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Turan C, Yurtseven A, Ozkaya P, Azarsiz E, Saz E. The Role of Soluble Urokinase Plasminogen Activator Receptor (suPAR) as an Early Indicator of Mortality in Pediatric Septic Shock. J Clin Lab Anal 2024; 38:e25040. [PMID: 38708489 PMCID: PMC11137844 DOI: 10.1002/jcla.25040] [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: 08/28/2023] [Revised: 04/02/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Despite advancements in antibiotic therapy and resuscitation protocols, sepsis and septic shock remain major contributors to morbidity and mortality in children. We aimed to investigate the utility of soluble urokinase plasminogen activator receptor (suPAR) for the early detection of septic shock and to evaluate its accuracy in predicting mortality. METHODS A prospective study was conducted in a tertiary pediatric emergency department (ED), enrolling patients diagnosed with the sepsis, severe sepsis, or septic shock. In addition to assessing infection biomarkers such as C-reactive protein and procalcitonin, suPAR levels were quantified upon admission using enzyme-linked immunosorbent assay. The primary outcome measure was 30-day mortality. RESULTS Overall 72 patients and 80 healthy children included. Plasma suPAR levels demonstrated a statistically significant elevation in the sepsis, severe sepsis, and septic shock groups compared with the control group (p < 0.001 for all). The septic shock group exhibited the highest suPAR levels upon admission, surpassing both the sepsis and severe sepsis groups (p = 0.009 and 0.042). ROC analysis underscored the promising potential of suPAR with an AUC of 0.832 for septic shock. Analysis of mortality prediction revealed significantly higher suPAR levels in nonsurvivors than survivors (9.7 ng/mL vs. 4.2 ng/mL; p < 0.001). Employing plasma suPAR levels to discriminate between mortality and survival, a threshold of ≥7.0 ng/mL demonstrated a sensitivity of 90.9% and specificity of 71.0%. CONCLUSION Plasma suPAR levels have the potential as a biomarker for predicting mortality in children with septic shock. In pediatric septic shock, the presence of plasma suPAR ≥7 ng/mL along with an underlying disease significantly increases the risk of mortality.
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Affiliation(s)
- Caner Turan
- Division of Pediatric Emergency, Department of PediatricsEge University School of MedicineIzmirTurkey
| | - Ali Yurtseven
- Division of Pediatric Emergency, Department of PediatricsEge University School of MedicineIzmirTurkey
| | - Pinar Yazici Ozkaya
- Division of Pediatric Intensive Care, Department of PediatricsEge University School of MedicineIzmirTurkey
| | - Elif Azarsiz
- Department of BiochemistryEge University School of MedicineIzmirTurkey
| | - Eylem Ulas Saz
- Division of Pediatric Emergency, Department of PediatricsEge University School of MedicineIzmirTurkey
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Arslan G, Besci T, Özdemir G, Evren G, Ilgaz Tüzen H, Prencuva P, Turan B, Benligül EM. Predictive Value of PRISM-4, PIM-3, CRP, Albumin, CRP/Albumin Ratio and Lactate in Critically Ill Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1731. [PMID: 38002822 PMCID: PMC10670452 DOI: 10.3390/children10111731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
The accurate prediction of the prognosis for critically ill children is crucial, with the Pediatric Index of Mortality (PIM) and Pediatric Risk of Mortality (PRISM) being extensively utilized for this purpose. Albumin, C-reactive protein (CRP), and lactate levels, which are indicative of inflammation and circulatory status in critically ill children, have not been incorporated into existing scoring systems. This retrospective cohort study evaluated the association between biological markers and the clinical outcomes in children with critical illnesses. PRISM-4 and PIM-3 death probability (DP), albumin, lactate, CRP, and CRP/albumin ratio were recorded upon admission. The accuracy of the indexes in predicting mortality were assessed by calculating the area under the curve (AUC). There were 942 patients included and the 28-day mortality rate was 7.9%. The AUC for PRISM-4, PIM-3, CRP, CRP/albumin ratio, albumin, and lactate were 0.923, 0.896, 0.798, 0.795, 0.751, 0.728, respectively. The findings in the subgroup analysis of septic patients were similar to those found in the overall population. Although CRP, CRP/albumin ratio, albumin, and lactate levels are all linked to mortality in children, CRP and the CRP/albumin ratio have lower predictive values than albumin and lactate. Incorporation of albumin and lactate into scoring systems will improve predictability.
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Affiliation(s)
- Gazi Arslan
- Department of Pediatrics, Division of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylül University, Konak 35220, Turkey; (T.B.); (G.Ö.); (G.E.); (H.I.T.); (P.P.); (B.T.); (E.M.B.)
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Yang Y, Griffin K, Li X, Sharp E, Young L, Garcia L, Griswold J, Pappas D. Combined CD25, CD64, and CD69 Biomarker in 3D-Printed Multizone Millifluidic Device for Sepsis Detection in Clinical Samples. Anal Chem 2023; 95:12819-12825. [PMID: 37556314 DOI: 10.1021/acs.analchem.3c01797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Sepsis is a serious medical condition that arises from a runaway response to an infection, which triggers the immune system to release chemicals into the bloodstream. This immune response can result in widespread inflammation throughout the body, which may cause harm to vital organs and, in more severe cases, lead to organ failure and death. Timely and accurate diagnosis of sepsis remains a challenge in analytical diagnostics. In this work, we have developed and validated a sepsis detection device, utilizing 3D printing technology, which incorporates multiple affinity separation zones. Our device requires minimal operator intervention and utilizes CD64, CD69, and CD25 as the biomarker targets for detecting sepsis in liquid biopsies. We assessed the effectiveness of our 3D-printed multizone cell separation device by testing it on clinical samples obtained from both septic patients (n = 35) and healthy volunteers (n = 8) and validated its performance accordingly. Unlike previous devices using poly(dimethyl siloxane), the 3D-printed device had reduced nonspecific binding for anti-CD25 capture, allowing this biomarker to be assayed for the first time in cell separations. Our results showed a statistically significant difference in cell capture between septic and healthy samples (with p values of 0.0001 for CD64, CD69, and CD25), suggesting that 3D-printed multizone cell capture is a reliable method for distinguishing sepsis. A receiver operator characteristic (ROC) analysis was performed to determine the accuracy of the captured cell counts for each antigen in detecting sepsis. The ROC area under the curve (AUC) values for on-chip detection of CD64+, CD69+, and CD25+ leukocytes were 0.96, 0.92, and 0.88, respectively, indicating our diagnostic test matches clinical outcomes. When combined for sepsis diagnosis, the AUC value for CD64, CD69, and CD25 was 0.99, indicating an improved diagnostic performance due to the use of multiple biomarkers.
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Affiliation(s)
- Yijia Yang
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Kitiara Griffin
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Xiao Li
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Elizabeth Sharp
- Clinical Research Institute, Texas Tech Health Sciences Center, Lubbock, Texas 79409, United States
| | - Lane Young
- Clinical Research Institute, Texas Tech Health Sciences Center, Lubbock, Texas 79409, United States
| | - Liza Garcia
- Clinical Research Institute, Texas Tech Health Sciences Center, Lubbock, Texas 79409, United States
| | - John Griswold
- Department of Surgery, Texas Tech Health Sciences Center, Lubbock, Texas 79409, United States
| | - Dimitri Pappas
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
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Jandari S, Rezvani R, Yousefian S, Mosalmanzadeh N, Bagherniya M, Soleimani D, Mousavian SZ, Shivappa N, Hébert JR, Jafarzadeh Esfahani A, Akhgari A, Jarahi L, Safarian M. The effect of low dietary inflammatory index score formula on inflammatory, metabolic, and clinical outcomes in critically ill traumatic brain injury patients: A single-blind randomized controlled pilot study. Food Sci Nutr 2023; 11:3365-3375. [PMID: 37324871 PMCID: PMC10261799 DOI: 10.1002/fsn3.3326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 06/17/2023] Open
Abstract
In traumatic brain injury (TBI) patients, a complex cascade of inflammatory responses are frequently observed following trauma. Numerous dietary agents have long been found to have potential in modulating inflammatory responses. This pilot study, designed an enteral formula with low inflammatory properties based on the dietary inflammatory index (DII®) and evaluated its effect on inflammatory and metabolic factors in critically ill TBI patients. This single-blind randomized controlled pilot study was conducted at the Neurosurgical ICU of Shahid Kamyab Hospital (Mashhad, Iran). A total of 20 TBI patients were randomly assigned to receive either low-DII score or standard formula at the intensive care unit (ICU). The primary outcomes of the study included clinical status, inflammatory biomarkers, APACHE II, SAPS II, SOFA, and NUTRIC scores. The trial groups did not differ significantly in baseline values. Following 14 days of intervention, there was a statistically significant decrease in the APACHE II, SAPS II, and NUTRIC scores and a significant increase in the GCS score in the low-DII score formula group compared to the standard formula group. Over 2 weeks, high sensitivity C-reactive protein (hs-CRP) values of -2.73 (95% CI: -3.67, -1.79) mg/dL in the low-DII score formula group versus 0.65 (95% CI: -0.29, 1.58) mg/dL in controls were obtained. Moreover, the length of hospital stay was longer for the standard formula group than for the low-DII score formula group. The low-DII score formula improves inflammatory factors (serum hs-CRP) and metabolic biomarkers (LDL-c and FBS). Furthermore, clinical outcomes, including the length of hospital stay and disease severity, appear to be enhanced.
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Affiliation(s)
- Sajedeh Jandari
- Department of Nutrition, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Reza Rezvani
- Department of Nutrition, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Sajedeh Yousefian
- Department of Nutrition SciencesVarastegan Institute for Medical SciencesMashhadIran
| | - Negin Mosalmanzadeh
- Department of Nutrition SciencesVarastegan Institute for Medical SciencesMashhadIran
| | - Mohammad Bagherniya
- Department of Community Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Davood Soleimani
- Department of Nutritional Sciences, School of Nutritional SciencesKermanshah University of Medical SciencesKermanshahIran
| | - Seyedeh Zeynab Mousavian
- Department of Nutritional Sciences, School of Nutritional SciencesKermanshah University of Medical SciencesKermanshahIran
| | - Nitin Shivappa
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSouth CarolinaUSA
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
- Connecting Health Innovations LLCColumbiaSouth CarolinaUSA
| | - James R. Hébert
- Cancer Prevention and Control ProgramUniversity of South CarolinaColumbiaSouth CarolinaUSA
- Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Ali Jafarzadeh Esfahani
- Department of Nutrition, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Abass Akhgari
- Targeted Drug Delivery Research CenterPharmaceutical Technology Institute, Mashhad University of Medical SciencesMashhadIran
- Department of Pharmaceutics, School of PharmacyMashhad University of Medical SciencesMashhadIran
| | - Lida Jarahi
- Department of Nutrition, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohammad Safarian
- Department of Nutrition, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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Book T, Engelke C, Brüggerhoff R, Winny M, Kraus M, Benecke C, Zimmermann M, Trostdorf U, Wedemeyer H, Marquardt JU, Voigtländer T, Wedemeyer J, Kirstein MM. Endoscopic vacuum-assisted closure therapy for leakage of the lower gastrointestinal tract: multicenter experiences. Endosc Int Open 2023; 11:E212-E217. [PMID: 36845275 PMCID: PMC9949981 DOI: 10.1055/a-1990-0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/29/2022] [Indexed: 02/25/2023] Open
Abstract
Background and study aims Only a few studies are available regarding endoscopic vacuum-assisted closure (E-VAC) therapy for the post-surgery leakage of the lower gastrointestinal tract. Patients and methods In this multicenter German study, we retrospectively analyzed patients treated with E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract from 2000-2020 at Hannover Medical School, University Medical Center Schleswig-Holstein, Campus Luebeck, and Robert Koch Hospital Gehrden. Results Overall, 147 patients were included in this study. Most patients had undergone tumor resections of the lower gastrointestinal tract (n = 88; 59.9 %). Median time to diagnosis of leakage was 10 days (interquartile range [IQR] 6-19). Median duration of E-VAC therapy was 14 days (IQR 8-27). Increase of C-reactive protein (CRP) levels significantly correlated with first diagnosis of leakage ( P < 0.001). E-VAC therapy led to closure or complete epithelialization of leakage in the majority of patients (n = 122; 83.0 %) and stoma reversal was achieved in 60.0 %. Stoma reversal was significantly more often achieved in patients with CRP levels ≤ 100 mg/L at first diagnosis compared to patients with CRP levels > 100 mg/L (78.4 % vs. 52.7 %; P = 0.012). Odds ratio for failure of stoma reversal was 3.36 in cases with CRP values > 100 mg/L ( P = 0.017). In total, leakage- and/ or E-VAC therapy-associated complications occurred in 26 patients (17.7 %). Minor complications included recurrent E-VAC dislocations and subsequent stenosis. Overall, 14 leakage- or E-VAC-associated deaths were observed most often due to sepsis. Conclusions E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract is safe and effective. High levels of CRP are a negative predictor of E-VAC therapy success.
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Affiliation(s)
- Thorsten Book
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Carsten Engelke
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Raphael Brüggerhoff
- Department of Internal Medicine, Robert Koch Hospital Gehrden, Gehrden, Germany
| | - Markus Winny
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Kraus
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Claudia Benecke
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Markus Zimmermann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Ulf Trostdorf
- Clinic for General, Visceral, and Vascular Surgery, Robert Koch Hospital Gehrden, Gehrden, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jens U. Marquardt
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jochen Wedemeyer
- Department of Internal Medicine, Robert Koch Hospital Gehrden, Gehrden, Germany
| | - Martha M. Kirstein
- 1st Department of Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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de Almeida CB, Leite HP, Lopes Junior E, Konstantyner T, Franco MDCP. Erythrocyte and plasma selenium in children with acute inflammatory response. J Trace Elem Med Biol 2022; 74:127068. [PMID: 36162157 DOI: 10.1016/j.jtemb.2022.127068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/20/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Plasma selenium may not reflect selenium status in critically ill patients because it transiently decreases inversely with the magnitude of the systemic inflammatory response. The decision to supplement selenium should ideally be based on laboratory measurements that reliably reflect selenium status. We hypothesized that erythrocyte selenium, unlike plasma selenium, is not affected by the systemic inflammatory response in critically ill children. METHODS In a prospective study of 109 critically ill children, plasma and erythrocyte selenium concentrations were evaluated on admission, and plasma selenoprotein P was evaluated on days 1, 2, and 3 of the ICU stay. The main outcome was the effect of systemic inflammation on the erythrocyte and plasma selenium concentrations. The magnitude of the systemic inflammatory response was measured using serum C-reactive protein (CRP) and procalcitonin levels. The covariates were age, sex, anthropometric nutritional status, diagnosis of severe sepsis/septic shock, and clinical severity on admission. Multiple linear regression and generalized estimating equations were used for statistical analysis. RESULTS Erythrocyte selenium levels were not influenced by the magnitude of the inflammatory response or by the patient's clinical severity. Procalcitonin (β coefficient=-0.99; 95%CI: -1.64; -0.34, p = 0.003) and clinical severity (β coefficient= -11.13; 95%CI: -21.6; -0.63), p = 0.038) on admission were associated with decreased plasma selenium concentrations. Erythrocyte selenium was associated with selenoprotein P in the first three days of ICU stay (β coefficient=0.32; 95%CI: 0.20; 0.44, p < 0.001). CONCLUSION Unlike plasma selenium, erythrocyte selenium does not change in children with an acute systemic inflammatory response and is associated with selenoprotein P concentrations. Erythrocyte selenium is probably a more reliable marker than plasma selenium for evaluating the selenium status in critically ill children.
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Affiliation(s)
- Cláudia Bezerra de Almeida
- Discipline of Pediatric Nutrition, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Heitor Pons Leite
- Discipline of Pediatric Nutrition, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Emilio Lopes Junior
- Discipline of Pediatric Nutrition, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Tulio Konstantyner
- Discipline of Pediatric Nutrition, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.
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Ou Y, An R, Wang H, Chen L, Shen Y, Cai W, Zhu W. Oxidative stress-related circulating miRNA-27a is a potential biomarker for diagnosis and prognosis in patients with sepsis. BMC Immunol 2022; 23:14. [PMID: 35337261 PMCID: PMC8957193 DOI: 10.1186/s12865-022-00489-1] [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: 11/09/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Oxidative stress plays a critical role on the processes of sepsis, and several microRNAs have been identified that may regulate the occurrence of oxidative stress. However, the relation between oxidative stress-related microRNA 27a (miR-27a) and sepsis is unknown. The present study aimed to determine the value of circulating miR-27a for the diagnosis and prognosis of sepsis. Methods This retrospective study included 23 patients with sepsis and 25 without sepsis treated at the emergency intensive care unit (EICU) or our institution between January 2019 and January 2020. Levels of circulating miR-27a and levels of oxidative stress-related indicators were measured and compared between sepsis and non-sepsis patients. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic efficiency of miR-27a. Results Circulating miR-27a levels in sepsis patients were higher than those in non-sepsis patients (p < 0.05), and levels were significantly higher in patients that died than those that lived (p < 0.05). In patients with sepsis, circulating miR-27a level was positively correlated with serum malondialdehyde (MDA) level (rs = 0.529, p = 0.007), and negatively correlated with serum glutathione peroxidase (GSH-Px) level (rs = − 0.477, p = 0.016). No significant correlation was observed between circulating miR-27a and serum superoxide dismutase (SOD) in sepsis patients (rs = − 0.340, p = 0.096). The area under the ROC curve (AUC) of miR-27a level for prediction of sepsis was 0.717 (p = 0.009) and for 28-day mortality was 0.739 (p = 0.003). Conclusions This study showed that circulating miR-27a level is correlated with oxidative stress and mortality in patients with sepsis, and may serve as a potential non-invasive molecular biomarker.
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Affiliation(s)
- Yingwei Ou
- Department of Emergency, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Rongcheng An
- Department of Emergency, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Haochu Wang
- Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Lue Chen
- Department of Emergency, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Yong Shen
- Department of Emergency, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Wenwei Cai
- Department of Emergency, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Wei Zhu
- Department of Emergency, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), 158 Shangtang Road, Hangzhou, 310014, Zhejiang, People's Republic of China.
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Santonocito C, Sanfilippo F, De Locker I, Chiarenza F, Giacomo C, Njimi H, George S, Astuto M, Vincent JL. C–Reactive protein kinetics after cardiac surgery: A retrospective multicenter study. Ann Card Anaesth 2022; 25:498-504. [DOI: 10.4103/aca.aca_141_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Book T, Wortmann N, Winkler M, Kirstein MM, Heidrich B, Wedemeyer H, Voigtländer T. Endoscopic vacuum assisted closure (E-VAC) of upper gastrointestinal leakages. Scand J Gastroenterol 2021; 56:1376-1379. [PMID: 34420453 DOI: 10.1080/00365521.2021.1963836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Endoscopic vacuum-assisted closure (E-VAC) of leaks of the upper gastrointestinal tract is an increasingly applied endoscopic technique. Data on indication, clinical success, complications and prognostic factors are still sparse. METHODS Patients treated with E-VAC between 2012 and 2019 at a tertiary referral center have been retrospectively analyzed. RESULTS Overall, 116 patients treated with E-VAC were identified. Indication for E-VAC placement was postoperative leakage in 94/116 (81%), iatrogenic perforations 7/116 (6%) and others 15/116 (13%). In 92/116 (79%) of the patients E-VAC therapy showed successful wound closure. The first E-VAC after detection of insufficiency was significantly more often placed intracavitary in patients with E-VAC failure (p = .031). There was a trend for longer intensive care unit treatment for patients with E-VAC failure (p = .069). Complications occurred significantly more often in patients with E-VAC failure (p = .009). Platelet count was significantly higher in patients with E-VAC success at day of insufficiency detection (257/Thsd/µL (interquartile range [IQR], 185-362) vs. 195 (IQR, 117-309); p = .039). Platelet count (375 Thsd/µL (IQR, 256-484) vs. 190 (IQR, 129-292)), hemoglobin (9.5 g/dL (IQR, 8.8-10.1) vs. 8.7 g/dL (IQR, 8.15-9.35)) and C-reactive protein level (79 mg/L (IQR, 39.7-121.9) vs. 152 mg/L (IQR, 73.7-231)) at day 14 differed significantly. The 30 days mortality rate was 33.3% (8/24) in E-VAC failure compared with 2.2% in patients with E-VAC success (p = .001). CONCLUSIONS E-VAC is an emerging highly effective interventional endoscopic technique for gastrointestinal wound closure even in highly selected patients.
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Affiliation(s)
- Thorsten Book
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Nicolas Wortmann
- Department of Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Michael Winkler
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Martha M Kirstein
- First Department of Medicine, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Sun S, Chen Y, Liu Z, Tian R, Liu J, Chen E, Mao E, Pan T, Qu H. Serum-soluble PD-L1 may be a potential diagnostic biomarker in sepsis. Scand J Immunol 2021; 94:e13049. [PMID: 33934376 DOI: 10.1111/sji.13049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
To investigate whether serum-soluble PD-L1 (sPD-L1) is a potential biomarker for identifying sepsis. This study enrolled 64 septic patients, 29 patients with acute appendicitis, 33 patients with acute pancreatitis and 30 healthy volunteers. Sepsis was defined according to the Sepsis 3.0 criteria.[1] The associated clinical parameters were recorded, blood samples were collected on the first day of diagnosis, and serum sPD-L1 levels were measured using enzyme-linked immunosorbent assays. Compared with the control group, a significant increase in sPD-L1 levels was observed in patients with sepsis (n = 64). Increased sPD-L1 expression correlated strongly with increased clinical inflammatory values (CRP, PCT and WBC) and decreased immunological functional parameters (CD3+ , CD4+ and CD8+ cell counts). The area under the ROC curve (AUC) for sPD-L1 in combination with the sequential organ failure assessment (SOFA) score was superior to the AUC for either sPD-L1 or SOFA score in regard to the diagnosis of sepsis. sPD-L1 may represent a valuable biomarker for the diagnosis of sepsis.
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Affiliation(s)
- Shaoqiong Sun
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaojun Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Tian
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gao D, Xu M, Wang G, Lv J, Ma X, Guo Y, Zhang D, Yang H, Jiang W, Deng F, Xia G, Lu Z, Lv L, Gong S. The efficiency and safety of high-dose vitamin C in patients with COVID-19: a retrospective cohort study. Aging (Albany NY) 2021; 13:7020-7034. [PMID: 33638944 PMCID: PMC7993712 DOI: 10.18632/aging.202557] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The inflammatory reaction is the main cause of acute respiratory distress syndrome and multiple organ failure in patients with Coronavirus disease 2019, especially those with severe and critical illness. Several studies suggested that high-dose vitamin C reduced inflammatory reaction associated with sepsis and acute respiratory distress syndrome. This study aimed to determine the efficacy and safety of high-dose vitamin C in Coronavirus disease 2019. METHODS We included 76 patients with Coronavirus disease 2019, classified into the high-dose vitamin C group (loading dose of 6g intravenous infusion per 12 hr on the first day, and 6g once for the following 4 days, n=46) and the standard therapy group (standard therapy alone, n=30). RESULTS The risk of 28-day mortality was reduced for the high-dose vitamin C versus the standard therapy group (HR=0.14, 95% CI, 0.03-0.72). Oxygen support status was improved more with high-dose vitamin C than standard therapy (63.9% vs 36.1%). No safety events were associated with high-dose vitamin C therapy. CONCLUSION High-dose vitamin C may reduce the mortality and improve oxygen support status in patients with Coronavirus disease 2019 without adverse events.
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Affiliation(s)
- Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Min Xu
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Gang Wang
- Department of Critical Care, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Jianrui Lv
- Department of Anesthesiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xiaorong Ma
- Department of Hematology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Yonghong Guo
- Department of Infectious Diseases, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Dexin Zhang
- Department of Respiratory and Critical Care, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Huiyun Yang
- Department of Nursing, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Wei Jiang
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Fuxue Deng
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Guozhi Xia
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Ziwei Lu
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Lv Lv
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Shouping Gong
- Department of Neurosurgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
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12
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Heffernan AJ, Denny KJ. Host Diagnostic Biomarkers of Infection in the ICU: Where Are We and Where Are We Going? Curr Infect Dis Rep 2021; 23:4. [PMID: 33613126 DOI: 10.1007/s11908-021-00747-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Purpose of Review Early identification of infection in the critically ill patient and initiation of appropriate treatment is key to reducing morbidity and mortality. On the other hand, the indiscriminate use of antimicrobials leads to harms, many of which may be exaggerated in the critically ill population. The current method of diagnosing infection in the intensive care unit relies heavily on clinical gestalt; however, this approach is plagued by biases. Therefore, a reliable, independent biomarker holds promise in the accurate determination of infection. We discuss currently used host biomarkers used in the intensive care unit and review new and emerging approaches to biomarker discovery. Recent Findings White cell count (including total white cell count, left shift, and the neutrophil-leucocyte ratio), C-reactive protein, and procalcitonin are the most common host diagnostic biomarkers for sepsis used in current clinical practice. However, their utility in the initial diagnosis of infection, and their role in the subsequent decision to commence treatment, remains limited. Novel approaches to biomarker discovery that are currently being investigated include combination biomarkers, host 'sepsis signatures' based on differential gene expression, site-specific biomarkers, biomechanical assays, and incorporation of new and pre-existing host biomarkers into machine learning algorithms. Summary To date, no single reliable independent biomarker of infection exists. Whilst new approaches to biomarker discovery hold promise, their clinical utility may be limited if previous mistakes that have afflicted sepsis biomarker research continue to be repeated.
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Affiliation(s)
- Aaron J Heffernan
- School of Medicine, Griffith University, Gold Coast, QLD Australia
- Centre for Translational Anti-infective Pharmacodynamics, Faculty of Medicine, University of Queensland, Herston, QLD Australia
| | - Kerina J Denny
- Department of Intensive Care, Gold Coast University Hospital, Gold Coast, QLD Australia
- School of Clinical Medicine, Faculty of Medicine, University of Queensland, Herston, QLD Australia
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13
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Ou M, Hao S, Chen J, Zhao S, Cui S, Tu J. Downregulation of interleukin-6 and C-reactive protein underlies a novel inhibitory role of microRNA-136-5p in acute lower extremity deep vein thrombosis. Aging (Albany NY) 2020; 12:21076-21090. [PMID: 33188660 PMCID: PMC7695373 DOI: 10.18632/aging.103140] [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: 01/13/2020] [Accepted: 03/31/2020] [Indexed: 12/23/2022]
Abstract
Deep vein thrombosis (DVT) comprises a critical and common health condition with high incidence, mortality, and long-term adverse sequelae. Several differentially expressed microRNAs (miRNAs) have emerged as promising prognostic markers in DVT. The present study intended to explore the functional relevance of miR-136-5p in acute lower extremity DVT (LEDVT). Rat models of acute LEDVT were established and miR-136-5p expression was altered by agomir or antagomir to assess its effects. In addition, in vitro gain- and loss-experiments, prior to exposure to CoCl2, were performed to investigate effects of miR-136-5p on human umbilical vein endothelial cell (HUVEC) apoptosis and levels of interleukin-6 (IL-6) and C-reactive protein (CRP). miR-136-5p was downregulated, whereas IL-6 and CRP were elevated in acute LEDVT patients. Notably, miR-136-5p was confirmed to target both IL-6 and CRP. Overexpression of miR-136-5p led to reduced length, weight, and ratio of weight to length of the venous thrombus. Furthermore, overexpressed miR-136-5p downregulated the expression of IL-6 and CRP, consequently inhibiting HUVEC apoptosis. Conjointly, our data indicate that the overexpression of miR-136-5p has the potential to bind to the 3’-UTR in the mRNAs for IL-6 and CRP and mitigate acute LEDVT, which provides a basis for new therapeutic targets in acute LEDVT treatment.
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Affiliation(s)
- Minghui Ou
- Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao 266011, P.R. China
| | - Shaobo Hao
- Department of Emergency, Qingdao Municipal Hospital, Qingdao 266011, P.R. China
| | - Jing Chen
- Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao 266011, P.R. China
| | - Shibo Zhao
- Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao 266011, P.R. China
| | - Shichao Cui
- Department of Vascular Surgery, Qingdao Municipal Hospital, Qingdao 266011, P.R. China
| | - Jie Tu
- Department of Science and Education, Qingdao Municipal Hospital, Qingdao 266011, P.R. China
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14
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Dzobo K, Chiririwa H, Dandara C, Dzobo W. Coronavirus Disease-2019 Treatment Strategies Targeting Interleukin-6 Signaling and Herbal Medicine. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2020; 25:13-22. [PMID: 32857671 DOI: 10.1089/omi.2020.0122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronavirus disease-2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is evolving across the world and new treatments are urgently needed as with vaccines to prevent the illness and stem the contagion. The virus affects not only the lungs but also other tissues, thus lending support to the idea that COVID-19 is a systemic disease. The current vaccine and treatment development strategies ought to consider such systems medicine perspectives rather than a narrower focus on the lung infection only. COVID-19 is associated with elevated levels of the inflammatory cytokines such as interleukin-6 (IL-6), IL-10, and interferon-gamma (IFN-γ). Elevated levels of cytokines and the cytokine storm have been linked to fatal disease. This suggests new therapeutic strategies through blocking the cytokine storm. IL-6 is one of the major cytokines associated with the cytokine storm. IL-6 is also known to display pleiotropic/diverse pathophysiological effects. We suggest the blockage of IL-6 signaling and its downstream mediators such as Janus kinases (JAKs), and signal transducer and activators of transcription (STATs) offer potential hope for the treatment of severe cases of COVID-19. Thus, repurposing of already approved IL-6-JAK-STAT signaling inhibitors as well as other anti-inflammatory drugs, including dexamethasone, is under development for severe COVID-19 cases. We conclude this expert review by highlighting the potential role of precision herbal medicines, for example, the Cannabis sativa, provided that omics technologies can be utilized to build a robust scientific evidence base on their clinical safety and efficacy. Precision herbal medicine buttressed by omics systems science would also help identify new molecular targets for drug discovery against COVID-19.
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Affiliation(s)
- Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town, South Africa.,Division of Medical Biochemistry and Institute of Infectious Disease and Molecular Medicine, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Harry Chiririwa
- Department of Chemical Engineering, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Witness Dzobo
- Immunology Department, Pathology, University Hospital Southampton, Southampton, United Kingdom.,Faculty of Science, University of Portsmouth, Portsmouth, United Kingdom
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15
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Riedel S. Predicting Bacterial Versus Viral Infection, or None of the Above: Current and Future Prospects of Biomarkers. Clin Lab Med 2020; 39:453-472. [PMID: 31383268 DOI: 10.1016/j.cll.2019.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sepsis and pneumonia cause significant morbidity and mortality worldwide. Despite improvements in diagnostic methodologies for organism identification, the early recognition and further risk stratification of these infections can be challenging. Although traditional clinical scoring systems are beneficial for the management of sepsis and pneumonia, biomarkers supporting the diagnosis and management of these infectious diseases are needed. Many biomarkers have been identified and there is no lack of studies and meta-analyses assessing the utility of biomarkers. Focusing primarily on sepsis and pneumonia, this article discusses the most commonly used biomarkers for which clinical laboratory testing methods are available.
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Affiliation(s)
- Stefan Riedel
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Yamins 309, Boston, MA 02215, USA.
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16
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Gradel KO, Engberg H, Zampieri FG, Póvoa P, Simonsen SF, Vinholt PJ, Garvik OS, Ljungdalh PS, Frederiksen H. Contributing factors to the plasma albumin level at diagnosis of hematological malignancy. Hosp Pract (1995) 2020; 48:223-229. [PMID: 32484370 DOI: 10.1080/21548331.2020.1770511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Many factors contribute to the plasma albumin (PA) level. We aimed to quantify different factors' relative contribution to the PA level when diagnosing hematological malignancy (HM). METHODS The study was a population-based registry study including patients with HM in a Danish region. We applied multivariate linear regression analyses with C-reactive protein (CRP), WHO performance score (WHO-PS), age, sex, comorbidity, and HM type as exposures and the PA level on the day of the HM diagnosis (DX) as the outcome. The relative contribution of each exposure was determined as a percentage of the models' coefficient of determination (R2). RESULTS In total, 2528 patients with HM had PA measured on DX. In the model comprising all exposures, CRP contributed with 65.8% to the R2 of 0.389 whereas 3 variables (CRP, WHO-PS, HM type) together contributed with 96.1%. When CRP was excluded from the model, R2 declined to 0.215 and the WHO-PS contributed with 96%. Other models, including separate analyses for each HM type, corroborated these results, except in myeloma patients where WHO-PS contributed with 61.1% to the R2 of 0.234. CONCLUSION The inflammation biomarker CRP was the main predictor of the PA level on DX. The WHO-PS also contributed to the PA level on DX whereas the remaining factors (HM type, age, sex, and comorbidity) were of much less importance.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark , Odense C, Denmark.,OPEN - Odense Patient Data Exploratory Network, Odense University Hospital , Odense C, Denmark
| | - Henriette Engberg
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark , Odense C, Denmark.,The Danish Clinical Quality Program and Clinical Registries (RKKP), Odense University Hospital , Odense, Denmark
| | - Fernando G Zampieri
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark , Odense C, Denmark.,HCor-Hospital Do Coração, R. Des. Eliseu Guilherme , São Paulo, Brazil
| | - Pedro Póvoa
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark , Odense C, Denmark.,Polyvalent Intensive Care Unit, Hospital De São Francisco Xavier, and NOVA Medical School, CHRC, New University of Lisbon , Lisbon, Portugal
| | - Simone F Simonsen
- Department of Geriatrics, Odense University Hospital , Svendborg, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital , Odense C, Denmark
| | - Olav Sivertsen Garvik
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark , Odense C, Denmark
| | - Pernille S Ljungdalh
- Department of Regional Health Research, University of Southern Denmark , Odense C, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, and the Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark , Odense C, Denmark
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17
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Wang L, Huang X, Zhou J, Wang Y, Zhong W, Yu Q, Wang W, Ye Z, Lin Q, Hong X, Zeng P, Zhang M. Predicting the occurrence of multidrug-resistant organism colonization or infection in ICU patients: development and validation of a novel multivariate prediction model. Antimicrob Resist Infect Control 2020; 9:66. [PMID: 32430043 PMCID: PMC7236142 DOI: 10.1186/s13756-020-00726-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/05/2020] [Indexed: 11/11/2022] Open
Abstract
Background Multidrug-resistant organisms (MDROs) have emerged as an important cause of poor prognoses of patients in the intensive care unit (ICU). This study aimed to establish an easy-to-use nomogram for predicting the occurrence of MDRO colonization or infection in ICU patients. Methods In this study, we developed a nomogram based on predictors in patients admitted to the ICU in the First Affiliated Hospital of Xiamen University from 2016 to 2018 using univariate and multivariate logistic regression analysis. We externally validated this nomogram in patients from another hospital over a similar period, and assessed its performance by calculating the area under the receiver operating characteristic (ROC) curve (AUC) and performing a decision curve analysis. Results 331 patients in the primary cohort and 181 patients in the validation cohort were included in the statistical analysis. Independent factors derived from the primary cohort to predict MDRO colonization or infection were male sex, higher C-reactive protein (CRP) levels and higher Pitt bacteremia scores (Pitt scores), which were all assembled in the nomogram. The nomogram yielded good discrimination with an AUC of 0.77 (95% CI 0.70–0.84), and the range of threshold probabilities of decision curves was approximately 30–95%. Conclusion This easy-to-use nomogram is potentially useful for predicting the occurrence of MDRO colonization or infection in ICU patients.
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Affiliation(s)
- Li Wang
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Xiaolong Huang
- Intensive Care Unit, First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Xiamen, 361000, Fujian Province, China
| | - Jiating Zhou
- Intensive Care Unit, First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Xiamen, 361000, Fujian Province, China
| | - Yajing Wang
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Weizhang Zhong
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Qing Yu
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Weiping Wang
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Zhiqiao Ye
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Qiaoyan Lin
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Xing Hong
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Ping Zeng
- Intensive Care Unit, Xiamen Hospital of Traditional Chinese Medicine, 1739 Xian Yue Road, Xiamen, 361009, Fujian Province, China
| | - Minwei Zhang
- Intensive Care Unit, First Affiliated Hospital of Xiamen University, 55 Zhen Hai Road, Xiamen, 361000, Fujian Province, China.
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18
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Kirstein MM, Book T, Manns MP, von Hahn T, Voigtländer T. Secondary sclerosing cholangitis in critically ill patients has a poor outcome but lower tumour incidence than primary sclerosing cholangitis. United European Gastroenterol J 2020; 8:716-724. [PMID: 32366182 PMCID: PMC7437091 DOI: 10.1177/2050640620924274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is an emerging disease with grim prognosis. OBJECTIVE Our aim was the analysis of prognostic factors, long-term outcome and risk of tumour development in SSC-CIP compared with primary sclerosing cholangitis (PSC) patients. METHODS Retrospective analysis between 2008 and 2018. RESULTS One hundred and eleven patients with SSC-CIP and 408 PSC patients were identified. Median orthotopic liver transplantation (OLT)-free survival was 16 months for SSC-CIP and 147 months for PSC (p < 0.001). OLT was performed in 18/111 SSC-CIP compared with 166/408 PSC patients (p < 0.001). Malignant tumours were detected in 17.9% of PSC patients (73/408) compared with 2.7% (3/111) in SSC-CIP (p < 0.001). In multivariate Cox regression analysis low levels of C-reactive protein (hazard ratio 4.687 (95% confidence interval (CI) 1.144-19.199, p = 0.032) were significantly associated with a prolonged survival whereas higher age (hazard ratio 0.488 (95% CI 0.23-1.038), p = 0.062) showed a trend for shorter survival in SSC-CIP. For PSC malignancies (hazard ratio 0.42 (95% CI 0.313-0.575), p < 0.001) and higher age (hazard ratio 0.709 (95% CI 0.544-0.922), p = 0.01) were associated with a shorter OLT-free survival. CONCLUSION SSC-CIP is characterized by acute onset of liver disease and poor prognosis but with lower tumour incidence compared with PSC.
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Affiliation(s)
- Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Thorsten Book
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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19
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Book T, Kirstein MM, Schneider A, Manns MP, Voigtländer T. Endoscopic decompression of acute intestinal distension is associated with reduced mortality in critically ill patients. BMC Gastroenterol 2020; 20:87. [PMID: 32252639 PMCID: PMC7137233 DOI: 10.1186/s12876-020-01233-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background Endoscopic placement of intestinal decompression tubes is a feasible technique for treatment of acute intestinal dilation. Given the heterogeneity of the underlying diseases leading to intestinal obstruction data on the significance of endoscopic procedures for treatment of these conditions are sparse. Methods In the study period from 2008 to 2019 all patients receiving a decompression tube were identified by retrospective chart review and analyzed. Results A total of 59 decompression tubes were placed in 50 patients. Technical success was achieved in 98% (58/59 tubes). As major complication one small bowel perforation occurred (1/59; 1.7%). Causes for impaired intestinal transit comprised tumor stenoses 22% (11/50), infections 18% (9/50), post-operative paralysis 14% (7/50), neurological diseases 8% (4/50), trauma 2% (1/50) and others 36% (18/50). Most patients (74%; 37/50) were critically ill and treated on intensive care unit. Treatment response after tube insertion was documented in 76% of patients (38/50) whereas 24% (12/50) did not fulfill response criteria. Patients with treatment response showed a significantly better outcome compared to non-responders. Responders had a median survival of 113 days (95% CI 41–186) compared to 15 days (95% CI 6–24) in non-responders (p = 0.002). Analysis of laboratory parameters after stratification in responders and non-responders to endoscopic therapy showed that non-responders had significantly higher levels of CRP and lower platelet count at baseline (CRP 262 mg/L (IQR 101–307) vs. 94 mg/L (IQR 26–153): p = 0.027; platelets 69 thsd/μL (IQR 33–161) vs. 199 thsd/μL (IQR 138–289): p = 0.009). Conclusions Endoscopic decompression is a safe procedure for acute management of impaired intestinal transit even in critically ill patients. Response to therapy is associated with improved outcome and markers of inflammation and organ function such as CRP, platelet count and serum lactate have to be taken into account for therapy monitoring and evaluation of prognosis.
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Affiliation(s)
- Thorsten Book
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
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20
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Claxton AN, Dark PM. Biomarker-guided antibiotic cessation in sepsis: evidence and future challenges. Br J Hosp Med (Lond) 2019. [PMID: 29528749 DOI: 10.12968/hmed.2018.79.3.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sepsis is a medical emergency, which requires the initiation of broad-spectrum antimicrobial agents as early as possible. In the absence of positive microbiological cultures providing targeted antimicrobial advice, broad-spectrum antibiotics are commonly continued until there is clinical evidence of infection resolution. With an absence of robust evidence to inform when it is safe to stop antimicrobial agents in sepsis, the duration of antimicrobial courses may be longer than is required. Prolonged courses of potent broad-spectrum antimicrobials increase the risk of adverse drug events and contribute to the growing emergence of multidrug resistant pathogens, which is a global public health emergency. The protocolised use of protein biomarkers to guide clinical decision making can be used to help combat excessive durations of antimicrobials in patients with sepsis. This article reviews the current evidence for biomarker-guided antimicrobial discontinuation protocols in sepsis, identifies related evidence gaps and examines future innovation challenges in this field.
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Affiliation(s)
- Andrew N Claxton
- Academic Clinical Fellow in Intensive Care Medicine, Nanomedicine Lab, Division of Pharmacy and Optometry, University of Manchester, Salford Royal NHS Foundation Trust, Salford M6 8HD
| | - Paul M Dark
- Professor of Critical Care Medicine, Division of Infection, Immunity and Respiratory Medicine, Manchester University Foundation Trust, University of Manchester, Manchester; Honorary NHS Consultant in Critical Care Medicine, Salford Royal Foundation Trust; NIHR CRN National Specialty Lead (Critical Care), King's College London, London
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21
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Basile-Filho A, Lago AF, Menegheti MG, Nicolini EA, Rodrigues LADB, Nunes RS, Auxiliadora-Martins M, Ferez MA. The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e16204. [PMID: 31261567 PMCID: PMC6617482 DOI: 10.1097/md.0000000000016204] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Several prognostic indices have been employed to predict the outcome of surgical critically ill patients. Among them, acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS 3) are widely used. It seems that biological markers such as C-reactive protein (CRP), albumin, and blood lactate levels correlate with the degree of inflammation during the immediate postoperative phase and could be used as independent predictors. The objective of this study is to compare the different predictive values of prognostic indices and biological markers in the outcome of 847 surgical patients admitted to the intensive care unit (ICU) in the postoperative phase.The patients were divided into survivors (n = 765, 57.4% males, age 61, interquartile range 51-71) and nonsurvivors (n = 82, 57.3% males, age 70, interquartile range 58-79). APACHE II, APACHE II death probability (DP), SOFA, SAPS 3, SAPS 3 DP, CRP, albumin, and lactate were recorded on ICU admission (first 24 hours). The area under the ROC curve (AUROC) and 95% confidence interval (95% CI) were used to measure the index accuracy to predict mortality.The AUROC and 95% CI for APACHE II, APACHE II DP, SOFA, SAPS 3, SAPS 3 DP, CRP/albumin ratio, CRP, albumin, and lactate were 0.850 (0.824-0.873), 0.855 (0.829-0.878), 0.791 (0.762-0.818), 0.840 (0.813-0.864), 0.840 (0.813-0.864), 0.731 (0.700-0.761), 0.708 (0.676-0.739), 0.697 (0.665-0.728), and 0.601 (0.567-0.634), respectively. The ICU and overall in-hospital mortality were 6.6 and 9.7%, respectively. The APACHE II, APACHE II DP, SAPS 3, SAPS 3 DP, and SOFA scores showed a better performance than CRP/albumin ratio, CRP, albumin, or lactate to predict in-hospital mortality of surgical critically ill patients.Even though all indices were able to discriminate septic from nonseptic patients, only APACHE II, APACHE II DP, SOFA and to a lesser extent SAPS 3, SAPS 3 DP, and blood lactate levels could predict in the first 24-hour ICU admission surgical patients who have survived sepsis.
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Affiliation(s)
- Anibal Basile-Filho
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo
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Lebedev NV, Klimov AE, Cherepanova ON, Barkhudarov AA. [Inflammatory markers in diagnosis and prognosis of abdominal sepsis]. Khirurgiia (Mosk) 2018:92-98. [PMID: 30531745 DOI: 10.17116/hirurgia201810192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For today, it is necessary to recognize, that treatment of patients with abdominal sepsis remains the basic problem in urgent surgery due to the invariably high mortality. Early diagnostics and targeted therapy are the key points for improving of sepsis outcome. At present, researchers around the world have proposed a large number of biological markers for diagnosing sepsis and predicting mortality. Ideally, doctors can use biomarkers for risk stratification, diagnosing, monitoring of treatment effectiveness and outcome prediction. The biomarker is a laboratory parameter that can be objectively measured and characterized as an indicator of normal and pathological biological processes. The article presents the modern concept of the sepsis pathogenesis for understanding the role of various biomarkers and inflammatory indicators in its development. We have analyzed literature data and summarized information on the possible use of biological markers and their combinations in the early detection of sepsis, for monitoring sepsis and predicting its outcome.
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Affiliation(s)
- N V Lebedev
- Chair of Faculty-Based Surgery, Peoples' Friendship University of Russia, Moscow, Russia
| | - A E Klimov
- Chair of Faculty-Based Surgery, Peoples' Friendship University of Russia, Moscow, Russia
| | - O N Cherepanova
- Chair of Faculty-Based Surgery, Peoples' Friendship University of Russia, Moscow, Russia
| | - A A Barkhudarov
- Chair of Faculty-Based Surgery, Peoples' Friendship University of Russia, Moscow, Russia
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Yan HP, Li M, Lu XL, Zhu YM, Ou-Yang WX, Xiao ZH, Qiu J, Li SJ. Use of plasma mitochondrial DNA levels for determining disease severity and prognosis in pediatric sepsis: a case control study. BMC Pediatr 2018; 18:267. [PMID: 30092777 PMCID: PMC6085664 DOI: 10.1186/s12887-018-1239-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 07/31/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The mortality rate due to severe sepsis is approximately 30-60%. Sepsis readily progresses to septic shock and multiple organ dysfunction, representing a significant problem in the pediatric intensive care unit (PICU). The aim of this study was to explore the value of plasma mitochondrial DNA (mtDNA) for early diagnosis and prognosis in children with sepsis. METHODS A total of 123 children with sepsis who were hospitalized in the Hunan Children's Hospital PICU from July 2013 to December 2014 were divided into the general sepsis group (n = 70) and severe sepsis group (n = 53) based on diagnostic standards. An additional 30 children with non-sepsis infection and 30 healthy children were randomly selected as a control group. Patients' plasma was collected during admission to the PICU. A pediatric critical illness score (PCIS) was also calculated. The plasma mtDNA level was examined using real-time polymerase chain reaction technology, and other parameters including routine laboratory values; blood lactate, procalcitonin (PCT), and C-reactive protein (CRP) levels; and data on survival were collected and compared among the groups. RESULTS The plasma mtDNA level in the sepsis group than that in the non-sepsis infection and healthy groups. The plasma mtDNA level was significantly higher in the severe sepsis than in the general sepsis group (p < 0.001). A lower PCIS was associated with a higher plasma mtDNA level (p < 0.001). A higher number of organs with dysfunction was associated with higher plasma mtDNA levels (p < 0.001). Plasma mtDNA levels were higher among patients with elevated alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, lactate dehydrogenase, creatine kinase, myoglobin, creatine kinase MB, and troponin than in those with values within the normal range. The mtDNA level was higher among non-survivors than among survivors, and this difference was significant. mtDNA showed a prognostic prediction value similar to that of lactate, PCT, and CRP. CONCLUSIONS Plasma mtDNA levels may be a suitable biomarker for diagnosis and prognosis in children with sepsis.
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Affiliation(s)
- Hai Peng Yan
- Department of Pediatric Intensive Care Unit (PICU), Hunan Children's Hospital, Changsha, China
| | - Miao Li
- Department of Pediatric Intensive Care Unit (PICU), Hunan Children's Hospital, Changsha, China
| | - Xiu Lan Lu
- Department of Pediatric Intensive Care Unit (PICU), Hunan Children's Hospital, Changsha, China
| | - Yi Min Zhu
- Hunan Provincial People's Hospital, the first affiliated hospital of Hunan normal University, Changsha, 410007, People's Republic of China
| | - Wen-Xian Ou-Yang
- Department of Section of Liver Disease, Hunan Children's Hospital, 86# Ziyuan Road, Changsha, 410007, China
| | - Zheng Hui Xiao
- Department of Pediatric Intensive Care Unit (PICU), Hunan Children's Hospital, Changsha, China
| | - Jun Qiu
- Department of Pediatric Intensive Care Unit (PICU), Hunan Children's Hospital, Changsha, China
| | - Shuang Jie Li
- Department of Section of Liver Disease, Hunan Children's Hospital, 86# Ziyuan Road, Changsha, 410007, China.
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Hall A, Crichton S, Varrier M, Bear DE, Ostermann M. suPAR as a marker of infection in acute kidney injury - a prospective observational study. BMC Nephrol 2018; 19:191. [PMID: 30071826 PMCID: PMC6090935 DOI: 10.1186/s12882-018-0990-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 07/23/2018] [Indexed: 11/30/2022] Open
Abstract
Background Soluble urokinase-type plasminogen activator receptor (suPAR) has emerged as a new sepsis biomarker. It is not known whether suPAR has a role in critically ill patients with severe acute kidney injury (AKI). Methods Our main aims were to describe serial serum suPAR concentrations in patients with severe AKI, to investigate a potential association between suPAR and C-reactive protein (CRP), and to compare suPAR and CRP as diagnostic markers of infection in patients with AKI. Between April 2013 – April 2014, we recruited adult patients (≥18 years) with AKI KDIGO stage 2/3 admitted to a multidisciplinary Intensive Care Unit (ICU) in a University Hospital in UK. Serial serum suPAR and CRP concentrations were measured for 6 days. We compared the characteristics and serial suPAR and CRP concentrations of patients with and without an infection using Chi-squared, Fisher’s exact, t-test and Mann-Whitney tests as appropriate, and calculated the area under the receiver operating characteristics curve (AUC). Results Data of 55 patients with AKI stage 2/3 were analysed (62% male; mean age 60.5) of whom 43 patients received continuous renal replacement therapy. suPAR was not detectable in effluent fluid. There was no significant correlation between daily suPAR and CRP concentrations. In patients with an infection, suPAR results were significantly higher than in those without an infection across all time points; there was no significant difference in CRP levels between both groups. After exclusion of patients with an infection before or on day of admission to ICU, the AUC of suPAR for predicting an infection later was 0.62 (95% CI 0.43–0.80) compared to 0.50 (95% CI 0.29–0.71) for CRP. Conclusions In critically ill patients with AKI stage 2/3, suPAR is a better marker of infection than CRP. Trial registration The study was retrospectively registered on the ISRCTN registry on 25 November 2012 (ISRCTN88354940).
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Affiliation(s)
- Anna Hall
- Guy's & St Thomas' NHS Foundation Trust, Department of Critical Care, London, SE1 9RT, UK
| | - Siobhan Crichton
- MRC Clinical Trials Unit, University College London, London, WC2B 6NH, UK
| | - Matt Varrier
- King's College London, Guy's & St Thomas' NHS Foundation Trust, Department of Critical Care, London, SE1 9RT, UK
| | - Danielle E Bear
- Guy's & St Thomas' NHS Foundation Trust, Departments of Nutrition and Dietetics & Critical Care, London, SE1 9RT, UK
| | - Marlies Ostermann
- King's College London, Guy's & St Thomas' NHS Foundation Trust, Department of Critical Care, London, SE1 9RT, UK. .,King's College London, Guy's and St Thomas' Foundation Hospital, Department of Critical Care, London, SE1 7EH, UK.
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Zhang Y, Zhou Y, Li W, Lyons V, Johnson A, Venable A, Griswold J, Pappas D. Multiparameter Affinity Microchip for Early Sepsis Diagnosis Based on CD64 and CD69 Expression and Cell Capture. Anal Chem 2018; 90:7204-7211. [DOI: 10.1021/acs.analchem.7b05305] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ye Zhang
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Yun Zhou
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Wenjie Li
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Veronica Lyons
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | | | | | | | - Dimitri Pappas
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
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García de Guadiana Romualdo L, Albaladejo Otón MD, Rebollo Acebes S, Esteban Torrella P, Hernando Holgado A, Jiménez Santos E, Jiménez Sánchez R, Ortón Freire A. Diagnostic accuracy of lipopolysaccharide-binding protein for sepsis in patients with suspected infection in the emergency department. Ann Clin Biochem 2017; 55:143-148. [PMID: 28135842 DOI: 10.1177/0004563217694378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Biomarkers can facilitate the diagnosis of sepsis, enabling early management and improving outcomes. Lipopolysaccharide-binding protein (LBP) has been reported as a biomarker for the detection of infection, but its diagnostic value is controversial. In this study, we assessed the diagnostic accuracy of LBP for sepsis in the emergency department (ED) patients, comparing it with more established biomarkers of sepsis, including procalcitonin (PCT) and C-reactive protein (CRP). Methods LBP and other sepsis biomarkers, including PCT and CRP, were measured on admission in 102 adult patients presenting with suspected infection . Classification of patients was performed using the recently updated definition for sepsis (Sepsis-3). The diagnostic accuracy of LBP, CRP and PCT for sepsis was evaluated by using receiver operating characteristic curve (ROC) analysis. Results A total of 49 patients were classified as having sepsis. In these patients, median (interquartile range) LBP (41.8 [41.1] µg/dL vs. 26.2 [25] µg/dL), CRP (240 [205] mg/L vs. 160 [148] mg/dL) and PCT (5.19 [13.68] µg/L vs. 0.39 [1.09] µg/L) were significantly higher than in patients classified as not having sepsis ( P < 0.001 for all three biomarkers). ROC curve analysis and area under curve (AUC) revealed a value of 0.701 for LBP, similar to CRP (0.707) and lower than that for PCT (0.844) ( P = 0.012). Conclusion In adult ED patients with suspected infection, the diagnostic accuracy for sepsis of LBP is similar to that of CRP but lower than that of PCT.
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Stalder G, Que YA, Calzavarini S, Burnier L, Kosinski C, Ballabeni P, Roger T, Calandra T, Duchosal MA, Liaudet L, Eggimann P, Angelillo-Scherrer A. Study of Early Elevated Gas6 Plasma Level as a Predictor of Mortality in a Prospective Cohort of Patients with Sepsis. PLoS One 2016; 11:e0163542. [PMID: 27788141 PMCID: PMC5082941 DOI: 10.1371/journal.pone.0163542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/09/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Growth arrest-specific gene 6 (Gas6), a vitamin K-dependent protein interacting with anionic phospholipids and TAM tyrosine kinase receptors, is elevated in plasma of septic patients. Previous studies did not find different levels between survivors and non-survivors at admission because either they included a low number of patients (<50) or a low number of non-survivors (5%). OBJECTIVES To determine, in a larger cohort of septic patients comprising an expected number of non-survivors, the performance of the plasma level of Gas6 and its soluble receptor Axl (sAxl) within 24 hours of admission to predict in-ICU mortality. PATIENTS Septic adults with or without shock. METHODS Gas6 and sAxl were prospectively measured by ELISA at day 0, 3, 7, and then weekly until discharge or death. RESULTS We evaluated 129 septic patients, including 82 with and 47 without shock, with in-ICU mortality rate of 19.4% and in-hospital mortality rate of 26%. Gas6 level was higher in non-survivors than in survivors (238 vs. 167%, P = 0.003); this difference remained constant during the ICU stay. The area under the ROC curve for Gas6 (0.695 [95% CI: 0.58-0.81]) was higher than for sAxl, procalcitonin, CRP, IL-1beta, IL-6 and-alpha, and slightly higher than for IL-8, IL-10, SOFA and APACHEII scores in predicting in-ICU mortality. Considering 249% as a cut-off value, Gas6 measurement had a negative predictive value for mortality of 87%. CONCLUSION It seems that Gas6 plasma level within 24 hours of ICU admission may predicts in-ICU mortality in patients with sepsis. If our result are confirmed in external validation, Gas6 plasma level measurement could contribute to the identification of patients who may benefit most from more aggressive management.
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Affiliation(s)
- Grégoire Stalder
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Yok Ai Que
- Service of Adult Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sara Calzavarini
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Laurent Burnier
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Christophe Kosinski
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Pierluigi Ballabeni
- Clinical Research Centre, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Thierry Roger
- Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Michel A. Duchosal
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Lucas Liaudet
- Service of Adult Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Philippe Eggimann
- Service of Adult Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Anne Angelillo-Scherrer
- Service and Central Laboratory of Hematology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
- * E-mail:
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Valor pronóstico de la interleucina 6 en la mortalidad de pacientes con sepsis. Med Clin (Barc) 2016; 147:281-6. [DOI: 10.1016/j.medcli.2016.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 05/13/2016] [Accepted: 06/02/2016] [Indexed: 11/30/2022]
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Khater WS, Salah-Eldeen NN, Khater MS, Saleh AN. Role of suPAR and Lactic Acid in Diagnosing Sepsis and Predicting Mortality in Elderly Patients. Eur J Microbiol Immunol (Bp) 2016; 6:178-185. [PMID: 27766166 PMCID: PMC5063010 DOI: 10.1556/1886.2016.00011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/09/2016] [Indexed: 12/11/2022] Open
Abstract
This study investigated the diagnostic value of soluble urokinase plasminogen activator receptor (suPAR) and serum lactate in elderly patients with sepsis and evaluated their capacity to predict mortality and their correlation to Sequential Organ Failure Assessment (SOFA) score. The study included 80 participants, divided into two groups: 40 cases (mean age, 68.9 ± 5.9) admitted to the intensive care unit and 40 healthy controls (mean age, 67.1 ± 6.2). Elderly patients with sepsis had significantly higher levels of serum suPAR and lactic acid compared to healthy controls. Receiver operating characteristic (ROC) curve analysis showed that suPAR (cutoff value, ≥4.37 ng/ml) has higher area under the curve (AUC) than lactic acid (cutoff value, ≥1.95 mmol/l) for diagnosing sepsis. Serum lactate has superior prognostic value compared to suPAR with AUC of 0.82 (cutoff value, 2.2 mmol/l) and 0.72 (cutoff value, 6.3 ng/ml), respectively. The diagnostic power of combined usage of suPAR and lactate serum concentrations showed AUC of 0.988 (95% confidence interval 0.934 to 1.0). The combination of both biomarkers either together or with SOFA score may serve as a useful guide to patients who need more intensive resuscitation.
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Affiliation(s)
- Walaa S. Khater
- Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Noha N. Salah-Eldeen
- Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed S. Khater
- Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Asghraf N. Saleh
- Anesthesia and Intensive Care Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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van der Geest PJ, Mohseni M, Linssen J, Duran S, de Jonge R, Groeneveld ABJ. The intensive care infection score - a novel marker for the prediction of infection and its severity. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:180. [PMID: 27384242 PMCID: PMC4936267 DOI: 10.1186/s13054-016-1366-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/01/2016] [Indexed: 12/16/2022]
Abstract
Background The prediction of infection and its severity remains difficult in the critically ill. A novel, simple biomarker derived from five blood-cell derived parameters that characterize the innate immune response in routine blood samples, the intensive care infection score (ICIS), could be helpful in this respect. We therefore compared the predictive value of the ICIS with that of the white blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT) for infection and its severity in critically ill patients. Methods We performed a multicenter, cluster-randomized, crossover study in critically ill patients between January 2013 and September 2014. Patients with a suspected infection for which blood cultures were taken by the attending intensivist were included. Blood was taken at the same time for WBC, ICIS, CRP and PCT measurements in the control study periods. Results of imaging and cultures were collected. Patients were divided into groups of increasing likelihood of infection and invasiveness: group 1 without infection or with possible infection irrespective of cultures, group 2 with probable or microbiologically proven local infection without blood stream infection (BSI) and group 3 with BSI irrespective of local infection. Septic shock was assessed. Results In total, 301 patients were enrolled. CRP, PCT and ICIS were higher in groups 2 and 3 than group 1. The area under the receiver operating characteristic curve (AUROC) for the prediction of infection was 0.70 for CRP, 0.71 for PCT and 0.73 for ICIS (P < 0.001). For the prediction of septic shock the AUROC was 0.73 for CRP, 0.85 for PCT and 0.76 for ICIS. These AUROC did not differ from each other. Conclusion The data suggest that the ICIS is potentially useful for the prediction of infection and its severity in critically ill patients, non-inferiorly to CRP and PCT. In contrast to CRP and PCT, the ICIS can be determined routinely without extra blood sampling and lower costs, yielding results within 15 minutes. Trial registration ClinicalTrials.gov identifier: ID NCT01847079. Registered on 24 April 2013.
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Affiliation(s)
- Patrick J van der Geest
- Department of Intensive Care Medicine of the Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.
| | - Mostafa Mohseni
- Department of Intensive Care Medicine of the Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Jo Linssen
- Faculty of Health Science, University of Medicine, Institute of Immunology, University Witten/Herdecke, Witten, Germany
| | - Servet Duran
- Department of Intensive Care Medicine of the Maasstad Hospital, Rotterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry of the Erasmus Medical Center, Rotterdam, The Netherlands
| | - A B Johan Groeneveld
- Department of Intensive Care Medicine of the Erasmus Medical Center, 's Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
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Zhang CY, Zhang HH, Zhao SL, Wu HY, Li HN, Li W, Yang J. Clinical value of alkaline phosphatase on the surface membrane of neutrophils for prediction of bacteremia in patients with systemic inflammatory response syndrome. Diagn Microbiol Infect Dis 2016; 100:114105. [PMID: 34279227 DOI: 10.1016/j.diagmicrobio.2016.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
In this study, the utility and diagnostic accuracy of alkaline phosphatase on the surface membrane of neutrophils (mNAP) for bacteremia in patients with systemic inflammatory response syndrome (SIRS) was investigated and assessed. A total of 149 patients with SIRS were included. mNAP values were significantly higher in bacteremic SIRS group compared with that in non-bacteremic SIRS group (P < 0.001). The mNAP levels were significantly higher in SIRS patients with gram-negative bacteremia than those with gram-positive bacteremia. (P < 0.001). The receiver operating characteristic (ROC) curve analysis revealed the areas under ROC (AUC) of 0.806 for mNAP in differentiating SIRS patients with bacteremia from those without, similar to that for procalcitonin (PCT) (0.797). Combination of PCT and mNAP gave an AUC of 0.841. mNAP shares a similar diagnostic accuracy to PCT in predicting bacteremia in SIRS patients. The combination of mNAP and PCT provides a better prediction of bacteremia in patients with SIRS than either test alone.
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Affiliation(s)
- Chun-Yan Zhang
- Department of Central Laboratory, the First People's Hospital of Lianyungang, Lianyungang, China
| | - Huan-Huan Zhang
- Department of Central Laboratory, the First People's Hospital of Lianyungang, Lianyungang, China
| | - Shao-Lin Zhao
- Department of Central Laboratory, the First People's Hospital of Lianyungang, Lianyungang, China
| | - Hui-Yi Wu
- Department of Central Laboratory, the First People's Hospital of Lianyungang, Lianyungang, China.
| | - Hai-Ning Li
- Department of Central Laboratory, the First People's Hospital of Lianyungang, Lianyungang, China
| | - Wei Li
- Department of Central Laboratory, the First People's Hospital of Lianyungang, Lianyungang, China
| | - Jin Yang
- Department of Central Laboratory, the First People's Hospital of Lianyungang, Lianyungang, China
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Abstract
PURPOSE Few studies on plasma glucagon levels in patients with sepsis have been performed. We aimed to assess clinical value of glucagon levels in comparison with clinical parameters and severity scores in patients with severe sepsis or septic shock. METHODS A total of 112 patients who were admitted to intensive care unit with severe sepsis or septic shock were included. Plasma levels of glucagon on days 0, 1, 3, and 7 were serially measured in 112 patients with severe sepsis or septic shock. RESULTS Compared with survivors, patients who died within 28 days had significantly higher glucagon levels on every day of examination. Glucagon levels were positively correlated with and Acute Physiology and Chronic Health Evaluation II score (day 0, r = 0.288, P < 0.01) and Sequential Organ Failure Assessment (day 0, r = 0.482, P< 0.01; day 1, r = 0.588, P < 0.01; day 3, r = 0.480, P < 0.01; day 7, r = 0.454, P < 0.01). Receiver operating characteristic analysis showed that the area under the curve of glucagon levels to predict 28-day survival was 0.65 (95% confidence interval [CI], 0.55-0.75; P = 0.005), similar to the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. Multivariate analysis revealed that glucagon levels of greater than 70 pg/mL (hazard ratio, 1.85; 95% CI, 1.03-3.29) and chronic liver disease (hazard ratio, 1.97; 95% CI, 1.02-3.79) were associated with mortality. CONCLUSIONS Glucagon levels might reflect disease severity and clinical outcomes in patients with severe sepsis or septic shock.
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Sunnetcioglu A, Sunnetcioglu M, Adıyaman F, Binici I, Soyoral L. Could soluble urokinase plasminogen receptor (suPAR) be used as a diagnostic biomarker for ventilator-associated pneumonia? CLINICAL RESPIRATORY JOURNAL 2016; 11:925-930. [PMID: 26683264 DOI: 10.1111/crj.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/12/2015] [Accepted: 12/14/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker that is increasingly used for evaluation of systemic inflammation. This study was performed to investigate whether suPAR may possess a diagnostic value in patients with ventilator-associated pneumonia (VAP). METHODS This clinical study was performed in the anesthesia intensive care units (ICUs) of our university. In addition to descriptive data, WBC, serum levels of C-reactive protein (CRP) and suPAR prior to and after development of VAP were noted and compared in 31 patients (22 men, 9 women) diagnosed with VAP (Study Group) and 19 patients without VAP (Control Group) in ICU (14 men, 5 women). RESULTS The suPAR (P = 0.023), CRP (P = 0.037), WBCs (P = 0.024) in patients with VAP were significantly higher than patients without VAP. There was no remarkable difference in terms of WBCs (P = 0.052) and suPAR levels (P = 0.616) between groups on the first day of connection to mechanical ventilator. The suPAR and CRP levels in patients with VAP were significantly higher than prior to development of VAP (P = 0.001 for both). Area under curve value after diagnosis of pneumonia was found 0.248 (P = 0.002). CONCLUSION To conclude, our results suggest that suPAR can be a useful diagnostic biomarker in patients with VAP. However, clinical trials on larger series are warranted to explore the clinical significance more accurately.
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Affiliation(s)
- Aysel Sunnetcioglu
- Department of Chest Diseases, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Mahmut Sunnetcioglu
- Department of Infectious Diseases, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Fırat Adıyaman
- Department of Infectious Diseases, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Irfan Binici
- Department of Infectious Disease, Ercis State Hospital, Van, Turkey
| | - Lokman Soyoral
- Department of Anesthesiology and Intensive Care, Yuzuncu Yil University, Medical Faculty, Van, Turkey
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Que YA, Guessous I, Dupuis-Lozeron E, de Oliveira CRA, Oliveira CF, Graf R, Seematter G, Revelly JP, Pagani JL, Liaudet L, Nobre V, Eggimann P. Prognostication of Mortality in Critically Ill Patients With Severe Infections. Chest 2015; 148:674-682. [PMID: 26065577 DOI: 10.1378/chest.15-0123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to confirm the prognostic value of pancreatic stone protein (PSP) 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. METHODS We enrolled prospectively patients with severe sepsis or septic shock in mixed tertiary ICUs in Switzerland (derivation cohort) and Brazil (validation cohort). Severity scores (APACHE [Acute Physiology and Chronic Health Evaluation] II or Simplified Acute Physiology Score [SAPS] II) were combined with biomarkers obtained at the time of diagnosis of sepsis, including C-reactive-protein, procalcitonin (PCT), and PSP. Logistic regression models with the lowest prediction errors were selected to predict in-hospital mortality. RESULTS Mortality rates of patients with septic shock enrolled in the derivation cohort (103 out of 158) and the validation cohort (53 out of 91) were 37% and 57%, respectively. APACHE II and PSP were significantly higher in dying patients. In the derivation cohort, the models combining either APACHE II, PCT, and PSP (area under the receiver operating characteristic curve [AUC], 0.721; 95% CI, 0.632-0.812) or SAPS II, PCT, and PSP (AUC, 0.710; 95% CI, 0.617-0.802) performed better than each individual biomarker (AUC PCT, 0.534; 95% CI, 0.433-0.636; AUC PSP, 0.665; 95% CI, 0.572-0.758) or severity score (AUC APACHE II, 0.638; 95% CI, 0.543-0.733; AUC SAPS II, 0.598; 95% CI, 0.499-0.698). These models were externally confirmed in the independent validation cohort. CONCLUSIONS We confirmed the prognostic value of PSP in patients with severe sepsis and septic shock requiring ICU management. A model combining severity scores with PCT and PSP improves mortality prediction in these patients.
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Affiliation(s)
- Yok-Ai Que
- Department of Adult Intensive Care Medicine, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland
| | - Idris Guessous
- Community Prevention Unit, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland; Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Elise Dupuis-Lozeron
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Research Center for Statistics, University of Geneva, Geneva, Switzerland
| | - Clara Rodrigues Alves de Oliveira
- Institute of Social and Preventive Medicine, Infectious Diseases Service, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland
| | - Carolina Ferreira Oliveira
- Institute of Social and Preventive Medicine, Infectious Diseases Service, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland
| | - Rolf Graf
- Swiss Hepato-Pancreatico-Biliary Center, Department of Visceral and Transplant Surgery, University Hospital, Zürich, Switzerland
| | - Gérald Seematter
- Service d'Anesthésiologie, Hôpital Riviera, Montreux, Switzerland
| | - Jean-Pierre Revelly
- Department of Adult Intensive Care Medicine, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Pagani
- Department of Adult Intensive Care Medicine, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland
| | - Lucas Liaudet
- Department of Adult Intensive Care Medicine, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland
| | - Vandack Nobre
- Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Philippe Eggimann
- Department of Adult Intensive Care Medicine, University Hospital Medical Center and University of Lausanne, Lausanne, Switzerland.
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Tziolos N, Kotanidou A, Orfanos SE. Biomarkers in infection and sepsis: Can they really indicate final outcome? Int J Antimicrob Agents 2015; 46 Suppl 1:S29-32. [PMID: 26607340 DOI: 10.1016/j.ijantimicag.2015.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Infectious diseases are among the most common reasons for admission to hospital and can easily lead to sepsis. Sepsis is globally associated with increased mortality, and although biomarkers could help clinicians in the early diagnosis of sepsis and immediate onset of antibiotics, there are always questions to be answered about their usefulness in the prognosis of infectious diseases. This article reviews some of the available biomarkers used in infectious diseases and sepsis in order to evaluate their utility to predict mortality and unfavourable outcome. Several studies present the pros and cons of each compound, but it is obvious that the ideal biomarker, with high sensitivity and specificity, cost effectiveness and with definite cut-off ranges and time of blood sampling, is yet to be found.
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Affiliation(s)
- Nikolaos Tziolos
- 4th Department of Internal Medicine, University of Athens Medical School, Athens, Greece
| | - Anastasia Kotanidou
- 1st Department of Critical Care, University of Athens Medical School, Athens, Greece
| | - Stylianos E Orfanos
- 2nd Department of Critical Care, University of Athens Medical School, Athens, Greece.
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Casagranda I, Vendramin C, Callegari T, Vidali M, Calabresi A, Ferrandu G, Cervellin G, Cavazza M, Lippi G, Zanotti I, Negro S, Rocchetti A, Arfini C. Usefulness of suPAR in the risk stratification of patients with sepsis admitted to the emergency department. Intern Emerg Med 2015; 10:725-30. [PMID: 26156446 DOI: 10.1007/s11739-015-1268-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/28/2015] [Indexed: 02/01/2023]
Abstract
To investigate the role of suPAR in patients with sepsis admitted to the Emergency Department (ED). We performed multicentre prospective trial including patients admitted to the ED of three different Italian hospitals. Patients were studied upon admission on day 1, 2, 4 and 7. They were subdivided into two groups: sepsis (group 1) and severe sepsis or septic shock (group 2). The two groups were comparable for age, gender and CRP level on day 1. Patients with severe sepsis or septic shock displayed significantly higher baseline levels of suPAR, PCT and lactate. In both groups, suPAR decreased across the time (p < 0.0005). Group 1 was not different from group 2 (p = 0.545) in mortality at 7 days, while group 2 had higher mortality at 30 days than group 1 (p = 0.022). At the multivariate analysis, lactate1 (p = 0.012) and age (p = 0.019) were independent predictors of mortality at 7 days, whereas suPAR1 (p = 0.023) and age (p = 0.032) were independent predictors of mortality at 30 days. Lactate and suPAR resulted the most predictive biomarkers in the risk stratification of patients with suspected infection initially admitted to the ED, according to their role in predicting 7- and 30-day mortality, respectively.
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Affiliation(s)
- Ivo Casagranda
- Emergency Department, SS. Antonio e Biagio e Cesare Arrigo Hospital, Via Venezia 16, 15100, Alessandria, Italy,
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[Predictive value of procalcitonin in children with suspected sepsis]. ACTA ACUST UNITED AC 2015; 86:331-6. [PMID: 26320678 DOI: 10.1016/j.rchipe.2015.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 05/26/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The use of biomarkers could be a tool for diagnosis, prognosis and stratifying children with sepsis. Our main goal was to analyze the value of procalcitonin (PCT), C reactive protein (CRP) and lactate in predicting mortality, septic shock and the stratification in children with suspected sepsis PATIENTS AND METHOD Prospective study in 81 patients. Plasma levels of PCT, CRP and lactate were measured at admission in the pediatric intensive care unit. Patients were categorized into systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock. RESULTS Concentrations of PCT (ng/mL) increased significantly according to the severity of sepsis: 0.36 (0-1.2) for systemic inflammatory response syndrome; 1.96 (0.4-3.5) for sepsis; 7.5 (3.9-11.1) for severe sepsis; and 58.9 (35.1-82.7) for septic shock (P<.001). Compared to CRP and lactate, the area under the ROC curve revealed a good discriminative power of PCT to predict septic shock and mortality, 0.91 (95% CI: 0.83-0.97) and 0.80 (95% CI: 0.69-0.88), respectively. CONCLUSIONS In contrast to CRP and lactate, the determination of PCT in pediatric intensive care unit admission is a good predictor of mortality and septic shock and can stratify patients according to severity of sepsis.
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Abstract
Sepsis is defined as an exaggerated, systemic inflammatory response to infection and is a common condition in horses. Systemic inflammatory response syndrome (SIRS) associated with bacterial infection is a hallmark of sepsis. Sepsis in neonatal foals is a common sequela of failure of passive transfer and, in addition to development of SIRS, may be characterised by bacteraemia, pneumonia, enterocolitis, omphalophlebitis, meningoencephalitis or arthritis. Sepsis in mature horses is most commonly observed secondary to gastrointestinal lesions that result in disrupted mucosa and bacterial translocation into circulation (endotoxaemia). Pleuropneumonia and metritis may also cause sepsis in mature horses. Diagnosis of sepsis is based on SIRS criteria as well as suspected or confirmed infection. Due to the relatively low sensitivity of microbial culture and the subjectivity of sepsis scoring, many sepsis biomarkers are being studied for their usefulness in diagnosis and prognostication of sepsis in horses. Treatment of sepsis requires an intensive care approach that includes antimicrobial drug administration, fluid resuscitation and pressure support, and treatment for inflammation, endotoxaemia and coagulopathy. Early recognition of sepsis and prompt antimicrobial drug treatment are critical for a successful outcome. Multiple organ dysfunction syndrome may occur in severe cases of sepsis, with common manifestations including laminitis and coagulopathies. Although prognosis for septic mature horses depends highly on the primary disease process, the overall survival rate in septic neonatal foals ranges from 26 to 86%, with most studies indicating a survival rate of 45-60%.
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Affiliation(s)
- S Taylor
- Veterinary Clinical Sciences Purdue University West Lafayette Indiana USA
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Abstract
Abstract
Background:
Multicapillary column ion-mobility spectrometry (MCC-IMS) may identify volatile components in exhaled gas. The authors therefore used MCC-IMS to evaluate exhaled gas in a rat model of sepsis, inflammation, and hemorrhagic shock.
Methods:
Male Sprague–Dawley rats were anesthetized and ventilated via tracheostomy for 10 h or until death. Sepsis was induced by cecal ligation and incision in 10 rats; a sham operation was performed in 10 others. In 10 other rats, endotoxemia was induced by intravenous administration of 10 mg/kg lipopolysaccharide. In a final 10 rats, hemorrhagic shock was induced to a mean arterial pressure of 35 ± 5 mmHg. Exhaled gas was analyzed with MCC-IMS, and volatile compounds were identified using the BS-MCC/IMS-analytes database (Version 1209; B&S Analytik, Dortmund, Germany).
Results:
All sham animals survived the observation period, whereas mean survival time was 7.9 h in the septic animals, 9.1 h in endotoxemic animals, and 2.5 h in hemorrhagic shock. Volatile compounds showed statistically significant differences in septic and endotoxemic rats compared with sham rats for 3-pentanone and acetone. Endotoxic rats differed significantly from sham for 1-propanol, butanal, acetophenone, 1,2-butandiol, and 2-hexanone. Statistically significant differences were observed between septic and endotoxemic rats for butanal, 3-pentanone, and 2-hexanone. 2-Hexanone differed from all other groups in the rats with shock.
Conclusions:
Breath analysis of expired organic compounds differed significantly in septic, inflammation, and sham rats. MCC-IMS of exhaled breath deserves additional study as a noninvasive approach for distinguishing sepsis from inflammation.
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Brodska H, Valenta J, Malickova K, Kohout P, Kazda A, Drabek T. Biomarkers in critically ill patients with systemic inflammatory response syndrome or sepsis supplemented with high-dose selenium. J Trace Elem Med Biol 2015; 31:25-32. [PMID: 26004888 DOI: 10.1016/j.jtemb.2015.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Low levels of selenium (Se) and glutathione peroxidase (GSHPx), a key selenoenzyme, were documented in systemic inflammatory response syndrome (SIRS) and sepsis, both associated with high mortality. Se supplementation had mixed effects on outcome. We hypothesized that Se supplementation could have a different impact on biomarkers and 28-day mortality in patients with SIRS vs. sepsis. METHODS Adult patients with SIRS or sepsis were randomized to either high-dose (Se+, n = 75) or standard-dose (Se-, n = 75) Se supplementation. Plasma Se, whole blood GSHPx activity, C-reactive protein (CRP), procalcitonin (PCT), prealbumin, albumin and cholesterol levels were measured serially up to day 14. RESULTS There was no difference in mortality between Se- (24/75) vs. Se+ group (19/75; p = 0.367) or between SIRS and septic patients (8/26 vs. 35/124; p = 0.794). There was a trend to reduced mortality in SIRS patients in the Se+ vs. Se- group (p = 0.084). Plasma Se levels increased in the Se+ group only in patients with sepsis but not in patients with SIRS. Plasma Se levels correlated with GSHPx. In SIRS/Se+ group, Se correlated only with GSHPx. In SIRS/Se- group, Se correlated with cholesterol but not with other biomarkers. In sepsis patients, Se levels correlated with cholesterol, GSHPx and prealbumin. Cholesterol levels were higher in survivors in the Se- group. CONCLUSIONS Se levels correlated with GSHPx activity and other nutritional biomarkers with significant differences between SIRS and sepsis groups. High-dose Se supplementation did not affect mortality but a strong trend to decreased mortality in SIRS patients warrants further studies in this population.
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Affiliation(s)
- Helena Brodska
- Institute of Clinical Biochemistry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jiri Valenta
- Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Karin Malickova
- Institute of Clinical Biochemistry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Pavel Kohout
- Department of Internal Medicine, Nutrition and Dietetic Center, Thomayer University Hospital, Prague, Czech Republic
| | - Antonin Kazda
- Institute of Clinical Biochemistry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Tomas Drabek
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Santonocito C, De Loecker I, Donadello K, Moussa MD, Markowicz S, Gullo A, Vincent JL. C-Reactive Protein Kinetics After Major Surgery. Anesth Analg 2014; 119:624-629. [DOI: 10.1213/ane.0000000000000263] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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García de Guadiana-Romualdo LM, Rebollo-Acebes S, Esteban-Torrella P, Jiménez-Sánchez R, Hernando-Holgado A, Ortín-Freire A, Viqueira-González M, Trujillo-Santos J, Jiménez Santos E, Pedregosa Díaz J, Albaladejo-Otón MD, Allegue-Gallego JM. [Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to intensive care]. Med Intensiva 2014; 39:207-12. [PMID: 24953001 DOI: 10.1016/j.medin.2014.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/21/2014] [Accepted: 04/24/2014] [Indexed: 01/17/2023]
Abstract
AIMS 1) To assess the prognostic value of levels on admission and serial measurements of lipopolysaccharide binding protein (LBP) and procalcitonin (PCT) in relation to in-hospital mortality; and 2) to determine whether the addition of these parameters to severity scores (APACHE II and SOFA) is able to improve prognostic accuracy. DESIGN A single-center, prospective observational study was carried out. SETTING Intensive Care unit of a university hospital. PATIENTS One hundred severe sepsis and septic shock patients were included. DATA COLLECTED Demographic data, APACHE II and SOFA scores, PCT and LBP levels on admission and after 48 hours, and in-hospital mortality. RESULTS The best area under the curve for predicting in-hospital mortality corresponded to APACHE II on admission and SOFA after 48 h (AUC ROC: 0.75 for both). PCT and LBP levels on admission and LBP clearance were not statistically different between in-hospital survivors and non-survivors. Only PCT clearance was higher among in-hospital survivors than in non-survivors (AUC ROC: 0.66). The combination of severity scores and PCT clearance did not result in superior areas under the curve. CONCLUSIONS LBP and PCT levels on admission and LBP clearance showed no prognostic value in severe sepsis and septic shock patients. Only PCT clearance was predictive of in-hospital mortality. The prognostic accuracy was significantly better for APACHE on admission and SOFA after 48 h than for any of the analyzed biomarkers, and the addition of PCT clearance did not improve their prognostic value.
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Affiliation(s)
| | - S Rebollo-Acebes
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | - P Esteban-Torrella
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - R Jiménez-Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | - A Hernando-Holgado
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - A Ortín-Freire
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | - M Viqueira-González
- Servicio de Microbiología y Parasitología, Hospital Universitario Santa Lucía, Cartagena, España
| | - J Trujillo-Santos
- Servicio de Medicina Interna, Hospital Universitario Santa Lucía, Cartagena, España
| | - E Jiménez Santos
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - J Pedregosa Díaz
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - M D Albaladejo-Otón
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - J M Allegue-Gallego
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
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Abstract
Sepsis, severe sepsis, and septic shock cause significant morbidity and mortality worldwide. Rapid diagnosis and therapeutic interventions are desirable to improve the overall mortality in patients with sepsis. However, gold standard laboratory diagnostic methods for sepsis, pose a significant challenge to rapid diagnosis of sepsis by physicians and laboratories. This article discusses the usefulness and potential of biomarkers and molecular test methods for a more rapid clinical and laboratory diagnosis of sepsis. Because new technologies are quickly emerging, physicians and laboratories must appreciate the key factors and characteristics that affect the clinical usefulness and diagnostic accuracy of these test methodologies.
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Affiliation(s)
- Stefan Riedel
- Division of Microbiology, Department of Pathology, School of Medicine, The Johns Hopkins University, and Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, A Building, Room 102-B, Baltimore, MD 21224, USA.
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Abstract
Sepsis remains a leading cause of death in critically ill patients, despite efforts to improve patient outcome. Thus far, no magic drugs exist for severe sepsis and septic shock. Instead, early diagnosis and prompt initial management such as early goal-directed therapy are key to improve sepsis outcome. For early detection of sepsis, biological markers (biomarkers) can help clinicians to distinguish infection from host response to inflammation. Ideally, biomarkers can be used for risk stratification, diagnosis, monitoring of treatment responses, and outcome prediction. More than 170 biomarkers have been identified as useful for evaluating sepsis, including C-reactive protein, procalcitonin, various cytokines, and cell surface markers. Recently, studies have reported on the usefulness of biomarker-guided antibiotic stewardships. However, the other side of these numerous biomarkers is that no novel single laboratory marker can diagnose, predict, and track the treatment of sepsis. The purpose of this review is to summarize several key biomarkers from recent sepsis studies.
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Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. ; Vaccine Bio Research Institute, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. ; Vaccine Bio Research Institute, The Catholic University of Korea College of Medicine, Seoul, Korea
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Hong CM, Tosun C, Kurland DB, Gerzanich V, Schreibman D, Simard JM. Biomarkers as outcome predictors in subarachnoid hemorrhage--a systematic review. Biomarkers 2014; 19:95-108. [PMID: 24499240 DOI: 10.3109/1354750x.2014.881418] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONTEXT Subarachnoid hemorrhage (SAH) has a high fatality rate and many suffer from delayed neurological deficits. Biomarkers may aid in the identification of high-risk patients, guide treatment/management and improve outcome. OBJECTIVE The aim of this review was to summarize biomarkers of SAH associated with outcome. METHODS An electronic database query was completed, including an additional review of reference lists to include all potential human studies. RESULTS A total of 298 articles were identified; 112 were reviewed; 55 studies were included. CONCLUSION This review details biomarkers of SAH that correlate with outcome. It provides the basis for research investigating their possible translation into the management of SAH patients.
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Affiliation(s)
- Caron M Hong
- Department of Anesthesiology, Division of Critical Care Medicine
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Fowler AA, Syed AA, Knowlson S, Sculthorpe R, Farthing D, DeWilde C, Farthing CA, Larus TL, Martin E, Brophy DF, Gupta S, Fisher BJ, Natarajan R. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med 2014; 12:32. [PMID: 24484547 PMCID: PMC3937164 DOI: 10.1186/1479-5876-12-32] [Citation(s) in RCA: 367] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/02/2014] [Indexed: 02/07/2023] Open
Abstract
Background Parenterally administered ascorbic acid modulates sepsis-induced inflammation and coagulation in experimental animal models. The objective of this randomized, double-blind, placebo-controlled, phase I trial was to determine the safety of intravenously infused ascorbic acid in patients with severe sepsis. Methods Twenty-four patients with severe sepsis in the medical intensive care unit were randomized 1:1:1 to receive intravenous infusions every six hours for four days of ascorbic acid: Lo-AscA (50 mg/kg/24 h, n = 8), or Hi-AscA (200 mg/kg/24 h, n = 8), or Placebo (5% dextrose/water, n = 8). The primary end points were ascorbic acid safety and tolerability, assessed as treatment-related adverse-event frequency and severity. Patients were monitored for worsened arterial hypotension, tachycardia, hypernatremia, and nausea or vomiting. In addition Sequential Organ Failure Assessment (SOFA) scores and plasma levels of ascorbic acid, C-reactive protein, procalcitonin, and thrombomodulin were monitored. Results Mean plasma ascorbic acid levels at entry for the entire cohort were 17.9 ± 2.4 μM (normal range 50-70 μM). Ascorbic acid infusion rapidly and significantly increased plasma ascorbic acid levels. No adverse safety events were observed in ascorbic acid-infused patients. Patients receiving ascorbic acid exhibited prompt reductions in SOFA scores while placebo patients exhibited no such reduction. Ascorbic acid significantly reduced the proinflammatory biomarkers C-reactive protein and procalcitonin. Unlike placebo patients, thrombomodulin in ascorbic acid infused patients exhibited no significant rise, suggesting attenuation of vascular endothelial injury. Conclusions Intravenous ascorbic acid infusion was safe and well tolerated in this study and may positively impact the extent of multiple organ failure and biomarkers of inflammation and endothelial injury. Trial registration ClinicalTrials.gov identifier NCT01434121.
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Affiliation(s)
- Alpha A Fowler
- Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, PO Box 980050, Richmond, VA 23298-0050, USA.
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Loonen AJM, de Jager CPC, Tosserams J, Kusters R, Hilbink M, Wever PC, van den Brule AJC. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One 2014; 9:e87315. [PMID: 24475269 PMCID: PMC3903623 DOI: 10.1371/journal.pone.0087315] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/19/2013] [Indexed: 01/22/2023] Open
Abstract
Molecular pathogen detection from blood is still expensive and the exact clinical value remains to be determined. The use of biomarkers may assist in preselecting patients for immediate molecular testing besides blood culture. In this study, 140 patients with ≥ 2 SIRS criteria and clinical signs of infection presenting at the emergency department of our hospital were included. C-reactive protein (CRP), neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT) and soluble urokinase plasminogen activator receptor (suPAR) levels were determined. One ml EDTA blood was obtained and selective pathogen DNA isolation was performed with MolYsis (Molzym). DNA samples were analysed for the presence of pathogens, using both the MagicPlex Sepsis Test (Seegene) and SepsiTest (Molzym), and results were compared to blood cultures. Fifteen patients had to be excluded from the study, leaving 125 patients for further analysis. Of the 125 patient samples analysed, 27 presented with positive blood cultures of which 7 were considered to be contaminants. suPAR, PCT, and NLCR values were significantly higher in patients with positive blood cultures compared to patients without (p < 0.001). Receiver operating characteristic curves of the 4 biomarkers for differentiating bacteremia from non-bacteremia showed the highest area under the curve (AUC) for PCT (0.806 (95% confidence interval 0.699–0.913)). NLCR, suPAR and CRP resulted in an AUC of 0.770, 0.793, and 0.485, respectively. When compared to blood cultures, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for SepsiTest and MagicPlex Sepsis Test were 11%, 96%, 43%, 80%, and 37%, 77%, 30%, 82%, respectively. In conclusion, both molecular assays perform poorly when one ml whole blood is used from emergency care unit patients. NLCR is a cheap, fast, easy to determine, and rapidly available biomarker, and therefore seems most promising in differentiating BSI from non-BSI patients for subsequent pathogen identification using molecular diagnostics.
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Affiliation(s)
- Anne J. M. Loonen
- Jeroen Bosch Hospital, Laboratory of Molecular Diagnostics, 's-Hertogenbosch, The Netherlands
- Fontys University of Applied Sciences, Department of Medical Molecular Diagnostics, Eindhoven, The Netherlands
| | - Cornelis P. C. de Jager
- Jeroen Bosch Hospital, Department of Intensive Care and Emergency Medicine, 's-Hertogenbosch, The Netherlands
| | - Janna Tosserams
- Jeroen Bosch Hospital, Department of Intensive Care and Emergency Medicine, 's-Hertogenbosch, The Netherlands
| | - Ron Kusters
- Jeroen Bosch Hospital, Department of Clinical Chemistry and Haematology, 's-Hertogenbosch, The Netherlands
| | - Mirrian Hilbink
- Jeroen Bosch Hospital, Jeroen Bosch Academy, 's-Hertogenbosch, The Netherlands
| | - Peter C. Wever
- Jeroen Bosch Hospital, Department of Medical Microbiology and Infection Control, 's-Hertogenbosch, The Netherlands
| | - Adriaan J. C. van den Brule
- Jeroen Bosch Hospital, Laboratory of Molecular Diagnostics, 's-Hertogenbosch, The Netherlands
- Fontys University of Applied Sciences, Department of Medical Molecular Diagnostics, Eindhoven, The Netherlands
- * E-mail:
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Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med 2013; 41:2336-43. [PMID: 23921272 DOI: 10.1097/ccm.0b013e31828e969f] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We sought to evaluate whether procalcitonin was superior to C-reactive protein in guiding antibiotic therapy in intensive care patients with sepsis. DESIGN Randomized open clinical trial. SETTING Two university hospitals in Brazil. PATIENTS Patients with severe sepsis or septic shock. INTERVENTIONS Patients were randomized in two groups: the procalcitonin group and the C-reactive protein group. Antibiotic therapy was discontinued following a protocol based on serum levels of these markers, according to the allocation group. The procalcitonin group was considered superior if the duration of antibiotic therapy was at least 25% shorter than in the C-reactive protein group. For both groups, at least seven full-days of antibiotic therapy were ensured in patients with Sequential Organ Failure Assessment greater than 10 and/or bacteremia at inclusion, and patients with evident resolution of the infectious process had antibiotics stopped after 7 days, despite biomarkers levels. MEASUREMENTS AND MAIN RESULTS Ninety-four patients were randomized: 49 patients to the procalcitonin group and 45 patients to the C-reactive protein group. The mean age was 59.8 (SD, 16.8) years. The median duration of antibiotic therapy for the first episode of infection was 7.0 (Q1-Q3, 6.0-8.5) days in the procalcitonin group and 6.0 (Q1-Q3, 5.0-7.0) days in the C-reactive protein group (p=0.13), with a hazard ratio of 1.206 (95% CI, 0.774-1.3; p=0.13). Overall, protocol overruling occurred in only 13 (13.8%) patients. Twenty-one patients died in each group (p=0.836). CONCLUSIONS C-reactive protein was as useful as procalcitonin in reducing antibiotic use in a predominantly medical population of septic patients, causing no apparent harm.
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Brodska H, Malickova K, Valenta J, Fabio A, Drabek T. Soluble receptor for advanced glycation end products predicts 28-day mortality in critically ill patients with sepsis. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 73:650-60. [PMID: 24164543 DOI: 10.3109/00365513.2013.849357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Multiple biomarkers are used to assess sepsis severity and prognosis. Increased levels of the soluble receptor for advanced glycation end products (sRAGE) were previously observed in sepsis but also in end-organ injury without sepsis. We evaluated associations between sRAGE and (i) 28-day mortality, (ii) sepsis severity, and (iii) individual organ failure. Traditional biomarkers procalcitonin (PCT), C-reactive protein (CRP) and lactate served as controls. METHODS sRAGE, PCT, CRP, and lactate levels were observed on days 1 (D1) and 3 (D3) in 54 septic patients. We also assessed the correlation between the biomarkers and acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and acute heart failure. RESULTS There were 38 survivors and 16 non-survivors. On D1, non-survivors had higher sRAGE levels than survivors (p = 0.027). On D3, sRAGE further increased only in non-survivors (p < 0.0001) but remained unchanged in survivors. Unadjusted odds ratio (OR) for 28-day mortality was 8.2 (95% CI: 1.02-60.64) for sRAGE, p = 0.048. Receiver operating characteristic analysis determined strong correlation with outcome on D3 (AUC = 0.906, p < 0.001), superior to other studied biomarkers. sRAGE correlated with sepsis severity (p < 0.00001). sRAGE showed a significant positive correlation with PCT and CRP on D3. In patients without ARDS, sRAGE was significantly higher in non-survivors (p < 0.0001) on D3. CONCLUSION Increased sRAGE was associated with 28-day mortality in patients with sepsis, and was superior compared to PCT, CRP and lactate. sRAGE correlated with sepsis severity. sRAGE was increased in patients with individual organ failure. sRAGE could be used as an early biomarker in prognostication of outcome in septic patients.
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Affiliation(s)
- Helena Brodska
- Institute of Clinical Biochemistry and Laboratory Diagnostics
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Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, Kurosawa S, Stepien D, Valentine C, Remick DG. Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev 2013; 93:1247-88. [PMID: 23899564 DOI: 10.1152/physrev.00037.2012] [Citation(s) in RCA: 284] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sepsis represents the host's systemic inflammatory response to a severe infection. It causes substantial human morbidity resulting in hundreds of thousands of deaths each year. Despite decades of intense research, the basic mechanisms still remain elusive. In either experimental animal models of sepsis or human patients, there are substantial physiological changes, many of which may result in subsequent organ injury. Variations in age, gender, and medical comorbidities including diabetes and renal failure create additional complexity that influence the outcomes in septic patients. Specific system-based alterations, such as the coagulopathy observed in sepsis, offer both potential insight and possible therapeutic targets. Intracellular stress induces changes in the endoplasmic reticulum yielding misfolded proteins that contribute to the underlying pathophysiological changes. With these multiple changes it is difficult to precisely classify an individual's response in sepsis as proinflammatory or immunosuppressed. This heterogeneity also may explain why most therapeutic interventions have not improved survival. Given the complexity of sepsis, biomarkers and mathematical models offer potential guidance once they have been carefully validated. This review discusses each of these important factors to provide a framework for understanding the complex and current challenges of managing the septic patient. Clinical trial failures and the therapeutic interventions that have proven successful are also discussed.
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Affiliation(s)
- Kendra N Iskander
- Department of Pathology, Boston University School of Medicine, Boston, Massachusetts, USA
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