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Tustumi F, Pinheiro Filho JEL, Stolzemburg LCP, Serigiolle LC, Costa TN, Pajecki D, Santo MA, Nahas SC. Management of biliary stones in bariatric surgery. Ther Adv Gastrointest Endosc 2022; 15:26317745221105087. [PMID: 36388729 PMCID: PMC9664186 DOI: 10.1177/26317745221105087] [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: 07/05/2021] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Morbidly obese and post-bariatric surgery patients are at increased risk for
biliary stones formation. The complications related to biliary stones may impose
complexity on their management. This study aimed to review the management of
biliary conditions in obese and bariatric patients. In this study, a narrative
review was performed of the medical, surgical, and endoscopic procedures for the
management of biliary stones and their related complications. Knowing the main
prophylactic and therapeutic interventions options is essential for clinicians
to properly manage the biliary stones in patients candidates or submitted to
bariatric surgery.
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Affiliation(s)
- Francisco Tustumi
- Department of Gastroenterology, Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255, Cerqueira Cesar, São Paulo 05403-000, SP, Brazil
- Department of Surgery, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | | | | | | | - Denis Pajecki
- Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Marco Aurélio Santo
- Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
| | - Sérgio Carlos Nahas
- Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
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2
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Rising Rate of Obesity in Patients Admitted for Crohn's Disease Increases Costs But Not Mortality. J Clin Gastroenterol 2021; 55:716-720. [PMID: 32947376 DOI: 10.1097/mcg.0000000000001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/05/2020] [Indexed: 12/10/2022]
Abstract
GOAL The goal of this study was to compare outcomes and trends for inpatients with Crohn's disease (CD) and obesity. BACKGROUND Obesity is a growing concern in the United States. Current data on the effect of obesity on the course of the CD are conflicted. METHODS Data from the 2016 to 2017 National Inpatient Sample were compared for obese, normal weight, and malnourished patients. After adjustment for comorbidities, demographics and disease type/inpatient surgery, outcomes including mortality, length of stay, hospitalization charges, and rates of deep venous thrombosis (DVT) in obese and malnourished patients were compared with those with normal body mass index using multivariable regression. For trend analysis, rates of obesity were compared from 2002 to 2017. RESULTS The percentage of patients with CD and obesity increased from 1.8% in 2002 to 9.5% in 2017 (0.5% per year, P<0.001). Rates of death were similar in obese versus normal-weight CD patients [odds ratio (OR)=1.21, 95% confidence interval (CI): 0.85-1.73, P=0.288]. In contrast, obese CD patients had increased length of stay (1.0 d, 95% CI: 0.81-1.26, P<0.001), cost ($8323, 95% CI: 5565-11,082, P<0.001), and DVT rate (OR=1.67, 95% CI: 1.13-2.46, P=0.01). Malnourished CD patients had OR for death of 2.15 (95% CI: 1.71-2.70, P<0.001) compared with normal-weight cohort. Similarly, length of stay, cost, and DVT rate were all increased. CONCLUSIONS Rates of hospitalized CD patients with obesity are increasing. Patients with obesity and CD have increased length of stay and costs, with no mortality difference. Malnourished CD patients continue to have higher mortality, length of stay, and cost. Obesity is a risk factor for adverse hospitalization outcomes.
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3
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Narayanan B, Kohler F, Arulanandam P. The Efficacy of In-Reach Rehabilitation in Morbidly Obese Post Septic Patients: Two Retrospective Case Reports. ACTA ACUST UNITED AC 2020; 3:1000042. [PMID: 33884144 PMCID: PMC8054740 DOI: 10.2340/20030711-1000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/18/2022]
Abstract
Objective To report the functional outcomes of two patients with morbid obesity (> 250 kg) who received in-reach rehabilitation after hospitalization for sepsis in Sydney, Australia. Case reports A retrospective review of hospital charts was performed with the informed consent of both patients. Body mass index, demographics, length of stay, functional status at admission and discharge, medical comorbidities, social history, hospital course, equipment needs, therapy methods used, and discharge disposition were compared. Results Both patients had a positive outcome. Function improved in case 1, from requiring hoist transfers, to mobilizing 80 m with 2 assistants. The patient was transferred to a subacute rehabilitation facility, but did not make any gain in Functional Independence Measure. Function improved in case 2, from requiring 2 assistants to walk with a frame, to walking independently with a 4-wheeled walker. The patient was discharged home from the acute hospital, with a minimal Functional Independence Measure gain of 8. Both patients lost approximately 45 kg during acute hospitalization. Conclusion These case reports demonstrate that in-reach rehabilitation can play an important role in the functional recovery of morbidly obese patients hospitalized with severe sepsis. This report also highlights the need for preventive interventions to reduce avoidable acute hospital presentations and to prevent functional decline.
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Affiliation(s)
- Baheerathan Narayanan
- Aged Care and Rehabilitation, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Friedbert Kohler
- Aged Care and Rehabilitation, South Western Sydney Local Health District, Sydney, NSW, Australia.,University of NSW, Sydney, Australia.,Hammondcare Health, Sydney, Australia
| | - Patrick Arulanandam
- Department of Rehabilitation Medicine, Royal Prince Alfred Hospital and St Vincent's Hospital, Sydney, NSW, Australia
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4
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Wijenayake S, Rahman MF, Lum CMW, De Vega WC, Sasaki A, McGowan PO. Maternal high-fat diet induces sex-specific changes to glucocorticoid and inflammatory signaling in response to corticosterone and lipopolysaccharide challenge in adult rat offspring. J Neuroinflammation 2020; 17:116. [PMID: 32293490 PMCID: PMC7158103 DOI: 10.1186/s12974-020-01798-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maternal obesity as a result of high levels of saturated fat (HFD) consumption leads to significant negative health outcomes in both mother and exposed offspring. Offspring exposed to maternal HFD show sex-specific alterations in metabolic, behavioral, and endocrine function, as well as increased levels of basal neuroinflammation that persists into adulthood. There is evidence that psychosocial stress or exogenous administration of corticosterone (CORT) potentiate inflammatory gene expression; however, the response to acute CORT or immune challenge in adult offspring exposed to maternal HFD during perinatal life is unknown. We hypothesize that adult rat offspring exposed to maternal HFD would show enhanced pro-inflammatory gene expression in response to acute administration of CORT and lipopolysaccharide (LPS) compared to control animals, as a result of elevated basal pro-inflammatory gene expression. To test this, we examined the effects of acute CORT and/or LPS exposure on pro and anti-inflammatory neural gene expression in adult offspring (male and female) with perinatal exposure to a HFD or a control house-chow diet (CHD). METHODS Rat dams consumed HFD or CHD for four weeks prior to mating, during gestation, and throughout lactation. All male and female offspring were weaned on to CHD. In adulthood, offspring were 'challenged' with administration of exogenous CORT and/or LPS, and quantitative PCR was used to measure transcript abundance of glucocorticoid receptors and downstream inflammatory markers in the amygdala, hippocampus, and prefrontal cortex. RESULTS In response to CORT alone, male HFD offspring showed increased levels of anti-inflammatory transcripts, whereas in response to LPS alone, female HFD offspring showed increased levels of pro-inflammatory transcripts. In addition, male HFD offspring showed greater pro-inflammatory gene expression and female HFD offspring exhibited increased anti-inflammatory gene expression in response to simultaneous CORT and LPS administration. CONCLUSIONS These findings suggest that exposure to maternal HFD leads to sex-specific changes that may alter inflammatory responses in the brain, possibly as an adaptive response to basal neuroinflammation.
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Affiliation(s)
- Sanoji Wijenayake
- Center for Environmental Epigenetics and Development, Department of Biological Sciences, University of Toronto, Scarborough, 1265 Military Trail, Toronto, ON, Canada
| | - Mouly F Rahman
- Center for Environmental Epigenetics and Development, Department of Biological Sciences, University of Toronto, Scarborough, 1265 Military Trail, Toronto, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Christine M W Lum
- Center for Environmental Epigenetics and Development, Department of Biological Sciences, University of Toronto, Scarborough, 1265 Military Trail, Toronto, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Wilfred C De Vega
- Center for Environmental Epigenetics and Development, Department of Biological Sciences, University of Toronto, Scarborough, 1265 Military Trail, Toronto, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Aya Sasaki
- Center for Environmental Epigenetics and Development, Department of Biological Sciences, University of Toronto, Scarborough, 1265 Military Trail, Toronto, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Patrick O McGowan
- Center for Environmental Epigenetics and Development, Department of Biological Sciences, University of Toronto, Scarborough, 1265 Military Trail, Toronto, ON, Canada.
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada.
- Department of Psychology, Department of Physiology, University of Toronto, Toronto, ON, Canada.
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5
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Vallejos A, Olivares P, Varela D, Echeverria C, Cabello-Verrugio C, Pérez-Leighton C, Simon F. Preventive Leptin Administration Protects Against Sepsis Through Improving Hypotension, Tachycardia, Oxidative Stress Burst, Multiple Organ Dysfunction, and Increasing Survival. Front Physiol 2018; 9:1800. [PMID: 30618812 PMCID: PMC6299116 DOI: 10.3389/fphys.2018.01800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/29/2018] [Indexed: 02/04/2023] Open
Abstract
Sepsis syndrome is the most important cause of mortality in critically ill patients admitted to intensive care units (ICUs). However, current therapies for its prevention and treatment are still unsatisfactory, and the mortality rate is still high. Non-septic ICU patients are vulnerable to acquire sepsis syndrome. Thus, a preventive treatment for this population is needed. During sepsis syndrome and endotoxemia, severe hypotension, tachycardia, oxidative and immune response increase, multiple organ dysfunction syndrome (MODS) and decreased survival are observed. Leptin administration protects against negative effects of sepsis syndrome and endotoxemia. Furthermore, it is has been reported that leptin elevates blood pressure mediated by sympathetic nervous system activation. However, whether leptin administration before sepsis induction mediates its protective effects during sepsis through blood pressure regulation is not known. Therefore, we investigated whether pre-treatment of leptin improves blood pressure and MODS, resulting in survival increase during endotoxemia. The results showed that leptin administration before endotoxemia induction reduced both the hypotension and tachycardia characteristically observed during endotoxemia. Notably, this protective effect was observed early and late in the course of endotoxemia. Endotoxemia-induced MODS decreased in leptin-treated rats, which was reflected in normal values for liver and kidney function, inhibition of muscle mass wasting and maintenance of glycemia. Furthermore, leptin pre-treatment decreased the oxidative stress burst in blood and blunted the increased pro-inflammatory cytokines TNF-α, IL-1β, and IL-6 observed during endotoxemia. Remarkably, according to the leptin-induced increase in survival, leptin pre-administration decreased the risk for death associated with sepsis syndrome at early and late times after endotoxemia induction. These results show a potential preventive therapy against sepsis syndrome and endotoxemia in vulnerable patients, based in the beneficial actions of leptin.
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Affiliation(s)
- Alejandro Vallejos
- Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Pedro Olivares
- Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Diego Varela
- Programa de Fisiología y Biofísica, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.,Millennium Nucleus of Ion Channels-Associated Diseases, Universidad de Chile, Santiago, Chile
| | - Cesar Echeverria
- Facultad de Medicina, Universidad de Atacama, Copiapo, Chile.,Facultad de Ingeniería, Ciencia y Tecnología, Universidad Bernardo O'Higgins, Santiago, Chile
| | - Claudio Cabello-Verrugio
- Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Claudio Pérez-Leighton
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Simon
- Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
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6
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The impact of body mass index on post resuscitation survival after cardiac arrest: A meta-analysis. Clin Nutr ESPEN 2018; 24:47-53. [DOI: 10.1016/j.clnesp.2018.01.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 12/19/2022]
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7
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DeMartini T, Nowell M, James J, Williamson L, Lahni P, Shen H, Kaplan JM. High fat diet-induced obesity increases myocardial injury and alters cardiac STAT3 signaling in mice after polymicrobial sepsis. Biochim Biophys Acta Mol Basis Dis 2017; 1863:2654-2660. [PMID: 28625915 PMCID: PMC5653424 DOI: 10.1016/j.bbadis.2017.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/06/2017] [Accepted: 06/10/2017] [Indexed: 11/24/2022]
Abstract
Little is known about how obesity affects the heart during sepsis and we sought to investigate the obesity-induced cardiac effects that occur during polymicrobial sepsis. Six-week old C57BL/6 mice were randomized to a high fat (HFD) (60% kcal fat) or normal diet (ND) (16% kcal fat). After 6weeks of feeding, mice were anesthetized with isoflurane and polymicrobial sepsis was induced by cecal ligation and puncture (CLP). Plasma and cardiac tissue were obtained for analysis. Echocardiography was performed on a separate cohort of mice at 0 and 18h after CLP. Following 6-weeks of dietary intervention, plasma cardiac troponin I was elevated in obese mice at baseline compared to non-obese mice but troponin increased only in non-obese septic mice. IL-17a expression was 27-fold higher in obese septic mice versus non-obese septic mice. Cardiac phosphorylation of STAT3 at Ser727 was increased at baseline in obese mice and increased further only in obese septic mice. Phosphorylation of STAT3 at Tyr705 was similar in both groups at baseline and increased after sepsis. SOCS3, a downstream protein and negative regulator of STAT3, was elevated in obese mice at baseline compared to non-obese mice. After sepsis non-obese mice had an increase in SOCS3 expression that was not observed in obese mice. Taken together, we show that obesity affects cardiac function and leads to cardiac injury. Furthermore, myocardial injury in obese mice during sepsis may occur through alteration of the STAT3 pathway.
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Affiliation(s)
- Theodore DeMartini
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marchele Nowell
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeanne James
- Division of Molecular Cardiovascular Biology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2005, Cincinnati, OH 45229, USA
| | - Lauren Williamson
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Patrick Lahni
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hui Shen
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jennifer M Kaplan
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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8
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Galatianou I, Karlis G, Apostolopoulos A, Intas G, Chalari E, Gulati A, Iacovidou N, Chalkias A, Xanthos T. Body mass index and outcome of out-of-hospital cardiac arrest patients not treated by targeted temperature management. Am J Emerg Med 2017; 35:1247-1251. [DOI: 10.1016/j.ajem.2017.03.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/17/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
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9
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Astiz M, Pernía O, Barrios V, Garcia-Segura LM, Diz-Chaves Y. Short-Term High-Fat Diet Feeding Provides Hypothalamic but Not Hippocampal Protection against Acute Infection in Male Mice. Neuroendocrinology 2017; 104:40-50. [PMID: 26862917 DOI: 10.1159/000444527] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 02/06/2016] [Indexed: 11/19/2022]
Abstract
Obesity is associated with increased fever and sickness behavior in response to infection. The hypothalamic-pituitary-adrenal (HPA) axis plays a key role in the reaction to immune stimuli. Bacterial infection, or bacterial lipopolysaccharide (LPS), induces the expression of peripheral cytokines that stimulate the hypothalamus and the hippocampus and activate the HPA axis. In this study, we explored whether the hypothalamic and hippocampal responses to infection are altered during the development of diet-induced obesity. Male mice were exposed to a high-fat diet (HFD) or a low-fat diet (LFD) for 15 days. They were then administered a single intraperitoneal injection of bacterial LPS or vehicle and sacrificed 24 h later. LPS increased circulating levels of insulin and leptin, but only in LFD animals. LPS induced a significant decrease in hypothalamic corticotrophin-releasing hormone and glucocorticoid receptor mRNA levels in LFD animals but exerted the opposite effect in HFD-fed mice. LPS increased the hypothalamic expression of molecules involved in the leptin signaling pathway (SOCS3 and STAT3), nuclear factor-κB pathway members, inflammatory mediators (tumor necrosis factor-α and interleukin-6) and glial proliferation markers (Emr1 and CD68) in LFD animals. These effects were dampened in HFD-fed mice. In contrast, the hippocampal responses to LPS were largely insensitive to HFD. These results suggest that HFD feeding reduced the inflammatory response induced by LPS in the hypothalamus but not in the hippocampus.
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10
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Karagozian R, Bhardwaj G, Wakefield DB, Baffy G. Obesity paradox in advanced liver disease: obesity is associated with lower mortality in hospitalized patients with cirrhosis. Liver Int 2016; 36:1450-6. [PMID: 27037497 DOI: 10.1111/liv.13137] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/24/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS To investigate how obesity impacts inpatient mortality, length of stay (LOS) and costs in patients with cirrhosis. Obesity is a growing epidemic associated with multiple co-morbidities, increased morbidity, and a significant economic burden on healthcare. Despite the overall harmful impact of obesity, the 'obesity paradox' has been described as decreased mortality among obese vs non-obese patients in various chronic medical conditions. METHODS Analysis of the Nationwide Inpatient Sample (NIS) for 2012, which contains data from 44 states and 4378 hospitals. Data from all cases with primary, secondary or tertiary discharge diagnosis of cirrhosis identified by International Classification of Diseases-9 code 571.2, 571.5 571.6 were included. Primary outcomes included inpatient mortality, LOS, and hospital charges. Obesity as a predictor of mortality was defined by a predetermined obesity co-morbidity variable. RESULTS A total of 32,605 patients were included. Crude mortality was lower for obese cirrhotic patients (2.7% vs 3.5%, P = 0.02) than for non-obese cirrhotic patients. In contrast, median LOS was longer (4 vs 3 days, P < 0.001) and median hospital charges were higher for obese cirrhotic patients ($26 803 vs $23 447, P < 0.001) In multivariate logistic regression, obesity was associated with a lower risk of inpatient mortality (OR=0.73, 95%CI: 0.55-0.95, P = 0.02). CONCLUSIONS In the acute care setting, obese patients with cirrhosis have lower mortality than non-obese patients with cirrhosis, longer hospitalizations and higher healthcare cost, providing new evidence for the obesity paradox in cirrhosis. Obese cirrhotic patients are more likely to have enhanced nutritional reserve which may play a role in survival during acute illness.
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Affiliation(s)
- Raffi Karagozian
- School of Medicine, University of Connecticut, Farmington, CT, USA.
| | - Gaurav Bhardwaj
- School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Dorothy B Wakefield
- Center for Public Health and Health Policy, UConn Health, Farmington, CT, USA
| | - Gyorgy Baffy
- Division of Gastroenterology & Hepatology, VA Boston Healthcare System, Harvard Medical School, Boston, MA, USA
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12
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Lalazar G, Ilyas G, Malik SA, Liu K, Zhao E, Amir M, Lin Y, Tanaka KE, Czaja MJ. Autophagy confers resistance to lipopolysaccharide-induced mouse hepatocyte injury. Am J Physiol Gastrointest Liver Physiol 2016; 311:G377-86. [PMID: 27469366 PMCID: PMC5076014 DOI: 10.1152/ajpgi.00124.2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/12/2016] [Indexed: 01/31/2023]
Abstract
During sepsis, bacterial products, particularly LPS, trigger injury in organs such as the liver. This common condition remains largely untreatable, in part due to a lack of understanding of how high concentrations of LPS cause cellular injury. In the liver, the lysosomal degradative pathway of autophagy performs essential hepatoprotective functions and is induced by LPS. We, therefore, examined whether hepatocyte autophagy protects against liver injury from septic levels of LPS. Mice with an inducible hepatocyte-specific knockout of the critical autophagy gene Atg7 were examined for their sensitivity to high-dose LPS. Increased liver injury occurred in knockout mice, as determined by significantly increased serum alanine aminotransferase levels, histological evidence of liver injury, terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate nick end-labeling, and effector caspase-3 and -7 activation. Hepatic inflammation and proinflammatory cytokine induction were unaffected by the decrease in hepatocyte autophagy. Although knockout mice had normal NF-κB signaling, hepatic levels of Akt1 and Akt2 phosphorylation in response to LPS were decreased. Cultured hepatocytes from knockout mice displayed a generalized defect in Akt signaling in response to multiple stimuli, including LPS, TNF, and IL-1β. Akt activation mediates hepatocyte resistance to TNF cytotoxicity, and anti-TNF antibodies significantly decreased LPS-induced liver injury in knockout mice, indicating that the loss of autophagy sensitized to TNF-dependent liver damage. Hepatocyte autophagy, therefore, protects against LPS-induced liver injury. Conditions such as aging and steatosis that impair hepatic autophagy may predispose to poor outcomes from sepsis through this mechanism.
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Affiliation(s)
- Gadi Lalazar
- 1Department of Medicine and the Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York;
| | - Ghulam Ilyas
- 1Department of Medicine and the Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York;
| | - Shoaib Ahmad Malik
- 2Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; ,3Department of Biochemistry, Sargodha Medical College, University of Sargodha, Sargodha, Pakistan; and
| | - Kun Liu
- 1Department of Medicine and the Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York;
| | - Enpeng Zhao
- 1Department of Medicine and the Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York;
| | - Mohammad Amir
- 1Department of Medicine and the Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York;
| | - Yu Lin
- 1Department of Medicine and the Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York;
| | - Kathryn E. Tanaka
- 4Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
| | - Mark J. Czaja
- 1Department of Medicine and the Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, New York; ,2Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia;
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13
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Maley N, Gebremariam A, Odetola F, Singer K. Influence of Obesity Diagnosis With Organ Dysfunction, Mortality, and Resource Use Among Children Hospitalized With Infection in the United States. J Intensive Care Med 2016; 32:339-345. [PMID: 26880005 DOI: 10.1177/0885066616631325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sepsis induces inflammation in response to infection and is a major cause of mortality and hospitalization in children. Obesity induces chronic inflammation leading to many clinical manifestations. Our understanding of the impact of obesity on diseases, such as infection and sepsis, is limited. The objective of this study was to evaluate the association of obesity with organ dysfunction, mortality, duration, and charges during among US children hospitalized with infection. METHODS Retrospective study of hospitalizations in children with infection aged 0 to 20 years, using the 2009 Kids' Inpatient Database. RESULTS Of 3.4 million hospitalizations, 357 701 were for infection, 5685 of which were reported as obese children. Obese patients had higher rates of organ dysfunction (7.35% vs 5.5%, P < .01), longer hospital stays (4.1 vs 3.5 days, P < .001), and accrued higher charges (US$29 019 vs US$21 200, P < .001). In multivariable analysis, mortality did not differ by obesity status (odds ratio: 0.56, 95% confidence interval: 0.23-1.34), however severity of illness modified the association between obesity status and the other outcomes. CONCLUSIONS While there was no difference in in-hospital mortality by obesity diagnosis, variation in organ dysfunction, hospital stay, and hospital charges according to obesity status was mediated by illness severity. Findings from this study have significant implications for targeted approaches to mitigate the burden of obesity on infection and sepsis.
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Affiliation(s)
- Nidhi Maley
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Achamyeleh Gebremariam
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Folafoluwa Odetola
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kanakadurga Singer
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
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Kolyva AS, Zolota V, Mpatsoulis D, Skroubis G, Solomou EE, Habeos IG, Assimakopoulos SF, Goutzourelas N, Kouretas D, Gogos CA. The role of obesity in the immune response during sepsis. Nutr Diabetes 2014; 4:e137. [PMID: 25244356 PMCID: PMC4183975 DOI: 10.1038/nutd.2014.34] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/21/2014] [Accepted: 08/07/2014] [Indexed: 01/08/2023] Open
Abstract
Background/Objectives: Sepsis is one of the most important causes of mortality in the developed world, where almost two-thirds of the population suffer from obesity. Therefore, the coexistence of both conditions has become frequent in clinical practice and a growing number of clinical studies attempts to examine the potential effect of obesity on sepsis with controversial results up to now. The present study investigates how obesity influences the immune response of septic patients, by assessing the number and activation state of adipose tissue macrophages, serum and adipose tissue tumor necrosis factor-alpha (TNFα) levels and plasma oxidative stress markers. Subjects/methods: The study included 106 patients, divided into four groups (control n=26, obesity n=27, sepsis n=27 and sepsis and obesity n=26). The number of macrophages in subcutaneous and visceral adipose tissue (SAT and VAT) and their subtypes (M1 and M2) were defined with immunohistochemical staining techniques under light microscopy. TNFα mRNA levels were determined in SAT and VAT using real-time reverse transcription-PCR. Serum levels of TNFα were determined with sandwich enzyme-linked immunosorbent assay. Plasma oxidative stress was evaluated using selective biomarkers (thiobarbituric acid-reactive substances (TBARS), protein carbonyls and total antioxidant capacity (TAC)). Results: Sepsis increased the total number of macrophages and their M2 subtype in (VAT), whereas obesity did not seem to affect the concentration of macrophages in fat. Obesity increased TNFα mRNA levels (P<0.05) in VAT as well as the plasma TBARS (P<0.001) and protein carbonyls (P<0.001) in septic patients. The plasma TAC levels were decreased and the serum TNFα levels were increased in sepsis although they were not influenced by obesity. Conclusions: Obesity is associated with elevated TNFα adipose tissue production and increased oxidative stress biomarkers, promoting the proinflammatory response in septic patients.
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Affiliation(s)
- A S Kolyva
- Division of Infectious Diseases, Department of Internal Medicine, Patras University Hospital, Rion-Patras, Greece
| | - V Zolota
- Department of Pathology, Patras University Hospital, Rion-Patras, Greece
| | - D Mpatsoulis
- Department of Pathology, Patras University Hospital, Rion-Patras, Greece
| | - G Skroubis
- Department of Surgery, Patras University Hospital, Rion-Patras, Greece
| | - E E Solomou
- Department of Internal Medicine, Patras University Hospital, Rion-Patras, Greece
| | - I G Habeos
- Division of Endocrinology, Department of Internal Medicine, Patras University Hospital, Rion-Patras, Greece
| | - S F Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, Patras University Hospital, Rion-Patras, Greece
| | - N Goutzourelas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - D Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - C A Gogos
- Division of Infectious Diseases, Department of Internal Medicine, Patras University Hospital, Rion-Patras, Greece
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Basharat S, Parker JA, Murphy KG, Bloom SR, Buckingham JC, John CD. Leptin fails to blunt the lipopolysaccharide-induced activation of the hypothalamic-pituitary-adrenal axis in rats. J Endocrinol 2014; 221:229-34. [PMID: 24578293 PMCID: PMC4045222 DOI: 10.1530/joe-13-0249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obesity is a risk factor for sepsis morbidity and mortality, whereas the hypothalamic-pituitary-adrenal (HPA) axis plays a protective role in the body's defence against sepsis. Sepsis induces a profound systemic immune response and cytokines serve as excellent markers for sepsis as they act as mediators of the immune response. Evidence suggests that the adipokine leptin may play a pathogenic role in sepsis. Mouse endotoxaemic models present with elevated leptin levels and exogenously added leptin increased mortality whereas human septic patients have elevated circulating levels of the soluble leptin receptor (Ob-Re). Evidence suggests that leptin can inhibit the regulation of the HPA axis. Thus, leptin may suppress the HPA axis, impairing its protective role in sepsis. We hypothesised that leptin would attenuate the HPA axis response to sepsis. We investigated the direct effects of an i.p. injection of 2 mg/kg leptin on the HPA axis response to intraperitoneally injected 25 μg/kg lipopolysaccharide (LPS) in the male Wistar rat. We found that LPS potently activated the HPA axis, as shown by significantly increased plasma stress hormones, ACTH and corticosterone, and increased plasma interleukin 1β (IL1β) levels, 2 h after administration. Pre-treatment with leptin, 2 h before LPS administration, did not influence the HPA axis response to LPS. In turn, LPS did not affect plasma leptin levels. Our findings suggest that leptin does not influence HPA function or IL1β secretion in a rat model of LPS-induced sepsis, and thus that leptin is unlikely to be involved in the acute-phase endocrine response to bacterial infection in rats.
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Affiliation(s)
| | - Jennifer A Parker
- University College London, Institute of NeurologyQueen Square House, Queen Square, London, WC1N 3BGUK
| | | | | | - Julia C Buckingham
- Brunel UniversityWilfred Brown Building, Kingston Lane, Uxbridge, UB8 3PHUK
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16
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Cuttitta F, Torres D, Vogiatzis D, Buttà C, Bellanca M, Gueli D, Lupo U, Schimmenti C, Virzì G, Petrantoni R, Balistreri F, Paterna S, Parrinello G. Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria. Eur J Intern Med 2014; 25:292-5. [PMID: 24529889 DOI: 10.1016/j.ejim.2014.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/11/2014] [Accepted: 01/23/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients. MATERIALS AND METHODS 330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria. RESULTS The analysis of clinical characteristics showed that the two groups of subjects (positive and negative urine culture for bacteriuria) were significant different (p<0.05) about obesity (76.7% vs 42% respectively), metabolic syndrome (80.6% vs 44,9%), cholelithiasis (35.5% vs 13,2%) and iron deficiency anemia (80.6% vs 53,6%). The univariate analysis showed that only obesity, cholelithiasis and iron deficiency anemia were positively associated with positive urine culture for bacteriuria (Odds Ratios [OR]=3.79, p=0.0003; OR=2,65, p=0.0091; OR=2.63, p=0.0097; respectively). However, the multivariate analysis by logistic regression showed that only obesity and iron deficiency anemia, independently associated with positive urine culture for bacteriuria (OR=3.9695, p=0.0075; OR=3.1569, p=0.03420 respectively). CONCLUSIONS This study shows that obesity and iron deficiency anemia are independent risk factors for asymptomatic bacteriuria.
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Affiliation(s)
- F Cuttitta
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy.
| | - D Torres
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - D Vogiatzis
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - C Buttà
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - M Bellanca
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - D Gueli
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - U Lupo
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - C Schimmenti
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - G Virzì
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - R Petrantoni
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - F Balistreri
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - S Paterna
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - G Parrinello
- Dipartimento Biomedico Medicina Interna e Specialistica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", Università degli Studi di Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Wang HE, Griffin R, Judd S, Shapiro NI, Safford MM. Obesity and risk of sepsis: a population-based cohort study. Obesity (Silver Spring) 2013; 21:E762-9. [PMID: 23526732 PMCID: PMC3795990 DOI: 10.1002/oby.20468] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/12/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Sepsis, the syndrome of microbial infection complicated by systemic inflammation, is associated with significant morbidity and mortality. To determine if obesity increases risk of sepsis events. DESIGN AND METHODS Data from the 30,239 subject population-based longitudinal cohort study REasons for Geographic and Racial Differences in Stroke (REGARDS) were used. Using measurements at the start of the study, we defined obesity using body mass index (BMI; <18.5 kg/m(2) = underweight, 18.5-24.9 = normal, 25.0-29.9 = overweight, 30.0-39.9 = obese, ≥40 = morbidly obese) and waist circumference (WC; [male ≤102 cm or female ≤88 cm] = normal, [male >102 cm or female >88 cm] = obese). Over an 8-year observation period, we evaluated the association between obesity and subsequent sepsis events, adjusting for sociodemographic factors, health behaviors, chronic medical conditions, statin use, and high-sensitivity C-reactive protein. RESULTS There were 975 incident sepsis events. Compared to those with a BMI of 18.5-24.9, sepsis risk was higher only for BMI ≥ 40 (hazard ratio [HR] 1.57, [1.16-2.14]). Risk of sepsis was associated with increased WC (HR 1.34 [1.14-1.56]). In a model with both BMI and WC, sepsis risk was associated with increased WC (HR 1.47 [1.20-1.79]) but not BMI. CONCLUSIONS Obesity is independently associated with future sepsis events. WC is a better predictor of future sepsis risk than BMI.
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Affiliation(s)
- Henry E Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA
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18
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Chapman K, Holmes M, Seckl J. 11β-hydroxysteroid dehydrogenases: intracellular gate-keepers of tissue glucocorticoid action. Physiol Rev 2013; 93:1139-206. [PMID: 23899562 DOI: 10.1152/physrev.00020.2012] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Glucocorticoid action on target tissues is determined by the density of "nuclear" receptors and intracellular metabolism by the two isozymes of 11β-hydroxysteroid dehydrogenase (11β-HSD) which catalyze interconversion of active cortisol and corticosterone with inert cortisone and 11-dehydrocorticosterone. 11β-HSD type 1, a predominant reductase in most intact cells, catalyzes the regeneration of active glucocorticoids, thus amplifying cellular action. 11β-HSD1 is widely expressed in liver, adipose tissue, muscle, pancreatic islets, adult brain, inflammatory cells, and gonads. 11β-HSD1 is selectively elevated in adipose tissue in obesity where it contributes to metabolic complications. Similarly, 11β-HSD1 is elevated in the ageing brain where it exacerbates glucocorticoid-associated cognitive decline. Deficiency or selective inhibition of 11β-HSD1 improves multiple metabolic syndrome parameters in rodent models and human clinical trials and similarly improves cognitive function with ageing. The efficacy of inhibitors in human therapy remains unclear. 11β-HSD2 is a high-affinity dehydrogenase that inactivates glucocorticoids. In the distal nephron, 11β-HSD2 ensures that only aldosterone is an agonist at mineralocorticoid receptors (MR). 11β-HSD2 inhibition or genetic deficiency causes apparent mineralocorticoid excess and hypertension due to inappropriate glucocorticoid activation of renal MR. The placenta and fetus also highly express 11β-HSD2 which, by inactivating glucocorticoids, prevents premature maturation of fetal tissues and consequent developmental "programming." The role of 11β-HSD2 as a marker of programming is being explored. The 11β-HSDs thus illuminate the emerging biology of intracrine control, afford important insights into human pathogenesis, and offer new tissue-restricted therapeutic avenues.
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Affiliation(s)
- Karen Chapman
- Endocrinology Unit, Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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19
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Kuperman EF, Showalter JW, Lehman EB, Leib AE, Kraschnewski JL. The impact of obesity on sepsis mortality: a retrospective review. BMC Infect Dis 2013; 13:377. [PMID: 23957291 PMCID: PMC3765286 DOI: 10.1186/1471-2334-13-377] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/17/2013] [Indexed: 01/30/2023] Open
Abstract
Background Recent sepsis guidelines have focused on the early identification and risk stratification of patients on presentation. Obesity is associated with alterations in multiple inflammatory regulators similar to changes seen in sepsis, suggesting a potential interaction between the presence of obesity and the severity of illness in sepsis. Methods We performed a retrospective chart review of patients admitted with a primary billing diagnosis of sepsis at a single United States university hospital from 2007 to 2010. Seven hundred and ninety-two charts were identified meeting inclusion criteria. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. The data recorded included age, race, sex, vital signs, laboratory values, length of stay, comorbidities, weight, height, and survival to discharge. A modified APACHE II score was calculated to estimate disease severity. The primary outcome variable was inpatient mortality. Results Survivors had higher average BMI than nonsurvivors (27.6 vs. 26.3 kg/m2, p = 0.03) in unadjusted analysis. Severity of illness and comorbid conditions including cancer were similar across BMI categories. Increased incidence of diabetes mellitus type 2 was associated with increasing BMI (p < 0.01) and was associated with decreased mortality, with an odds ratio of 0.53 compared with nondiabetic patients. After adjusting for age, gender, race, severity of illness, length of stay, and comorbid conditions, the trend of decreased mortality for increased BMI was no longer statistically significant, however diabetes continued to be strongly protective (odds ratio 0.52, p = 0.03). Conclusions This retrospective analysis suggests obesity may be protective against mortality in septic inpatients. The protective effect of obesity may be dependent on diabetes, possibly through an unidentified hormonal intermediary. Further prospective studies are necessary to elaborate the specific mechanism of this protective effect.
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Chalkias A, Nitsotolis T, Papalexandrou A, Mikros S, Iacovidou N, Xanthos T. Sagittal abdominal diameter may effectively predict future complications and increased mortality in intensive care unit patients with severe sepsis. J Crit Care 2013; 28:964-9. [PMID: 23948146 DOI: 10.1016/j.jcrc.2013.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/28/2013] [Accepted: 06/30/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate whether increased visceral adipose tissue is a risk factor for increased morbidity and mortality in intensive care patients with severe sepsis. MATERIALS AND METHODS In this prospective cohort study, body mass index (BMI) and sagittal abdominal diameter (SAD) were measured in all patients with severe sepsis immediately after admission in the intensive care unit (ICU). The patients were followed up until death or discharge from ICU. The study's primary outcome measure was mortality until day 60 after admission, while secondary outcomes were morbidity, length of stay, and length of ventilation in ICU. RESULTS Of the 30 patients, 24 (80%) developed septic shock, 6 (20%) multiple organ dysfunction syndrome, 13 (43.3%) necessitated continuous venovenous hemodiafiltration, while 6 (20%) of them died. BMI and SAD had a statistically significant positive linear correlation with ICU length of stay (P < .001) and length of ventilation (P ≤ .001). However, only SAD was significantly correlated with the development of multiple organ dysfunction syndrome (P = .033), the need for continuous venovenous hemodiafiltration (P = .004), and death (P = .033). CONCLUSION An increased SAD may effectively predict future complications and increased mortality in intensive care unit patients with severe sepsis.
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Affiliation(s)
- Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
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21
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Chae MK, Choi DJ, Shin TG, Jeon K, Suh GY, Sim MS, Song KJ, Jeong YK, Jo IJ. Body Mass Index and Outcomes in Patients with Severe Sepsis or Septic Shock. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.4.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Minjung Kathy Chae
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Jong Choi
- Department of Emergency Medicine, Osan Hankook Hospital, Osan, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun Jeong Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Kwon Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lawrence CB, Brough D, Knight EM. Obese mice exhibit an altered behavioural and inflammatory response to lipopolysaccharide. Dis Model Mech 2012; 5:649-59. [PMID: 22328591 PMCID: PMC3424462 DOI: 10.1242/dmm.009068] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Obesity is associated with an increase in the prevalence and severity of infections. Genetic animal models of obesity (ob/ob and db/db mice) display altered centrally-mediated sickness behaviour in response to acute inflammatory stimuli such as lipopolysaccharide (LPS). However, the effect of diet-induced obesity (DIO) on the anorectic and febrile response to LPS in mice is unknown. This study therefore determined how DIO and ob/ob mice respond to a systemic inflammatory challenge. C57BL/6 DIO and ob/ob mice, and their respective controls, were given an intraperitoneal (i.p.) injection of LPS. Compared with controls, DIO and ob/ob mice exhibited an altered febrile response to LPS (100 μg/kg) over 8 hours. LPS caused a greater and more prolonged anorexic effect in DIO compared with control mice and, in ob/ob mice, LPS induced a reduction in food intake and body weight earlier than it did in controls. These effects of LPS in obese mice were also seen after a fixed dose of LPS (5 μg). LPS (100 μg/kg) induced Fos protein expression in several brain nuclei of control mice, with fewer Fos-positive cells observed in the brains of obese mice. An altered inflammatory response to LPS was also observed in obese mice compared with controls: changes in cytokine expression and release were detected in the plasma, spleen, liver and peritoneal macrophages in obese mice. In summary, DIO and ob/ob mice displayed an altered behavioural response and cytokine release to systemic inflammatory challenge. These findings could help explain why obese humans show increased sensitivity to infections.
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Affiliation(s)
- Catherine B Lawrence
- AV Hill Building, Faculty of Life Sciences, University of Manchester, Manchester, M13 9PT, UK.
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Sepsis-Induced Adipokine Change with regard to Insulin Resistance. Int J Inflam 2012; 2012:972368. [PMID: 22272381 PMCID: PMC3261472 DOI: 10.1155/2012/972368] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 09/22/2011] [Accepted: 10/05/2011] [Indexed: 12/31/2022] Open
Abstract
Background. Assessment of white adipose tissue has changed in recent years, with WAT now being considered as an active endocrine organ, secreting a large number of bioactive mediators, so-called adipokines. Besides other functions, these adipokines are involved in inflammatory response thereby exhibiting predominantly proinflammatory or anti-inflammatory properties and contribute to insulin resistance. Methods. Comprehensive review of the literature of the role of adipokines relevant to critical care medicine using PubMed search. Results. Adiponectin—the prototype of an anti-inflammatory and insulin-sensitizing adipokine—is diminished in sepsis, while resistin—a protein with proinflammatory properties—is elevated. Plasminogen activator inhibitor-1, interleukin (IL)-1, IL-6, IL-8, and IL-10, and tumor-necrosis-factor-alpha mediate insulin resistance and are elevated in sepsis, while retinol-binding protein-4 concentrations are significantly reduced in sepsis. Chemerin displays potent anti-inflammatory and insulin-resistance properties, while monocyte chemotactic protein-1—increased in sepsis—contributes to macrophage infiltration in adipose tissue and insulin resistance. Conclusions. The expression of adipokines in humans is altered as well in obese as in septic patients with elevated levels of proinflammatory adipokines. Changes in adipokine levels in acute sepsis could contribute to insulin resistance. Consequently, in critically ill patients, these alterations underline a possible contribution of adipokines in the development of hyperglycemia.
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25
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Hillenbrand A, Knippschild U, Weiss M, Schrezenmeier H, Henne-Bruns D, Huber-Lang M, Wolf AM. Sepsis induced changes of adipokines and cytokines - septic patients compared to morbidly obese patients. BMC Surg 2010; 10:26. [PMID: 20825686 PMCID: PMC2944119 DOI: 10.1186/1471-2482-10-26] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Accepted: 09/09/2010] [Indexed: 01/04/2023] Open
Abstract
Background Hyperglycemia and insulin resistance frequently occur in critically ill and in morbidly obese (MO) patients. Both conditions are associated with altered serum levels of cytokines and adipokines. In addition, obesity related alterations in adipokine expression contribute to insulin resistance in metabolic syndrome. In this study we examined the serum adipocytokine profile in critically ill patients, MO patients, and healthy blood donors. Methods 33 patients who fulfilled the clinical criteria for severe sepsis or septic shock (SP) were prospectively enrolled in this study. A multiplex analysis was performed to evaluate plasma levels of adiponectin, resistin, leptin, active PAI-1, MCP-1, IL-1 alpha, IL-6, IL-8, IL-10, and TNF-alpha in 33 critically ill patients, 37 MO patients and 60 healthy blood donors (BD). Results In SP, adiponectin was significantly lowered and resistin, active PAI-1, MCP-1, IL-1 alpha, IL-6, IL-8, IL-10, and TNF-alpha were significantly elevated compared to BD. Leptin levels were unchanged. In MO, adiponectin and IL-8 were significantly lowered, leptin, active PAI-1, MCP-1, IL-1 alpha, IL-6, and IL-10 significantly elevated, whereas resistin was unaltered. In SP, adiponectin correlated negatively with BMI, SAPS II and SOFA scores, while resistin correlated positively with SAPS II and SOFA scores and leptin correlated positively with the BMI. Adiponectin was approximately equally diminished in SP and MO compared to BD. With the exception of active PAI-1, cytokine levels in SP were clearly higher compared to MO. Conclusion A comparable adipocytokine profile was determined in critically ill and MO patients. As in MO, SP showed reduced adiponectin levels and elevated MCP-1, active PAI-1, IL-1 alpha, IL-6, and IL-10 levels. Leptin is only elevated in MO, while resistin, IL-8, and TNF-alpha is only elevated in SP. As in MO patients, increased levels of proinflammatory cytokines and altered levels of adipokines may contribute to the development of insulin resistance in critically ill patients.
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Affiliation(s)
- Andreas Hillenbrand
- Department of General-, Visceral-, and Transplantation Surgery, University Hospital of Ulm, Steinhoevelstr, Ulm, Germany.
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Miehsler W. Mortality, morbidity and special issues of obese ICU patients. Wien Med Wochenschr 2010; 160:124-8. [PMID: 20364415 DOI: 10.1007/s10354-010-0767-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 01/28/2010] [Indexed: 11/29/2022]
Abstract
Obesity is on the advance in western industrialised countries and is therefore increasingly relevant also to intensive care medicine. In contrast to the common prejudice that obese patients probably have a higher ICU mortality than lean patients, convincing meta-analyses have revealed that this is not the case. Nevertheless, obese ICU patients are challenging. Especially mechanic ventilation has to be addressed: besides obesity-related anatomical problems that may complicate intubation, obstructive sleep apnoea, obesity hypoventilation syndrome and increased intra-abdominal pressure are of major relevance concerning ventilation, weaning and successful extubation. Also the risk of infections is increased in obese ICU patients, although this does not seem to increase the risk of sepsis. Nevertheless, the interplay of obesity and sepsis is a fascinating field in that adipous tissue is not just a passive reservoir of energy but an active endocrine and immunomodulating organ. However, the way of how adipokines interact with inflammation and coagulation in sepsis has yet to be clarified.
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Affiliation(s)
- Wolfgang Miehsler
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Wang HE, Devereaux RS, Yealy DM, Safford MM, Howard G. National variation in United States sepsis mortality: a descriptive study. Int J Health Geogr 2010; 9:9. [PMID: 20156361 PMCID: PMC2831852 DOI: 10.1186/1476-072x-9-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Accepted: 02/15/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The regional distribution of a disease may provide important insights regarding its pathophysiology, risk factors and clinical care. While sepsis is a prominent cause of death in the United States (US), few studies have examined regional variations with this malady. We identified the national variation in sepsis deaths in the US. We conducted a descriptive analysis of 1999-2005 national vital statistics data from the National Center for Health Statistics summarized at the state-level. We defined sepsis deaths as deaths attributed to an infection, classified according to the International Classification of Diseases, Version 10. We calculated national and state age-adjusted sepsis-attributed mortality rates. RESULTS National age-adjusted sepsis mortality was 65.5 per 100,000 persons (95% CI: 65.8 - 66.0). State level sepsis mortality varied more than two-fold (range 41 to 88.6 per 100,000 persons; median 60.8 per 100,000, IQR 53.9-74.4 per 100,000). A cluster extending from the Southeastern to the mid-Atlantic US encompassed states with the highest sepsis mortality. CONCLUSIONS Sepsis mortality varies across the US. The states with highest sepsis mortality form a contiguous cluster in the Southeastern and mid-Atlantic US. These observations highlight unanswered questions regarding the characteristics and care of sepsis.
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Affiliation(s)
- Henry E Wang
- Department of Emergency Medicine, University of Alabama at Birmingham, USA.
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Gong MN, Bajwa EK, Thompson BT, Christiani DC. Body mass index is associated with the development of acute respiratory distress syndrome. Thorax 2009; 65:44-50. [PMID: 19770169 DOI: 10.1136/thx.2009.117572] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) and development of acute respiratory distress syndrome (ARDS) is unknown. METHODS A cohort study of critically ill patients at risk for ARDS was carried out. BMI was calculated from admission height and weight. Patients were screened daily for AECC (American European Consensus Committee)-defined ARDS and 60-day ARDS mortality. RESULTS Of 1795 patients, 83 (5%) patients were underweight (BMI <18.5 kg/m(2)), 627 (35%) normal (BMI 18.5-24.9), 605 (34%) overweight (BMI 25-29.9), 364 (20%) obese (BMI 30-39.9) and 116 (6%) severely obese (BMI > or =40). Increasing weight was associated with younger age (p<0.001), diabetes (p<0.0001), higher blood glucose (p<0.0001), lower prevalence of direct pulmonary injury (p<0.0001) and later development of ARDS (p = 0.01). BMI was associated with ARDS on multivariate analysis (OR(adj) 1.24 per SD increase; 95% CI 1.11 to 1.39). Similarly, obesity was associated with ARDS compared with normal weight (OR(adj) 1.66; 95% CI 1.21 to 2.28 for obese; OR(adj) 1.78; 95% CI 1.12 to 2.92 for severely obese). Exploratory analysis in a subgroup of intubated patients without ARDS on admission (n = 1045) found that obese patients received higher peak (p<0.0001) and positive end-expiratory pressures (p<0.0001) than non-obese patients. Among patients with ARDS, increasing BMI was associated with increased length of stay (p = 0.007) but not with mortality (OR(adj) 0.89 per SD increase; 95% CI 0.71 to 1.12). CONCLUSION BMI was associated with increased risk of ARDS in a weight-dependent manner and with increased length of stay, but not with mortality. Additional studies are needed to determine whether differences in initial ventilator settings may contribute to ARDS development in the obese.
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Affiliation(s)
- M N Gong
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
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Chapman KE, Coutinho AE, Gray M, Gilmour JS, Savill JS, Seckl JR. The role and regulation of 11beta-hydroxysteroid dehydrogenase type 1 in the inflammatory response. Mol Cell Endocrinol 2009; 301:123-31. [PMID: 18973788 DOI: 10.1016/j.mce.2008.09.031] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 09/24/2008] [Accepted: 09/25/2008] [Indexed: 02/08/2023]
Abstract
Cortisone, a glucocorticoid hormone, was first used to treat rheumatoid arthritis in humans in the late 1940s, for which Hench, Reichstein and Kendall were awarded a Nobel Prize in 1950 and which led to the discovery of the anti-inflammatory effects of glucocorticoids. To be effective, the intrinsically inert cortisone must be converted to the active glucocorticoid, cortisol, by the intracellular action of 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1). Whilst orally administered cortisone is rapidly converted to the active hormone, cortisol, by first pass metabolism in the liver, recent work has highlighted an anti-inflammatory role for 11beta-HSD1 within specific tissues, including in leukocytes. Here, we review recent evidence pertaining to the anti-inflammatory role of 11beta-HSD1 and describe how inhibition of 11beta-HSD1, as widely proposed for treatment of metabolic disease, may impact upon inflammation. Finally, the mechanisms that regulate 11beta-HSD1 transcription will be discussed.
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Affiliation(s)
- Karen E Chapman
- Endocrinology Unit, Centre for Cardiovascular Sciences, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
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