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Dungu AM, Lundgaard AT, Ryrsø CK, Hegelund MH, Jensen AV, Kristensen PL, Krogh-Madsen R, Faurholt-Jepsen D, Ostrowski SR, Banasik K, Lindegaard B. Inflammatory and endothelial host responses in community-acquired pneumonia: exploring the relationships with HbA1c, admission plasma glucose, and glycaemic gap-a cross-sectional study. Front Immunol 2024; 15:1372300. [PMID: 38840922 PMCID: PMC11150596 DOI: 10.3389/fimmu.2024.1372300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/22/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Diabetes is associated with dysregulated immune function and impaired cytokine release, while transient acute hyperglycaemia has been shown to enhance inflammatory cytokine release in preclinical studies. Although diabetes and acute hyperglycaemia are common among patients with community-acquired pneumonia (CAP), the impact of chronic, acute, and acute-on-chronic hyperglycaemia on the host response within this population remains poorly understood. This study investigated whether chronic, acute, and acute-on- chronic hyperglycaemia are associated with distinct mediators of inflammatory, endothelial, and angiogenic host response pathways in patients with CAP. Methods In a cross-sectional study of 555 patients with CAP, HbA1c, admission plasma (p)-glucose, and the glycaemic gap (admission p-glucose minus HbA1c- derived average p-glucose) were employed as measures of chronic, acute, and acute-on-chronic hyperglycaemia, respectively. Linear regression was used to model the associations between the hyperglycaemia measures and 47 proteins involved in inflammation, endothelial activation, and angiogenesis measured at admission. The models were adjusted for age, sex, CAP severity, pathogen, immunosuppression, comorbidity, and body mass index. Adjustments for multiple testing were performed with a false discovery rate threshold of less than 0.05. Results The analyses showed that HbA1c levels were positively associated with IL-8, IL-15, IL-17A/F, IL-1RA, sFlt-1, and VEGF-C. Admission plasma glucose was also positively associated with these proteins and GM-CSF. The glycaemic gap was positively associated with IL-8, IL-15, IL-17A/F, IL-2, and VEGF-C. Conclusion In conclusion, chronic, acute, and acute-on-chronic hyperglycaemia were positively associated with similar host response mediators. Furthermore, acute and acute-on-chronic hyperglycaemia had unique associations with the inflammatory pathways involving GM-CSF and IL-2, respectively.
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Affiliation(s)
- Arnold Matovu Dungu
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Agnete Troen Lundgaard
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Koch Ryrsø
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hein Hegelund
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Andreas Vestergaard Jensen
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital – Hvidovre Hospital, Hvidovre, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Malézieux-Picard A, Nascè A, Azurmendi L, Pagano S, Vuilleumier N, Sanchez JC, Reny JL, Zekry D, Roux X, Stirnemann J, Garin N, Prendki V. Kinetics of inflammatory biomarkers to predict one-year mortality in older patients hospitalized for pneumonia: a multivariable analysis. Int J Infect Dis 2022; 122:63-69. [PMID: 35550179 DOI: 10.1016/j.ijid.2022.05.002] [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: 03/15/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Long-term mortality is increased in older patients with pneumonia. We aimed to test whether residual inflammation is predictive of one-year mortality after pneumonia. METHODS Inflammation biomarkers (C-reactive protein [CRP], interleukin [IL]-6 and IL-8, tumor necrosis factor-α, serum amyloid A, neopterin, myeloperoxidase, anti-apolipoprotein A-1, and anti-phosphorylcholine IgM) were measured at admission and discharge in older patients hospitalized for pneumonia in a prospective study. Univariate and multivariate analyses were conducted using absolute level at discharge and relative and absolute differences between admission and discharge for all biomarkers, along with usual prognostic factors. RESULTS In the 133 included patients (median age, 83 years [interquartile range: 78-89]), one-year mortality was 26%. In univariate analysis, the relative difference of CRP levels had the highest area under the receiver operating characteristic curve (0.70; 95% confidence interval [CI] 0.60-0.80). A decrease of CRP levels of more than 67% between admission and discharge had 68% sensitivity and 68% specificity to predict survival. In multivariate analysis, lower body mass index (hazard ratio=0.87 [CI 95% 0.79-0.96], P-value=0.01), higher IL-8 (hazard ratio=1.02 [CI 95% 1.00-1.04], P-value=0.02), and higher CRP (1.01 [95% CI 1.00-1.02], P=0.01) at discharge were independently associated with mortality. CONCLUSION Higher IL-8 and CRP levels at discharge were independently associated with one-year mortality. The relative CRP difference during hospitalization was the best individual biomarker for predicting one-year mortality.
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Affiliation(s)
- Astrid Malézieux-Picard
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland.
| | - Alberto Nascè
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland
| | - Leire Azurmendi
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland
| | - Sabrina Pagano
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland
| | - Nicolas Vuilleumier
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Jean-Charles Sanchez
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Xavier Roux
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Intensive Care Division, Geneva University Hospitals, Genève, Switzerland
| | - Jérôme Stirnemann
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Nicolas Garin
- Medical Faculty, University of Geneva, Genève, Switzerland; Department of General Internal Medicine, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Genève, Switzerland
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Role of Clinical Characteristics and Biomarkers at Admission to Predict One-Year Mortality in Elderly Patients with Pneumonia. J Clin Med 2021; 11:jcm11010105. [PMID: 35011845 PMCID: PMC8745347 DOI: 10.3390/jcm11010105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A hospitalization for community-acquired pneumonia results in a decrease in long-term survival in elderly patients. We assessed biomarkers at admission to predict one-year mortality in a cohort of elderly patients with pneumonia. METHODS A prospective observational study included patients >65 years hospitalized with pneumonia. Assessment of PSI, CURB-65, and biomarkers (C-reactive protein (CRP), procalcitonin (PCT), NT-pro-B-type natriuretic peptide (NT-proBNP), interleukin (IL)-6 and -8, tumor necrosis factor alpha (TNF-α), serum amyloid A (SAA), neopterin (NP), myeloperoxidase (MPO), anti-apolipoprotein A-1 IgG (anti-apoA-1), and anti-phosphorylcholine IgM (anti-PC IgM)) was used to calculate prognostic values for one-year mortality using ROC curve analyses. Post hoc optimal cutoffs with corresponding sensitivity (SE) and specificity (SP) were determined using the Youden index. RESULTS A total of 133 patients were included (median age 83 years [IQR: 78-89]). Age, dementia, BMI, NT-proBNP (AUROC 0.65 (95% CI: 0.55-0.77)), and IL-8 (AUROC 0.66 (95% CI: 0.56-0.75)) were significantly associated with mortality, with NT-proBNP (HR 1.01 (95% CI 1.00-1.02) and BMI (HR 0.92 (95% CI 0.85-1.000) being independent of age, gender, comorbidities, and PSI with Cox regression. At the cutoff value of 2200 ng/L, NT-proBNP had 67% sensitivity and 70% specificity. PSI and CURB-65 were not associated with mortality. CONCLUSIONS NT-proBNP levels upon admission and BMI displayed the highest prognostic accuracy for one-year mortality and may help clinicians to identify patients with poor long-term prognosis.
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Song Y, Sun W, Dai D, Liu Y, Li Z, Tian Z, Liu X. Prediction value of procalcitonin combining CURB-65 for 90-day mortality in community-acquired pneumonia. Expert Rev Respir Med 2020; 15:689-696. [PMID: 33336607 DOI: 10.1080/17476348.2021.1865810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Due to its high mortality rate, immediate and reliable severity assessment and accurate prediction of prognosis at hospital admission is critical for the management of community-acquired pneumonia (CAP) patients.Methods: Consecutive patients with primary diagnosis of CAP and hospitalized at our hospital from January 2013 to December 2015 were screened for this retrospective study. Demographic information, clinical and laboratory examination, severity model scoring, and 90-day outcomes were studied. Area under the curve (AUC) of receiver operating characteristic curve (ROC) was analyzed to compare the predictive value of different prognostic scoring methods.Results: 2099 CAP patients with a median age of 60 (IQR 44.0-73.0) years-old were included in this study. Median length of stay was 10 days (IQR 8.0-13.0). The all-cause 90-day mortality was found in 2.19% (46/2099) of all patients. PCT was identified as an independent predictor for the prognosis of CAP patients. CURB-65 in combination with PCT outperformed other predictive methods in 90-day mortality with the optimal AUC of 0.900 and Youden's Index of 0.706.Conclusions: PCT is a good marker for the assessment of severity and 90-day mortality of CAP patients. The combination of PCT and CURB-65 was more accurate than other prognostic models in predicting 90-day mortality.
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Affiliation(s)
- Yu Song
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenxue Sun
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Deyu Dai
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Liu
- The Respiratory Department, Cang Zhou People's Hospital, China
| | - Zhongyi Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhennan Tian
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaomin Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Hermann S, Brandes F, Kirchner B, Buschmann D, Borrmann M, Klein M, Kotschote S, Bonin M, Reithmair M, Kaufmann I, Schelling G, Pfaffl MW. Diagnostic potential of circulating cell-free microRNAs for community-acquired pneumonia and pneumonia-related sepsis. J Cell Mol Med 2020; 24:12054-12064. [PMID: 32916773 PMCID: PMC7578906 DOI: 10.1111/jcmm.15837] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023] Open
Abstract
Cell-free microRNAs (miRNAs) are transferred in disease state including inflammatory lung diseases and are often packed into extracellular vesicles (EVs). To assess their suitability as biomarkers for community-acquired pneumonia (CAP) and severe secondary complications such as sepsis, we studied patients with CAP (n = 30), sepsis (n = 65) and healthy volunteers (n = 47) subdivided into a training (n = 67) and a validation (n = 75) cohort. After precipitating crude EVs from sera, associated small RNA was profiled by next-generation sequencing (NGS) and evaluated in multivariate analyses. A subset of the thereby identified biomarker candidates was validated both technically and additionally by reverse transcription quantitative real-time PCR (RT-qPCR). Differential gene expression (DGE) analysis revealed 29 differentially expressed miRNAs in CAP patients when compared to volunteers, and 25 miRNAs in patients with CAP, compared to those with sepsis. Sparse partial-least discriminant analysis separated groups based on 12 miRNAs. Three miRNAs proved as a significant biomarker signature. While expression levels of miR-1246 showed significant changes with an increase in overall disease severity from volunteers to CAP and to sepsis, miR-193a-5p and miR-542-3p differentiated patients with an infectious disease (CAP or sepsis) from volunteers. Cell-free miRNAs are potentially novel biomarkers for CAP and may help to identify patients at risk for progress to sepsis, facilitating early intervention and treatment.
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Affiliation(s)
- Stefanie Hermann
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Florian Brandes
- Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Benedikt Kirchner
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Dominik Buschmann
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Melanie Borrmann
- Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Klein
- Department of Neurology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | | | - Marlene Reithmair
- Institute of Human Genetics, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ines Kaufmann
- Department of Anesthesia, Klinikum Neuperlach, Munich City Hospitals, Munich, Germany
| | - Gustav Schelling
- Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael W Pfaffl
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
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Lim JU, Choi JY, Jeong HJ, Ko JH, Lee JE, Rhee CK. Comparison of clinical characteristics and inflammatory cytokines between hypoxemic and non-hypoxemic human adenovirus 55 pneumonia. J Thorac Dis 2020; 12:4044-4056. [PMID: 32944316 PMCID: PMC7475563 DOI: 10.21037/jtd-19-4067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Human adenovirus (HAdV) can cause severe community-acquired pneumonia, but there are few studies on the associated cytokine patterns. The purpose of this study was to analyze the relationship between inflammatory cytokine and severity of adenovirus pneumonia. Methods This was a prospective observational study. We evaluated pneumonia patients admitted to the Armed Forces Capital Hospital in Korea. On admission, blood samples were acquired from patients who showed signs of pneumonia. HAdV infection was diagnosed using Real-Q RV detection Kit, and types of HAdV were confirmed by nucleotide blast analysis. We used enzyme-linked immunosorbent assays (ELISAs) to quantify the serum levels of cytokines [interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, γ-interferon (IFN-γ), and IL-10]. We evaluated clinical characteristics and cytokine patterns. Results Of 74 pneumonia patients, respiratory specimens from 43 tested positive for HAdV-55, and the other 31 tested negatives. The length of hospital stay was significantly longer in the HAdV group. The serum concentrations of IL-6, IL-8, IL-10, and IFN-γ were all significantly higher in the HAdV group. Of the 43 HAdV pneumonia patients, 6 evidenced PaO2/FiO2 (PF) ratio <300, and 37 did not. Compared to the non-hypoxemic group, the hypoxemic group showed significantly lower lymphocyte and monocyte counts, and increased IL-6 and IFN-γ concentrations. Logistic regression analysis showed that the IL-6, IL-10, and IFN-γ were significantly associated with hypoxemia in the HAdV group. The IL-6, and IFN-γ levels correlated significantly with the PF ratio. Conclusions We found that the levels IL-6, IL-10, and IFN-γ were significantly associated with hypoxemia in patients with HAdV-55 pneumonia.
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Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Ho Jung Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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