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Halldorsdottir H, Lindbom L, Ebberyd A, Oldner A, Weitzberg E. The effect of heparins on plasma concentration of heparin-binding protein: a pilot study. BJA OPEN 2024; 9:100256. [PMID: 38318270 PMCID: PMC10839136 DOI: 10.1016/j.bjao.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024]
Abstract
Background Neutrophil-derived heparin-binding protein (HBP) plays a role in the pathophysiology of impaired endothelial dysfunction during inflammation. HBP has been suggested as a predictor of organ dysfunction and disease progression in sepsis. We investigated the effects of heparins on plasma concentrations of HBP in patients undergoing surgery. Methods We studied three groups of patients receiving heparins during or after surgery. The vascular surgery group received 3000-7500 U, whereas the cardiac surgery group received 27 500-40 000 U. After major general surgery, the third group received 5000 U of low-molecular-weight heparin (LMWH) subcutaneously. Serial plasma HBP concentrations were measured after these treatments with two different methods: Axis-Shield ELISA and Joinstar FIC-Q100. In addition, plasma myeloperoxidase and syndecan-1 were measured in the cardiac surgery group. Results During vascular surgery, heparin induced a six-fold increase in HBP within 2 min, from 3.6 (2.4-5.4) to 21.4 (9.0-35.4) ng ml-1 (P<0.001). During cardiac surgery, the higher dose of heparin elevated HBP concentrations from 5.3 (2.7-6.1) to 48.7 (38.4-70.1) ng ml-1 (P<0.0001) within 3 min. Patients receiving LMWH showed an increase from a baseline of 5.7 (3.7-12.1) ng ml-1 to a peak HBP concentration of 14.8 (9.5-18.1) ng ml-1 (P<0.0001) after 3 h. Plasma concentrations of myeloperoxidase, but not syndecan-1, also responded with a rapid increase after heparin. There was a strong correlation between the two methods for HBP analysis (r=0.94). Conclusions Plasma concentrations of HBP increased rapidly and dose-dependently after heparin administration. Subcutaneous administration of LMWH increases plasma HBP, but to a lesser degree. Clinical trial registration ClinicalTrials.gov identifier: NCT04146493.
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Affiliation(s)
- Halla Halldorsdottir
- Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Lindbom
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Anette Ebberyd
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Anders Oldner
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Eddie Weitzberg
- Department of Physiology and Pharmacology, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Liu J, Lin L, Yao P, Zhao W, Hu J, Shi XH, Zhang S, Zhu X, Pang DW, Liu AA. Immunoprofiling of Severity and Stage of Bacterial Infectious Diseases by Ultrabright Fluorescent Nanosphere-Based Dyad Test Strips. Anal Chem 2022; 94:8818-8826. [PMID: 35686482 DOI: 10.1021/acs.analchem.2c02028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bacterial infectious diseases are common clinical diseases that seriously threaten human health, especially in countries and regions with poor environmental hygiene. Due to the lack of characteristic clinical symptoms and signs, it is a challenge to distinguish a bacterial infection from other infections, leading to misdiagnosis and antibiotic overuse. Therefore, there is an urgent need to develop a specific method for detection of bacterial infections. Herein, utilizing ultrabright fluorescent nanospheres (FNs) as reporters, immunochromatographic dyad test strips are developed for the early detection of bacterial infections and distinction of different stages of bacterial infectious diseases in clinical samples. C-reactive protein (CRP) and heparin-binding protein (HBP) are quantified and assayed because their levels in plasma are varied dynamically and asynchronously during the progression of the disease. The detection limits of CRP and HBP can reach as low as 0.51 and 0.65 ng/mL, respectively, due to the superior fluorescence intensity of each FN, which is 570 times stronger than that of a single quantum dot. The assay procedure can be achieved in 22 min, fully meeting the needs of rapid and ultrasensitive detection in the field. This constructed strip has been successfully used to profile the stage and severity of bacterial infections by monitoring the levels of CRP and HBP in human plasma samples, showing great potential as a point-of-care biosensor for clinical diagnosis. In addition to bacterial infections, the developed ultrabright FN-based point-of-care testing can be readily expanded for rapid, quantitative, and ultrasensitive detection of other trace substances in complex systems.
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Affiliation(s)
- Juanzu Liu
- State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Biosensing and Molecular Recognition, Frontiers Science Center for New Organic Matter, Research Center for Analytical Sciences, College of Chemistry, Frontiers Science Center for Cell Responses, Haihe Laboratory of Sustainable Chemical Transformations, Nankai University, Tianjin 300071, P. R. China
| | - Leping Lin
- State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Biosensing and Molecular Recognition, Frontiers Science Center for New Organic Matter, Research Center for Analytical Sciences, College of Chemistry, Frontiers Science Center for Cell Responses, Haihe Laboratory of Sustainable Chemical Transformations, Nankai University, Tianjin 300071, P. R. China.,Wuhan Jiayuan Quantum Dots Co., Ltd., Wuhan 430074, P. R. China
| | - Peiyu Yao
- Department of Emergency, Department of Pathology, Tianjin Union Medical Center, Tianjin 300121, P. R. China
| | - Wei Zhao
- State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Biosensing and Molecular Recognition, Frontiers Science Center for New Organic Matter, Research Center for Analytical Sciences, College of Chemistry, Frontiers Science Center for Cell Responses, Haihe Laboratory of Sustainable Chemical Transformations, Nankai University, Tianjin 300071, P. R. China
| | - Jiao Hu
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, School of Environment and Health, Jianghan University, Wuhan 430056, P. R. China
| | - Xue-Hui Shi
- State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Biosensing and Molecular Recognition, Frontiers Science Center for New Organic Matter, Research Center for Analytical Sciences, College of Chemistry, Frontiers Science Center for Cell Responses, Haihe Laboratory of Sustainable Chemical Transformations, Nankai University, Tianjin 300071, P. R. China
| | - Shiwu Zhang
- Department of Emergency, Department of Pathology, Tianjin Union Medical Center, Tianjin 300121, P. R. China
| | - Xiaobo Zhu
- Wuhan Jiayuan Quantum Dots Co., Ltd., Wuhan 430074, P. R. China
| | - Dai-Wen Pang
- State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Biosensing and Molecular Recognition, Frontiers Science Center for New Organic Matter, Research Center for Analytical Sciences, College of Chemistry, Frontiers Science Center for Cell Responses, Haihe Laboratory of Sustainable Chemical Transformations, Nankai University, Tianjin 300071, P. R. China
| | - An-An Liu
- State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Biosensing and Molecular Recognition, Frontiers Science Center for New Organic Matter, Research Center for Analytical Sciences, College of Chemistry, Frontiers Science Center for Cell Responses, Haihe Laboratory of Sustainable Chemical Transformations, Nankai University, Tianjin 300071, P. R. China
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3
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Sjöbeck M, Sternby H, Herwald H, Thorlacius H, Regnér S. Heparin-binding protein is significantly increased in acute pancreatitis. BMC Gastroenterol 2021; 21:337. [PMID: 34454419 PMCID: PMC8403433 DOI: 10.1186/s12876-021-01910-6] [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: 02/16/2021] [Accepted: 08/18/2021] [Indexed: 01/15/2023] Open
Abstract
Background Most patients with acute pancreatitis (AP) experience mild, self-limiting disease with little or no need for hospital care. However, 20–25% of patients develop a more severe and potentially life-threatening condition with progressive systemic inflammatory response syndrome (SIRS) and multiorgan failure, resulting in high morbidity and mortality rates. Predicting disease severity at an early stage is important, as immediate supportive care has been demonstrated to reduce the incidence of SIRS and organ failure, improving patient outcome. Several studies have demonstrated elevated levels of heparin-binding protein (HBP) in patients with sepsis and septic shock, and HBP is believed to play a part in endothelial dysfunction leading to vascular leakage. As HBP levels increase prior to other known biomarkers, HBP has emerged as a promising early predictor of severe sepsis with organ dysfunction. Methods Patients admitted to Skåne University Hospital in Malmö between 2010 and 2013 fulfilling the criteria for AP were identified in the emergency department and prospectively enrolled in this study. The primary outcome was measured levels of HBP upon hospital admission in patients with confirmed AP. Correlations among HBP concentrations, disease severity and fluid balance were considered secondary endpoints. The correlation between HBP levels and fluid balance were analysed using Pearson correlation, and the ability of HBP to predict moderately severe/severe AP was assessed using a receiver operating characteristic (ROC) curve. Results The overall median HBP level in this study was 529 (307–898) ng/ml. There were no significant group differences in HBP levels based on AP severity. Fluid balance differed significantly between patients with mild versus moderately severe and severe pancreatitis, but we found no correlation between HBP concentration and fluid balance. Conclusions HBP levels are dramatically increased in patients with AP, and these levels far exceed those previously reported in other conditions. In this study, we did not observe any significant correlation between HBP levels and disease severity or the need for intravenous fluid. Additional studies on HBP are needed to further explore the role of HBP in the pathogenesis of AP and its possible clinical implications. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01910-6.
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Affiliation(s)
- Martina Sjöbeck
- Department of Surgery, Clinical Sciences, Malmö, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Hanna Sternby
- Department of Surgery, Clinical Sciences, Malmö, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Heiko Herwald
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Thorlacius
- Department of Surgery, Clinical Sciences, Malmö, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Sara Regnér
- Department of Surgery, Clinical Sciences, Malmö, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden.
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4
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Grossestreuer AV, Yankama TT, Moskowitz A, Ngo L, Donnino MW. Use of SOFA score in cardiac arrest research: A scoping review. Resusc Plus 2020; 4:100040. [PMID: 34223317 PMCID: PMC8244435 DOI: 10.1016/j.resplu.2020.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background The Sequential Organ Failure Assessment (SOFA) score is a commonly used severity-of-illness score in cardiac arrest research. Due to its nature, the SOFA score often has missing data. How much data is missing and how that missing data is handled is unknown. Objectives We conducted a scoping review on cardiac arrest studies using SOFA, focusing on missing data. Data sources PubMed, Embase, and Web of Science. Study selection All English-language peer-reviewed studies of cardiac arrest with SOFA as an outcome or exposure were included. Data extraction For each study, quantity of missing SOFA data, analytic strategy to handle missing SOFA variables, whether/to what degree mortality influenced the amount of missing SOFA scores), SOFA score modifications, and number of SOFA measurements was extracted. Data synthesis We included 66 studies published between 2006–2019. Five studies were randomized controlled trials, 26 were prospective cohort studies, and 25 were retrospective cohort studies. SOFA was used as an outcome in 36 (55%) and a primary outcome in 10 (15%). Nine studies (14%) mentioned the quantity of missing SOFA data, which ranged from 0 to 76% (median: 10% [IQR: 6%, 42%]). Twenty-seven (41%) studies reported a method to handle missing SOFA. The most common method used excluded subjects with missing data (81%). In the 50 studies using serial SOFA scores, 11 (22%) documented mortality prior to SOFA measurement; which ranged from 3% to 76% (median: 12% [IQR: 6%–35%]). Conclusions Missing data is common in cardiac arrest research using SOFA scores. Variability exists in reporting and handling missing SOFA variables.
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Affiliation(s)
- Anne V. Grossestreuer
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Corresponding author at: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA.
| | - Tuyen T. Yankama
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ari Moskowitz
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Long Ngo
- Department of Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael W. Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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5
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Stienen S, Ferreira JP, Kobayashi M, Preud'homme G, Dobre D, Machu JL, Duarte K, Bresso E, Devignes MD, López N, Girerd N, Aakhus S, Ambrosio G, Brunner-La Rocca HP, Fontes-Carvalho R, Fraser AG, van Heerebeek L, Heymans S, de Keulenaer G, Marino P, McDonald K, Mebazaa A, Papp Z, Raddino R, Tschöpe C, Paulus WJ, Zannad F, Rossignol P. Enhanced clinical phenotyping by mechanistic bioprofiling in heart failure with preserved ejection fraction: insights from the MEDIA-DHF study (The Metabolic Road to Diastolic Heart Failure). Biomarkers 2020; 25:201-211. [PMID: 32063068 DOI: 10.1080/1354750x.2020.1727015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome for which clear evidence of effective therapies is lacking. Understanding which factors determine this heterogeneity may be helped by better phenotyping. An unsupervised statistical approach applied to a large set of biomarkers may identify distinct HFpEF phenotypes.Methods: Relevant proteomic biomarkers were analyzed in 392 HFpEF patients included in Metabolic Road to Diastolic HF (MEDIA-DHF). We performed an unsupervised cluster analysis to define distinct phenotypes. Cluster characteristics were explored with logistic regression. The association between clusters and 1-year cardiovascular (CV) death and/or CV hospitalization was studied using Cox regression.Results: Based on 415 biomarkers, we identified 2 distinct clusters. Clinical variables associated with cluster 2 were diabetes, impaired renal function, loop diuretics and/or betablockers. In addition, 17 biomarkers were higher expressed in cluster 2 vs. 1. Patients in cluster 2 vs. those in 1 experienced higher rates of CV death/CV hospitalization (adj. HR 1.93, 95% CI 1.12-3.32, p = 0.017). Complex-network analyses linked these biomarkers to immune system activation, signal transduction cascades, cell interactions and metabolism.Conclusion: Unsupervised machine-learning algorithms applied to a wide range of biomarkers identified 2 HFpEF clusters with different CV phenotypes and outcomes. The identified pathways may provide a basis for future research.Clinical significanceMore insight is obtained in the mechanisms related to poor outcome in HFpEF patients since it was demonstrated that biomarkers associated with the high-risk cluster were related to the immune system, signal transduction cascades, cell interactions and metabolismBiomarkers (and pathways) identified in this study may help select high-risk HFpEF patients which could be helpful for the inclusion/exclusion of patients in future trials.Our findings may be the basis of investigating therapies specifically targeting these pathways and the potential use of corresponding markers potentially identifying patients with distinct mechanistic bioprofiles most likely to respond to the selected mechanistically targeted therapies.
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Affiliation(s)
- Susan Stienen
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - João Pedro Ferreira
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France.,Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Masatake Kobayashi
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - Gregoire Preud'homme
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - Daniela Dobre
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France.,Clinical research and Investigation Unit, Psychotherapeutic Center of Nancy, Laxou, France
| | - Jean-Loup Machu
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - Kevin Duarte
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - Emmanuel Bresso
- Equipe CAPSID, LORIA (CNRS, Inria NGE, Université de Lorraine), Vandoeuvre-lès-Nancy, France
| | | | - Natalia López
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Nicolas Girerd
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - Svend Aakhus
- Department of Cardiology and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,ISB, Norwegian University of Science and Technology, Trondheim, Norway
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | | | - Ricardo Fontes-Carvalho
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alan G Fraser
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Loek van Heerebeek
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, Leuven, Belgium.,William Harvey Research Institute, Barts Heart Centre, Queen Mary University of London, London, UK
| | - Gilles de Keulenaer
- Laboratory of Physiopharmacology, Antwerp University, and ZNA Hartcentrum, Antwerp, Belgium
| | - Paolo Marino
- Clinical Cardiology, Università del Piemonte Orientale, Department of Translational Medicine, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Kenneth McDonald
- School of Medicine and Medical Sciences, St Michael's Hospital Dun Laoghaire Co. Dublin, Dublin, Ireland
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France
| | - Zoltàn Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Riccardo Raddino
- Department of Cardiology, Spedali Civili di Brescia, Brescia, Italy
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow-Klinikum, C, Harite Universitaetsmedizin Berlin, Berlin Institute of Health - Center for Regenerative Therapies (BIH-BCRT), and the German Center for Cardiovascular Research (DZHK; Berlin partner site), Berlin, Germany
| | - Walter J Paulus
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Faiez Zannad
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
| | - Patrick Rossignol
- CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre d'Investigation Clinique et Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
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Mai N, Miller-Rhodes K, Knowlden S, Halterman MW. The post-cardiac arrest syndrome: A case for lung-brain coupling and opportunities for neuroprotection. J Cereb Blood Flow Metab 2019; 39:939-958. [PMID: 30866740 PMCID: PMC6547189 DOI: 10.1177/0271678x19835552] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic inflammation and multi-organ failure represent hallmarks of the post-cardiac arrest syndrome (PCAS) and predict severe neurological injury and often fatal outcomes. Current interventions for cardiac arrest focus on the reversal of precipitating cardiac pathologies and the implementation of supportive measures with the goal of limiting damage to at-risk tissue. Despite the widespread use of targeted temperature management, there remain no proven approaches to manage reperfusion injury in the period following the return of spontaneous circulation. Recent evidence has implicated the lung as a moderator of systemic inflammation following remote somatic injury in part through effects on innate immune priming. In this review, we explore concepts related to lung-dependent innate immune priming and its potential role in PCAS. Specifically, we propose and investigate the conceptual model of lung-brain coupling drawing from the broader literature connecting tissue damage and acute lung injury with cerebral reperfusion injury. Subsequently, we consider the role that interventions designed to short-circuit lung-dependent immune priming might play in improving patient outcomes following cardiac arrest and possibly other acute neurological injuries.
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Affiliation(s)
- Nguyen Mai
- 1 Department of Neuroscience, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA.,2 Center for Neurotherapeutics Discovery, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA
| | - Kathleen Miller-Rhodes
- 1 Department of Neuroscience, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA.,2 Center for Neurotherapeutics Discovery, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA
| | - Sara Knowlden
- 2 Center for Neurotherapeutics Discovery, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA.,3 Department of Neurology, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA
| | - Marc W Halterman
- 1 Department of Neuroscience, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA.,2 Center for Neurotherapeutics Discovery, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA.,3 Department of Neurology, School of Medicine and Dentistry, The University of Rochester, Rochester, NY, USA
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7
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Ipek E, Yolcu M, Yildirim E, Altinkaynak K, Ozbek Sebin S, Kalkan K, Gulcu O, Ermis E, Ozturk M. A Novel Marker of Inflammation: Azurocidin in Patients with ST Segment Elevation Myocardial Infarction. Int J Mol Sci 2018; 19:ijms19123797. [PMID: 30501029 PMCID: PMC6321077 DOI: 10.3390/ijms19123797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 12/22/2022] Open
Abstract
(1) To investigate the role of azurocidin, an antimicrobial protein, in patients with ST segment elevation myocardial infarction (STEMI). (2) This single-center prospective observational study included patients with STEMI and healthy age- and sex-matched control subjects. Baseline demographic, clinical and biochemical data were compared between the two groups. Azurocidin levels at baseline were determined using an enzyme-linked immunosorbent assay. Multivariate linear regression analysis with enter method was used to test the association between azurocidin and independent variables, such as the thrombolysis in myocardial infarction (TIMI) score, synergy between percutaneous coronary intervention with TAXUS and cardiac surgery score, global registry of acute coronary events score, Killip class, C-reactive protein (CRP), and creatinine kinase-myocardial band (CK-MB). (3) A total of 76 patients with STEMI and 30 healthy control subjects were enrolled in the study. Mean ± SD azurocidin levels were significantly higher in patients compared with healthy controls (18.07 ± 13.99 versus 10.09 ± 5.29 ng/mL, respectively). In a receiver-operating characteristic curve analysis, an azurocidin cut-off level of >11.46 ng/mL had 74% sensitivity and 58% specificity in predicting myocardial infarction. Azurocidin levels had a positive correlation with TIMI score (r = 0.651). In multivariate linear regression analysis, the TIMI score was an independent predictor of the azurocidin level. (4) Azurocidin is an infection marker that may be important in patients with STEMI.
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Affiliation(s)
- Emrah Ipek
- Department of Cardiology, Istanbul Cerrahi Hospital, 34365 Istanbul, Turkey.
| | - Mustafa Yolcu
- Department of Cardiology, Medicana International Hospital, Yeniyuzyil University, 34365 Istanbul, Turkey.
| | - Erkan Yildirim
- Department of Cardiology, Biruni University, 34365 Istanbul, Turkey.
| | - Konca Altinkaynak
- Department of Clinical Biochemistry, University of Health Sciences, Erzurum Training and Research Hospital, 25100 Erzurum, Turkey.
| | - Saime Ozbek Sebin
- Department of Physiology, Ataturk University School of Medicine, 25100 Erzurum, Turkey.
| | - Kamuran Kalkan
- Department of Cardiology, University of Health Sciences, Erzurum Training and Research Hospital, 25100 Erzurum, Turkey.
| | - Oktay Gulcu
- Department of Cardiology, University of Health Sciences, Erzurum Training and Research Hospital, 25100 Erzurum, Turkey.
| | - Emrah Ermis
- Department of Cardiology, Biruni University, 34365 Istanbul, Turkey.
| | - Mustafa Ozturk
- Department of Cardiology, University of Health Sciences, Erzurum Training and Research Hospital, 25100 Erzurum, Turkey.
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8
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Tydén J, Larsson N, Lehtipalo S, Herwald H, Hultin M, Walldén J, Behndig AF, Johansson J. Heparin-binding protein in ventilator-induced lung injury. Intensive Care Med Exp 2018; 6:33. [PMID: 30203380 PMCID: PMC6131685 DOI: 10.1186/s40635-018-0198-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/03/2018] [Indexed: 12/26/2022] Open
Abstract
Background Although mechanical ventilation is often lifesaving, it can also cause injury to the lungs. The lung injury is caused by not only high pressure and mechanical forces but also by inflammatory processes that are not fully understood. Heparin-binding protein (HBP), released by activated granulocytes, has been indicated as a possible mediator of increased vascular permeability in the lung injury associated with trauma and sepsis. We investigated if HBP levels were increased in the bronchoalveolar lavage fluid (BALF) or plasma in a pig model of ventilator-induced lung injury (VILI). We also investigated if HBP was present in BALF from healthy volunteers and in intubated patients in the intensive care unit (ICU). Methods Anaesthetized pigs were randomized to receive ventilation with either tidal volumes of 8 ml/kg (controls, n = 6) or 20 ml/kg (VILI group, n = 6). Plasma and BALF samples were taken at 0, 1, 2, 4, and 6 h. In humans, HBP levels in BALF were sampled from 16 healthy volunteers and from 10 intubated patients being cared for in the ICU. Results Plasma levels of HBP did not differ between pigs in the control and VILI groups. The median HBP levels in BALF were higher in the VILI group after 6 h of ventilation compared to those in the controls (1144 ng/ml (IQR 359–1636 ng/ml) versus 89 ng/ml (IQR 33–191 ng/ml) ng/ml, respectively, p = 0.02). The median HBP level in BALF from healthy volunteers was 0.90 ng/ml (IQR 0.79–1.01 ng/ml) as compared to 1959 ng/ml (IQR 612–3306 ng/ml) from intubated ICU patients (p < 0.001). Conclusions In a model of VILI in pigs, levels of HBP in BALF increased over time compared to controls, while plasma levels did not differ between the two groups. HBP in BALF was high in intubated ICU patients in spite of the seemingly non-harmful ventilation, suggesting that inflammation from other causes might increase HBP levels. Electronic supplementary material The online version of this article (10.1186/s40635-018-0198-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jonas Tydén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Östersund), Umeå University, Umeå, Sweden. .,Anestesiläkaravdelningen, Östersund Hospital, 831 32, Östersund, Sweden.
| | - N Larsson
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - S Lehtipalo
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - H Herwald
- Department of Cell and Molecular Biology, Lund University, Lund, Sweden
| | - M Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - J Walldén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Sundsvall), Umeå University, Umeå, Sweden
| | - A F Behndig
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - J Johansson
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine (Östersund), Umeå University, Umeå, Sweden
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9
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Robel R, Caroccio P, Maze M. Methods for Defining the Neuroprotective Properties of Xenon. Methods Enzymol 2018; 602:273-288. [PMID: 29588034 DOI: 10.1016/bs.mie.2018.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Xenon has features that make it an ideal general anesthetic agent; cost and scarcity mitigate xenon's widespread use in the operating room. Discovery of xenon's cytoprotective properties resulted in its application to thwart ongoing acute neurologic injury, an unmet clinical need. The discovery that xenon's neuroprotective effect interacts synergistically with targeted temperature management (TTM) led to its investigation in clinical settings, including in the management of the postcardiac arrest syndrome, in which TTM is indicated. Following successful demonstration of xenon's efficacy in combination with TTM in a preclinical model of porcine cardiac arrest, xenon plus TTM was shown to significantly decrease an imaging biomarker of brain injury for out of hospital cardiac arrest victims that had been successfully resuscitated. With the development of an efficient delivery system the stage is now set to investigate whether xenon improves survival, with good clinical outcome, for successfully resuscitated victims of a cardiac arrest.
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Affiliation(s)
| | | | - Mervyn Maze
- University of California San Francisco, San Francisco, CA, United States.
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10
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Fisher J, Linder A. Heparin-binding protein: a key player in the pathophysiology of organ dysfunction in sepsis. J Intern Med 2017; 281:562-574. [PMID: 28370601 DOI: 10.1111/joim.12604] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Infectious diseases remain a major health problem, and sepsis and other severe infectious diseases are common causes of morbidity and mortality. There is a need for clinical and laboratory tools to identify patients with severe infections early and to distinguish between bacterial and nonbacterial conditions. Heparin-binding protein (HBP), also known as azurocidin or cationic antimicrobial protein of 37 KDa, is a promising biomarker to distinguish between patients with these conditions. It is biologically plausible that HBP is an early and predictive biomarker because it is prefabricated and rapidly mobilized from migrating neutrophils in response to bacterial infections. HBP induces vascular leakage and oedema formation and has a pro-inflammatory effect on a variety of white blood cells and epithelial cells. The dysregulation of vascular barrier function and cellular inflammatory responses can then lead to organ dysfunction. Indeed, it has been shown that patients with sepsis express elevated levels of HBP in plasma several hours before they develop hypotension or organ dysfunction. HBP has a major role in the pathophysiology of severe bacterial infections and thus represents a potential diagnostic marker and a target for the treatment of sepsis.
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Affiliation(s)
- J Fisher
- Division of Infection Medicine, Department of Clinical Sciences, University of Lund, Lund, Sweden
| | - A Linder
- Division of Infection Medicine, Department of Clinical Sciences, University of Lund, Lund, Sweden
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11
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Ristagno G, Masson S, Tiainen M, Bendel S, Bernasconi R, Varpula T, Milani V, Vaahersalo J, Magnoli M, Spanuth E, Barlera S, Latini R, Hoppu S, Pettilä V, Skrifvars MB. Elevated plasma heparin-binding protein is associated with early death after resuscitation from cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:251. [PMID: 27497949 PMCID: PMC4976065 DOI: 10.1186/s13054-016-1412-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/19/2016] [Indexed: 12/27/2022]
Abstract
Background An intense systemic inflammatory response is observed following reperfusion after cardiac arrest. Heparin-binding protein (HBP) is a granule protein released by neutrophils that intervenes in endothelial permeability regulation. In the present study, we investigated plasma levels of HBP in a large population of patients resuscitated from out-of-hospital cardiac arrest. We hypothesized that high circulating levels of HBP are associated with severity of post-cardiac arrest syndrome and poor outcome. Methods Plasma was obtained from 278 patients enrolled in a prospective multicenter observational study in 21 intensive care units (ICU) in Finland. HBP was assayed at ICU admission and 48 h later. Multiple organ dysfunction syndrome (MODS) was defined as the 24 h Sequential Organ Failure Assessment (SOFA) score ≥ 12. ICU death and 12-month Cerebral Performance Category (CPC) were evaluated. Multiple linear and logistic regression tests and receiver operating characteristic curves with area under the curve (AUC) were performed. Results Eighty-two percent of patients (229 of 278) survived to ICU discharge and 48 % (133 of 276) to 1 year with a favorable neurological outcome (CPC 1 or 2). At ICU admission, median plasma levels of HBP were markedly elevated, 15.4 [9.6–31.3] ng/mL, and persisted high 48 h later, 14.8 [9.8–31.1] ng/mL. Admission levels of HBP were higher in patients who had higher 24 h SOFA and cardiovascular SOFA score (p < 0.0001) and in those who developed MODS compared to those who did not (29.3 [13.7–60.1] ng/mL vs. 13.6 [9.1–26.2] ng/mL, p < 0.0001; AUC = 0.70 ± 0.04, p = 0.0001). Admission levels of HBP were also higher in patients who died in ICU (31.0 [17.7–78.2] ng/mL) compared to those who survived (13.5 [9.1–25.5] ng/mL, p < 0.0001) and in those with an unfavorable 12-month neurological outcome compared to those with a favorable one (18.9 [11.3–44.3] ng/mL vs. 12.8 [8.6–30.4] ng/mL, p < 0.0001). Admission levels of HBP predicted early ICU death with an AUC of 0.74 ± 0.04 (p < 0.0001) and were independently associated with ICU death (OR [95 %CI] 1.607 [1.076–2.399], p = 0.020), but not with unfavorable 12-month neurological outcome (OR [95 %CI] 1.154 [0.834–1.596], p = 0.387). Conclusions Elevated plasma levels of HBP at ICU admission were independently associated with early death in ICU. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1412-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giuseppe Ristagno
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Serge Masson
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Stepani Bendel
- Division of Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Roberto Bernasconi
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Tero Varpula
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PL 266, 00029 HUS, Helsinki, Finland
| | - Valentina Milani
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Jukka Vaahersalo
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PL 266, 00029 HUS, Helsinki, Finland
| | - Michela Magnoli
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Eberhard Spanuth
- DIAneering - Diagnostics Engineering & Research, Heidelberg, Germany
| | - Simona Barlera
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Sanna Hoppu
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Ville Pettilä
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PL 266, 00029 HUS, Helsinki, Finland.,Intensive Care, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Markus B Skrifvars
- Division of Intensive Care Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, PL 266, 00029 HUS, Helsinki, Finland. .,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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12
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Annborn M, Nilsson F, Dankiewicz J, Rundgren M, Hertel S, Struck J, Cronberg T, Nielsen N. The Combination of Biomarkers for Prognostication of Long-Term Outcome in Patients Treated with Mild Hypothermia After Out-of-Hospital Cardiac Arrest—A Pilot Study. Ther Hypothermia Temp Manag 2016; 6:85-90. [DOI: 10.1089/ther.2015.0033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Martin Annborn
- Department of Anesthesia and Intensive Care, Helsingborg General Hospital, Helsingborg, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Fredrik Nilsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- R&D Centre Skåne, Skåne University Hospital, Lund, Sweden
| | - Josef Dankiewicz
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | - Malin Rundgren
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | - Sabine Hertel
- Thermo Fisher Scientific BRAHMS, Clinical Diagnostics, Hennigsdorf, Germany
| | | | - Tobias Cronberg
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Division of Neurology, Skåne University Hospital, Lund, Sweden
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg General Hospital, Helsingborg, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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13
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Tydén J, Herwald H, Sjöberg F, Johansson J. Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure. PLoS One 2016; 11:e0152035. [PMID: 27007333 PMCID: PMC4805239 DOI: 10.1371/journal.pone.0152035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/07/2016] [Indexed: 02/06/2023] Open
Abstract
Purpose Heparin-binding protein (HBP) is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU) would be associated with decreased oxygenation or circulatory failure. Methods This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS) 3 was recorded on admission. Sequential organ failure assessment (SOFA) scores were recorded daily for three days. Results Median SAPS 3 was 58.8 (48–70) and 30-day mortality 64/278 (23%). There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p<0.001) as well as with circulatory failure (p<0.001), after 48–72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002). ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality. Conclusions A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population it´s predictive value at the individual patient level is low.
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Affiliation(s)
- Jonas Tydén
- Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
- * E-mail:
| | - Heiko Herwald
- Department of Cell and Molecular Biology, Lund University, Lund, Sweden
| | - Folke Sjöberg
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- The Burn Center, Department of Hand, Plastic Surgery and Intensive Care, Linköping County Council, Linköping, Sweden
| | - Joakim Johansson
- Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
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14
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Pohl J, Rammos C, Totzeck M, Stock P, Kelm M, Rassaf T, Luedike P. MIF reflects tissue damage rather than inflammation in post-cardiac arrest syndrome in a real life cohort. Resuscitation 2016; 100:32-7. [PMID: 26784134 DOI: 10.1016/j.resuscitation.2015.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/13/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Following successful resuscitation from cardiac arrest (CA), neurological impairment and other types of organ dysfunction cause significant morbidity and mortality-a condition termed post-cardiac arrest syndrome. Whole-body ischemia/reperfusion with oxygen debt activates immunologic and coagulation pathways increasing the risk of multiple organ failure and infection. We here examined the role of the pro-inflammatory cytokine macrophage migration inhibitory factor (MIF) in post-cardiac arrest syndrome. METHODS MIF plasma levels of n=16 patients with return of spontaneous circulation (ROSC) after CA were assessed with a previously validated method and compared to markers of systemic inflammation and cellular damage. ICU patients without former CA and healthy volunteers served as controls. RESULTS MIF levels in patients after ROSC were higher compared to those in healthy volunteers and ICU patients without CA. Kaplan-Meyer analysis revealed a distinctly elevated mortality since day one that further increased towards an elevated 60-days-mortality in patients with high plasma MIF. ROC curve identified plasma MIF as a predictor for mortality in patients after CA. Correlation with inflammatory parameters revealed that high MIF levels did not mirror post CA inflammatory syndrome, but distinctive cellular damage after ROSC as there were strong correlations with markers of cellular damage like LDH and GOT/GPT. CONCLUSION High MIF levels were associated with elevated 60-days-mortality and high MIF predicted mortality after CA. We found a close relation between circulating MIF levels and cellular damage, but not with an inflammatory syndrome.
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Affiliation(s)
- Julia Pohl
- University Hospital Essen, West German Heart and Vascular Center, Department of Cardiology, Hufelandstr. 55, Essen 45147, Germany
| | - Christos Rammos
- University Hospital Essen, West German Heart and Vascular Center, Department of Cardiology, Hufelandstr. 55, Essen 45147, Germany
| | - Matthias Totzeck
- University Hospital Essen, West German Heart and Vascular Center, Department of Cardiology, Hufelandstr. 55, Essen 45147, Germany
| | - Pia Stock
- University Hospital Essen, West German Heart and Vascular Center, Department of Cardiology, Hufelandstr. 55, Essen 45147, Germany
| | - Malte Kelm
- University Hospital Duesseldorf, Medical Faculty Heinrich-Heine-University, Division of Cardiology, Pulmonology and Vascular Medicine, Moorenstrasse 5, Duesseldorf D-40225, Germany
| | - Tienush Rassaf
- University Hospital Essen, West German Heart and Vascular Center, Department of Cardiology, Hufelandstr. 55, Essen 45147, Germany
| | - Peter Luedike
- University Hospital Essen, West German Heart and Vascular Center, Department of Cardiology, Hufelandstr. 55, Essen 45147, Germany.
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Zanfaly H, Shalaby S, Elshal A. Heparin-binding protein as a predictive and diagnostic biomarker for severe sepsis and septic shock in patients with sepsis. ACTA ACUST UNITED AC 2016. [DOI: 10.4103/2356-9115.193408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Spaich S, Zelniker T, Endres P, Stiepak J, Uhlmann L, Bekeredjian R, Chorianopoulos E, Giannitsis E, Backs J, Katus HA, Preusch MR. Fibroblast growth factor 23 (FGF-23) is an early predictor of mortality in patients with cardiac arrest. Resuscitation 2015; 98:91-6. [PMID: 26655587 DOI: 10.1016/j.resuscitation.2015.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/29/2015] [Accepted: 11/18/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Post-cardiac arrest management has seen significant advances with profound improvements in survival and neurologic outcome. However, early prognostication after return of spontaneous circulation remains most challenging. Biomarkers have evolved as helpful tools in identifying patients who are at increased risk of adverse outcome. While fibroblast growth factor 23 (FGF-23) has recently emerged as a promising predictor of mortality in patients with cardiogenic shock, its role in risk stratification in post-resuscitation management remains unresolved. METHODS This study included 90 patients who had been resuscitated and transferred to the ICU of the University Hospital Heidelberg. Survivors and non-survivors were retrospectively analyzed for known prognostic biomarkers as well as FGF-23 serum levels 24h and 72 h post cardiac arrest (CA). RESULTS FGF-23 levels were significantly elevated in non-survivors compared to survivors. ROC analysis of FGF-23 levels at 24h and 72 h post CA yielded an AUC of 0.759 and 0.726, respectively, for prediction of overall survival after 6 months. FGF-23 levels remained as significant prognosticators after adjusting for age, renal function, and initial cardiac rhythm. FGF-23 levels did not show significant differences in patient outcome after stratification for cardiac origin of CA or left ventricular dysfunction. Furthermore, FGF-23 levels were moderately predictive of poor neurologic outcome in ROC analysis on day 1 and day 3 post CA with an AUC of 0.738 and 0.687, respectively. CONCLUSION This study demonstrates elevated FGF-23 serum levels to be potentially helpful in prediction of mortality and poor neurological outcome as early as 24h post cardiac arrest.
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Affiliation(s)
- Sebastian Spaich
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Thomas Zelniker
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Philipp Endres
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Jan Stiepak
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Emmanuel Chorianopoulos
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Johannes Backs
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Michael R Preusch
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg 69120, Germany.
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Rundgren M, Lyngbaek S, Fisker H, Friberg H. The Inflammatory Marker suPAR After Cardiac Arrest. Ther Hypothermia Temp Manag 2015; 5:89-94. [DOI: 10.1089/ther.2014.0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Malin Rundgren
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
| | | | | | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care, Skane University Hospital, Lund University, Lund, Sweden
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18
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Devaux Y, Stammet P, Friberg H, Hassager C, Kuiper MA, Wise MP, Nielsen N. MicroRNAs: new biomarkers and therapeutic targets after cardiac arrest? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:54. [PMID: 25886727 PMCID: PMC4324045 DOI: 10.1186/s13054-015-0767-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite advances in resuscitation medicine, including target temperature management as part of post-cardiac arrest care, many patients will have a poor neurological outcome, most often resulting in death. It is a commonly held belief that the ability to prognosticate outcome at an early stage after cardiac arrest would allow subsequent health care delivery to be tailored to individual patients. However, currently available predictive methods and biomarkers lack sufficient accuracy and therefore cannot be generally recommended in clinical practice. MicroRNAs have recently emerged as potential biomarkers of cardiovascular diseases. While the biomarker value of microRNAs for myocardial infarction or heart failure has been extensively studied, less attention has been devoted to their prognostic value after cardiac arrest. This review highlights the recent discoveries suggesting that microRNAs may be useful both to predict outcome and to treat patients after cardiac arrest.
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Affiliation(s)
- Yvan Devaux
- Laboratory of Cardiovascular Research, Luxembourg Institute of Health, L-1526, Luxembourg, Luxembourg.
| | - Pascal Stammet
- Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier, L-1445, Luxembourg, Luxembourg.
| | - Hans Friberg
- Skane University Hospital, Lund University, SE-205 02, Malmo, Sweden.
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet, DK - 2100, Copenhagen, Denmark.
| | - Michael A Kuiper
- Department of Intensive Care Medicine, Medical Center Leeuwarden, 8934 AD, Leeuwarden, The Netherlands.
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Niklas Nielsen
- Helsingborg Hospital, Lund University, S-251 87, Helsingborg, Sweden.
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Taccone F, Cronberg T, Friberg H, Greer D, Horn J, Oddo M, Scolletta S, Vincent JL. How to assess prognosis after cardiac arrest and therapeutic hypothermia. Crit Care 2014; 18:202. [PMID: 24417885 PMCID: PMC4056000 DOI: 10.1186/cc13696] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prognosis of patients who are admitted in a comatose state following successful resuscitation after cardiac arrest remains uncertain. Although the introduction of therapeutic hypothermia (TH) and improvements in post-resuscitation care have significantly increased the number of patients who are discharged home with minimal brain damage, short-term assessment of neurological outcome remains a challenge. The need for early and accurate prognostic predictors is crucial, especially since sedation and TH may alter the neurological examination and delay the recovery of motor response for several days. The development of additional tools, including electrophysiological examinations (electroencephalography and somatosensory evoked potentials), neuroimaging and chemical biomarkers, may help to evaluate the extent of brain injury in these patients. Given the extensive literature existing on this topic and the confounding effects of TH on the strength of these tools in outcome prognostication after cardiac arrest, the aim of this narrative review is to provide a practical approach to post-anoxic brain injury when TH is used. We also discuss when and how these tools could be combined with the neurological examination in a multimodal approach to improve outcome prediction in this population.
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Friberg H, Cronberg T. Prognostication after cardiac arrest. Best Pract Res Clin Anaesthesiol 2013; 27:359-72. [DOI: 10.1016/j.bpa.2013.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 06/28/2013] [Indexed: 11/25/2022]
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