B and thus seems to be an interesting protein for detecting all CT-positive mTBI patients with a GCS score of 15 and at least one clinical symptom.
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Muñoz-Sánchez MÁ, Rodríguez-Rodríguez A, Egea-Guerrero JJ, Gordillo-Escobar E, Vilches-Arenas Á, Carrillo-Vico A, Guerrero JM, Murillo-Cabezas F. Urotensinergic system genes in experimental subarachnoid hemorrhage. Med Intensiva 2017; 41:468-474. [PMID: 28081921 DOI: 10.1016/j.medin.2016.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/14/2016] [Accepted: 10/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cerebral vasospasm, one of the main complications of subarachnoid hemorrhage (SAH), is characterized by arterial constriction and mainly occurs from day 4 until the second week after the event. Urotensin-II (U-II) has been described as the most potent vasoconstrictor peptide in mammals. An analysis is made of the serum U-II concentrations and mRNA expression levels of U-II, urotensin related peptide (URP) and urotensin receptor (UT) genes in an experimental murine model of SAH. DESIGN An experimental study was carried out. SETTING Experimental operating room of the Biomedicine Institute of Seville (IBiS), Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS 96 Wistar rats: 74 SAH and 22 sham intervention animals. INTERVENTIONS Day 1: blood sampling, followed by the percutaneous injection of 100μl saline (sham) or blood (SAH) into the subarachnoid space. Day 5: blood sampling, followed by sacrifice of the animals. MAIN VARIABLES OF INTEREST Weight, early mortality, serum U-II levels, mRNA values for U-II, URP and UT. RESULTS Serum U-II levels increased in the SAH group from day 1 (0.62pg/mL [IQR 0.36-1.08]) to day 5 (0.74pg/mL [IQR 0.39-1.43]) (p<0.05), though not in the sham group (0.56pg/mL [IQR 0.06-0.83] day 1; 0.37pg/mL [IQR 0.23-0.62] day 5; p=0.959). Between-group differences were found on day 5 (p<0.05). The ROC analysis showed that the day 5 serum U-II levels (AUC=0.691), URP mRNA (AUC=0.706) and UT mRNA (AUC=0.713) could discriminate between sham and SAH rats. The normal serum U-II concentration range in rats was 0.56pg/mL (IQR 0.06-0.83). CONCLUSION The urotensinergic system is upregulated on day 5 in an experimental model of SAH.
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MESH Headings
- Animals
- Biomarkers
- Disease Models, Animal
- Gene Expression Regulation
- Peptide Hormones/biosynthesis
- Peptide Hormones/blood
- Peptide Hormones/genetics
- RNA, Messenger/biosynthesis
- RNA, Messenger/blood
- RNA, Messenger/genetics
- ROC Curve
- Rats
- Rats, Wistar
- Real-Time Polymerase Chain Reaction
- Receptors, G-Protein-Coupled/biosynthesis
- Receptors, G-Protein-Coupled/blood
- Receptors, G-Protein-Coupled/genetics
- Sensitivity and Specificity
- Subarachnoid Hemorrhage/complications
- Subarachnoid Hemorrhage/genetics
- Urotensins/biosynthesis
- Urotensins/blood
- Urotensins/genetics
- Vasoconstriction/genetics
- Vasospasm, Intracranial/etiology
- Vasospasm, Intracranial/genetics
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Rodríguez-Rodríguez A, Egea-Guerrero JJ. The utility of biomarkers in traumatic brain injury clinical management. Crit Care 2016; 20:376. [PMID: 27855696 PMCID: PMC5114747 DOI: 10.1186/s13054-016-1545-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022] Open
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Egea-Guerrero JJ, Martín-Villén L, Ruiz de Azúa-López Z. [Quality of life after kidney transplant]. Med Clin (Barc) 2016; 147:326. [PMID: 27431889 DOI: 10.1016/j.medcli.2016.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
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Egea-Guerrero JJ, Rodríguez-Rodríguez A. Sepsis biomarkers in severe burn patients: Cut-off point or time profile? Med Intensiva 2016; 40:595-596. [PMID: 27267774 DOI: 10.1016/j.medin.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
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de Azúa López ZR, Egea-Guerrero JJ, Rivera-Rubiales G, Rodríguez-Rodríguez A, Vilches-Arenas Á, Murillo-Cabezas F. Serum brain injury biomarkers as predictors of mortality after severe aneurysmal subarachnoid hemorrhage: preliminary results. Clin Chem Lab Med 2016; 53:e179-81. [PMID: 25781685 DOI: 10.1515/cclm-2014-1189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/26/2015] [Indexed: 11/15/2022]
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Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD, Egea-Guerrero JJ, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, Pino-Sánchez FI, Homar-Ramírez J. Mortality prediction using TRISS methodology in the Spanish ICU Trauma Registry (RETRAUCI). Med Intensiva 2016; 40:395-402. [PMID: 27068001 DOI: 10.1016/j.medin.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI). DESIGN A prospective, multicenter registry evaluation was carried out. SETTING Thirteen Spanish Intensive Care Units (ICUs). PATIENTS Individuals with traumatic disease and available data admitted to the participating ICUs. INTERVENTIONS Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant. MAIN VARIABLES OF INTEREST Predicted and observed mortality. RESULTS A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality. CONCLUSIONS TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma.
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Freire-Aragón MD, Martínez-Roldán A, Egea-Guerrero JJ, Rivera-Fernandez V. Fogging effect. Do we have in mind in early cerebral infarction following aneurysmal subarachnoid hemorrhage? Med Intensiva 2016; 40:590-592. [PMID: 27015788 DOI: 10.1016/j.medin.2016.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
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Rodríguez-Rodríguez A, Egea-Guerrero JJ, Gordillo-Escobar E, Enamorado-Enamorado J, Hernández-García C, Ruiz de Azúa-López Z, Vilches-Arenas Á, Guerrero JM, Murillo-Cabezas F. S100B and Neuron-Specific Enolase as mortality predictors in patients with severe traumatic brain injury. Neurol Res 2016; 38:130-7. [PMID: 27078699 DOI: 10.1080/01616412.2016.1144410] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine temporal profile and prognostic ability of S100B protein and neuron-specific enolase (NSE) for prediction of short/long-term mortality in patients suffering from severe traumatic brain injury (sTBI). METHODS Ninety-nine patients with sTBI were included in the study. Blood samples were drawn on admission and on subsequent 24, 48, 72, and 96 h. RESULTS 15.2% of patients died in NeuroCritical Care Unit, and 19.2% died within 6 months of the accident. S100B concentrations were significantly higher in patients who died compared to survivors. NSE levels were different between groups just at 48 h. In the survival group, S100B levels decreased from 1st to 5th sample (p < 0.001); NSE just from 1st to 3rd (p < 0.001) and then stabilized. Values of S100B and NSE in non-survival patients did not significantly vary over the four days post sTBI. ROC-analysis showed that all S100B samples were useful tools for predicting mortality, the best the 72 h sample (AUC 0.848 for discharge mortality, 0.855 for six-month mortality). NSE ROC-analysis indicated that just the 48-h sample predicted mortality (AUC 0.733 for discharge mortality, 0.720 for six-month mortality). CONCLUSION S100B protein showed higher prognostic capacity than NSE to predict short/long-term mortality in sTBI patients.
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Revuelto-Rey J, Rosich-Andreu S, Egea-Guerrero JJ. Intracranial pressure and hypercapnia during the apnoea test for the diagnosis of brain death. Eur J Neurol 2016; 22:e84. [PMID: 26538271 DOI: 10.1111/ene.12786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/05/2015] [Indexed: 11/28/2022]
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