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Dimopoulos G, Theodorakopoulou M, Armaganidis A, Tzepi IM, Lignos M, Giamarellos-Bourboulis EJ, Tsaganos T. Esmolol: immunomodulator in pyelonephritis by Pseudomonas aeruginosa. J Surg Res 2015; 198:175-84. [PMID: 26073350 DOI: 10.1016/j.jss.2015.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/03/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Based on previous animal studies showing promising immunomodulatory efficacy esmolol, a selective β1-blocker, it was assumed that administration of esmolol in experimental pyelonephritis by multidrug-resistant Pseudomonas aeruginosa would prolong survival and modulate immune response. METHODS Acute pyelonephritis was induced in 80 rabbits and assigned to eight groups receiving normal saline (controls), esmolol, amikacin, or both agents as pretreatment and as treatment. Blood was sampled for measurement of malondialdehyde and tumor necrosis factor alpha. Animals were followed up for survival, and after death quantitative tissue cultures were performed. The in vitro effect of esmolol on bacterial growth and on the oxidative burst of neutrophils of healthy controls and of sepsis patients was studied. RESULTS Survival of pretreatment groups administered single esmolol or esmolol and amikacin was prolonged compared with that of controls (P = 0.018 and P = 0.014, respectively); likewise, survival of treatment groups administered single esmolol or both agents was prolonged compared with that of controls (P = 0.007 and P = 0.014, respectively). Circulating malondialdehyde was significantly lower in pretreated animals administered esmolol or esmolol and amikacin compared with that in controls and in treated animals administered both agents compared with in controls (P = 0.020). In these groups, the bacterial load of the lung was significantly lower compared with controls. Serum tumor necrosis factor alpha did not change. Amikacin was increased in serum of esmolol-treated animals at levels which inhibited the in vitro growth of the studied isolate. Esmolol did not modify the in vitro growth of P aeruginosa and the oxidative burst of neutrophils. CONCLUSIONS It is concluded that esmolol prolonged survival after experimental infection by multidrug-resistant P aeruginosa. Survival benefit may be related with pleiotropic actions connected with modulation of pharmacokinetics and attenuation of inflammation.
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Theodorakopoulou M, Apollonatou S, Nikitas N, Vassiliadi D, Diamantakis A, Tsagkari V, Frantzeskaki F, Dimopoulou I. Mitochondrial dysfunction and ischemia in critical illness: an adipose tissue microdialysis study in 203 ICU patients. Crit Care 2015. [PMCID: PMC4470667 DOI: 10.1186/cc14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Papadopoulos P, Pistiki A, Christodoulopoulou T, Theodorakopoulou M, Tsagkari V, Armaganidis A, Tsiodras S, Dimopoulou I, Briassoulis G, Briassoulis G. Heat shock proteins 70/90 and associations with immunosuppression along with sepsis: preliminary data. Crit Care 2015. [PMCID: PMC4471461 DOI: 10.1186/cc14122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ilias I, Vassiliadi DA, Theodorakopoulou M, Boutati E, Maratou E, Mitrou P, Nikitas N, Apollonatou S, Dimitriadis G, Armaganidis A, Dimopoulou I. Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: effects of shock and treatment. J Crit Care 2014; 29:1130.e5-9. [PMID: 25012960 DOI: 10.1016/j.jcrc.2014.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/26/2014] [Accepted: 06/01/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study is to assess lipid metabolism at the tissue level in critically ill subjects. MATERIALS AND METHODS We studied 182 patients with systemic inflammatory response syndrome/severe sepsis or shock during the acute (day 1) and subacute phase of critical illness (day 6). All subjects had a tissue microdialysis (MD) catheter placed in femoral adipose tissue upon admission to the intensive care unit (ICU). Plasma cholesterol, high-density lipoprotein, low-density lipoprotein, free fatty acids (FFAs), triglyceride, and MD glycerol (GLYC) were measured on days 1 and 6 in the ICU. RESULTS On admission, 56% of the patients had increased levels (>200 μmol/L) of MD GLYC. Patients with shock displayed more pronounced subcutaneous tissue lipolysis and more profound derangements of circulating lipids vs patients without shock (but no appreciable differences in FFA levels). Furthermore, in patients with shock during the acute period, there were positive, albeit weak, correlations of subcutaneous tissue lipolysis (MD GLYC), plasma FFAs (r=0.260; P=.01), and norepinephrine's dose (r=0.230; P=.01), whereas during the subacute phase, MD GLY levels were higher in patients receiving glucocorticoids (344.7±276.0 μmol/L vs 252.2±158.4 μmol/L; P=.03). CONCLUSIONS Subcutaneous tissue lipolysis is only one of the many determinants of plasma FFAs. Routinely applied therapeutic modalities in the ICU interfere with adipose tissue metabolism.
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Theodorakopoulou M, Dimopoulou I, Karambi S, Strilakou A, Diamantakis A, Orfanos S, Armaganidis A. Early enteral feeding in the septic critically ill patient: evaluation of our feeding protocol. Crit Care 2014. [PMCID: PMC4069561 DOI: 10.1186/cc13616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Theodorakopoulou M, Orfanos S, Nikitas N, Vasilliadi D, Apolonatou S, Diamantakis A, Karkouli G, Diakaki C, Armaganidis A, Dimopoulou I. Adipose tissue lactate clearance but not blood lactate clearance is associated with clinical outcome in severe sepsis or septic shock during the post-resuscitation period. Crit Care 2014. [PMCID: PMC4068836 DOI: 10.1186/cc13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nikitas N, Kopterides P, Ilias I, Theodorakopoulou M, Vassiliadi DA, Armaganidis A, Dimopoulou I. Elevated adipose tissue lactate to pyruvate (L/P) ratio predicts poor outcome in critically ill patients with septic shock: a microdialysis study. Minerva Anestesiol 2013; 79:1229-1237. [PMID: 23857439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Sepsis is a disease affecting tissue metabolism; in vivo microdialysis (MD) is a bedside technique enabling researchers to monitor tissue metabolic changes. We conducted this study aiming to evaluate the relationship between lactate to pyruvate (L/P) ratio, a sensitive marker of tissue oxygenation and perfusion, and mortality in critically ill septic patients. METHODS We enrolled 105 patients with septic shock hospitalized in the mixed intensive care unit of a tertiary hospital. A MD catheter was inserted in the subcutaneous adipose tissue of the upper thigh and interstitial fluid samples were collected and analyzed for glucose, lactate, pyruvate, and glycerol. RESULTS Multivariate regression analysis showed that among variables registered on day 1, APACHE II and SOFA scores, blood lactate and microdialysis-assessed tissue L/P ratio were independently associated with 28-day mortality. Even in patients with normal (<2 mmol/L) blood lactate, adipose tissue L/P ratio showed a strong trend to statistical significance. During the 6-day study period, non-survivors had significantly higher L/P ratios compared to survivors (P=0.001) and mixed model analysis revealed a different pattern of evolution in time with non-survivors experiencing an increase while survivors had a late decline in their L/P ratio. The AUC for L/P ratio was similar to that of APACHE II (P=0.67) and SOFA score (P=0.73). Comparison of the Kaplan-Meier 28-day survival curves of patients with normal (≤ 25) versus elevated (>25) L/P ratios showed that the latter survived significantly less (P=0.02; log-rank test). CONCLUSION Elevated adipose tissue L/P ratio is associated with poor outcome in critically ill patients with septic shock. Microdialysis deserves to be further studied as a research tool in the multi-modal monitoring of septic critically ill patients.
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Flevari A, Theodorakopoulou M, Velegraki A, Armaganidis A, Dimopoulos G. Treatment of invasive candidiasis in the elderly: a review. Clin Interv Aging 2013; 8:1199-208. [PMID: 24043935 PMCID: PMC3772869 DOI: 10.2147/cia.s39120] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Fungi are major causes of infections among immunocompromised or hospitalized patients with serious underlying diseases and comorbidities. Candida species remain the most important cause of opportunistic infections worldwide, affecting predominantly patients over 65 years old, while they are considered to be the fourth most common cause of nosocomial bloodstream infections. The rapidly growing elderly population has specific physiological characteristics, which makes it susceptible to colonization and subsequent infection due to Candida species. Comorbidities and multidrug use should be taken into account any time the therapeutic regimen is under consideration. Different classes of antifungal drugs are available for the treatment of invasive fungal infections but echinocandins, apart from their activity against resistant strains (Candida glabrata and Candida krusei), seem to be safe, with limited adverse events and minimal drug-drug interactions in comparison to the other regimens. Therefore, these agents are strongly recommended when dealing with elderly patients suffering from an invasive form of Candida infection.
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Theodorakopoulou M, Perros E, Giamarellos-Bourboulis EJ, Dimopoulos G. Controversies in the management of the critically ill: the role of probiotics. Int J Antimicrob Agents 2013; 42 Suppl:S41-4. [PMID: 23664676 DOI: 10.1016/j.ijantimicag.2013.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Probiotics are commercially available, viable, non-pathogenic micro-organisms that, when ingested in sufficient quantities, exert a health benefit to the host derived through modification of the gut flora, local release of antimicrobial factors, maintenance of integrity of the gut barrier, competition for epithelial adherence, prevention of bacterial translocation, and modulation of the local immune response. In critically ill patients, probiotics appear to lead to decreased susceptibility to antibiotic-associated diarrhoea, Clostridium difficile infections, ventilator-associated pneumonia, necrotising enterocolitis, acute severe pancreatitis, sepsis and multiple organ dysfunction syndrome as well as a shortened duration of infections. Current scientific evidence supporting the use of probiotics is not conclusive and is mainly derived from single-centre, not very well designed trials that are limited by many factors including small sample sizes, heterogeneity in the probiotic strains used, effectiveness of the combined strains, optimum dose regimens, frequency and duration of administration, and certainly incomplete knowledge of the mechanism of action of each strain. Probiotics appear to be well tolerated, whilst adverse events are very rare. The most commonly reported adverse events include bacteraemia, fungaemia and sepsis. At present, based on the available evidence and although helpful and relatively safe for certain disease conditions, routine use of probiotics in the critically ill is not recommended.
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Kopterides P, Theodorakopoulou M, Ilias I, Nikitas N, Frantzeskaki F, Vassiliadi DA, Armaganidis A, Dimopoulou I. Interrelationship between blood and tissue lactate in a general intensive care unit: a subcutaneous adipose tissue microdialysis study on 162 critically ill patients. J Crit Care 2012; 27:742.e9-18. [PMID: 23089678 DOI: 10.1016/j.jcrc.2012.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 08/04/2012] [Accepted: 08/07/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of the study was to study the interrelationship between blood and tissue lactate in critically ill patients with or without shock admitted in a general intensive care unit. MATERIALS AND METHODS We studied 162 mechanically ventilated patients: 106 with shock (septic shock, 97; cardiogenic shock, 9) and 56 without shock (severe sepsis, 38; systemic inflammatory response syndrome, 18). A microdialysis catheter was inserted in the subcutaneous adipose tissue of the upper thigh, and interstitial fluid was collected every 4 hours for a maximum of 6 days. We assessed the relationship between tissue and blood lactate using cross-approximate entropy and cross-correlation analysis. RESULTS Patients with shock had higher area under the curve for blood (261 vs 175 mmol/L*hours, P < .0001) and tissue lactate (386 vs 281 mmol/L*hours, P < .0001) compared with patients without shock. The interrelationship of tissue-blood lactate, as assessed with cross-approximate entropy, was more regular in patients with shock compared with patients without shock. Cross-correlation of tissue vs blood lactate yielded higher correlation coefficients in patients with shock compared with those without shock, being higher when tissue lactate preceded blood lactate by 4 hours compared with tissue vs blood lactate with no lag time. CONCLUSIONS In critical illness, the detailed dynamics between blood and tissue lactate are affected by the presence of shock. In patients with shock, microdialysis-assessed tissue lactate is higher compared with those without shock and may detect metabolic disturbances before these become evident in the systemic circulation.
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Kopterides P, Nikitas N, Theodorakopoulou M, Diamantakis A, Vassiliadi D, Kaziani A, Assoti S, Drakopanagiotakis F, Antonopoulou A, Papadopoulos P, Mavrou E, Georgiadou C, Tsantes A, Armaganidis A, Dimopoulou I. Red blood cell transfusion improves microdialysis-assessed interstitial lactate/pyruvate ratio in critically ill septic patients. Crit Care 2012. [PMCID: PMC3363864 DOI: 10.1186/cc11053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ilias I, Kopterides P, Nikitas N, Vassiliadi D, Theodorakopoulou M, Papadomichelakis E, Lygnos M, Flevari A, Rizos M, Frantzeskaki F, Diakaki C, Paramythiotou E, Dimitriadou E, Orfanos S, Armaganidis A, Dimopoulou I. Cross-correlation analysis of blood and microdialysis-assessed tissue lactate monitoring: a study in critically ill septic patients. Crit Care 2012. [PMCID: PMC3363678 DOI: 10.1186/cc10867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Poukoulidou T, Spyridaki A, Mihailidou I, Kopterides P, Pistiki A, Alexiou Z, Chrisofos M, Dimopoulou I, Drimoussis P, Giamarellos-Bourboulis EJ, Koutelidakis I, Marioli A, Mega A, Orfanos SE, Theodorakopoulou M, Tsironis C, Maggina N, Polychronopoulos V, Tsangaris I. TREM-1 expression on neutrophils and monocytes of septic patients: relation to the underlying infection and the implicated pathogen. BMC Infect Dis 2011; 11:309. [PMID: 22050935 PMCID: PMC3241479 DOI: 10.1186/1471-2334-11-309] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/04/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Current knowledge on the exact ligand causing expression of TREM-1 on neutrophils and monocytes is limited. The present study aimed at the role of underlying infection and of the causative pathogen in the expression of TREM-1 in sepsis. METHODS Peripheral venous blood was sampled from 125 patients with sepsis and 88 with severe sepsis/septic shock. The causative pathogen was isolated in 91 patients. Patients were suffering from acute pyelonephritis, community-acquired pneumonia (CAP), intra-abdominal infections (IAIs), primary bacteremia and ventilator-associated pneumonia or hospital-acquired pneumonia (VAP/HAP). Blood monocytes and neutrophils were isolated. Flow cytometry was used to estimate the TREM-1 expression from septic patients. RESULTS Within patients bearing intrabdominal infections, expression of TREM-1 was significantly lower on neutrophils and on monocytes at severe sepsis/shock than at sepsis. That was also the case for severe sepsis/shock developed in the field of VAP/HAP. Among patients who suffered infections by Gram-negative community-acquired pathogens or among patients who suffered polymicrobial infections, expression of TREM-1 on monocytes was significantly lower at the stage of severe sepsis/shock than at the stage of sepsis. CONCLUSIONS Decrease of the expression of TREM-1 on the membrane of monocytes and neutrophils upon transition from sepsis to severe sepsis/septic shock depends on the underlying type of infection and the causative pathogen.
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Kopterides P, Nikitas N, Vassiliadi D, Orfanos SE, Theodorakopoulou M, Ilias I, Boutati E, Dimitriadis G, Maratou E, Diamantakis A, Armaganidis A, Ungerstedt U, Dimopoulou I. Microdialysis-assessed interstitium alterations during sepsis: relationship to stage, infection, and pathogen. Intensive Care Med 2011; 37:1756-64. [PMID: 21847648 DOI: 10.1007/s00134-011-2336-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 07/25/2011] [Indexed: 01/19/2023]
Abstract
PURPOSE More than a disorder of macrocirculation, sepsis is a disease affecting the microcirculation and the tissue metabolism. In vivo microdialysis (MD) is a bedside technique that can monitor tissue metabolic changes. We conducted this study aiming (1) to assess whether patients at different sepsis stages present with different MD-assessed tissue metabolic profiles and (2) to determine if different underlying types of infections and implicated pathogens are associated with dissimilar metabolic alterations. METHODS We studied 90 mechanically ventilated patients, 65 with septic shock and 25 with severe sepsis. An MD catheter was inserted in the subcutaneous adipose tissue of the upper thigh and interstitial fluid samples were collected along with arterial blood samples every 4 h for a maximum of 6 days. Lactate, pyruvate, glycerol, and glucose concentrations were measured. RESULTS During the study period, patients with septic shock had higher MD-assessed glycerol (P = 0.009), glycerol gradient (P = 0.016), and glucose (P = 0.004) than patients with severe sepsis, whereas tissue lactate, lactate gradient, and pyruvate dropped significantly with time (P = 0.007, <0.001, and <0.001, respectively) in both patient groups without any observed between-group difference. In addition, there was no between-group difference in their tissue lactate/pyruvate ratio on any day, nor did the ratio decrease significantly with time. Compared with pneumonia patients, and despite similar baseline clinical characteristics, those suffering from intra-abdominal infections showed a pattern of higher and progressively increasing tissue levels of glucose (P = 0.001) and glycerol (P = 0.001). Finally, patients harboring gram-positive infections had higher tissue levels of glycerol (P = 0.027) and glycerol gradient (P = 0.029) than patients with gram-negative infections. CONCLUSIONS MD can detect tissue metabolic abnormalities that differ in relation to the sepsis stage and the type of underlying infection or responsible pathogen. Some of the MD-assessed abnormalities are not reflected by conventional blood measurements and possess prognostic potential. It remains to be determined if this type of metabolic monitoring can find clinical applications in the wide population of septic critically ill patients.
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Frantzeskaki F, Theodorakopoulou M, Mavrou I, Armaganidis A. Acute renal failure and neurological manifestations following ingestion of wild mushrooms. Indian J Nephrol 2011; 19:175-7. [PMID: 20535261 PMCID: PMC2875715 DOI: 10.4103/0971-4065.59347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Theodorakopoulou M, Nikitas N, Ilias I, Tzanela M, Vassiliadi D, Kopterides P, Maniatis N, Diamantakis A, Orfanos S, Perogamvros I, Armaganidis A, Ungerstedt U, Keevil K, Tsagarakis T, Dimopoulou D. Interstitial cortisol levels obtained by adipose tissue microdialysis in mechanically ventilated septic patients: correlations with total and free serum cortisol. Crit Care 2011. [PMCID: PMC3068340 DOI: 10.1186/cc9831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Flevari AG, Maniatis N, Dimitriadou E, Theodorakopoulou M, Paramythiotou E, Christoforidis N, Kaziani A, Koukios D, Drakopanagiotakis F, Armaganidis A. Rohrer's constant, k2, as a factor for determining endotracheal tube obstruction. Crit Care 2011. [PMCID: PMC3061786 DOI: 10.1186/cc9576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Vassiliadi D, Mavrou I, Tzanela M, Nikitas N, Theodorakopoulou M, Orfanos S, Armaganidis A, Tsagarakis S, Dimopoulou I. Salivary cortisol measurements in mechanically ventilated patients. Crit Care 2011. [PMCID: PMC3068338 DOI: 10.1186/cc9829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Theodorakopoulou M, Nikitas N, Orfanos S, Maratou I, Boutati E, Diamantakis A, Armaganidis A, Dimopoulou I. Lipid metabolism in critically ill patients: a microdialysis study. Crit Care 2011. [PMCID: PMC3066959 DOI: 10.1186/cc9705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Georgopoulou AP, Savva A, Giamarellos-Bourboulis EJ, Georgitsi M, Raftogiannis M, Antonakos N, Apostolidou E, Carrer DP, Dimopoulos G, Economou A, Efthymiou G, Galanakis N, Galani L, Gargalianos P, Karaiskos I, Katsenos C, Kavatha D, Koratzanis E, Labropoulos P, Lada M, Nakos G, Paggalou E, Panoutsopoulos G, Paraschos M, Pavleas I, Pontikis K, Poulakou G, Prekates A, Sybardi S, Theodorakopoulou M, Trakatelli C, Tsiaoussis P, Gogos C, Giamarellou H, Armaganidis A, Meisner M. Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis. J Crit Care 2010; 26:331.e1-7. [PMID: 20869839 DOI: 10.1016/j.jcrc.2010.07.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. METHODS A prospective multicenter observational study was conducted in 289 patients. Blood samples were drawn on day 1, that is, within less than 24 hours from advent of signs of sepsis, and on days 3, 7, and 10. Procalcitonin was estimated in serum by the ultrasensitive Kryptor assay (BRAHMS GmbH, Hennigsdorf, Germany). Patients were divided into the following 2 groups according to the type of change of PCT: group 1, where PCT on day 3 was decreased by more than 30% or was below 0.25 ng/mL, and group 2, where PCT on day 3 was either increased above 0.25 ng/mL or decreased less than 30%. RESULTS Death occurred in 12.3% of patients of group 1 and in 29.9% of those of group 2 (P < .0001). Odds ratio for death of patients of group 1 was 0.328. Odds ratio for the administration of inappropriate antimicrobials of patients of group 2 was 2.519 (P = .003). CONCLUSIONS Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials.
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Theodorakopoulou M, Orfanos S, Diamantakis A, Tsafou E, Karkouli G, Nikitas N, Ikonomidis I, Ilias I, Tsangaris I, Armaganidis A, Dimopoulou I. Tissue microdialysis in critically ill septic patients: associations with sepsis severity and mortality. Crit Care 2010. [PMCID: PMC2934197 DOI: 10.1186/cc8380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Theodorakopoulou M, Nikitas N, Orfanos S, Vassiliadou D, Diamantakis A, Kotanidou A, Kopterides P, Maniatis N, Armaganidis A, Dimopoulou I. Extracellular metabolic alterations in critically ill septic patients studied by adipose tissue microdialysis. Crit Care 2010. [PMCID: PMC3254949 DOI: 10.1186/cc9134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dimopoulou I, Orfanos SE, Pelekanou A, Kotanidou A, Livaditi O, Augustatou C, Zervou M, Douka E, Theodorakopoulou M, Karagianni V, Douzinas E, Armaganidis A, Giamarellos-Bourboulis EJ. Serum of patients with septic shock stimulates the expression of Trem-1 on U937 monocytes. Inflamm Res 2009; 58:127-32. [PMID: 19109693 DOI: 10.1007/s00011-008-7039-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the concentrations of sTREM-1 in patients with sepsis and to explore the effects of their serum on the expression of TREM-1 on U937 monocytes. METHODS Blood was sampled at regular time intervals in 56 patients with sepsis. Concentrations of tumour necrosis factor-alpha (TNFalpha), interleukin-1beta (IL-1alpha), IL-6, IL-8, IL-10 and IL-12p70 and sTREM-1 were measured. U937 monocytes were incubated in the presence of serum at sepsis onset. RESULTS Median sTREM-1 concentration on day 1 for patients with septic shock was 915 pg/ml and 228.5 pg/ml for those without shock (p = 0.002). TNFalpha, IL-1alpha, IL-6, IL-8 and IL-10 did not differ between them. A positive correlation was found between changes of sTREM-1 and SOFA scores from day 1 to 7. Sera of patients with septic shock evoked a significant increase of the expression of TREM-1. The concentrations of TNFalpha and IL-8 in supernatants increased only after stimulating with sera of patients without shock, but not after stimulating with sera of patients with shock. CONCLUSIONS Levels of sTREM-1 correlated with sepsis severity. sTREM-1 is considerably higher in patients with shock compared to patients without shock. The serum of shocked patients could stimulate the expression of TREM-1 on U937 monocytes.
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Kopterides P, Mavrou I, Kostadima E, Zakynthinos E, Lignos M, Kontopithari G, Papadomichelakis E, Theodorakopoulou M, Tsangaris I, Dimopoulos G, Dimopoulou I, Orfanos S, Bonovas S, Armaganidis A. Venous oxygen saturation and lactate gradient from the superior vena cava to the pulmonary artery in ICU patients with septic shock. Crit Care 2009. [PMCID: PMC4084121 DOI: 10.1186/cc7399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kopterides P, Synetos A, Theodorakopoulou M, Armaganidis A, Lerakis S. Osborn waves in sepsis-induced hypothermia. Int J Cardiol 2008; 129:297-9. [PMID: 17651838 DOI: 10.1016/j.ijcard.2007.06.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 06/23/2007] [Indexed: 11/29/2022]
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