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Feng A, Pokharel MD, Liang Y, Ma W, Aggarwal S, Black SM, Wang T. Free Radical-Associated Gene Signature Predicts Survival in Sepsis Patients. Int J Mol Sci 2024; 25:4574. [PMID: 38674159 PMCID: PMC11049877 DOI: 10.3390/ijms25084574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Sepsis continues to overwhelm hospital systems with its high mortality rate and prevalence. A strategy to reduce the strain of sepsis on hospital systems is to develop a diagnostic/prognostic measure that identifies patients who are more susceptible to septic death. Current biomarkers fail to achieve this outcome, as they only have moderate diagnostic power and limited prognostic capabilities. Sepsis disrupts a multitude of pathways in many different organ systems, making the identification of a single powerful biomarker difficult to achieve. However, a common feature of many of these perturbed pathways is the increased generation of reactive oxygen species (ROS), which can alter gene expression, changes in which may precede the clinical manifestation of severe sepsis. Therefore, the aim of this study was to evaluate whether ROS-related circulating molecular signature can be used as a tool to predict sepsis survival. Here we created a ROS-related gene signature and used two Gene Expression Omnibus datasets from whole blood samples of septic patients to generate a 37-gene molecular signature that can predict survival of sepsis patients. Our results indicate that peripheral blood gene expression data can be used to predict the survival of sepsis patients by assessing the gene expression pattern of free radical-associated -related genes in patients, warranting further exploration.
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Affiliation(s)
- Anlin Feng
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Marissa D. Pokharel
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
| | - Ying Liang
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Wenli Ma
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
| | - Saurabh Aggarwal
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
| | - Stephen M. Black
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
| | - Ting Wang
- Center for Translational Science, Florida International University, Port Saint Lucie, FL 34987, USA
- Department of Environmental Health Sciences, Florida International University, Miami, FL 33199, USA
- Department of Cellular and Molecular Medicine, Florida International University, Miami, FL 33199, USA
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Adami ME, Kotsaki A, Antonakos N, Giannitsioti E, Chalvatzis S, Saridaki M, Avgoustou C, Akinosoglou K, Dakou K, Damoraki G, Katrini K, Koufargyris P, Lekakis V, Panagaki A, Safarika A, Eugen-Olsen J, Giamarellos-Bourboulis EJ. qSOFA combined with suPAR for early risk detection and guidance of antibiotic treatment in the emergency department: a randomized controlled trial. Crit Care 2024; 28:42. [PMID: 38321472 PMCID: PMC10848347 DOI: 10.1186/s13054-024-04825-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/01/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Sepsis guidelines suggest immediate start of resuscitation for patients with quick Sequential Organ Failure Assessment (qSOFA) 2 or 3. However, the interpretation of qSOFA 1 remains controversial. We investigated whether measurements of soluble urokinase plasminogen activator receptor (suPAR) may improve risk detection when qSOFA is 1. METHODS The study had two parts. At the first part, the combination of suPAR with qSOFA was analyzed in a prospective cohort for early risk detection. At the second part, the double-blind, randomized controlled trial (RCT) SUPERIOR evaluated the efficacy of the suPAR-guided medical intervention. SUPERIOR took place between November 2018 and December 2020. Multivariate stepwise Cox regression was used for the prospective cohort, while univariate and multivariate logistic regression was used for the RCT. Consecutive admissions at the emergency department (ED) with suspected infection, qSOFA 1 and suPAR ≥ 12 ng/mL were allocated to single infusion of placebo or meropenem. The primary endpoint was early deterioration, defined as at least one-point increase of admission Sequential Organ Failure Assessment (SOFA) score the first 24 h. RESULTS Most of the mortality risk was for patients with qSOFA 2 and 3. Taking the hazard ratio (HR) for death of patients with qSOFA = 1 and suPAR < 12 ng/mL as reference, the HR of qSOFA = 1 and suPAR ≥ 12 ng/mL for 28-day mortality was 2.98 (95% CI 2.11-3.96). The prospective RCT was prematurely ended due to pandemia-related ED re-allocations, with 91 patients enrolled: 47 in the placebo and 44 in the meropenem arm. The primary endpoint was met in 40.4% (n = 19) and 15.9% (n = 7), respectively (difference 24.5% [5.9-40.8]; odds ratio 0.14 [0.04-0.50]). One post hoc analysis showed significant median changes of SOFA score after 72 and 96 h equal to 0 and - 1, respectively. CONCLUSIONS Combining qSOFA 1 with the biomarker suPAR improves its prognostic performance for unfavorable outcome and can help decision for earlier treatment. Trial registration EU Clinical Trials Register (EudraCT, 2018-001008-13) and Clinical-Trials.gov (NCT03717350). Registered 24 October 2018.
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Affiliation(s)
- Maria Evangelia Adami
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Antigone Kotsaki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Nikolaos Antonakos
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Stamatios Chalvatzis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Maria Saridaki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Christina Avgoustou
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | | | | | - Georgia Damoraki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Konstantina Katrini
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Panagiotis Koufargyris
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Vasileios Lekakis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Antonia Panagaki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Asimina Safarika
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Evangelos J Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Str, 124 62, Athens, Greece.
- Hellenic Institute for the Study of Sepsis, Athens, Greece.
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Haupt T, Elfving B, Eugen-Olsen J, Mors O, Köhler-Forsberg O. SuPAR in major depression: Association with 26 weeks antidepressant response and 10-year depression outcomes. Brain Behav Immun Health 2023; 33:100685. [PMID: 37731957 PMCID: PMC10507069 DOI: 10.1016/j.bbih.2023.100685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/26/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Inflammation has been associated with depression and differential antidepressant (AD) treatment response. Soluble urokinase plasminogen activator receptor (suPAR) is a novel measure of chronic inflammation. We investigated whether suPAR is associated with depression severity and AD response. Methods We included 90 patients with major depressive disorder (MDD) who participated in a part-randomized clinical trial of 26 weeks of treatment with escitalopram or nortriptyline. suPAR levels were measured in serum samples collected at baseline and after 8, 12 and 26 weeks. Mixed effects models for the association between suPAR levels and AD response were performed. By merging with Danish nationwide registers, we included information on psychiatric hospital contacts during ten years after the GENDEP trial. Cox regression analyses calculated the hazard rate ratios between suPAR levels and subsequent hospitalizations. Results At baseline, higher suPAR levels were not associated with overall depression severity but with greater severity of neurovegetative depressive symptoms, specifically appetite and weight changes. 57 (63.3%) patients responded positively to treatment. Among 57 (63.3%) patients who achieved response, those who responded had significantly higher baseline suPAR levels levels, and response was associated with a significant decrease in suPAR during AD treatment. Remitters decreased from 3.1 ng/ml at baseline to 2.8 ng/ml after 26 weeks (p = 0.003) and responders from 3.0 to 2.8 ng/ml (p = 0.02), whereas non-remitters and non-responders showed unchanged suPAR levels. We found no correlation between a change in suPAR and a change in MADRS, but a lowering of suPAR correlated with a decrease in neurovegetative symptoms. We found no association between suPAR levels and 10-year risk for hospitalizations. Discussion The present study suggests that an elevated level of chronic inflammation, measured as the suPAR level, is associated with better response to AD treatment.
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Affiliation(s)
- T.H. Haupt
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Psychiatric Center Ballerup, Ballerup, Denmark
| | - B. Elfving
- Translational Neuropsychiatry Unit (TNU), Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J. Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - O. Mors
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - O. Köhler-Forsberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
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Abstract
The medical disorders of alcoholism rank among the leading public health problems worldwide and the need for predictive and prognostic risk markers for assessing alcohol use disorders (AUD) has been widely acknowledged. Early-phase detection of problem drinking and associated tissue toxicity are important prerequisites for timely initiations of appropriate treatments and improving patient's committing to the objective of reducing drinking. Recent advances in clinical chemistry have provided novel approaches for a specific detection of heavy drinking through assays of unique ethanol metabolites, phosphatidylethanol (PEth) or ethyl glucuronide (EtG). Carbohydrate-deficient transferrin (CDT) measurements can be used to indicate severe alcohol problems. Hazardous drinking frequently manifests as heavy episodic drinking or in combinations with other unfavorable lifestyle factors, such as smoking, physical inactivity, poor diet or adiposity, which aggravate the metabolic consequences of alcohol intake in a supra-additive manner. Such interactions are also reflected in multiple disease outcomes and distinct abnormalities in biomarkers of liver function, inflammation and oxidative stress. Use of predictive biomarkers either alone or as part of specifically designed biological algorithms helps to predict both hepatic and extrahepatic morbidity in individuals with such risk factors. Novel approaches for assessing progression of fibrosis, a major determinant of prognosis in AUD, have also been made available. Predictive algorithms based on the combined use of biomarkers and clinical observations may prove to have a major impact on clinical decisions to detect AUD in early pre-symptomatic stages, stratify patients according to their substantially different disease risks and predict individual responses to treatment.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland.
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Blood Cell Responses Following Heavy Alcohol Consumption Coincide with Changes in Acute Phase Reactants of Inflammation, Indices of Hemolysis and Immune Responses to Ethanol Metabolites. Int J Mol Sci 2022; 23:ijms232112738. [PMID: 36361528 PMCID: PMC9656529 DOI: 10.3390/ijms232112738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Aberrations in blood cells are common among heavy alcohol drinkers. In order to shed further light on such responses, we compared blood cell status with markers of hemolysis, mediators of inflammation and immune responses to ethanol metabolites in alcohol-dependent patients at the time of admission for detoxification and after abstinence. Blood cell counts, indices of hemolysis (LDH, haptoglobin, bilirubin), calprotectin (a marker of neutrophil activation), suPAR, CD163, pro- and anti-inflammatory cytokines and autoantibodies against protein adducts with acetaldehyde, the first metabolite of ethanol, were measured from alcohol-dependent patients (73 men, 26 women, mean age 43.8 ± 10.4 years) at baseline and after 8 ± 1 days of abstinence. The assessments also included information on the quantities of alcohol drinking and assays for biomarkers of alcohol consumption (CDT), liver function (AST, ALT, ALP, GGT) and acute phase reactants of inflammation. At baseline, the patients showed elevated values of CDT and biomarkers of liver status, which decreased significantly during abstinence. A significant decrease also occurred in LDH, bilirubin, CD163 and IgA and IgM antibodies against acetaldehyde adducts, whereas a significant increase was noted in blood leukocytes, platelets, MCV and suPAR levels. The changes in blood leukocytes correlated with those in serum calprotectin (p < 0.001), haptoglobin (p < 0.001), IL-6 (p < 0.02) and suPAR (p < 0.02). The changes in MCV correlated with those in LDH (p < 0.02), MCH (p < 0.01), bilirubin (p < 0.001) and anti-adduct IgG (p < 0.01). The data indicates that ethanol-induced changes in blood leukocytes are related with acute phase reactants of inflammation and release of neutrophil calprotectin. The studies also highlight the role of hemolysis and immune responses to ethanol metabolites underlying erythrocyte abnormalities in alcohol abusers.
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Barichello T, Generoso JS, Singer M, Dal-Pizzol F. Biomarkers for sepsis: more than just fever and leukocytosis-a narrative review. Crit Care 2022; 26:14. [PMID: 34991675 PMCID: PMC8740483 DOI: 10.1186/s13054-021-03862-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023] Open
Abstract
A biomarker describes a measurable indicator of a patient's clinical condition that can be measured accurately and reproducibly. Biomarkers offer utility for diagnosis, prognosis, early disease recognition, risk stratification, appropriate treatment (theranostics), and trial enrichment for patients with sepsis or suspected sepsis. In this narrative review, we aim to answer the question, "Do biomarkers in patients with sepsis or septic shock predict mortality, multiple organ dysfunction syndrome (MODS), or organ dysfunction?" We also discuss the role of pro- and anti-inflammatory biomarkers and biomarkers associated with intestinal permeability, endothelial injury, organ dysfunction, blood-brain barrier (BBB) breakdown, brain injury, and short and long-term mortality. For sepsis, a range of biomarkers is identified, including fluid phase pattern recognition molecules (PRMs), complement system, cytokines, chemokines, damage-associated molecular patterns (DAMPs), non-coding RNAs, miRNAs, cell membrane receptors, cell proteins, metabolites, and soluble receptors. We also provide an overview of immune response biomarkers that can help identify or differentiate between systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and sepsis-associated encephalopathy. However, significant work is needed to identify the optimal combinations of biomarkers that can augment diagnosis, treatment, and good patient outcomes.
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Affiliation(s)
- Tatiana Barichello
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC Brazil
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77054 USA
| | - Jaqueline S. Generoso
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC Brazil
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Felipe Dal-Pizzol
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC Brazil
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Abstract
BACKGROUND Prediction modelling can greatly assist the health-care professionals in the management of diseases, thus sparking interest in neonatal sepsis diagnosis. The main objective of the study was to provide a complete picture of performance of prediction models for early detection of neonatal sepsis. METHODS PubMed, Scopus, CINAHL databases were searched and articles which used various prediction modelling measures for the early detection of neonatal sepsis were comprehended. Data extraction was carried out based on Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Extricate data consisted of objective, study design, patient characteristics, type of statistical model, predictors, outcome, sample size and location. Prediction model Risk of Bias Assessment Tool was applied to gauge the risk of bias of the articles. RESULTS An aggregate of ten studies were included in the review among which eight studies had applied logistic regression to build a prediction model, while the remaining two had applied artificial intelligence. Potential predictors like neonatal fever, birth weight, foetal morbidity and gender, cervicovaginitis and maternal age were identified for the early detection of neonatal sepsis. Moreover, birth weight, endotracheal intubation, thyroid hypofunction and umbilical venous catheter were promising factors for predicting late-onset sepsis; while gestational age, intrapartum temperature and antibiotics treatment were utilised as budding prognosticators for early-onset sepsis detection. CONCLUSION Prediction modelling approaches were able to recognise promising maternal, neonatal and laboratory predictors in the rapid detection of early and late neonatal sepsis and thus, can be considered as a novel way for clinician decision-making towards the disease diagnosis if not used alone, in the years to come.
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Jousi M, Mäkinen M, Kaartinen J, Meriläinen L, Castrén M. Pre-hospital suPAR, lactate and CRP measurements for decision-making: a prospective, observational study of patients presenting non-specific complaints. Scand J Trauma Resusc Emerg Med 2021; 29:150. [PMID: 34656150 PMCID: PMC8520226 DOI: 10.1186/s13049-021-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background In the pre-hospital setting, non-urgent patients with non-specific chief complaints pose assessment challenges for the emergency medical systems (EMS). Severely ill patients should be identified among these patients, and unnecessary transport to the emergency department (ED) should be avoided. Unnecessary admissions burden EDs, deplete EMS resources and can even be harmful to patients, especially elderly patients. Therefore, tools for facilitating pre-hospital decision-making are needed. They could be based on vital signs or point-of-care laboratory biomarkers. In this study, we examined whether the biomarker soluble urokinase plasminogen activator receptor (suPAR), either alone or combined with C-reactive protein (CRP) and/or lactate, could predict discharge from the ED and act as a pre-hospital support tool for non-conveyance decision-making.
Methods This was a prospective, observational study of adult patients with normal or near-normal vital signs transported by an EMS to an ED with a code referring to deteriorated general condition. The levels of suPAR, CRP and lactate in the patients’ pre-hospital blood samples were analysed. The values of hospitalized patients were compared to those of discharged patients to determine whether these biomarkers could predict direct discharge from the ED. Results A total of 109 patients (median age: 81 years) were included in the study. Of those, 52% were hospitalized and 48% were discharged from the ED. No statistically significant association was found between suPAR and the ED discharge vs hospitalization outcome (OR: 1.04, 95% CI 0.97–1.13, AUROC: 0.58, 95% CI 0.47–0.69). Adding CRP (AUROC: 0.64, 95% CI 0.54–0.75) or lactate (AUROC: 0.60, 95% CI 0.49–0.71) to the regression models did not improve their diagnostic accuracy. None of the patients with a suPAR value of less than 2 ng/ml were admitted to hospital, while 64% of the patients with a suPAR value of more than 6 ng/ml were hospitalized. Conclusion Pre-hospital suPAR measurements alone or combined with CRP and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints and normal or near-normal vital signs.
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Affiliation(s)
- Milla Jousi
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland.
| | - Marja Mäkinen
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland
| | - Johanna Kaartinen
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland
| | - Leena Meriläinen
- Aidian Oy (Previously Orion Diagnostica), PL 83, 02101, Espoo, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, HYKS Akuutti, PL 340, 00029, HUS, Helsinki, Finland
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Nivukoski U, Bloigu A, Bloigu R, Kultti J, Tuomi H, Niemelä O. Comparison of serum calprotectin, a marker of neutrophil activation, and other mediators of inflammation in response to alcohol consumption. Alcohol 2021; 95:45-50. [PMID: 34228990 DOI: 10.1016/j.alcohol.2021.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 12/20/2022]
Abstract
AIMS Previous studies have indicated that heavy alcohol intake stimulates inflammation and impairs the body's ability to regulate inflammation. The aim of this study was to compare changes in neutrophil calprotectin and a wide spectrum of other inflammatory mediators in response to heavy alcohol drinking. METHODS Serum calprotectin (a marker of neutrophil activation), suPAR, CD163, and pro- (IL-6, IL-8, TNF-α) and anti-inflammatory (IL-10, TGF-β) cytokines were measured from 61 alcohol-dependent subjects (46 men, 15 women, mean age 43.6 ± 11.0 years) at the time of admission for detoxification and after 8 ± 2 days of abstinence. These biomarkers were also measured from age- and sex-matched healthy controls representing abstainers or light drinkers. The clinical assessments included detailed clinical interviews on the amounts and patterns of alcohol consumption and assays for biomarkers of alcohol consumption (GGT, CDT, MCV, GGT-CDT) and liver function (AST, ALT). RESULTS The subjects with alcohol use disorder showed significantly higher concentrations of serum calprotectin (p < 0.0005), suPAR (p < 0.01), CD163 (p < 0.01), IL-6 (p < 0.0005), IL-8 (p < 0.0005), TNF-α (p < 0.001), and IL-10 (p < 0.0005) than healthy controls. These inflammatory mediators, except for CD163, remained elevated after the 8 ± 2-day period of supervised abstinence, which resulted in significant decreases in the biomarkers of alcohol consumption and indices of liver status. The AUC (0.855) for serum calprotectin in differentiating between the heavy drinkers and healthy controls was equal or equivalent with those of the conventional biomarkers of alcohol consumption (GGT:0.835 or CDT:0.803). CONCLUSIONS The data indicate that neutrophil calprotectin is released in response to heavy alcohol intake in a sensitive manner and may be associated with perpetuation of inflammation in patients with alcohol use disorder. Serum calprotectin may also prove to be a useful biomarker for inflammatory activity in alcohol-consuming patients.
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Affiliation(s)
- Ulla Nivukoski
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, 90014, Finland
| | - Risto Bloigu
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014, Finland
| | - Johanna Kultti
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Heidi Tuomi
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
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Ivic R, Nurmi J, Kurland L, Vicente V, Lindström V, Djärv T, Kaartinen J, Castrén M, Bohm K. Soluble urokinase plasminogen activator receptor and lactate as prognostic biomarkers in patients presenting with non-specific chief complaints in the pre-hospital setting - the PRIUS-study. Scand J Trauma Resusc Emerg Med 2021; 29:116. [PMID: 34384460 PMCID: PMC8358910 DOI: 10.1186/s13049-021-00908-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency Medical Services (EMS) are faced daily with patients presenting with non-specific chief complaints (NSC). Patients presenting with NSCs often have normal vital signs. It has previously been established that NSCs may have a serious underlying condition that has yet to be identified. The aim of the current study was to determine if soluble urokinase plasminogen activator receptor (suPAR) and lactate could be used to identify serious conditions among patients presenting with NSCs to the EMS. The secondary aim was to describe the prognostic value for mortality in the group. METHOD A blinded prospective observational cohort study was conducted of patients brought to the ED by ambulance after calling the national emergency number 112 and who were assessed as having NSC by the EMS. Biomarkers were measured during index EMS assessment before transportation to the ED. Patients were followed via EMS and hospital electronic health records. Descriptive and logistic regression analyses were used. RESULTS A total of 414 patients were included, with a median age of 82 years. A serious condition was present in 15.2% of the patients. Elevated suPAR above 3 ng/ml had a positive likelihood ratio (LR+) of 1.17 and a positive predictive value (PPV) of 17.3% as being predictive of a prevalent serious condition. Elevated suPAR above 9 ng/ml had LR+ 4.67 and a PPV of 16.7% as being predictive of 30-day mortality. Lactate was not significantly predictive. CONCLUSION Pre-hospital suPAR and lactate cannot differentiate serious conditions in need of urgent treatment and assessment in the ED among patients presenting with non-specific chief complaints. suPAR has shown to be predictive of 30-day mortality, which could add some value to the clinical assessment. TRIAL REGISTRATION NCT03089359. Registered 20 March 2017, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03089359 .
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Affiliation(s)
- Robert Ivic
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden.
| | - Jouni Nurmi
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Lisa Kurland
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department for Medical Sciences, Örebro University, Örebro, Sweden
| | - Veronica Vicente
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Lindström
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, division of nursing, Stockholm, Sweden.,Samariten Ambulance Stockholm, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Kaartinen
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Maaret Castrén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Katarina Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden
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11
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Velissaris D, Pierrakos C, Karamouzos V, Pantzaris ND, Gogos C. The use of soluble urokinase plasminogen activator receptor (suPAR) as a marker of sepsis in the emergency department setting. A current review. Acta Clin Belg 2021; 76:79-84. [PMID: 31434557 DOI: 10.1080/17843286.2019.1653519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Aim: The purpose of this review is to summarize all relevant publications regarding the use and validity of the soluble urokinase plasminogen activator receptor (suPAR) when used by clinicians in the emergency department (ED) for the detection and monitoring of patients with sepsis syndrome. Methods: A PubMed search was conducted in order to identify all publications related to the use of suPAR in sepsis patients in the ED setting. Results: Although suPAR is actively involved in the pathophysiology of sepsis, over the last 15 years, only a few studies have been published referring to its predictive validity in the ED. Conclusions: SuPAR can be easily and rapidly measured in an ED setting, and its role in the exclusion of an infection and the management of sepsis, alone or in combination to other biomarkers, should be further evaluated. The optimal cut-off value, the timing of the measurement and the role of the suPAR in an ED setting should be further investigated.
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Affiliation(s)
- Dimitrios Velissaris
- Internal Medicine Department, University of Patras, University Hospital of Patras, Patras, Greece
| | | | | | | | - Charalampos Gogos
- Internal Medicine Department, University of Patras, University Hospital of Patras, Patras, Greece
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12
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Niemelä M, Niemelä O, Bloigu R, Bloigu A, Kangastupa P, Juvonen T. Serum Calprotectin, a Marker of Neutrophil Activation, and Other Mediators of Inflammation in Response to Various Types of Extreme Physical Exertion in Healthy Volunteers. J Inflamm Res 2020; 13:223-231. [PMID: 32547154 PMCID: PMC7250293 DOI: 10.2147/jir.s250675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/01/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose While extreme physical exertion is known to induce changes in the status of inflammation comparisons of the responses for various mediators of inflammation after acute bouts of high-intensity exercise have been limited. Subjects and Methods We examined the responses in serum levels of novel inflammatory proteins, calprotectin, suPAR, CD163, and pro- and anti-inflammatory cytokines in 12 physically active volunteers (10 men, 2 women, mean age 37±14 years) before and after completing various types of extreme physical exertion (marathon run, half-marathon run or 24-h cross-country skiing). For comparisons, the levels of the biomarkers were also measured at rest in 30 healthy controls (25 men, 5 women, mean age 42 ± 12 years) with low or sedentary activity. Results Extreme physical exertion induced significant increases in serum calprotectin (p < 0.0005), suPAR (p < 0.01), CD163 (p < 0.05), IL-6 (p < 0.0005), IL-8 (p < 0.01) and IL-10 (p < 0.0005) (pre- vs 3h-post-exercise). These responses were found to normalize within 48 hours. While the increases in blood leukocytes were of similar magnitude following the different types of exercise, markedly more pronounced responses occurred in serum TNF-α (p < 0.01), IL-8 (p < 0.01) and CD163 (p < 0.05) in those with more intense activity. In 3-h post-exercise samples significant correlations were observed between serum calprotectin and IL-6 (rs = 0.720, p < 0.01), IL-10 (rs = 0.615, p < 0.05), TNF-α (rs = 0.594, p < 0.05), suPAR (rs = 0.587, p < 0.05) and blood leukocytes (rs = 0.762, p < 0.01). Conclusion The present results suggest distinct exercise-intensity dependent changes in mediators of inflammation (including calprotectin, suPAR and CD163) following extreme physical exertion. Our findings indicate that there is a major reversible impact of high-intensity physical exertion on the status of inflammation.
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Affiliation(s)
- Markus Niemelä
- Department of Surgery, Oulu University Hospital, Oulu 90029, Finland.,Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki 60220, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki 60220, Finland
| | - Risto Bloigu
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu 90014, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland
| | - Päivikki Kangastupa
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki 60220, Finland
| | - Tatu Juvonen
- Department of Surgery, Oulu University Hospital, Oulu 90029, Finland.,Department of Cardiac Surgery, Helsinki University Hospital, Helsinki 00029, Finland
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13
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Abstract
Sepsis is a dysregulated systemic reaction to a common infection, that can cause life-threatening organ dysfunction. Over the last decade, the mortality rate of patients with sepsis has decreased as long as patients are treated according to the recommendations of the Surviving Sepsis Campaign, but is still unacceptably high. Patients at risk of sepsis should therefore be identified prior to the onset of organ dysfunction and this requires a rapid diagnosis and a prompt initiation of treatment. Unfortunately, there is no gold standard for the diagnosis of sepsis and traditional standard culture methods are time-consuming. Recently, in order to overcome these limitations, biomarkers which could help in predicting the diagnosis and prognosis of sepsis, as well as being useful for monitoring the response to treatments, have been identified. In addition, recent advances have led to the development of newly identified classes of biomarkers such as microRNAs, long-non-coding RNAs, and the human microbiome. This review focuses on the latest information on biomarkers that can be used to predict the diagnosis and prognosis of sepsis.
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Affiliation(s)
- Mi Hee Kim
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Choi
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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14
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Chen D, Wu X, Yang J, Yu L. Serum plasminogen activator urokinase receptor predicts elevated risk of acute respiratory distress syndrome in patients with sepsis and is positively associated with disease severity, inflammation and mortality. Exp Ther Med 2019; 18:2984-2992. [PMID: 31555383 PMCID: PMC6755407 DOI: 10.3892/etm.2019.7931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/13/2019] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to evaluate the predictive value of serum soluble urokinase plasminogen activator receptor (suPAR) regarding the risk of acute respiratory distress syndrome (ARDS) in sepsis patients, and investigate its correlation/association with disease severity, inflammation and mortality in sepsis patients with ARDS. A total of 57 sepsis patients with ARDS and 58 sepsis patients without ARDS were recruited for the present case-control study. Laboratory tests, acute physiology and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were evaluated, and mortality during hospitalization was recorded. Blood samples were collected and serum suPAR was detected by ELISA. Furthermore, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-10 and IL-17, as well as C-reactive protein (CRP) were detected. The results indicated that the serum levels of suPAR in sepsis patients with ARDS were higher than those in sepsis patients without ARDS. Receiver operating characteristics (ROC) curve analysis indicated that it was possible to distinguish sepsis patients with ARDS from sepsis patients without ARDS based on their serum suPAR levels, and multivariate logistic regression analysis suggested that serum suPAR levels were an independent predictor of the risk of ARDS in sepsis patients. In sepsis patients with ARDS, serum suPAR levels were positively correlated with the APACHE II score, SOFA score and the levels of CRP, TNF-α, IL-1β and IL-8. In addition, serum suPAR levels were lower in survivors compared with those in non-survivors, and ROC curve analysis suggested that serum suPAR was able to predict the probability of mortality. In conclusion, serum suPAR independently predicted an elevated risk of ARDS in patients with sepsis, and was correlated/associated with greater disease severity, higher inflammation and increased mortality in patients with sepsis and ARDS.
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Affiliation(s)
- Dan Chen
- Department of Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Xiaoling Wu
- Department of Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Junhui Yang
- Department of Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
| | - Li Yu
- Department of Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, P.R. China
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15
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Gussen H, Hohlstein P, Bartneck M, Warzecha KT, Buendgens L, Luedde T, Trautwein C, Koch A, Tacke F. Neutrophils are a main source of circulating suPAR predicting outcome in critical illness. J Intensive Care 2019; 7:26. [PMID: 31061709 PMCID: PMC6487050 DOI: 10.1186/s40560-019-0381-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Circulating levels of soluble urokinase plasminogen activation receptor (suPAR) have been proposed as a prognostic biomarker in patients with critical illness and sepsis. However, the origin of suPAR in sepsis has remained obscure. We investigated the potential cellular sources of suPAR by analyzing membrane-bound urokinase plasminogen activator receptor (uPAR, CD87) and evaluated its clinical relevance in critically ill patients. Methods We studied 87 critically ill patients (44 with sepsis, 43 without sepsis) from the medical intensive care unit (ICU) in comparison to 48 standard care patients with infections and 27 healthy controls in a prospective single-center non-interventional cohort study. Cellular uPAR expression of different immune cell subsets (by flow cytometry from peripheral blood) and corresponding serum suPAR concentrations were determined upon ICU admission and at day 3. Furthermore, we analyzed the effects of serum from sepsis patients on the activation and uPAR cleavage of primary human neutrophils and macrophages in vitro. Results In healthy controls, uPAR (CD87) expression was detected on nearly all blood neutrophils and monocytes, but only scarcely on lymphocytes. While uPAR expression on monocytes was maintained in ICU patients, only 58% of neutrophils from critically ill patients expressed uPAR, which was significantly lower than in healthy controls or standard care patients. Concomitantly, serum suPAR levels were significantly increased in ICU patients. We noted a clear inverse correlation between low neutrophilic uPAR and high serum suPAR in standard care and ICU patients, indicating that shedding of uPAR from activated neutrophils represents a main source of suPAR in systemic inflammation. Both low uPAR and high suPAR were closely associated with mortality in critically ill patients. Furthermore, serum from sepsis patients induced uPAR protein expression and subsequent receptor shedding on isolated primary neutrophils, but not on macrophages, in vitro. Conclusions The inverse correlation between low uPAR surface expression on neutrophils and high serum suPAR in critically ill patients supports that neutrophils are a main source of shed suPAR proteins in systemic inflammation. Furthermore, high suPAR levels and low neutrophilic uPAR expression predict mortality in ICU patients. Electronic supplementary material The online version of this article (10.1186/s40560-019-0381-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hendrik Gussen
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany
| | - Philipp Hohlstein
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany
| | - Matthias Bartneck
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany
| | | | - Lukas Buendgens
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany
| | - Tom Luedde
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany
| | - Christian Trautwein
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany
| | - Alexander Koch
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany
| | - Frank Tacke
- 1Department of Medicine III, RWTH-University Hospital Aachen, Aachen, 52074 Germany.,2Department of Hepatology/Gastroenterology, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany
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16
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Polzik P, Grøndal O, Tavenier J, Madsen MB, Andersen O, Hedetoft M, Hyldegaard O. SuPAR correlates with mortality and clinical severity in patients with necrotizing soft-tissue infections: results from a prospective, observational cohort study. Sci Rep 2019; 9:5098. [PMID: 30911053 PMCID: PMC6434142 DOI: 10.1038/s41598-019-41688-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/13/2019] [Indexed: 01/12/2023] Open
Abstract
Necrotizing soft tissue infections (NSTI) have a 90-day mortality rate of 18–22%. Tools are needed for estimating the prognosis and severity of NSTI upon admission. We evaluated soluble urokinase-type plasminogen activator receptor (suPAR) levels at admission as a prognostic marker of NSTI severity and mortality. In a prospective, observational cohort study, suPAR was measured in 200 NSTI patients. We compared admission suPAR levels in survivors and non-survivors, patients with septic shock and non-shock, amputation and non-amputation, correlations with Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score. Admission suPAR levels were higher in septic shock vs. non-septic shock patients (9.2 vs. 5.8 ng/mL, p-value < 0.001) and non-survivors vs. survivors (11 vs. 6.1 ng/mL, p-value < 0.001) and correlated with SAPS II (r = 0.52, p < 0.001) and SOFA score (r = 0.64, p < 0.001). Elevated suPAR upon admission was associated with 90-day mortality (log-rank test p < 0.001), however not after adjustment for age, sex, and SOFA score. The AUC for suPAR and 90-day mortality was 0.77. We found that suPAR is a promising candidate for prognosis and severity in patients with NSTI.
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Affiliation(s)
- Peter Polzik
- Department of Anesthesiology, Center of Head and Orthopedics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark.
| | - Olav Grøndal
- Department of Anesthesiology, Center of Head and Orthopedics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
| | - Juliette Tavenier
- Clinical Research Center, Copenhagen University Hospital (Hvidovre), Hvidovre, Denmark
| | - Martin B Madsen
- Department of Intensive Care, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ove Andersen
- Clinical Research Center, Copenhagen University Hospital (Hvidovre), Hvidovre, Denmark.,The Emergency Department, Copenhagen University Hospital (Hvidovre), Hvidovre, Denmark
| | - Morten Hedetoft
- Hyperbaric Medicine Center, Department of Anesthesiology, Center of Head and Orthopedics, University Hospital of Copenhagen (Rigshospitalet), Copenhagen, Denmark
| | - Ole Hyldegaard
- Department of Anesthesiology, Center of Head and Orthopedics, Copenhagen University Hospital (Rigshospitalet), Copenhagen Ø, Denmark
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17
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Long D, Wang Y, Wang H, Wu X, Yu L. Correlation of Serum and Ascitic Fluid Soluble Form Urokinase Plasminogen Activator Receptor Levels With Patient Complications, Disease Severity, Inflammatory Markers, and Prognosis in Patients With Severe Acute Pancreatitis. Pancreas 2019; 48:335-342. [PMID: 30768571 PMCID: PMC6426350 DOI: 10.1097/mpa.0000000000001247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022]
Abstract
Supplemental digital content is available in the text. Objectives The aim of the study was to investigate the correlation of serum and ascitic fluid soluble form urokinase plasminogen activator receptor (suPAR) levels with patients' complications, disease severity, inflammatory markers, and prognosis in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP, 47 patients with mild acute pancreatitis, and 50 healthy controls were enrolled. Serum samples were obtained from all participants after enrollment; meanwhile, ascitic fluid samples were collected from 20 patients with SAP who developed ascites. Serum and ascitic fluid suPAR levels were determined by enzyme-linked immunosorbent assay. Results Serum suPAR level was greatly elevated in patients with SAP than patients with mild acute pancreatitis and healthy controls. Receiver operating characteristic curve showed that serum suPAR presented with good value in predicting risk of pancreatic necrosis, pancreatic infection, and multiple organ dysfunction syndrome, whereas serum suPAR did not predict mortality. Serum suPAR level was also positively correlated with Acute Physiology and Chronic Health Evaluation II score, Balthazar index, and Sequential Organ Failure Assessment score. As to ascitic fluid suPAR, it was positively correlated with serum suPAR level, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, risk of pancreatic infection, and multiple organ dysfunction syndrome. Conclusions Serum and ascetic fluid suPAR levels could be served as markers for disease severity and risk of severe complications in patients with SAP.
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Affiliation(s)
- Ding Long
- From the Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Hu C, Zhou Y, Liu C, Kang Y. Pentraxin-3, procalcitonin and lactate as prognostic markers in patients with sepsis and septic shock. Oncotarget 2017; 9:5125-5136. [PMID: 29435167 PMCID: PMC5797038 DOI: 10.18632/oncotarget.23701] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/05/2017] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to confirm the prognostic value of pentraxin-3 (PTX3), procalcitonin (PCT) and lactate in patients with severe infections requiring ICU management and to develop and validate a model to enhance mortality prediction by combining severity scores with biomarkers. We included 141 patients with the diagnosis of sepsis/septic shock. The levels of PTX3, PCT and lactate were measured on day 0, 3, 7 of hospitalization and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were also evaluated. The influence of these variables on 28-day mortality was evaluated. The 28-day mortality rate in this study was 28.8%. The baseline levels of PTX3, PCT and lactate in the non-survival group were higher than in the survival group (P < 0.05 for all). Pearson's correlation found that PTX3, PCT and lactate were all positively correlated with SOFA and APACHE II scores (P <0.01 for all). Univariate and multivariate Cox regression revealed that PTX3, PCT and lactate were independently associated with 28-day mortality. The models combining above three biomarkers performed better predictive property than each individual one as determined by receiver operating characteristic (ROC) analysis. In summary, our results suggest that PTX3, PCT and lactate could serve as clinically informative biomarkers of disease severity and patient outcome in sepsis/septic shock. A model combining PTX3, PCT and lactate improves mortality prediction in these patients.
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Affiliation(s)
- Chenggong Hu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, Nanchong, China
| | - Yongfang Zhou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, Nanchong, China
| | - Chang Liu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, Nanchong, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, Nanchong, China
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19
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Larsen FF, Petersen JA. Novel biomarkers for sepsis: A narrative review. Eur J Intern Med 2017; 45:46-50. [PMID: 28965741 DOI: 10.1016/j.ejim.2017.09.030] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/12/2017] [Accepted: 09/23/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sepsis is a prevalent condition among hospitalized patients that carries a high risk of morbidity and mortality. Rapid recognition of sepsis as the cause of deterioration is desirable, so effective treatment can be initiated rapidly. Traditionally, diagnosis was based on presence of two or more positive SIRS criteria due to infection. However, recently published sepsis-3 criteria put more emphasis on organ dysfunction caused by infection in the definition of sepsis. Regardless of this, no gold standard for diagnosis exist, and clinicians still rely on a number of traditional and novel biomarkers to discriminate between patients with and without infection, as the cause of deterioration. METHOD Narrative review of current literature. RESULTS A number of the most promising biomarkers for diagnoses and prognostication of sepsis are presented. CONCLUSION Procalcitonin, presepsin, CD64, suPAR, and sTREM-1 are the best evaluated biomarkers for diagnosis and prognostication of sepsis to date. All have limitations in differentiation between infected and non-infected patients with SIRS, and their future role in diagnosis needs to be evaluated. It is important to test utility, performance, and validity of future biomarkers before implementing them in routine clinical care.
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Affiliation(s)
| | - J Asger Petersen
- Department of Day Surgery, Hvidovre Hospital, Kettegaards Alle 30, 2650 Hvidovre, Denmark.
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20
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Desmedt S, Desmedt V, Delanghe JR, Speeckaert R, Speeckaert MM. The intriguing role of soluble urokinase receptor in inflammatory diseases. Crit Rev Clin Lab Sci 2017; 54:117-133. [DOI: 10.1080/10408363.2016.1269310] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - J. R. Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
| | - R. Speeckaert
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
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21
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Patrani M, Tsaganos T, Kotzampassi K, Paraschos M, Katsenos C, Giamarellos-Bourboulis EJ, Mandragos K. Soluble urokinase plasminogen activator receptor informs on the progression course after multiple injuries. Biomarkers 2016; 21:660-4. [PMID: 27121128 DOI: 10.3109/1354750x.2016.1171911] [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] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study is to study the use of soluble urokinase plasminogen activator receptor (suPAR) for the prognosis of multiple organ dysfunction (MOF) after multiple traumas. METHODS Serum suPAR was measured within the first 24 h after multiple injuries in 85 patients. Measurements were repeated after 4 d or at sepsis onset. RESULTS Odds ratio for trauma-associated MOF was 4.09 (p: 0.026) with admission suPAR greater than 8 ng/ml. More than 40% increases of suPAR were associated with odds ratio 9.33 (p: 0.047) for severe sepsis. CONCLUSIONS suPAR is a useful surrogate biomarker for development of MOF and severe sepsis after multiple traumas.
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Affiliation(s)
- Maria Patrani
- a Intensive Care Unit, Korgialeneion Benakeion General Hospital , Athens , Greece
| | - Thomas Tsaganos
- b 4th Department of Internal Medicine , National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Katerina Kotzampassi
- c Department of Surgery , Aristotle University of Thessaloniki, Faculty of Medicine, AHEPA Hospital , Thessaloniki , Greece
| | - Michael Paraschos
- a Intensive Care Unit, Korgialeneion Benakeion General Hospital , Athens , Greece
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22
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Niemelä M, Kangastupa P, Niemelä O, Bloigu R, Juvonen T. Acute Changes in Inflammatory Biomarker Levels in Recreational Runners Participating in a Marathon or Half-Marathon. SPORTS MEDICINE-OPEN 2016; 2:21. [PMID: 27747777 PMCID: PMC5005625 DOI: 10.1186/s40798-016-0045-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/22/2016] [Indexed: 12/30/2022]
Abstract
Background Strenuous physical activity activates the participant’s immune responses; however, few studies exist, observing exercise-induced simultaneous changes in mediators of inflammation. Methods We examined individual responses in soluble urokinase-type plasminogen activator receptor (suPAR), a marker of immune activation, soluble endocytic receptor for haptoglobin-hemoglobin complexes (CD163), a marker of monocyte-macrophage activation, C-reactive protein (CRP), and pro- and anti-inflammatory cytokines from blood samples drawn at baseline, at 3- and 48-h post-races from recreational runners who successfully completed the marathon (199 ± 8 min, n = 4) or half-marathon (132 ± 4 min, n = 4) run. For comparisons, biomarkers reflecting muscle, heart, kidney, and liver functions were measured. Results Significant 3-h post-race increases occurred in levels of suPAR (p < 0.01), CD163 (p < 0.05), white blood cells (p < 0.001), pro-inflammatory cytokines, interleukin-6 (IL-6) (p < 0.001), IL-8 (p < 0.05), and anti-inflammatory cytokine IL-10 (p < 0.05), whereas tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) remained relatively stable. Full-marathon running lead to more pronounced increases in suPAR, CD163, IL-8, and IL-10 than half-marathon running. In addition, 3-h post-race increases of all these parameters correlated significantly with changes in serum TNF-α and cortisol. The 48-h levels of serum suPAR and both pro- and anti-inflammatory cytokines had decreased to baseline levels, whereas CRP, a marker of acute phase response, increased in those with the most prominent IL-6 and IL-10 elevations in their preceding samples. The highest suPAR, CRP, IL-6, TNF-α, IL-10, and cortisol levels were noted in the individual with the most severe post-race fatigue. Conclusions Prolonged running increases mediators of inflammation in an exercise-dose-dependent manner which should be considered in the assessment of health status of physically active individuals after recent acute bouts of strenuous exercise.
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Affiliation(s)
- Markus Niemelä
- Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029 OYS, Oulu, Finland
| | - Päivikki Kangastupa
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and University of Tampere, Hanneksenrinne 7, 60220, Seinäjoki, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and University of Tampere, Hanneksenrinne 7, 60220, Seinäjoki, Finland.
| | - Risto Bloigu
- Medical Informatics and Statistics Research Group, University of Oulu, Oulu, Finland
| | - Tatu Juvonen
- Department of Surgery, Oulu University Hospital, P.O. Box 21, 90029 OYS, Oulu, Finland
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Abstract
Investigation of biomarkers that can promptly predict unfavourable outcome of critically illness is an emerging necessity taking into consideration the need for early intervention, the shortage of available beds in intensive care units and the considerable cost of hospitalisation. The most promising biomarker is soluble urokinase-type plasminogen activator receptor (suPAR). Three studies in large populations of critically ill patients and patients admitted to the emergency department have shown that concentrations >12 ng/mL can safely predict unfavourable outcome. This review presents a thorough analysis of the data from these studies.
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