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Luebbering N, Abdullah S, Lounder D, Lane A, Dole N, Rubinstein J, Hewison M, Gloude N, Jodele S, Perentesis KMR, Lake K, Litts B, Duell A, Dandoy CE, Davies SM. Endothelial injury, F-actin and vitamin-D binding protein after hematopoietic stem cell transplant and association with clinical outcomes. Haematologica 2021; 106:1321-1329. [PMID: 32241849 PMCID: PMC8094097 DOI: 10.3324/haematol.2019.233478] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 01/22/2023] Open
Abstract
Endothelial injury after hematopoietic stem cell transplant is an important initiating factor for early transplant toxicities of thrombotic microangiopathy and acute graft versus host disease. We hypothesized that release of the angiopathic molecule filamentous actin (F-actin) from hematopoietic cells lysed during conditioning prior to stem cell transplant would be associated with clinical outcomes. We detected F-actin in the blood of 52% of stem cell transplant recipients in the first 14 days after transplant, and children with detectable F-actin had a significantly elevated risk of thrombotic microangiopathy (P=0.03) and non-relapse mortality (P=0.04). F-actin is cleared from the circulation by vitamin D binding protein (VDBP) so we expected that higher levels of VDBP would improve outcomes. In a cohort of 190 children receiving an allogeneic transplant, risk of thrombotic microangiopathy was reduced in those with serum concentrations of VDBP above the median at day 30 (10% vs. 31%, P=0.01), and graft versus host disease and non-relapse mortality were reduced in those with levels above the median at day 100 (3% vs. 18%, P=0.04 and 0% vs. 15%, P=0.002). Western blot analyses demonstrated actin-VDBP complexes in the blood, which cleared by day 21-28. Our data support modulation of cytokine secretion and macrophage phenotype by VDBP later after transplant. Taken together, our data identify an association between Factin, a mediator of endothelial damage, and VDBP, an actin scavenger, as modifiers of risk of clinical consequences of endothelial injury.
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Affiliation(s)
- Nathan Luebbering
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sheyar Abdullah
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dana Lounder
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Lane
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nikhil Dole
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeremy Rubinstein
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Martin Hewison
- School of Clinical and Experimental Medicine, University of, University of Birmingham, UK
| | - Nicholas Gloude
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sonata Jodele
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kitty M R Perentesis
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kelly Lake
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bridget Litts
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alexandra Duell
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher E Dandoy
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stella M Davies
- Department of Pediatric, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Hazeldine J, Dinsdale RJ, Naumann DN, Acharjee A, Bishop JRB, Lord JM, Harrison P. Traumatic injury is associated with reduced deoxyribonuclease activity and dysregulation of the actin scavenging system. BURNS & TRAUMA 2021; 9:tkab001. [PMID: 33834079 PMCID: PMC8014516 DOI: 10.1093/burnst/tkab001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Indexed: 11/15/2022]
Abstract
Background Traumatic injury is associated with increased concentrations of cell-free DNA (cfDNA) in the circulation, which contribute to post-injury complications. The endonuclease deoxyribonuclease 1 (DNase-1) is responsible for removing 90% of circulating cfDNA. Recently, DNase activity was reported to be significantly reduced following major non-traumatic brain injury (TBI), but the processes responsible were not investigated. Moreover, it is not known how quickly following injury DNase activity is reduced and whether this also occurs after TBI. Methods At 3 post-injury time points (≤1, 4–12 and 48–72 hours), blood samples were obtained from 155 adult trauma patients that had sustained an isolated TBI (n = 21), TBI with accompanying extracranial injury (TBI+) (n = 53) or an extracranial injury only (ECI) (n = 81). In addition to measuring cfDNA levels and the activity and expression of DNase, circulating concentrations of monomeric globular action (G-actin), an inhibitor of DNase-1, and the actin scavenging proteins gelsolin (GSN) and vitamin D binding protein (VDBP) were determined and values compared to a cohort of healthy controls. Results Significantly elevated concentrations of plasma cfDNA were seen in TBI, TBI+ and ECI patients at all study time points when compared to healthy controls. cfDNA levels were significantly higher at ≤1 hour post-injury in ECI patients who subsequently developed multiple organ dysfunction syndrome when compared to those who did not. Plasma DNase-1 protein was significantly elevated in all patient groups at all sampling time points. In contrast, DNase enzyme activity was significantly reduced, with this impaired function evident in TBI+ patients within minutes of injury. Circulating concentrations of G-actin were elevated in all patient cohorts in the immediate aftermath of injury and this was accompanied by a significant reduction in the levels of GSN and VDBP. Conclusions The post-traumatic increase in circulating cfDNA that occurs following extracranial trauma and TBI is accompanied by reduced DNase activity. We propose that, secondary to reduced GSN and VDBP levels, elevated circulating concentrations of G-actin underlie the post-injury reduction in DNase activity. Reducing circulating cfDNA levels via therapeutic restoration of DNase-1 activity may improve clinical outcomes post-injury.
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Affiliation(s)
- Jon Hazeldine
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Heritage Building, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom
| | - Robert J Dinsdale
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, United Kingdom.,Scar Free Foundation Birmingham Centre for Burns Research, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom
| | - David N Naumann
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Heritage Building, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom.,Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom
| | - Animesh Acharjee
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Heritage Building, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom.,Institute of Cancer and Genomic Sciences, Centre for Computational Biology, University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, United Kingdom
| | - Jonathan R B Bishop
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Heritage Building, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, United Kingdom.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Heritage Building, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom.,Scar Free Foundation Birmingham Centre for Burns Research, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom
| | - Paul Harrison
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, United Kingdom.,Scar Free Foundation Birmingham Centre for Burns Research, University Hospital Birmingham Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, West Midlands, B15 2TH, United Kingdom
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3
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Vitamin D: A magic bullet or a myth? Clin Nutr 2020; 39:2663-2674. [DOI: 10.1016/j.clnu.2019.12.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 02/08/2023]
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4
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Dinsdale RJ, Hazeldine J, Al Tarrah K, Hampson P, Devi A, Ermogenous C, Bamford AL, Bishop J, Watts S, Kirkman E, Dalle Lucca JJ, Midwinter M, Woolley T, Foster M, Lord JM, Moiemen N, Harrison P. Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury. Br J Surg 2019; 107:391-401. [PMID: 31502663 PMCID: PMC7079039 DOI: 10.1002/bjs.11310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/21/2019] [Accepted: 06/08/2019] [Indexed: 01/25/2023]
Abstract
Background Circulating cell‐free DNA (cfDNA) is not found in healthy subjects, but is readily detected after thermal injury and may contribute to the risk of multiple organ failure. The hypothesis was that a postburn reduction in DNase protein/enzyme activity could contribute to the increase in cfDNA following thermal injury. Methods Patients with severe burns covering at least 15 per cent of total body surface area were recruited to a prospective cohort study within 24 h of injury. Blood samples were collected from the day of injury for 12 months. Results Analysis of blood samples from 64 patients revealed a significant reduction in DNase activity on days 1–28 after injury, compared with healthy controls. DNase protein levels were not affected, suggesting the presence of an enzyme inhibitor. Further analysis revealed that actin (an inhibitor of DNase) was present in serum samples from patients but not those from controls, and concentrations of the actin scavenging proteins gelsolin and vitamin D‐binding protein were significantly reduced after burn injury. In a pilot study of ten military patients with polytrauma, administration of blood products resulted in an increase in DNase activity and gelsolin levels. Conclusion The results of this study suggest a novel biological mechanism for the accumulation of cfDNA following thermal injury by which high levels of actin released by damaged tissue cause a reduction in DNase activity. Restoration of the actin scavenging system could therefore restore DNase activity, and reduce the risk of cfDNA‐induced host tissue damage and thrombosis.
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Affiliation(s)
- R J Dinsdale
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J Hazeldine
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - K Al Tarrah
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - P Hampson
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - A Devi
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - C Ermogenous
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - A L Bamford
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Bishop
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Watts
- Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - E Kirkman
- Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - J J Dalle Lucca
- Translational Medical Division, Department of Chemical and Biological Technologies, Defense Threat Reduction Agency, Fort Belvoir, Virginia, USA
| | - M Midwinter
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - T Woolley
- ICT Centre, Birmingham Research Park, Birmingham, UK.,Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - M Foster
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J M Lord
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - N Moiemen
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - P Harrison
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Horváth-Szalai Z, Kustán P, Szirmay B, Lakatos Á, Christensen PH, Huber T, Bugyi B, Mühl D, Ludány A, Miseta A, Kovács GL, Kőszegi T. Predictive value of serum gelsolin and Gc globulin in sepsis - a pilot study. Clin Chem Lab Med 2019; 56:1373-1382. [PMID: 29320362 DOI: 10.1515/cclm-2017-0782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/09/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Simultaneous determination of the two main actin scavenger proteins in sepsis has not been investigated until now. In our pilot study, we elucidated the predictive values of Gc globulin and gelsolin (GSN) in sepsis by comparing them to classic laboratory and clinical parameters. METHODS A 5-day follow-up was performed, including 46 septic patients, 28 non-septic patients and 35 outpatients as controls. Serum Gc globulin and GSN levels were determined by automated immune turbidimetric assay on a Cobas 8000/c502 analyzer. Patients were retrospectively categorized according to the sepsis-3 definitions, and 14-day mortality was also investigated. RESULTS First-day GSN also differentiated sepsis from non-sepsis (AUC: 0.88) similarly to C-reactive protein (AUC: 0.80) but was slightly inferior to procalcitonin (PCT) (AUC: 0.98) with a cutoff value of GSN at 22.29 mg/L (sensitivity: 83.3%; specificity: 86.2%). Only first-day SOFA scores (0.88) and GSN (0.71) distinguished septic survivors from non-survivors, whereas lactate (0.99), Gc globulin (0.76) and mean arterial pressure (MAP) (0.74) discriminated septic shock from sepsis. Logistic regression analyses revealed SOFA scores and GSN being significant factors regarding 14-day mortality. First-day GSN levels were higher (p<0.05) in septic survivors than in non-survivors. Gc globulin levels remained higher (p<0.01) in sepsis when compared with septic shock during the follow-up period. CONCLUSIONS Both serum GSN and Gc globulin may have predictive values in sepsis. Considering the small sample size of our study, further measurements are needed to evaluate our results. Measurement of Gc globulin and GSN maybe useful in assessment of sepsis severity and in therapeutic decision-making.
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Affiliation(s)
- Zoltán Horváth-Szalai
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Péter Kustán
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary.,Department of Anaesthesiology and Intensive Therapy, University of Pécs, Medical School, Pécs, Hungary
| | - Balázs Szirmay
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Ágnes Lakatos
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | | | - Tamás Huber
- Department of Biophysics, University of Pécs, Medical School, Pécs, Hungary
| | - Beáta Bugyi
- Department of Biophysics, University of Pécs, Medical School, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Diána Mühl
- Department of Anaesthesiology and Intensive Therapy, University of Pécs, Medical School, Pécs, Hungary
| | - Andrea Ludány
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Attila Miseta
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Gábor L Kovács
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Tamás Kőszegi
- Department of Laboratory Medicine, University of Pécs, Medical School, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary
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Wad MS, Laursen T, Fruergaard S, Morgen SS, Dahl B. Survival and health related quality of life after severe trauma - a 15 years follow up study. Injury 2018; 49:191-194. [PMID: 29017766 DOI: 10.1016/j.injury.2017.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As the primary treatment of patients with severe trauma continues to improve, increasing interest has been directed towards long-term survival and Health Related Quality of Life (HRQoL). In trauma patients, there are few studies describing long-term outcome using tools specifically directed at HRQoL. HYPOTHESIS HRQoL measured with EQ-5D is significantly reduced compared to the Danish norm score 15 years after severe injury. MATERIALS AND METHODS All patients more than 18 years of age, admitted to a level 1 trauma center from March 1996 to September 1997 were prospectively included and scored with Injury Severity Score (ISS). Survival status was recorded in May 2012 and EQ-5D questionnaires were sent out. RESULTS 95 of the original 154 trauma patients were eligible for participation. The response rate was 66%. The average EQ-5D index score in the trauma population was significantly reduced compared to the index score in the Danish norm population (P=0.00, one-sample t-test). In addition, ISS is associated with HRQoL and ISS≥16 predicts poorer HRQoL. CONCLUSION EQ-5D is significantly reduced 15years after severe trauma High ISS was associated with low HRQoL. Knowledge of the distribution and predictors of long-term disability can be used to develop more efficient prevention policies and to improve trauma care in general.
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Affiliation(s)
- Morten S Wad
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.
| | - Thomas Laursen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Sidsel Fruergaard
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Søren Schmidt Morgen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Denmark
| | - Benny Dahl
- Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Domingues CDA, Coimbra R, Poggetti RS, Nogueira LDS, Sousa RMC. Performance of new adjustments to the TRISS equation model in developed and developing countries. World J Emerg Surg 2017; 12:17. [PMID: 28360930 PMCID: PMC5370451 DOI: 10.1186/s13017-017-0129-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Trauma and Injury Severity Score (TRISS) has been criticized for being based on data from the USA and Canada-high-income countries-and therefore, it may not be applicable to low-income and middle-income countries. The present study evaluated the accuracy of three adjustments to the TRISS equation model (NTRISS-like; TRISS SpO2; NTRISS-like SpO2) in a high-income and a middle-income country to compare their performance when derived and applied to different groups. METHODS This was a retrospective study of trauma patients admitted to two institutions: a university medical center in São Paulo, Brazil (a middle-income country), and a level 1 university trauma center in San Diego, USA (a high-income country). Patients were admitted between January 1, 2006, and December 31, 2010. The subjects were 2416 patients from Brazil and 8172 patients from the USA. All equations had adjusted coefficients for São Paulo and San Diego and for blunt and penetrating trauma. Receiver operating characteristic (ROC) curves were used to evaluate performance of the models. RESULTS Regardless of the population where the equation was generated, it performed better when applied to patients in the USA (AUC from 0.911 to 0.982) compared to patients in Brazil (AUC from 0.840 to 0.852). When the severity was considered and homogenized, the performance of equations were similar to both application in the USA and Brazil. CONCLUSIONS Survival probability models showed better performance when applied in data collected in the high-income countries (HIC) regardless the country they were derived. The severity is an important factor to consider when using non-adjusted survival probability models for the local population. Adjusted models for severely traumatized patients better predict survival probability in less severely traumatized populations. Other factors besides physiological and anatomical data may impact final outcomes and should be identified in each environment if they are to be used in the development of the trauma care performance improvement process in middle-income countries.
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Affiliation(s)
| | - Raul Coimbra
- University of California San Diego Medical Center, San Diego, CA USA
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Critically Ill Children Have Low Vitamin D-Binding Protein, Influencing Bioavailability of Vitamin D. Ann Am Thorac Soc 2016; 12:1654-61. [PMID: 26356094 DOI: 10.1513/annalsats.201503-160oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Vitamin D deficiency, often defined by total serum 25-hydroxyvitamin D (25[OH]D) <20 ng/ml, is common in critically ill patients, with associations with increased mortality and morbidity in the intensive care unit. Correction of vitamin D deficiency in critical illness has been recommended, and ongoing clinical trials are investigating the effect of repletion on patient outcome. The biologically active amount of 25(OH)D depends on the concentration and protein isoform of vitamin D-binding protein (VDBP), which is also an acute-phase reactant affected by inflammation and injury. OBJECTIVES We performed a secondary analysis of a cohort of critically ill children in which we reported a high rate of vitamin D deficiency, to examine how VDBP level and genotype would impact vitamin D status. METHODS We prospectively enrolled 511 children admitted to the pediatric intensive care unit over a 12-month period. MEASUREMENTS AND MAIN RESULTS We measured serum VDBP in 479 children. We genotyped single nucleotide polymorphisms rs7041 and rs4588 in the VDBP gene (GC) to determine haplotypes GC1F, GC1S, and GC2 in 178 subjects who consented, then calculated bioavailable 25(OH)D from serum 25(OH)D, VDBP, albumin, and GC haplotype. The median serum VDBP level was 159 μg/ml (interquartile range, 108-221), lower than has been reported in healthy children. Factors predicting lower levels in multivariate analysis included age <1 year, nonwhite race, being previously healthy, 25(OH)D <20 ng/ml and greater illness severity. In the subgroup that was genotyped, GC haplotype had the strongest association with VDBP level; carriage of one additional copy of GC1S was associated with a 37.5% higher level (95% confidence interval, 31.9-44.8; P < 0.001). Bioavailable 25(OH)D was also inversely associated with illness severity (r = -0.24, P < 0.001), and ratio to measured total 25(OH)D was variable and related to haplotype. CONCLUSIONS Physiologic deficiency of 25(OH)D in critical illness may be more difficult to diagnose, given that lower VDBP levels increase bioavailability. Treatment studies conducted on the basis of total 25(OH)D level, without consideration of VDBP concentration and genotype, may increase the risk of falsely negative results.
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9
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Rousseau AF, Damas P, Ledoux D, Lukas P, Carlisi A, Le Goff C, Gadisseur R, Cavalier E. Vitamin D status after a high dose of cholecalciferol in healthy and burn subjects. Burns 2015; 41:1028-34. [DOI: 10.1016/j.burns.2014.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022]
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Moraes RB, Friedman G, Wawrzeniak IC, Marques LS, Nagel FM, Lisboa TC, Czepielewski MA. Vitamin D deficiency is independently associated with mortality among critically ill patients. Clinics (Sao Paulo) 2015; 70:326-32. [PMID: 26039948 PMCID: PMC4449478 DOI: 10.6061/clinics/2015(05)04] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/06/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Studies suggest an association between vitamin D deficiency and morbidity/mortality in critically ill patients. Several issues remain unexplained, including which vitamin D levels are related to morbidity and mortality and the relevance of vitamin D kinetics to clinical outcomes. We conducted this study to address the association of baseline vitamin D levels and vitamin D kinetics with morbidity and mortality in critically ill patients. METHOD In 135 intensive care unit (ICU) patients, vitamin D was prospectively measured on admission and weekly until discharge from the ICU. The following outcomes of interest were analyzed: 28-day mortality, mechanical ventilation, length of stay, infection rate, and culture positivity. RESULTS Mortality rates were higher among patients with vitamin D levels <12 ng/mL (versus vitamin D levels >12 ng/mL) (32.2% vs. 13.2%), with an adjusted relative risk of 2.2 (95% CI 1.07-4.54; p< 0.05). There were no differences in the length of stay, ventilation requirements, infection rate, or culture positivity. CONCLUSIONS This study suggests that low vitamin D levels on ICU admission are an independent risk factor for mortality in critically ill patients. Low vitamin D levels at ICU admission may have a causal relationship with mortality and may serve as an indicator for vitamin D replacement among critically ill patients.
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Affiliation(s)
- Rafael Barberena Moraes
- Division of Critical Care Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Department of Internal Medicine
- *Corresponding author: Rafael Barberena Moraes, E-mail:
| | - Gilberto Friedman
- Division of Critical Care Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Department of Internal Medicine
| | - Iuri Christmann Wawrzeniak
- Division of Critical Care Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Department of Internal Medicine
| | - Leonardo S. Marques
- Division of Critical Care Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Department of Internal Medicine
| | - Fabiano Márcio Nagel
- Division of Critical Care Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Department of Internal Medicine
| | - Thiago Costa Lisboa
- Division of Critical Care Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Department of Internal Medicine
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Bagchi A, Kumar S, Ray PC, Das BC, Gumma PK, Kar P. Predictive value of serum actin-free Gc-globulin for complications and outcome in acute liver failure. J Viral Hepat 2015; 22:192-200. [PMID: 24774007 DOI: 10.1111/jvh.12259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/09/2014] [Indexed: 12/26/2022]
Abstract
This prospective study was designed to evaluate whether early changes in actin-free Gc-globulin levels were associated with complications and outcomes and to identify factors associated with persistent low actin-free Gc-globulin levels in acute liver failure (ALF). Thirty-two consecutive ALF patients admitted from October 2011 to December 2012 were followed up until death or complete recovery. All had serum actin-free Gc-globulin estimation at admission and at day three or expiry. Logistic regression analysis was performed to identify independent predictors of mortality. A receiver operating characteristic curve analysis was also performed. Nonsurvivors had significantly lower median actin-free Gc-globulin levels than survivors (87.32 vs 180 mg/L; P < 0.001). A receiver operating characteristic curve analysis revealed an area under curve (AUC) of 0.771 and showed that serum actin-free Gc-globulin level of ≤124 mg/L would predict mortality with 92% sensitivity and 71.4% specificity. Patients with lower serum actin-free Gc-globulin levels and decreasing trend in serum actin-free Gc-globulin levels were found to have more mortality and developed more complications. Logistic regression analysis showed that serum actin-free Gc-globulin, total leucocyte count and serum creatinine at admission were independent predictors of mortality. Incorporating these variables, a score predicting mortality risk at admission was derived. The scoring system was compared to MELD score and King's College Criteria as individual predictor of mortality. Serum actin-free Gc-globulin level at presentation is predictive of outcome and can be used for risk stratification. Its persistent low-level predicts mortality and is correlated with various complications.
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Affiliation(s)
- A Bagchi
- General Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
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Speeckaert MM, Speeckaert R, van Geel N, Delanghe JR. Vitamin D binding protein: a multifunctional protein of clinical importance. Adv Clin Chem 2014; 63:1-57. [PMID: 24783350 DOI: 10.1016/b978-0-12-800094-6.00001-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the discovery of group-specific component and its polymorphism by Hirschfeld in 1959, research has put spotlight on this multifunctional transport protein (vitamin D binding protein, DBP). Besides the transport of vitamin D metabolites, DBP is a plasma glycoprotein with many important functions, including sequestration of actin, modulation of immune and inflammatory responses, binding of fatty acids, and control of bone development. A considerable DBP polymorphism has been described with a specific allele distribution in different geographic area. Multiple studies have shed light on the interesting relationship between polymorphisms of the DBP gene and the susceptibility to diseases. In this review, we give an overview of the multifunctional character of DBP and describe the clinical importance of DBP and its polymorphisms. Finally, we discuss the possibilities to use DBP as a novel therapeutic agent.
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Trujillo G, Habiel DM, Ge L, Ramadass M, Cooke NE, Kew RR. Neutrophil recruitment to the lung in both C5a- and CXCL1-induced alveolitis is impaired in vitamin D-binding protein-deficient mice. THE JOURNAL OF IMMUNOLOGY 2013; 191:848-56. [PMID: 23752613 DOI: 10.4049/jimmunol.1202941] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Knowledge of how neutrophils respond to chemotactic signals in a complex inflammatory environment is not completely understood. Moreover, even less is known about factors in physiological fluids that regulate the activity of chemoattractants. The vitamin D-binding protein (DBP) has been shown to significantly enhance chemotaxis to complement activation peptide C5a using purified proteins in vitro, and by ex vivo depletion of DBP in physiological fluids, but this function has not been determined in vivo. DBP null ((-/-)) mice were used to investigate how a systemic absence of this plasma protein affects leukocyte recruitment in alveolitis models of lung inflammation. DBP(-/-) mice had significantly reduced (~50%) neutrophil recruitment to the lungs compared with their wild-type DBP(+/+) counterparts in three different alveolitis models, two acute and one chronic. The histology of DBP(-/-) mouse lungs also showed significantly less injury than wild-type animals. The chemotactic cofactor function of DBP appears to be selective for neutrophil recruitment, but, in contrast to previous in vitro results, in vivo DBP can enhance the activity of other chemoattractants, including CXCL1. The reduced neutrophil response in DBP(-/-) mice could be rescued to wild-type levels by administering exogenous DBP. Finally, in inflammatory fluids, DBP binds to G-actin released from damaged cells, and this complex may be the active chemotactic cofactor. To our knowledge, results show for the first time that DBP is a significant chemotactic cofactor in vivo and not specific for C5a, suggesting that this ubiquitous plasma protein may have a more significant role in neutrophil recruitment than previously recognized.
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Affiliation(s)
- Glenda Trujillo
- Department of Pathology, Stony Brook University School of Medicine, Stony Brook, NY 11794, USA
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Abstract
BACKGROUND AND AIM To investigate the role of group-specific component globulin (Gc-globulin) in the early process of severe acute pancreatitis (SAP). PATIENTS AND METHODS A total of 37 patients with SAP and 31 patients with mild acute pancreatitis (MAP) were enrolled in the study. Twenty healthy individuals served as controls. Blood samples were taken from SAP and MAP patients on the day of admission (day 1), day 7, and day 14. Serum total Gc-globulin levels were measured using an enzyme-linked immunosorbent assay. RESULTS On admission, the total Gc-globulin levels of patients in the SAP group were 368 (270-455) mg/l (expressed as medians with interquartile range), which were significantly lower (P=0.007) compared with the control group [420 (299-585) mg/l]. In the SAP group, a significant decrease in serum total Gc-globulin was observed in patients who developed organ dysfunction [267 (242-306) mg/l] compared with patients who did not [414 (329-513) mg/l, P<0.001]. Patients with lower Gc-globulin levels were at a higher risk of developing organ dysfunction (P=0.005). Furthermore, serial measurements displayed increasing total Gc-globulin levels in survivors. CONCLUSION Decreased total Gc-globulin was linked to poor outcomes of SAP. These data support our hypothesis that Gc-globulin may play an important role in the early process of acute pancreatitis. Gc-globulin might be a novel target for prognosis and therapy of SAP.
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Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr 2012; 36:713-20. [PMID: 22523178 DOI: 10.1177/0148607112444449] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes. METHODS The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes. RESULTS Of analyzable patients, 50 (26%) were deficient (≤30 nmol/L) and 109 (56%) were insufficient (>30 and ≤60 nmol/L). Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001). 25(OH)D status was not significantly associated with 28-day all-cause mortality (hazard ratio [HR], 0.89; 95% confidence interval, [CI] 0.37-2.24). Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge (HR, 2.11; 95% CI, 1.27-3.51). 25(OH)D-deficient patients showed a nonstatistically significant trend toward a higher infection rate (odds ratio [OR], 3.20; 95% CI, 0.784-13.07; P = .11) compared with patients with sufficient levels of 25(OH)D. CONCLUSIONS This study demonstrates significant decreases in vitamin D status over the duration of the patient's ICU stay. Low levels of vitamin D are associated with longer time to ICU discharge alive and a trend toward increased risk of ICU-acquired infection.
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Affiliation(s)
- David M Higgins
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
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Via MA, Gallagher EJ, Mechanick JI. Bone physiology and therapeutics in chronic critical illness. Ann N Y Acad Sci 2010; 1211:85-94. [PMID: 21062297 DOI: 10.1111/j.1749-6632.2010.05807.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Modern medical practices allow patients to survive acute insults and be sustained by machinery and medicines for extended periods of time. We define chronic critical illness as a later stage of prolonged critical illness that requires tracheotomy. These patients have persistent elevations of inflammatory cytokines, diminished hypothalamic-pituitary function, hypercatabolism, immobilization, and malnutrition. The measurement of bone turnover markers reveals markedly enhanced osteoclastic bone resorption that is uncoupled from osteoblastic bone formation. We review the mechanisms by which these factors contribute to the metabolic bone disease of chronic critical illness and suggest potential therapeutics.
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Affiliation(s)
- Michael A Via
- Division of Endocrinology and Metabolism, Beth Israel Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Speeckaert MM, Wehlou C, De Somer F, Speeckaert R, Van Nooten GJ, Delanghe JR. Evolution of vitamin D binding protein concentration in sera from cardiac surgery patients is determined by triglyceridemia. Clin Chem Lab Med 2010; 48:1345-50. [DOI: 10.1515/cclm.2010.250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dahl B. The extracellular actin scavenger system in trauma and major surgery. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009. [DOI: 10.1080/03008820510040694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Antoniades CG, Berry PA, Bruce M, Cross TJS, Portal AJ, Hussain MJ, Bernal W, Wendon JA, Vergani D. Actin-free Gc globulin: a rapidly assessed biomarker of organ dysfunction in acute liver failure and cirrhosis. Liver Transpl 2007; 13:1254-61. [PMID: 17763400 DOI: 10.1002/lt.21196] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Reductions in serum levels of Gc globulin, a hepatically synthesized component of the extracellular actin scavenger system responsible for complexing circulating actin and attenuating intravascular microthrombus formation, are associated with poor outcome in acute liver failure. Clinically applicable assays of the important actin-free fraction (Af-Gc) have not been available until now. We measured actin-free Gc globulin levels with a novel, rapid assay in 61 cases of acute liver failure (ALF) and in 91 patients with cirrhosis (40 of whom were clinically unstable with extrahepatic organ dysfunction), and studied associations with liver dysfunction, extrahepatic organ dysfunction, indices of disseminated coagulation, and outcome. Reductions in Af-Gc levels mirrored hepatic dysfunction and organ dysfunction in both groups, and discriminated patients with poor prognosis from those with good prognosis in the ALF cohort. Levels were lowest in patients with ALF (10% of control values), but levels were also markedly reduced in both unstable (28%) and stable (44%) patients with cirrhosis. Associations with markers of disseminated intravascular coagulation were seen in both groups, most notably in the cirrhosis cohort, supporting a pathophysiological role for reduced Af-Gc in the evolution of organ dysfunction. In acetaminophen-induced ALF, Af-Gc identified patients with poor prognosis as well as did the Acute Physiology and Chronic Health Evaluation (APACHE II) score (area under the receiver operating characteristic curve, 0.7), and in cirrhosis, Af-Gc was an independent predictor of mortality by multifactorial analysis. In conclusion, the importance of Af-Gc reductions in the development of multiple organ dysfunction in ALF and cirrhosis is highlighted, probably resulting from reduced hepatic production and peripheral exhaustion of this arm of the extracellular actin scavenger system.
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Speeckaert M, Huang G, Delanghe JR, Taes YEC. Biological and clinical aspects of the vitamin D binding protein (Gc-globulin) and its polymorphism. Clin Chim Acta 2006; 372:33-42. [PMID: 16697362 DOI: 10.1016/j.cca.2006.03.011] [Citation(s) in RCA: 340] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Revised: 03/10/2006] [Accepted: 03/10/2006] [Indexed: 11/23/2022]
Abstract
The vitamin D binding protein (DBP) is the major plasma carrier protein of vitamin D and its metabolites. Unlike other hydrophobic hormone-binding systems, it circulates in a considerably higher titer compared to its ligands. Apart from its specific sterol binding capacity, DBP exerts several other important biological functions such as actin scavenging, fatty acid transport, macrophage activation and chemotaxis. The DBP-gene is a member of a multigene cluster that includes albumin, alpha-fetoprotein, and alpha-albumin/afamin. All four genes are expressed predominantly in the liver with overlapping developmental profiles. DBP is a highly polymorphic serum protein with three common alleles (Gc1F, Gc1S and Gc2) and more than 120 rare variants. The presence of unique alleles is a useful tool for anthropological studies to discriminate and to reveal ancestral links between populations. Many studies have discussed the link between DBP-phenotypes and susceptibility or resistance to osteoporosis, Graves' disease, Hashimoto's thyroiditis, diabetes, COPD, AIDS, multiple sclerosis, sarcoidosis and rheumatic fever. This article reviews the general characteristics, functions and clinical aspects of DBP.
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Schiødt FV, Rossaro L, Stravitz RT, Shakil AO, Chung RT, Lee WM. Gc-globulin and prognosis in acute liver failure. Liver Transpl 2005; 11:1223-7. [PMID: 16184570 DOI: 10.1002/lt.20437] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serum concentrations of the actin scavenger Gc-globulin are reduced in acute liver failure (ALF). Prospectively, we tested Gc-globulin's value to predict outcome following ALF using sera from 182 patients with ALF from the U.S. ALF Study Group. Admission serum levels of Gc-globulin (normal range: 350-500 mg/L) were studied by an immunonephelometric method. The median (range) serum Gc-globulin level on admission for the entire group was 91 (5-307) mg/L. Gc-globulin levels were significantly higher in spontaneous survivors than in patients who died or underwent transplantation (113 [5-301] mg/L vs. 73 [5-307] mg/L, P < 0.001). Those surviving non-acetaminophen (paracetamol)-induced ALF without transplantation had higher Gc-globulin levels than nonsurvivors (102 [5-301] mg/L vs. 61 [5-232] mg/L, P = 0.002), whereas there was no significant difference in levels between the groups in patients with acetaminophen-induced ALF. A cutoff level of 80 mg/L in the non-acetaminophen group yielded positive and negative predictive values of 85% and 43%, respectively. The corresponding figures for the King's College criteria were 90% and 49%, respectively. In conclusion, we found that Gc-globulin levels were markedly decreased in patients with ALF; the lowest levels were observed in patients who died or were transplanted. In contrast to previous studies, this study demonstrated that Gc-globulin has prognostic value in patients with non-acetaminophen-induced ALF, in the same range as the King's College criteria. Further refinements of the assay would be necessary to make it more accurate and of practical utility.
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Affiliation(s)
- Frank V Schiødt
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390-9151, USA
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Dahl B, Schiødt FV, Ott P, Wians F, Lee WM, Balko J, O'Keefe GE. Plasma concentration of Gc-globulin is associated with organ dysfunction and sepsis after injury. Crit Care Med 2003; 31:152-6. [PMID: 12545009 DOI: 10.1097/00003246-200301000-00024] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinical and experimental studies suggest that the proteins of the extracellular actin scavenger system have a role in the pathophysiological processes taking place in critically ill and injured patients. Circulating levels of Gc-globulin and gelsolin are reduced shortly after severe trauma, and admission levels of Gc-globulin are associated with survival. Herein, we sought to measure the association between admission levels of Gc-globulin and postinjury organ dysfunction and infection. We also wanted to describe the serial changes in Gc-globulin in these severely injured patients. DESIGN Prospective cohort. SETTING Intensive care unit at a county hospital that serves as a level one trauma center. PATIENTS Ninety-eight consecutive trauma victims admitted to the intensive care unit for >24 hrs during a 4-month period. MEASUREMENTS AND MAIN RESULTS Circulating levels of Gc-globulin were measured by using immunonephelometry. All patients were evaluated daily to obtain the necessary data for assessment of organ dysfunction and sepsis. The median Gc-globulin concentration at admission was 127 mg/L in patients who developed severe multiple organ dysfunction compared with 184 mg/L in patients who did not (p =.001). The admission level of Gc-globulin was comparable to known risk factors such as age and injury severity score, regarding development of organ dysfunction. Plasma concentrations of Gc-globulin remained significantly lower in patients who developed respiratory failure and sepsis, compared with patients who did not develop these complications (p =.02 and p=.015, respectively). CONCLUSIONS Admission plasma concentration of Gc-globulin is lower in patients who develop organ dysfunction and sepsis after traumatic injury. These data, combined with the work of others, support the hypothesis that actin release and depletion of the extracellular actin scavenger system proteins are associated with, and may contribute in part to, the complications of sepsis and organ dysfunction, particularly respiratory failure and thrombocytopenia.
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Affiliation(s)
- Benny Dahl
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
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Muratore MT, Pontillo D, Mongiardo B, Ciapini A. Gc-globulin in acute coronary syndrome. Clin Chem Lab Med 2001; 39:1004-5. [PMID: 11758599 DOI: 10.1515/cclm.2001.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
In recent years, our understanding of the many physiological, biochemical, and molecular functions and attributes of vitamin D-binding protein (DBP) has seen exciting and significant advances. Since its identification in 1959, many important functions of this abundant serum protein have been discovered. These range from the transport of vitamin D metabolites to possible roles in the immune system and host defense. With these discoveries, many questions regarding the biology of DBP have been raised and many remain to be answered. Our current understanding of the classic and less-recognized activities of DBP is discussed here.
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Affiliation(s)
- P White
- Division of Endocrinology, Diabetes and Metabolism, Departments of Medicine and Genetics, University of Pennsylvania School of Medicine, 778 Clinical Research Building, 415 Curie Boulevard, Philadelphia, PA 19104-6149, USA
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