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He S, Leng W, Du X, He Y, Zhao Y, Wang Y, Yu S. Diagnostic significance of heart-type fatty acid-binding protein as a potential biomarker to predict the mortality rate of patients with sepsis: a systematic review and meta-analysis. Expert Rev Mol Diagn 2022; 22:379-386. [PMID: 35196937 DOI: 10.1080/14737159.2022.2046464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Some studies have found that heart-type fatty acid-binding protein (H-FABP) is related to the prognosis of patients with sepsis. This study aimed to explore whether H-FABP could predict the 28-day mortality in patients with sepsis. METHODS Seven databases were searched, and the studies were screened based on the inclusion and exclusion criteria to assess the quality. The pooled sensitivity (SEN), specificity (SPE) positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve were calculated along with the 95% confidence interval (CI) values. Deeks' funnel plot was used to ascertain any publication bias. Meta-regression analysis was performed to explore the possible sources of heterogeneity. RESULTS Seven studies were assessed that included 822 patients with sepsis. The pooled SEN was 0.76 (95% CI, 0.71-0.81), SPE was 0.66 (95% CI, 0.61-0.70), PLR was 2.21 (95% CI, 1.73-2.83), NLR was 0.36 (95% CI, 0.29-0.54), DOR was 6.23 (95% CI, 4.27-9.11) and the pooled AUC was 0.8137. There was no publication bias. Race, literature language, sampling time, threshold division and threshold effect were not the causes for the large heterogeneity. CONCLUSIONS This meta-analysis suggests that H-FABP has high accuracy in predicting the 28-day mortality rate of patients with sepsis.
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Affiliation(s)
- Songbai He
- Department of emergency, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Wenying Leng
- Department of emergency, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Xiaoli Du
- Department of Radiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yue He
- Department of Radiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yunxia Zhao
- Department of Radiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yuanjun Wang
- Department of Radiology, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Shenghui Yu
- Department of emergency, Chengdu First People's Hospital, Chengdu, Sichuan, China
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Chen FC, Xu YC, Zhang ZC. Multi-biomarker strategy for prediction of myocardial dysfunction and mortality in sepsis. J Zhejiang Univ Sci B 2021; 21:537-548. [PMID: 32633108 DOI: 10.1631/jzus.b2000049] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The present study was to evaluate the feasibility of using the multi-biomarker strategy for the prediction of sepsis-induced myocardial dysfunction (SIMD) and mortality in septic patients. METHODS Brain natriuretic peptide (BNP), cardiac troponin I (cTnI), and heart-type fatty acid-binding protein (h-FABP) in 147 septic patients were assayed within 6 h after admission. We also determined the plasma levels of myeloperoxidase (MPO) and pregnancy-associated plasma protein-A (PAPP-A). The receiver operating characteristic (ROC) curve was used to assess the best cutoff values of various single-biomarkers for the diagnosis of SIMD and the prediction of mortality. Also, the ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) indices were used to evaluate the feasibility of using multi-biomarkers to predict SIMD and mortality. RESULTS Our statistics revealed that only h-FABP independently predicted SIMD (P<0.05). The addition of MPO and cTnI to h-FABP for SIMD prediction provided an NRI of 18.7% (P=0.025) and IDI of 3.3% (P=0.033). However, the addition of MPO or cTnI to h-FABP did not significantly improve the predictive ability of h-FABP to SIMD, as evidenced by the area under the curve (AUC), NRI, and IDI (all P>0.05). A history of shock and MPO were independent predictors of mortality in septic patients (both P<0.05). The addition of PAPP-A and h-FABP to MPO resulted in a mortality prediction with NRI of 25.5% (P=0.013) and IDI of 2.9% (P=0.045). However, this study revealed that the addition of h-FABP or PAPP-A to MPO did not significantly improve the ability to predict mortality, as evidenced by the AUC, NRI, and IDI (all P>0.05). CONCLUSIONS The findings of this study indicate that a sensitive and specific strategy for early diagnosis of SIMD and mortality prediction in sepsis should incorporate three biomarkers.
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Affiliation(s)
- Fa-Chao Chen
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yin-Chuan Xu
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhao-Cai Zhang
- Intensive Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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Tani K, Shirakabe A, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Shigihara S, Sawatani T, Otsuka Y, Takayasu T, Asano M, Nomura A, Hata N, Asai K, Shimizu W. The prognostic impact of the serum heart-type fatty acid-binding protein level in patients with sepsis who were admitted to the non-surgical intensive-care unit. Heart Vessels 2021; 36:1765-1774. [PMID: 34028584 DOI: 10.1007/s00380-021-01865-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 05/07/2021] [Indexed: 11/29/2022]
Abstract
Ongoing myocardial damage at the acme of the sepsis status has not been sufficiently evaluated. The clinical data of 160 sepsis patients who require intensive care and 127 outpatients with chronic heart failure (HF) were compared as a retrospective cohort study. Thereafter, the sepsis patients were divided into 3 groups according to the serum heart-type fatty acid-binding protein (H-FABP) quartiles [low H-FABP = Q1 (n = 39), middle H-FABP = Q2/Q3 (n = 81), and high H-FABP = Q4 group (n = 40)]. The H-FABP level was measured within 15 min of admission. The serum H-FABP levels in the sepsis patients [26.6 (9.3-79.0) ng/ml] were significantly higher than in the choric HF patients [6.6 (4.6-9.7) ng/ml]. A Kaplan-Meier curve showed that the survival rate of the high-H-FABP group was significantly lower than that of the middle- and low-H-FABP groups. The multivariate Cox regression analysis for the 365-day mortality showed that the high-H-FABP group (hazard ratio: 6.544, 95% confidence interval [CI] 2.026-21.140; p = 0.002) was an independent predictor of the 365-day mortality. The same trend in the prognostic impact was significantly (p = 0.015) observed in the cohort that had not been suffering from the cardiac disease before admission. The serum H-FABP level was an independent predictor of the 365-day mortality in the patients who were emergently hospitalized in the intensive-care unit due to sepsis. Ongoing myocardial damage was detected in the majority of patients with sepsis, suggesting that ongoing myocardial damage might be a candidate predictor of adverse outcomes in sepsis patients.
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Affiliation(s)
- Kenichi Tani
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yusuke Otsuka
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Tsutomu Takayasu
- Department of Internal Medicine, Toho Kamagaya Hospital, Chiba, Japan
| | - Miwako Asano
- Department of Internal Medicine, Hasegawa Hospital, Chiba, Japan
| | - Akiko Nomura
- Department of Internal Medicine, Kanamachi Daiichi Hospital, Tokyo, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
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Yang D, Liu G, Guo S, Ren H, Lu H, Zhou L, Bao L. Prognostic value of serum heart-type fatty acid-binding protein in patients with sepsis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24715. [PMID: 33578613 PMCID: PMC10545160 DOI: 10.1097/md.0000000000024715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Sepsis is commonly acute and critical illness with high morbidity and high mortality, and requires timely diagnosis and treatment. Septic patients had elevated serum H-FABP levels, which may correlate with disease severity and mortality. However, previous studies showed that the association between H-FABP and mortality during the sepsis remains unclear. Thus, we performed a study to analyze this relationship. METHODS The electronic databases such as Cochrane Library, PubMed, Embase, Web of Science, Cochrane Clinical Trials Database, Wanfang Database, and China National knowledge Infrastructure (CNKI) were systematically searched to determine the qualified clinical trials. The study language is limited to English or Chinese. The 2 authors used Cochrane Risk of Bias Tool v.2.0 to independently check the quality of papers and extract relevant data. Comprehensive analysis of data extracted in the research using appropriate statistical methods. RESULTS Evaluation of the relationship between the prognosis of patients with sepsis and serum H-FABP is the result of this study. CONCLUSION The analysis results of this study can infer that H-FABP may be an independent risk factor for the prognosis of patients with sepsis. It is also helpful for clinical workers to make early evaluation and early treatment of patients with sepsis. ETHICS AND DISSEMINATION The conclusions of this meta-analysis study are based on the published evidence. Therefore, moral recognition is unnecessary. OSF REGISTRATION NUMBER DOI: 10.17605/ OSF.IO / 2V4HN.(https://osf.io/2v4hn/).
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Affiliation(s)
- Dagang Yang
- Department of Critical Care Medicine, Affiliated Hospital of Inner Mongolia Medical University
| | - Guojuan Liu
- Department of Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital
| | - Shuang Guo
- Department of Surgical Anaesthesia, Traditional Chinese Medicine Hospital of Inner Mongolia Autonomous Region
| | - Huibang Ren
- Emergency ICU, Qinghai Provincial People's Hospital
| | - Hongnan Lu
- Emergency Department, First Affiliated Hospital of Jiamusi University
| | - Lihua Zhou
- Department of Critical Care Medicine, Affiliated Hospital of Inner Mongolia Medical University
| | - Longtang Bao
- Daytime Ward, Affiliated Hospital of Inner Mongolia Medical University, China
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Weng G, Tian P, Yan X, Cheng Q. Altered function of the left ventricle and clinical significance of heart-type fatty acid-binding protein in cardiac dysfunction among patients with sepsis. Exp Ther Med 2020; 20:58. [PMID: 32952648 PMCID: PMC7485322 DOI: 10.3892/etm.2020.9186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to determine the clinical significance of heart-type fatty acid-binding protein (H-FABP) in patients with sepsis-induced cardiac dysfunction. A total of 30 healthy subjects served as the control group and 80 patients with sepsis were recruited for the present single-center prospective observational study for the final analysis. Among these patients, 50 developed cardiac dysfunction, while no cardiac dysfunction was detected in the remaining 30 patients. Echocardiography was performed on days 1, 3, 7 and 10 of hospitalization. Routine blood biochemistry, serum H-FABP, N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin I were also analyzed. Alterations in cardiac biomarkers and echocardiography results were compared between patients with sepsis who did and who did not develop any cardiac dysfunction to determine the time of the occurrence of sepsis-induced cardiac dysfunction. Furthermore, the significance of H-FABP in the prediction of the 28-day mortality rate was evaluated using binary logistic regression analysis for sepsis and receiver operating characteristic (ROC) curve analysis. In addition, the specificity and sensitivity of H-FABP in the prediction of sepsis-induced cardiac dysfunction were verified using ROC curve analysis. For patients with cardiac dysfunction, the levels of cardiac output (CO), stroke volume (SV), mitral early diastolic peak velocity to mitral atrial systolic peak velocity ratio (E/A) and left ventricle ejection fraction (LVEF) were relatively decreased, while the levels of H-FABP and NT-proBNP were markedly increased compared with patients with sepsis and without cardiac dysfunction. CO and SV initially increased and subsequently decreased. EF was elevated, and E/A initially decreased and subsequently increased. Furthermore, H-FABP and NT-proBNP decreased in sepsis patients with cardiac dysfunction. The results of the ROC curve and binary logistic regression analyses suggest that H-FABP was associated with the 28-day prognosis for patients with sepsis. An H-FABP level of >35.7 ng/ml was able to predict the 28-day mortality for patients with sepsis, with an area under the curve (AUC) of 0.680. Furthermore, >30.3 ng/ml was the threshold for the prediction of sepsis-induced cardiac dysfunction, and the sensitivity and specificity were 76.27 and 61.76%, respectively, with an AUC of 0.673. In summary, patients with sepsis had an increased risk of cardiac insufficiency on days 7-10 of hospitalization. In addition, H-FABP may serve as an indicator to predict the prognosis of patients with sepsis in the short term, which has a certain significance in the diagnosis of sepsis-induced cardiac dysfunction.
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Affiliation(s)
- Guopeng Weng
- Second Department of Critical Care Medicine, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang 832002, P.R. China
| | - Peigang Tian
- Second Department of Critical Care Medicine, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang 832002, P.R. China
| | - Xiaojun Yan
- Department of Cardiac Echocardiography, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang 832002, P.R. China
| | - Qinghong Cheng
- Second Department of Critical Care Medicine, The First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang 832002, P.R. China
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Jeong JH, Seo YH, Ahn JY, Kim KH, Seo JY, Kim MJ, Lee HT, Park PW. The Prognostic Value of Serum Levels of Heart-Type Fatty Acid Binding Protein and High Sensitivity C-Reactive Protein in Patients With Increased Levels of Amino-Terminal Pro-B Type Natriuretic Peptide. Ann Lab Med 2017; 36:420-6. [PMID: 27374706 PMCID: PMC4940484 DOI: 10.3343/alm.2016.36.5.420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/22/2016] [Accepted: 06/02/2016] [Indexed: 11/19/2022] Open
Abstract
Background Amino-terminal pro-B type natriuretic peptide (NT-proBNP) is a well-established prognostic factor in heart failure (HF). However, numerous causes may lead to elevations in NT-proBNP, and thus, an increased NT-proBNP level alone is not sufficient to predict outcome. The aim of this study was to evaluate the utility of two acute response markers, high sensitivity C-reactive protein (hsCRP) and heart-type fatty acid binding protein (H-FABP), in patients with an increased NT-proBNP level. Methods The 278 patients were classified into three groups by etiology: 1) acute coronary syndrome (ACS) (n=62), 2) non-ACS cardiac disease (n=156), and 3) infectious disease (n=60). Survival was determined on day 1, 7, 14, 21, 28, 60, 90, 120, and 150 after enrollment. Results H-FABP (P<0.001), NT-proBNP (P=0.006), hsCRP (P<0.001) levels, and survival (P<0.001) were significantly different in the three disease groups. Patients were divided into three classes by using receiver operating characteristic curves for NT-proBNP, H-FABP, and hsCRP. Patients with elevated NT-proBNP (≥3,856 pg/mL) and H-FABP (≥8.8 ng/mL) levels were associated with higher hazard ratio for mortality (5.15 in NT-proBNP and 3.25 in H-FABP). Area under the receiver operating characteristic curve analysis showed H-FABP was a better predictor of 60-day mortality than NT-proBNP. Conclusions The combined measurement of H-FABP with NT-proBNP provides a highly reliable means of short-term mortality prediction for patients hospitalized for ACS, non-ACS cardiac disease, or infectious disease.
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Affiliation(s)
- Ji Hun Jeong
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yiel Hea Seo
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jeong Yeal Ahn
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyung Hee Kim
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ja Young Seo
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Moon Jin Kim
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hwan Tae Lee
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Pil Whan Park
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea.
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Shirakabe A, Kobayashi N, Hata N, Shinada T, Tomita K, Tsurumi M, Okazaki H, Matsushita M, Yamamoto Y, Yokoyama S, Asai K, Shimizu W. The serum heart-type fatty acid-binding protein (HFABP) levels can be used to detect the presence of acute kidney injury on admission in patients admitted to the non-surgical intensive care unit. BMC Cardiovasc Disord 2016; 16:174. [PMID: 27596162 PMCID: PMC5011936 DOI: 10.1186/s12872-016-0340-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/23/2016] [Indexed: 01/12/2023] Open
Abstract
Background No cardiac biomarkers for detecting acute kidney injury (AKI) on admission in non-surgical intensive care patients have been reported. The aim of the present study is to elucidate the role of cardiac biomarkers for quickly identifying the presence of AKI on admission. Methods Data for 1183 patients who underwent the measurement of cardiac biomarkers, including the serum heart-type fatty acid-binding protein (s-HFABP) level, in the emergency department were screened, and 494 non-surgical intensive care patients were enrolled in this study. Based on the RIFLE classification, which was the ratio of the serum creatinine value recorded on admission to the baseline creatinine value, the patients were assigned to a no-AKI (n = 349) or AKI (Class R [n = 83], Class I [n = 36] and Class F [n = 26]) group on admission. We evaluated the diagnostic value of the s-H-FABP level for detecting AKI and Class I/F. The mid-term prognosis, as all-cause death within 180 days, was also evaluated. Results The s-H-FABP levels were significantly higher in the Class F (79.2 [29.9 to 200.3] ng/mL) than in the Class I (41.5 [16.7 to 71.6] ng/mL), the Class R (21.1 [10.2 to 47.9] ng/mL), and no-AKI patients (8.8 [5.4 to 17.7] ng/mL). The most predictive values for detecting AKI were Q2 (odds ratio [OR]: 3.743; 95 % confidence interval [CI]: 1.693–8.274), Q3 (OR: 9.427; 95 % CI: 4.124–21.548), and Q4 (OR: 28.000; 95 % CI: 11.245–69.720), while those for Class I/F were Q3 (OR: 5.155; 95 % CI: 1.030–25.790) and Q4 (OR: 22.978; 95 % CI: 4.814–109.668). The s-HFABP level demonstrating an optimal balance between sensitivity and specificity (70.3 and 72.8 %, respectively; area under the curve: 0.774; 95 % CI: 0.728–0.819) was 15.7 ng/mL for AKI and 20.7 ng/mL for Class I/F (71.0 and 83.1 %, respectively; area under the curve: 0.818; 95 % CI: 0.763–0.873). The prognosis was significantly poorer in the high serum HFABP with AKI group than in the other groups. Conclusions The s-H-FABP level is an effective biomarker for detecting AKI in non-surgical intensive care patients.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Takuro Shinada
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kazunori Tomita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masafumi Tsurumi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yoshiya Yamamoto
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shinya Yokoyama
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Meng JB, Hu MH, Lai ZZ, Ji CL, Xu XJ, Zhang G, Tian S. Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial. Med Sci Monit 2016; 22:1486-96. [PMID: 27138236 PMCID: PMC4861009 DOI: 10.12659/msm.898457] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock. MATERIAL AND METHODS After achieving normovolemia and a mean arterial pressure of at least 65 mmHg, 38 septic shock patients with low cardiac output (left ventricular ejective fraction), LEVF £45%) were randomly divided into two groups: levosimendan dobutamine. Patients in the levosimendan and dobutamine groups were maintained with intravenous infusion of levosimendan (0.2 μg/kg/minute) and dobutamine (5 μg/kg/minute) for 24 hours respectively. During treatment we monitored hemodynamics and LVEF, and measured levels of heart-type fatty acid binding protein (HFABP), troponin I (TNI), and brain natriuretic peptide(BNP). In addition, the length of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, and 28-day mortality were compared between the two groups. RESULTS The levosimendan group and the dobutamine group were well matched with respect to age (years, 55.4 ± 1 7.5 versus 50.2 ± 13.6) and gender (males, 68.4% versus 57.9%). Levosimendan-treated patients had higher stroke volume index (SVI), cardiac index (CI), LVEF, and left ventricular stroke work index (LVSWI), and lower extravascular lung water index (EVLWI) compared to dobutamine-treated patients (p<0.05). HFABP, TNI, and BNP in the levosimendan group were less than in the dobutamine group (p<0.05). There was no difference in the mechanical ventilation time, length of stay in ICU and hospital, and 28-day mortality between the two groups. CONCLUSIONS Compared with dobutamine, levosimendan reduces biomarkers of myocardial injury and improves systemic hemodynamics in patients with septic shock. However, it does not reduce the days on mechanical ventilation, length of stay in ICU and hospital, or 28-day mortality.
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Affiliation(s)
- Jianb-biao Meng
- Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Ma-hong Hu
- Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Zhi-zhen Lai
- Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Chun-lian Ji
- Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Xiu-juan Xu
- Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Geng Zhang
- Department of Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Shuyuan Tian
- Department of Ultrasonography, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
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Tsao TC, Tsai HC, Chang SC. Clinical Usefulness of Urinary Fatty Acid Binding Proteins in Assessing the Severity and Predicting Treatment Response of Pneumonia in Critically Ill Patients: A Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3682. [PMID: 27175705 PMCID: PMC4902547 DOI: 10.1097/md.0000000000003682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To investigate the clinical relevance of urinary fatty acid binding proteins (FABPs), including intestinal-FABP, adipocyte-FABP, liver-FABP, and heart-FABP in pneumonia patients required admission to respiratory intensive care unit (RICU).Consecutive pneumonia patients who admitted to RICU from September 2013 to October 2014 were enrolled except for those with pneumonia for more than 24 h before admission to RICU. Pneumonia patients were further divided into with and without septic shock subgroups. Twelve patients without infection were enrolled to serve as control group. Urine samples were collected on days 1 and 7 after admission to RICU for measuring FABPs and inflammatory cytokines. Clinical and laboratory data were collected and compared between pneumonia and control groups, and between the pneumonia patients with and without septic shock.There were no significant differences in urinary levels of various FABPs and inflammatory cytokines measured on day 1 between control and pneumonia groups. Urinary values of intestine-FABP (P = 0.020), adipocyte-FABP (P = 0.005), heart-FABP (P = 0.025), and interleukin-6 (P = 0.019) were significantly higher and arterial oxygen tension/fraction of inspired oxygen (PaO2/FiO2, P/F) ratio (P = 0.024) was significantly lower in pneumonia patients with septic shock on day 1 than in those without septic shock. After multivariate analysis, adipocyte-FABP was the independent factor (P = 0.026). Urinary levels of FABPs measured on day 7 of pneumonia patients were significantly lower in the improved than in nonimproved groups (P = 0.030 for intestine-FABP, P = 0.003 for adipocyte-FABP, P = 0.010 for heart-FABP, and P = 0.008 for liver-FABP, respectively). After multivariate analysis, adipocyte-FABP was the independent factor (P = 0.023).For pneumonia patients required admission to RICU, urinary levels of adipocyte-FABP on days 1 and 7 after admission to RICU may be valuable in assessing the pneumonia severity and in predicting treatment response, respectively. Further studies with larger populations are needed to verify these issues.
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Affiliation(s)
- Tsung-Cheng Tsao
- From the Institute of Emergency and Critical Care Medicine, National Yang-Ming University (T-CT, S-CC) and Department of Nursing (T-CT, H-CT) and Department of Chest Medicine (S-CC), Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
Sepsis-induced myocardial dysfunction is a common complication in septic patients and is associated with increased mortality. In the clinical setting, it was once believed that myocardial dysfunction was not a major pathological process in the septic patients, at least in part, due to the unavailability of suitable clinical markers to assess intrinsic myocardial function during sepsis. Although sepsis-induced myocardial dysfunction has been studied in clinical and basic research for more than 30 years, its pathophysiology is not completely understood, and no specific therapies for this disorder exist. The purpose of this review is to summarize our current knowledge of sepsis-induced myocardial dysfunction with a special focus on pathogenesis and clinical characteristics.
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Affiliation(s)
- Xiuxiu Lv
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People’s Republic of China, School of Medicine, Jinan University, Guangzhou, Guangdong 510632 China
| | - Huadong Wang
- Department of Pathophysiology, Key Laboratory of State Administration of Traditional Chinese Medicine of the People’s Republic of China, School of Medicine, Jinan University, Guangzhou, Guangdong 510632 China
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Siegler BH, Weiterer S, Lichtenstern C, Stumpp D, Brenner T, Hofer S, Weigand MA, Uhle F. [Use of biomarkers in sepsis. Update and perspectives]. Anaesthesist 2015; 63:678-90. [PMID: 25002138 DOI: 10.1007/s00101-014-2347-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sepsis and related complications are a challenge for intensive care medicine. Despite many advances in antibiotic therapy sepsis remains one of the most common diseases of patients in intensive care units and is designated as the main cause of death in critically ill patients. Persisting sepsis leads to impaired immunity, resulting in immunosuppression. Unspecific predictive signs complicate an early diagnosis; however, an early initiation of adequate therapy is of crucial importance for the prognosis. Scoring systems can be applied for the initial evaluation but are controversially discussed concerning the monitoring of disease progression and therapy as well as outcome prediction. Biomarkers are considered as a complementary approach.
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Affiliation(s)
- B H Siegler
- Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen, Rudolf-Buchheim Str. 7, 35392, Gießen, Deutschland
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Kojic D, Siegler BH, Uhle F, Lichtenstern C, Nawroth PP, Weigand MA, Hofer S, Brenner T. Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis? World J Exp Med 2015; 5:50-63. [PMID: 25992320 PMCID: PMC4436940 DOI: 10.5493/wjem.v5.i2.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/09/2015] [Accepted: 04/02/2015] [Indexed: 02/06/2023] Open
Abstract
Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects - i.e., sepsis induced immunosuppression - but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under intensive investigation. So far, clinical decision just based on biomarker assessment is not yet feasible. However, biomarkers should be considered as a complementary approach.
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Shirakabe A, Kobayashi N, Hata N, Yamamoto M, Shinada T, Tomita K, Tsurumi M, Matsushita M, Okazaki H, Yamamoto Y, Yokoyama S, Asai K, Shimizu W. Prognostic impact of the serum heart-type fatty acid-binding protein (H-FABP) levels in patients admitted to the non-surgical intensive care unit. Clin Res Cardiol 2014; 103:791-804. [DOI: 10.1007/s00392-014-0717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/15/2014] [Indexed: 12/24/2022]
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Glatz JFC, Renneberg R. Added value of H-FABP as plasma biomarker for the early evaluation of suspected acute coronary syndrome. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.13.87] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
There is much enthusiasm and interest in sepsis biomarkers, particularly because sepsis is a highly lethal condition, its diagnosis is challenging, and even simple treatment with antibiotics has led to serious adverse consequences such as emergence of resistant pathogens. Yet development of a sepsis biomarker requires many more steps than simply finding an association between a particular molecule and a clinical state or outcome. Demonstration of improvement of therapeutic practice using receiver-operating characteristic and other analyses is important. Validation in independent, prospective and, preferably, multicenter trials is essential. Many promising candidate sepsis biomarkers have recently been proposed. While procalcitonin (PCT) is currently the most studied sepsis biomarker, evidence of potential value has been found for a wide array of blood biomarkers including proteins, mRNA expression in whole blood or leukocytes, micro-RNAs (miRNA), pathogen and host DNA, pathogen and host genetic variants and metabolomic panels, and even in the novel use of currently available clinical data. While the most common early reports link putative sepsis biomarker levels to severity of illness and outcome (prognostic), this is not anticipated to be their primary use. More important is the distinction between infection and noninfectious inflammatory responses (diagnostic) and the use of sepsis biomarkers to direct therapy (predictive).
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Balta S, Demirkol S, Hatipoglu, M, Ardic S, Arslan Z, Celik T. Red cell distribution width is a predictor of mortality in patients with severe sepsis and septic shock. Am J Emerg Med 2013; 31:989-90. [DOI: 10.1016/j.ajem.2013.02.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 02/22/2013] [Indexed: 11/26/2022] Open
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Park SY, Kim J, Kim OJ, Kim JK, Song J, Shin DA, Oh SH. Predictive value of circulating interleukin-6 and heart-type fatty acid binding protein for three months clinical outcome in acute cerebral infarction: multiple blood markers profiling study. Crit Care 2013; 17:R45. [PMID: 23497639 PMCID: PMC3672476 DOI: 10.1186/cc12564] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/13/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction There is no single blood marker for predicting the prognosis in ischemic stroke. A combination of multiple blood markers may enhance the ability to predict long-term outcome following ischemic stroke. Methods Blood concentrations of neuronal markers (neuron-specific enolase, visinin-like protein 1, heart type fatty acid binding protein (hFABP) and neuroglobin), astroglial markers (S100B and glial fibrillary acidic protein), inflammatory markers (IL-6, TNF-α, and C-reactive protein), blood-brain barrier marker (matrix metalloproteinase 9), and haemostatic markers (D-dimer and PAI-1) were measured within 24 hours after stroke onset. The discrimination and reclassification for favorable and poor outcome were compared after adding individual or a combination of blood markers to the clinical model of stroke outcome. Results In multivariate analysis, natural log-transformed (log) IL-6 (odds ratio (OR): 1.75, 95% CI: 1.25 to 2.25, P = 0.001) and loghFABP (OR: 3.23, 95% CI: 1.44 to 7.27, P = 0.005) were independently associated with poor outcome. The addition of a single blood marker to the clinical model did not improve the discriminating ability of the clinical model of stroke outcome. However, the addition of the combination of logIL-6 and loghFABP to the clinical model showed improved discrimination (area under receiver operating characteristic (AUROC) curve: 0.939 versus 0.910, P = 0.03) and reclassification performance (net reclassification improvement index: 0.18, P = 0.005). Conclusions A combination of circulating IL-6 and hFABP level has an additive clinical value for the prediction of stroke outcome.
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Jo YH, Kim K, Lee JH, Kang C, Kim T, Park HM, Kang KW, Kim J, Rhee JE. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013; 31:545-8. [DOI: 10.1016/j.ajem.2012.10.017] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 10/17/2012] [Accepted: 10/23/2012] [Indexed: 01/07/2023] Open
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