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Mikacenic C, Price BL, Harju-Baker S, O'Mahony DS, Robinson-Cohen C, Radella F, Hahn WO, Katz R, Christiani DC, Himmelfarb J, Liles WC, Wurfel MM. A Two-Biomarker Model Predicts Mortality in the Critically Ill with Sepsis. Am J Respir Crit Care Med 2017; 196:1004-1011. [PMID: 28418697 DOI: 10.1164/rccm.201611-2307oc] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Improving the prospective identification of patients with systemic inflammatory response syndrome (SIRS) and sepsis at low risk for organ dysfunction and death is a major clinical challenge. OBJECTIVES To develop and validate a multibiomarker-based prediction model for 28-day mortality in critically ill patients with SIRS and sepsis. METHODS A derivation cohort (n = 888) and internal test cohort (n = 278) were taken from a prospective study of critically ill intensive care unit (ICU) patients meeting two of four SIRS criteria at an academic medical center for whom plasma was obtained within 24 hours. The validation cohort (n = 759) was taken from a prospective cohort enrolled at another academic medical center ICU for whom plasma was obtained within 48 hours. We measured concentrations of angiopoietin-1, angiopoietin-2, IL-6, IL-8, soluble tumor necrosis factor receptor-1, soluble vascular cell adhesion molecule-1, granulocyte colony-stimulating factor, and soluble Fas. MEASUREMENTS AND MAIN RESULTS We identified a two-biomarker model in the derivation cohort that predicted mortality (area under the receiver operator characteristic curve [AUC], 0.79; 95% confidence interval [CI], 0.74-0.83). It performed well in the internal test cohort (AUC, 0.75; 95% CI, 0.65-0.85) and the external validation cohort (AUC, 0.77; 95% CI, 0.72-0.83). We determined a model score threshold demonstrating high negative predictive value (0.95) for death. In addition to a low risk of death, patients below this threshold had shorter ICU length of stay, lower incidence of acute kidney injury, acute respiratory distress syndrome, and need for vasopressors. CONCLUSIONS We have developed a simple, robust biomarker-based model that identifies patients with SIRS/sepsis at low risk for death and organ dysfunction.
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Affiliation(s)
- Carmen Mikacenic
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | | | - D Shane O'Mahony
- 3 Department of Pulmonary and Critical Care Medicine, Swedish Medical Center, Seattle, Washington
| | | | - Frank Radella
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - William O Hahn
- 5 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | | | - David C Christiani
- 6 Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; and.,7 Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts
| | | | - W Conrad Liles
- 5 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Mark M Wurfel
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine
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52
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García Villalba E, Bernal Morell E, Egea MP, Marín I, Alcaraz Garcia A, Muñoz A, Vera M, Valero S, Martinez M, Callejo Hurtado V, Gomez Verdu JM, Santo A, Cano Sanchez A. El fragmento N-terminal del propéptido natriurético cerebral es el mejor predictor de mortalidad intrahospitalaria en pacientes con sepsis y bajo riesgo de lesión orgánica. Med Clin (Barc) 2017; 149:189-195. [DOI: 10.1016/j.medcli.2017.02.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/17/2022]
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Lin WC, Chen CW, Chao L, Chao J, Lin YS. Plasma kallistatin in critically ill patients with severe sepsis and septic shock. PLoS One 2017; 12:e0178387. [PMID: 28542440 PMCID: PMC5443576 DOI: 10.1371/journal.pone.0178387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/14/2017] [Indexed: 02/03/2023] Open
Abstract
Kallistatin, an endogenous serine proteinase inhibitor, is protective against sepsis in animal models. The aim of this study was to determine the plasma concentration of kallistatin in intensive care unit (ICU) patients with severe sepsis and septic shock and to determine their potential correlation with disease severity and outcomes. We enrolled 86 ICU patients with severe sepsis and septic shock. Their plasma concentrations of kallistatin, kallikrein, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8 were measured by enzyme-linked immunosorbent assay. The association of kallistatin levels with disease severity and patient outcomes was evaluated. The relationship between kallistatin and other biomarkers was also analyzed. Plasma kallistatin levels on day 1 of ICU admission were lower in patients with septic shock compared with patients with severe sepsis (p = 0.004). Twenty-nine patients who died in the hospital had significantly lower day 1 kallistatin levels than patients who survived (p = 0.031). Using the optimal cutoff value (4 μg/ml) of day 1 plasma kallistatin determined by receiver operating characteristic curves for 60-day mortality, we found that high kallistatin levels were associated with a preferable 60-day survival (p = 0.012) by Kaplan-Meier analysis and lower Sequential Organ Failure Assessment (SOFA) scores over the first 5 days in the ICU (p = 0.001). High kallistatin levels were also independently associated with a decreased risk of septic shock, the development of acute respiratory distress syndrome, and positive blood cultures. In addition, there were inverse correlations between day 1 kallistatin levels and the levels of TNF-α, IL-1β, IL-6, and C-reactive protein, and SOFA scores on day 1. Our results indicate that during severe sepsis and septic shock, a decrease in plasma concentrations of kallistatin reflects increased severity and poorer outcome of disease.
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Affiliation(s)
- Wei-Chieh Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Wen Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lee Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Julie Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Yee-Shin Lin
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
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54
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Rebello A, Thabah MM, Dutta TK, Bobby Z, Harish BN, Mehalingam V. Procalcitonin levels in sepsis and its association with clinical outcome in southern India. Trop Doct 2017; 47:331-336. [PMID: 28409531 DOI: 10.1177/0049475517702314] [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] [Indexed: 01/31/2023]
Abstract
Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, data on procalcitonin levels to predict the clinical outcome in patients with sepsis are limited. The aim of our study was to estimate serum procalcitonin levels in patients with sepsis and to identify its relationship with the clinical outcome. This was a prospective observational study conducted on 112 patients with sepsis admitted to the medical wards and medical intensive care unit of a tertiary care teaching hospital. Serum procalcitonin was measured at baseline before antibiotic administration and on day 5. The clinical outcome studied was death or survival on day 28. Baseline mean serum procalcitonin was highest in patients with septic shock and lowest in patients having sepsis without organ dysfunction. Mean values of procalcitonin at baseline and on day 5 were significantly higher in non-survivors when compared with survivors. There was a significant difference in the change in procalcitonin levels from baseline to day 5 between survivors and non-survivors, with survivors having declining values on day 5 while non-survivors had increasing values from baseline. The baseline APACHE II and SOFA scores also showed a significant correlation with the baseline procalcitonin level. Declining values of procalcitonin therefore indicate a favourable clinical outcome in patients with sepsis.
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Affiliation(s)
- Alex Rebello
- 1 Junior Resident, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Molly Mary Thabah
- 2 Associate Professor, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Tarun Kumar Dutta
- 3 Senior Professor, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Zachariah Bobby
- 4 Professor and Head, Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - B N Harish
- 5 Senior Professor, Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Vadivelan Mehalingam
- 2 Associate Professor, Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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55
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Oh J, Kim SH, Park KN, Oh SH, Kim YM, Kim HJ, Youn CS. High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med 2017; 4:19-24. [PMID: 28435898 PMCID: PMC5385513 DOI: 10.15441/ceem.16.158] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/15/2016] [Accepted: 12/27/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to test the hypothesis that an elevated high-sensitivity C-reactive protein (hs-CRP)/albumin ratio at admission increases the risk of mortality in older patients admitted to the hospital via the emergency department (ED). METHODS We performed a retrospective analysis of patients admitted to the ED with any medical problem between May 2013 and October 2013 who were older than 65 years. The hs-CRP and albumin levels were measured at the time of admission to the ED. The primary outcome was all-cause in-hospital mortality. Multivariate logistic analysis was performed. RESULTS A total of 811 patients were finally included in this study. The mean age was 76±7 years, and 438 subjects (54%) were male. The in-hospital mortality rate was 9.0% (73 patients). The hs-CRP/albumin ratio was higher in nonsurvivors than in survivors (34.2±37.6 vs. 16.2±25.5, P<0.001). Multivariate logistic analysis showed that the hs-CRP/albumin ratio was associated with all-cause in-hospital mortality after adjusting for other confounding factors (odds ratio, 1.011; 95% confidence interval [CI], 1.003 to 1.020). The prognostic value of the hs-CRP/albumin ratio for predicting mortality (area under the curve, 0.728; 95% CI, 0.696 to 0.758) was greater than that of hs-CRP alone (area under the curve, 0.706; 95% CI, 0.674 to 0.738; P<0.001). CONCLUSION The hs-CRP/albumin ratio at admission to the ED is associated with all-cause in-hospital mortality among patients older than 65 years. The hs-CRP/albumin ratio may serve as a surrogate marker of disease severity.
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Affiliation(s)
- Jaehun Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo Hyun Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han Joon Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chun Song Youn
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Ticinesi A, Lauretani F, Nouvenne A, Porro E, Fanelli G, Maggio M, Meschi T. C-reactive protein (CRP) measurement in geriatric patients hospitalized for acute infection. Eur J Intern Med 2017; 37:7-12. [PMID: 27594414 DOI: 10.1016/j.ejim.2016.08.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/31/2016] [Accepted: 08/21/2016] [Indexed: 11/19/2022]
Abstract
The physiology of inflammatory response is modified by the aging process and is substantially affected by multimorbidity and disability. Infection is the most frequent cause of acute inflammation in both adult and older subjects. C-reactive protein (CRP) is the most used biomarker of inflammation, and a substantial amount of literature has demonstrated its importance and clinical usefulness in adult subjects. However, the clinical significance of serum CRP determination has not been completely clarified in older subjects with acute infection, especially in the light of the age-related rearrangements in immunity and cytokine production. Thus, in the present review, we focus on the existing knowledge about serum CRP level interpretation in geriatric patients hospitalized with acute infection. Our aims were to determine the significance of CRP measurement at hospital admission for establishing a diagnosis of infection and/or a prognosis and to evaluate whether it is indicated to repeat hs-CRP measurements during hospital stay for monitoring disease course and, possibly, guiding the discharge timing. We concluded that CRP dosage at hospital admission is helpful to detect acute infection, and particularly sepsis, in geriatric patients, and that CRP elevation may provide valuable short-term prognostic information. At the current state of art, serial CRP measurements are instead not indicated to monitor disease course and plan hospital discharge in this setting.
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Affiliation(s)
- Andrea Ticinesi
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy.
| | - Fulvio Lauretani
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Antonio Nouvenne
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Emanuela Porro
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Guido Fanelli
- Department of Surgical Sciences, University of Parma, Italy; Anesthesia, Intensive Care and Pain Therapy Unit, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Marcello Maggio
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Clinical Geriatrics Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Tiziana Meschi
- Department of Clinical and Experimental Medicine, University of Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Italy
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57
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Pyrpasopoulou A, Pateinakis P, Varouktsi A, Georgianou E, Zografou I, Roilides E, Karagiannis A. Epidemiology and outcome of elderly admitted to the ward for sepsis. Hippokratia 2016; 20:274-278. [PMID: 29416299 PMCID: PMC5788225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The elderly represent a significant cohort of patients presenting at the emergency department, especially in the developed countries. They are characterized by impaired physical condition, comorbidities, and little immune system resources and make frequent use of the healthcare system and its facilities. This study aimed to describe the features and prognostic factors of sepsis in elderly patients (>60 years old) admitted to an internal medicine ward. MATERIAL AND METHODS Two hundred eighty eight consecutively patients aged >60 years who were admitted with sepsis during a two-year-period were retrospectively included in the study. Clinical and laboratory parameters at presentation were analyzed. Causes of sepsis and biochemical markers were compared between the healthcare facility-naïve and the healthcare facility-exposed groups. The effect of comorbidities and previous exposure to the healthcare system on clinical course and outcome of the patients was analyzed. RESULTS Among the comorbidities that were recorded and included in the analysis, the presence of chronic and acute renal impairment and neurologic disabilities were associated with a worse outcome of sepsis in the elderly. In the same cohort, a previous contact with the healthcare system was found to affect the duration of hospital stay, but not the outcome per se. Sepsis-related markers, such as inflammatory markers were not found to be associated with clinical progression and outcome. CONCLUSIONS Timely diagnosis and accurate evaluation of the severity of sepsis is required to ensure a better outcome for the patients. Sensitive markers and accurate prognostic models are constantly pursued. The impact of living characteristics of the modern aging society is additionally addressed and their effect on sepsis outcome assessed. Hippokratia 2016, 20(4): 274-278.
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Affiliation(s)
- A Pyrpasopoulou
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece
- Infectious Diseases Unit, Hippokration Hospital, Thessaloniki, Greece
| | - P Pateinakis
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece
| | - A Varouktsi
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece
| | - E Georgianou
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece
| | - I Zografou
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece
| | - E Roilides
- Infectious Diseases Unit, Hippokration Hospital, Thessaloniki, Greece
- 3 Pediatric Department, Hippokration Hospital, Thessaloniki, Greece
| | - A Karagiannis
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Thessaloniki, Greece
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Conte L, Rossi A, Picariello C, Zuin M, Abbasciano RG, Rigatelli G, Roncon L. Silent large vegetative mitral-aortic enterococcal endocarditis. J Cardiovasc Med (Hagerstown) 2016; 17 Suppl 2:e199-e204. [PMID: 27652816 DOI: 10.2459/jcm.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: In spite of the evolution of diagnostic and imaging tools, infective endocarditis still remains a challenging diagnostic problem. We report the case of a 77-year-old heart failure patient with a very large mitral vegetative lesion but without fever or any other clinical or microbiological 'endocarditis criteria' except the echocardiographic findings. In this scenario, the second more likely differential diagnosis was neoformation of the mitral valve but despite an exhaustive preoperative diagnostic cardiac imaging, this hypothesis could not be excluded before surgical excision and microbiological examination of the surgical specimen.
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Affiliation(s)
- Luca Conte
- aDivision of Cardiology, Rovigo General Hospital, Rovigo bDivision of Cardiology cDivision of Cardiovascular Surgery, Verona University Hospital, Verona dCardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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59
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Simm M, Söderberg E, Larsson A, Castegren M, Nilsen T, Eriksson M, Lipcsey M. Performance of plasma calprotectin as a biomarker of early sepsis: a pilot study. Biomark Med 2016; 10:811-8. [PMID: 27414210 DOI: 10.2217/bmm-2016-0032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM To determine the performance of plasma calprotectin as a marker of sepsis on intensive care unit (ICU) admission and as a marker of mortality day 30 post-ICU admission. MATERIALS & METHODS Consecutive ICU patients were allocated to: sepsis (n = 15), postoperative inflammation (n = 23) and intoxication without inflammation (n = 7) groups. RESULTS Calprotectin was 4.3 (2.6-8.2; mg/l; median [interquartile range]) in the sepsis, 2.8 (1.6-4.4) in the postoperative and 0.7 (0.4-1.6) in the intoxication groups. Area under the receiver operating characteristic curve for sepsis versus intoxication group was: 0.95, for sepsis versus postoperative groups: 0.65 and for survivors versus nonsurvivors: 0.70. CONCLUSION Calprotectin was a sensitive marker of systemic inflammation, is a potential sepsis marker and performed well as mortality predictor in this pilot study.
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Affiliation(s)
- Mikael Simm
- Department of Surgical Sciences/Anaesthesiology & Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ewa Söderberg
- Department of Surgical Sciences/Anaesthesiology & Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences/Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Markus Castegren
- Department of Anaesthesia, Intensive Care & Surgical Services, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Tom Nilsen
- Department of Medical Sciences/Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Mats Eriksson
- Department of Surgical Sciences/Anaesthesiology & Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Hedenstierna laboratory, Department of Surgical Sciences/Anaesthesiology & Intensive Care Medicine, Uppsala University, Uppsala, Sweden
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