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Snyper NYF, Pike J, Ekwueme K, Shergill I, Hughes SF. Selective biomarkers for inflammation and infection are associated with post-operative complications following transperineal template prostate biopsy (TTPB): a single-centre observational clinical pilot-study. Eur J Med Res 2022; 27:187. [PMID: 36154663 PMCID: PMC9511755 DOI: 10.1186/s40001-022-00807-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) are the most common prostate disorders in the UK, which cause considerable ill health in older men. Transperineal template prostate biopsy (TTPB) has emerged as a reliable procedure for the histopathological diagnosis of PCa and BPH due to its higher cancer detection rates. Although antiseptic preparation and antibiotic prophylaxis are used to ensure safety in patients undergoing surgical intervention, post-operative complications, such as infection and bleeding are still unavoidable, resulting in re-admissions, with resource implications. Currently, there is no biomarker profile to predict outcomes or monitor patients during the post-operative course. The main aim of this single-centre observational clinical pilot-study was to investigate the role of inflammatory and infection biomarkers following TTPB and their association with post-operative complications. Methods Forty-five patients scheduled for elective TTPB were recruited after informed consent at the Wrexham Maelor and Glan Clwyd Hospitals, North Wales, UK (n = 45). Prior to surgery, venous blood samples were collected at baseline and subsequently at 30, 120, and 240 min post-operatively. Urine samples were collected before and 120 min after the procedure. Serum procalcitonin (PCT), serum ferritin, and urine B2MG analysis were done using enzyme-linked fluorescent assay (ELFA) and the magnetic Luminex® multiplex performance assay was used to analyse IL-6, IL-8, IL-10 and TNF-α plasma concentrations. Data on clinical outcomes were collected from patients’ medical records. Results Following TTPB, significant (p ≤ 0.05) increases were observed in uB2MG, IL-6, IL-8, IL-10 and TNF-α. Significant decreases were observed in ferritin (p ≤ 0.05). No significant change was observed in PCT concentration (p ≥ 0.05). One patient developed an infection and severe haematuria post-operatively following TTPB. Conclusion Although not confirmative, changes seen in biomarkers such as uB2MG, IL-10 and TNF-α in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications such as infection and bleeding which can develop following TTPB for the diagnosis of PCa and BPH.
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Affiliation(s)
- Nana Yaa Frempomaa Snyper
- North Wales & Northwest Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,Maelor Academic Unit of Medical and Surgical Sciences, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,Faculty of Social and Life Sciences, Wrexham Glyndwr University, Wrexham, Wales, UK.,Pathology Division, 37 Military Hospital, Accra, Ghana
| | - Joanne Pike
- Faculty of Social and Life Sciences, Wrexham Glyndwr University, Wrexham, Wales, UK
| | - Kingsley Ekwueme
- Maelor Academic Unit of Medical and Surgical Sciences, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,Faculty of Social and Life Sciences, Wrexham Glyndwr University, Wrexham, Wales, UK.,Department of Urology, BCUHB Glan Clwyd Hospital, Rhyl, Wales, UK
| | - Iqbal Shergill
- North Wales & Northwest Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,Maelor Academic Unit of Medical and Surgical Sciences, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.,Faculty of Social and Life Sciences, Wrexham Glyndwr University, Wrexham, Wales, UK.,Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Stephen Fôn Hughes
- North Wales & Northwest Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK. .,Maelor Academic Unit of Medical and Surgical Sciences, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK. .,Faculty of Social and Life Sciences, Wrexham Glyndwr University, Wrexham, Wales, UK.
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Sint A, Lutz R, Assenmacher M, Küchenhoff H, Kühn F, Faist E, Bazhin AV, Rentsch M, Werner J, Schiergens TS. Monocytic HLA-DR Expression for Prediction of Anastomotic Leak after Colorectal Surgery. J Am Coll Surg 2019; 229:200-209. [PMID: 30905855 DOI: 10.1016/j.jamcollsurg.2019.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Earlier detection of anastomotic leakage (AL) after colorectal procedures could minimize the detrimental clinical impact of AL and thereby reduce morbidity and mortality. STUDY DESIGN We conducted a prospective study with assessment of the diagnostic accuracy of monocytic HLA-DR (mHLA-DR) expression compared with WBCs, C-reactive protein (CRP), and procalcitonin (PCT) in predicting AL in patients undergoing elective colorectal operation with anastomosis. RESULTS Comparison of the blood marker values on postoperative day (POD) 4 revealed significant differences for all markers, but the difference for mHLA-DR was highly significant (15% expression of monocytes in AL patients vs 34% in patients without AL; p = 0.001). Together with WBC (p = 0.026), mHLA-DR expression was the only test to show significance on day 3 (14% vs 31%; p < 0.001). Receiver operating characteristic analysis revealed that mHLA-DR expression had superior diagnostic accuracy compared with all other diagnostic markers both on POD 3 (mHLA-DR area under the curve [AUC] 0.928; WBC AUC 0.734; CRP AUC 0.707; PCT AUC 0.672) and POD 4 (mHLA-DR AUC 0.887; WBC AUC 0.738; CRP AUC 0.709; PCT AUC 0.696). Monocytic HLA-DR had a negative predictive value of at least 94% on PODs 3 and 4, as well as specificity and positive predictive values of 100% at a threshold of 23% on POD 3 and 24% on POD 4, respectively. CONCLUSIONS Expression of mHLA-DR appears to be a more accurate predictor for AL after colorectal operation compared with WBC, CRP, and PCT. It represents a promising test to precisely monitor the perioperative course of high-risk patients and contribute to safer discharge.
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Affiliation(s)
- Alena Sint
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rebecca Lutz
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Helmut Küchenhoff
- Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Kühn
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Eugen Faist
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexandr V Bazhin
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus Rentsch
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias S Schiergens
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
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Barnes J, Hunter J, Harris S, Shankar-Hari M, Diouf E, Jammer I, Kalkman C, Klein AA, Corcoran T, Dieleman S, Grocott MPW, Mythen MG. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis. Br J Anaesth 2019; 122:500-508. [PMID: 30857606 DOI: 10.1016/j.bja.2019.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/26/2018] [Accepted: 01/08/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures. RESULTS A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n=8), 67% (n=62), and 80% (n=8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use. CONCLUSIONS We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results.
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Affiliation(s)
- Jonathan Barnes
- Department of Anaesthesia, Great Western Hospital, Swindon, UK
| | - Jennifer Hunter
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK
| | - Steve Harris
- Bloomsbury Institute of Intensive Care Medicine, University College London Hospital, London, UK.
| | - Manu Shankar-Hari
- School of Immunology & Microbial Sciences, Kings College London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Elisabeth Diouf
- Anesthesia and Intensive Care Unit, Le Dantec Hospital, Cheikh Anta DIOP University, Dakar, Senegal
| | - Ib Jammer
- Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Cor Kalkman
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridgeshire, UK
| | - Tomas Corcoran
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Stefan Dieleman
- Department of Anaesthesia & Perioperative Medicine Westmead Hospital, Sydney, Australia
| | - Michael P W Grocott
- Anaesthesia and Critical Care Research Group, NIHR Biomedical Research Centre, UK; Faculty of Medicine, University of Southampton, Southampton, UK; Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Michael G Mythen
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, UK; National Institute of Health Research Biomedical Research Centre, London, UK
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