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Ulaj A, Ibsen A, Azurmendi L, Sanchez JC, Prendki V, Roux X. Improving prognostication of pneumonia among elderly patients: usefulness of suPAR. BMC Geriatr 2024; 24:709. [PMID: 39182045 PMCID: PMC11344914 DOI: 10.1186/s12877-024-05270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/01/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE Elderly patients with suspected pneumonia represent a significant proportion of hospital admissions, which is a prognostic challenge for physicians. Our research aimed to assess the prognosis of patients with pneumonia using soluble urokinase plasminogen activator receptor (suPAR) combined with clinical data. METHODS In a prospective observational study including 164 patients > 65 years (mean age 84.2 (+/-7.64) years) who were hospitalized for a suspicion of pneumonia, suPAR was assessed for each patient, as was the prognosis score (PSI, CURB65) and inflammatory biomarkers (C-reactive protein, procalcitonin, white blood cells). The prognostic value of the suPAR for 30-day mortality was assessed using receiver operating characteristic (ROC) curve analyses. Optimal cut-offs with corresponding sensitivity (SE) and specificity (SP) were determined using the Youden index. RESULTS A suPAR > 5.1 ng/mL was predictive of 30-day mortality with a sensitivity of 100% and a specificity of 40.4%. A combination of the following parameters exhibited an SE of 100% (95% CI, 100-100) for an SP value of 64.9% (95% CI, 57.6-72.2) when at least two of them were above or below the following cut-off threshold values: suPAR > 9.8 ng/mL, BMI < 29.3 kg/m2 and PSI > 106.5. CONCLUSION The suPAR seems to be a promising biomarker that can be combined with the PSI and BMI to improve the prognosis of pneumonia among elderly patients. Prospective studies with larger populations are needed to confirm whether this new approach can improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov (NCT02467192), 27th may 2015.
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Affiliation(s)
- Artida Ulaj
- Division of Anesthesiology, Department of Acute Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Arni Ibsen
- Division of Anesthesiology, Department of Acute Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Leire Azurmendi
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Charles Sanchez
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
- Medical Faculty, Geneva, Switzerland
| | - Virginie Prendki
- Division of Infectious Diseases, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
- Division of Geriatric Medicine, Department of Rehabilitation and Geriatrics Medicine, Geneva University Hospitals, Thônex, Switzerland
| | - Xavier Roux
- Division of Geriatric Medicine, Department of Rehabilitation and Geriatrics Medicine, Geneva University Hospitals, Thônex, Switzerland.
- Division of Intensive Care, Department of Acute Medicine Geneva, Geneva University Hospital, Geneva, Switzerland.
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Malézieux-Picard A, Nascè A, Azurmendi L, Pagano S, Vuilleumier N, Sanchez JC, Reny JL, Zekry D, Roux X, Stirnemann J, Garin N, Prendki V. Kinetics of inflammatory biomarkers to predict one-year mortality in older patients hospitalized for pneumonia: a multivariable analysis. Int J Infect Dis 2022; 122:63-69. [PMID: 35550179 DOI: 10.1016/j.ijid.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/25/2022] [Accepted: 05/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Long-term mortality is increased in older patients with pneumonia. We aimed to test whether residual inflammation is predictive of one-year mortality after pneumonia. METHODS Inflammation biomarkers (C-reactive protein [CRP], interleukin [IL]-6 and IL-8, tumor necrosis factor-α, serum amyloid A, neopterin, myeloperoxidase, anti-apolipoprotein A-1, and anti-phosphorylcholine IgM) were measured at admission and discharge in older patients hospitalized for pneumonia in a prospective study. Univariate and multivariate analyses were conducted using absolute level at discharge and relative and absolute differences between admission and discharge for all biomarkers, along with usual prognostic factors. RESULTS In the 133 included patients (median age, 83 years [interquartile range: 78-89]), one-year mortality was 26%. In univariate analysis, the relative difference of CRP levels had the highest area under the receiver operating characteristic curve (0.70; 95% confidence interval [CI] 0.60-0.80). A decrease of CRP levels of more than 67% between admission and discharge had 68% sensitivity and 68% specificity to predict survival. In multivariate analysis, lower body mass index (hazard ratio=0.87 [CI 95% 0.79-0.96], P-value=0.01), higher IL-8 (hazard ratio=1.02 [CI 95% 1.00-1.04], P-value=0.02), and higher CRP (1.01 [95% CI 1.00-1.02], P=0.01) at discharge were independently associated with mortality. CONCLUSION Higher IL-8 and CRP levels at discharge were independently associated with one-year mortality. The relative CRP difference during hospitalization was the best individual biomarker for predicting one-year mortality.
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Affiliation(s)
- Astrid Malézieux-Picard
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland.
| | - Alberto Nascè
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland
| | - Leire Azurmendi
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland
| | - Sabrina Pagano
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland
| | - Nicolas Vuilleumier
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Jean-Charles Sanchez
- Department of Internal Medicine, Medical Faculty, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Jean-Luc Reny
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Dina Zekry
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Xavier Roux
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Intensive Care Division, Geneva University Hospitals, Genève, Switzerland
| | - Jérôme Stirnemann
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland
| | - Nicolas Garin
- Medical Faculty, University of Geneva, Genève, Switzerland; Department of General Internal Medicine, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the Elderly, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Genève, Switzerland; Medical Faculty, University of Geneva, Genève, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Genève, Switzerland
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Zhang X, Zhang S, Wang C, Liu R, Li A. High Neutrophil-to-Albumin Ratio Predicts Postoperative Pneumonia in Aneurysmal Subarachnoid Hemorrhage. Front Neurol 2022; 13:840858. [PMID: 35463142 PMCID: PMC9021997 DOI: 10.3389/fneur.2022.840858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimThere is still an absence of objective and easily accessible biomarkers despite the variety of risk factors associated with postoperative pneumonia (POP) in patients with aneurysmal subarachnoid hemorrhage (aSAH). In the present study, we have thus evaluated the relationship between the neutrophil-to-albumin ratio (NAR) and POP in patients with aSAH.MethodsSeveral consecutive patients (n = 395) who had undergone clipping or coiling of the aneurism were retrospectively assessed, of which we were able to analyze the existing population data and the related baseline variables. The patients were divided into POP and revealed not to occur. To identify independent predictors, we used the recipient operation feature (receiver operating characteristic, ROC) curve and a logic regression analysis.ResultsThis cohort was based on POP that occurred in 78 out of the 395 patients (19.7%), and these revealed a significantly higher NAR than those without (0.31 [0.25–0.39] vs. 0.23 [0.18–0.28]; p < 0.001). On the other hand, a multivariate logistic regression analysis showed that NAR (odds ratio = 1.907; 95% confidence interval, 1.232–2.953; p = 0.004) was independently associated with a POP after due adjustment for confounders. Moreover, the predictive performances of NAR for POP were also significant (area under the ROC curve [95% CI] 0.775 [0.717–0.832]; p < 0.001).ConclusionThe elevation of NAR at admission in patients with aSAH might help predict POP.
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Affiliation(s)
- Xin Zhang
- Lianyungang Clinical College, Nanjing Medical University, Lianyungang, China
| | - Sheng Zhang
- Qingpu Branch, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Congkai Wang
- Lianyungang Clinical College, Nanjing Medical University, Lianyungang, China
| | - Ran Liu
- The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Aimin Li
- Lianyungang Clinical College, Nanjing Medical University, Lianyungang, China
- *Correspondence: Aimin Li
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Role of Clinical Characteristics and Biomarkers at Admission to Predict One-Year Mortality in Elderly Patients with Pneumonia. J Clin Med 2021; 11:jcm11010105. [PMID: 35011845 PMCID: PMC8745347 DOI: 10.3390/jcm11010105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A hospitalization for community-acquired pneumonia results in a decrease in long-term survival in elderly patients. We assessed biomarkers at admission to predict one-year mortality in a cohort of elderly patients with pneumonia. METHODS A prospective observational study included patients >65 years hospitalized with pneumonia. Assessment of PSI, CURB-65, and biomarkers (C-reactive protein (CRP), procalcitonin (PCT), NT-pro-B-type natriuretic peptide (NT-proBNP), interleukin (IL)-6 and -8, tumor necrosis factor alpha (TNF-α), serum amyloid A (SAA), neopterin (NP), myeloperoxidase (MPO), anti-apolipoprotein A-1 IgG (anti-apoA-1), and anti-phosphorylcholine IgM (anti-PC IgM)) was used to calculate prognostic values for one-year mortality using ROC curve analyses. Post hoc optimal cutoffs with corresponding sensitivity (SE) and specificity (SP) were determined using the Youden index. RESULTS A total of 133 patients were included (median age 83 years [IQR: 78-89]). Age, dementia, BMI, NT-proBNP (AUROC 0.65 (95% CI: 0.55-0.77)), and IL-8 (AUROC 0.66 (95% CI: 0.56-0.75)) were significantly associated with mortality, with NT-proBNP (HR 1.01 (95% CI 1.00-1.02) and BMI (HR 0.92 (95% CI 0.85-1.000) being independent of age, gender, comorbidities, and PSI with Cox regression. At the cutoff value of 2200 ng/L, NT-proBNP had 67% sensitivity and 70% specificity. PSI and CURB-65 were not associated with mortality. CONCLUSIONS NT-proBNP levels upon admission and BMI displayed the highest prognostic accuracy for one-year mortality and may help clinicians to identify patients with poor long-term prognosis.
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Azurmendi Gil L, Krattinger-Turbatu L, Schweizer J, Katan M, Sanchez JC. A Panel Comprising Serum Amyloid A, White Blood Cells and Nihss for the Triage of Patients at Low Risk of Post-Stroke Infection. Diagnostics (Basel) 2021; 11:diagnostics11061070. [PMID: 34200779 PMCID: PMC8230378 DOI: 10.3390/diagnostics11061070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/05/2022] Open
Abstract
Accurate and early prediction of poststroke infections is important to improve antibiotic therapy guidance and/or to avoid unnecessary antibiotic treatment. We hypothesized that the combination of blood biomarkers with clinical parameters could help to optimize risk stratification during hospitalization. In this prospective observational study, blood samples of 283 ischemic stroke patients were collected at hospital admission within 72 h from symptom onset. Among the 283 included patients, 60 developed an infection during the first five days of hospitalization. Performance predictions of blood biomarkers (Serum Amyloid-A (SAA), C-reactive protein, procalcitonin (CRP), white blood cells (WBC), creatinine) and clinical parameters (National Institutes of Health Stroke Scale (NIHSS), age, temperature) for the detection of poststroke infection were evaluated individually using receiver operating characteristics curves. Three machine learning techniques were used for creating panels: Associative Rules Mining, Decision Trees and an internal iterative-threshold based method called PanelomiX. The PanelomiX algorithm showed stable performance when applied to two representative subgroups obtained as splits of the main subgroup. The panel including SAA, WBC and NIHSS had a sensitivity of 97% and a specificity of 45% to identify patients who did not develop an infection. Therefore, it could be used at hospital admission to avoid unnecessary antibiotic (AB) treatment in around half of the patients, and consequently, to reduce AB resistance.
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Affiliation(s)
- Leire Azurmendi Gil
- Human Protein Sciences Department, University of Geneva, 1211 Geneva, Switzerland; (L.A.G.); (L.K.-T.)
| | - Laura Krattinger-Turbatu
- Human Protein Sciences Department, University of Geneva, 1211 Geneva, Switzerland; (L.A.G.); (L.K.-T.)
| | - Juliane Schweizer
- Department of Neurology and University of Zurich, University Hospital, 8057 Zürich, Switzerland; (J.S.); (M.K.)
| | - Mira Katan
- Department of Neurology and University of Zurich, University Hospital, 8057 Zürich, Switzerland; (J.S.); (M.K.)
| | - Jean-Charles Sanchez
- Human Protein Sciences Department, University of Geneva, 1211 Geneva, Switzerland; (L.A.G.); (L.K.-T.)
- Correspondence:
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Chen Y, Lian BQ, Peng L, Ding CY, Lin YX, Yu LH, Wang DL, Kang DZ. Neutrophil to lymphocyte ratio is a prognosis factor for post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients. Chin Med J (Engl) 2020; 134:682-689. [PMID: 33394700 PMCID: PMC7989986 DOI: 10.1097/cm9.0000000000001304] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients. Methods: We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed. Results: POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P < 0.001). Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors, including the age, World Federation of Neurosurgical Societies (WFNS) grade, endovascular treatment, and ventilator use. And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR (NLR vs. WFNS grade × NLR, P = 0.011). Conclusions: Regardless of good or poor WNFS grade, patients having NLR >10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.
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Affiliation(s)
- Yue Chen
- The Graduate School of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Bao-Qiang Lian
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Lei Peng
- Department of Neurosurgery, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang, Yichang, Hubei 443000, China
| | - Chen-Yu Ding
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Liang-Hong Yu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Deng-Liang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - De-Zhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
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Schweizer J, Bustamante A, Lapierre-Fétaud V, Faura J, Scherrer N, Azurmendi Gil L, Fluri F, Schütz V, Luft A, Boned S, Sanchez JC, Montaner J, Katan M. SAA (Serum Amyloid A): A Novel Predictor of Stroke-Associated Infections. Stroke 2020; 51:3523-3530. [PMID: 33161846 DOI: 10.1161/strokeaha.120.030064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate and independently validate SAA (serum amyloid A)-a recently discovered blood biomarker-to predict poststroke infections. METHODS The derivation cohort (A) was composed of 283 acute ischemic stroke patients and the independent validation cohort (B), of 367 patients. The primary outcome measure was any stroke-associated infection, defined by the criteria of the US Centers for Disease Control and Prevention, occurring during hospitalization. To determine the association of SAA levels on admission with the development of infections, logistic regression models were calculated. The discriminatory ability of SAA was assessed, by calculating the area under the receiver operating characteristic curve. RESULTS After adjusting for all predictors that were significantly associated with any infection in the univariate analysis, SAA remained an independent predictor in study A (adjusted odds ratio, 1.44 [95% CI, 1.16-1.79]; P=0.001) and in study B (adjusted odds ratio, 1.52 [1.05-2.22]; P=0.028). Adding SAA to the best regression model without the biomarker, the discriminatory accuracy improved from 0.76 (0.69-0.83) to 0.79 (0.72-0.86; P<0.001; likelihood ratio test) in study A. These results were externally validated in study B with an improvement in the area under the receiver operating characteristic curve, from 0.75 (0.70-0.81) to 0.76 (0.71-0.82; P<0.038). CONCLUSIONS Among patients with ischemic stroke, blood SAA measured on admission is a novel independent predictor of infection after stroke. SAA improved the discrimination between patients who developed an infection compared with those who did not in both derivation and validation cohorts. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00390962.
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Affiliation(s)
- Juliane Schweizer
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain (A.B., J.F., J.M.).,Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (A.B., S.B.)
| | - Vanessa Lapierre-Fétaud
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Switzerland (V.L.-F., L.A., J.-C.S.)
| | - Júlia Faura
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain (A.B., J.F., J.M.)
| | | | - Leire Azurmendi Gil
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Switzerland (V.L.-F., L.A., J.-C.S.)
| | - Felix Fluri
- Department of Neurology, University Hospital Wuerzburg, Germany (F.F.)
| | - Valerie Schütz
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
| | - Andreas Luft
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
| | - Sandra Boned
- Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (A.B., S.B.)
| | - Jean-Charles Sanchez
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Switzerland (V.L.-F., L.A., J.-C.S.)
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain (A.B., J.F., J.M.)
| | - Mira Katan
- Department of Neurology, University Hospital Zurich, Switzerland (J.S., N.S., V.S., A.L., M.K.)
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Posti JP, Takala RSK, Raj R, Luoto TM, Azurmendi L, Lagerstedt L, Mohammadian M, Hossain I, Gill J, Frantzén J, van Gils M, Hutchinson PJ, Katila AJ, Koivikko P, Maanpää HR, Menon DK, Newcombe VF, Tallus J, Blennow K, Tenovuo O, Zetterberg H, Sanchez JC. Admission Levels of Interleukin 10 and Amyloid β 1-40 Improve the Outcome Prediction Performance of the Helsinki Computed Tomography Score in Traumatic Brain Injury. Front Neurol 2020; 11:549527. [PMID: 33192979 PMCID: PMC7661930 DOI: 10.3389/fneur.2020.549527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/28/2020] [Indexed: 01/05/2023] Open
Abstract
Background: Blood biomarkers may enhance outcome prediction performance of head computed tomography scores in traumatic brain injury (TBI). Objective: To investigate whether admission levels of eight different protein biomarkers can improve the outcome prediction performance of the Helsinki computed tomography score (HCTS) without clinical covariates in TBI. Materials and methods: Eighty-two patients with computed tomography positive TBIs were included in this study. Plasma levels of β-amyloid isoforms 1–40 (Aβ40) and 1–42 (Aβ42), glial fibrillary acidic protein, heart fatty acid-binding protein, interleukin 10 (IL-10), neurofilament light, S100 calcium-binding protein B, and total tau were measured within 24 h from admission. The patients were divided into favorable (Glasgow Outcome Scale—Extended 5–8, n = 49) and unfavorable (Glasgow Outcome Scale—Extended 1–4, n = 33) groups. The outcome was assessed 6–12 months after injury. An optimal predictive panel was investigated with the sensitivity set at 90–100%. Results: The HCTS alone yielded a sensitivity of 97.0% (95% CI: 90.9–100) and specificity of 22.4% (95% CI: 10.2–32.7) and partial area under the curve of the receiver operating characteristic of 2.5% (95% CI: 1.1–4.7), in discriminating patients with favorable and unfavorable outcomes. The threshold to detect a patient with unfavorable outcome was an HCTS > 1. The three best individually performing biomarkers in outcome prediction were Aβ40, Aβ42, and neurofilament light. The optimal panel included IL-10, Aβ40, and the HCTS reaching a partial area under the curve of the receiver operating characteristic of 3.4% (95% CI: 1.7–6.2) with a sensitivity of 90.9% (95% CI: 81.8–100) and specificity of 59.2% (95% CI: 40.8–69.4). Conclusion: Admission plasma levels of IL-10 and Aβ40 significantly improve the prognostication ability of the HCTS after TBI.
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Affiliation(s)
- Jussi P Posti
- Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Leire Azurmendi
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Linnéa Lagerstedt
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mehrbod Mohammadian
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Iftakher Hossain
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland.,Neurosurgery Unit, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Jessica Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Janek Frantzén
- Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Mark van Gils
- VTT Technical Research Centre of Finland Ltd., Tampere, Finland
| | - Peter J Hutchinson
- Neurosurgery Unit, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Pia Koivikko
- Perioperative Services, Intensive Care Medicine and Pain Management, Department of Anesthesiology and Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Henna-Riikka Maanpää
- Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - David K Menon
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Virginia F Newcombe
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Jussi Tallus
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olli Tenovuo
- Turku Brain Injury Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom.,The United Kingdom Dementia Research Institute at University College London, University College London, London, United Kingdom
| | - Jean-Charles Sanchez
- Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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9
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Prendki V, Malézieux-Picard A, Azurmendi L, Sanchez JC, Vuilleumier N, Carballo S, Roux X, Reny JL, Zekry D, Stirnemann J, Garin N. Accuracy of C-reactive protein, procalcitonin, serum amyloid A and neopterin for low-dose CT-scan confirmed pneumonia in elderly patients: A prospective cohort study. PLoS One 2020; 15:e0239606. [PMID: 32997689 PMCID: PMC7526885 DOI: 10.1371/journal.pone.0239606] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/09/2020] [Indexed: 01/16/2023] Open
Abstract
Objective The diagnosis of pneumonia based on semiology and chest X-rays is frequently inaccurate, particularly in elderly patients. Older (C-reactive protein (CRP); procalcitonin (PCT)) or newer (Serum amyloid A (SAA); neopterin (NP)) biomarkers may increase the accuracy of pneumonia diagnosis, but data are scarce and conflicting. We assessed the accuracy of CRP, PCT, SAA, NP and the ratios CRP/NP and SAA/NP in a prospective observational cohort of elderly patients with suspected pneumonia. Methods We included consecutive patients more than 65 years old, with at least one respiratory symptom and one symptom or laboratory finding suggestive of infection, and a working diagnosis of pneumonia. Low-dose CT scan and comprehensive microbiological testing were done in all patients. The index tests, CRP, PCT, SAA and NP, were obtained within 24 hours. The reference diagnosis was assessed a posteriori by a panel of experts considering all available data, including patients’ outcome. We used area under the curve (AUROC) and Youden index to assess the accuracy and obtain optimal cut-off of the index tests. Results 200 patients (median age 84 years) were included; 133 (67%) had pneumonia. AUROCs for the diagnosis of pneumonia was 0.64 (95% CI: 0.56–0.72) for CRP; 0.59 (95% CI: 0.51–0.68) for PCT; 0.60 (95% CI: 0.52–0.69) for SAA; 0.41 (95% CI: 0.32–0.49) for NP; 0.63 (95% CI: 0.55–0.71) for CRP/NP; and 0.61 (95% CI: 0.53–0.70) for SAA/NP. No cut-off resulted in satisfactory sensitivity or specificity. Conclusions Accuracy of traditional (CRP, PCT) and newly proposed biomarkers (SAA, NP) and ratios of CRP/NP and SAA/NP was too low to help diagnosing pneumonia in the elderly. CRP had the highest AUROC. Clinical Trial Registration NCT 02467092
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Affiliation(s)
- Virginie Prendki
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- Medical Faculty, Geneva, Switzerland
| | - Astrid Malézieux-Picard
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- * E-mail:
| | - Leire Azurmendi
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Charles Sanchez
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Vuilleumier
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine Specialties, Medical Faculty, Geneva University Hospitals, Geneva, Switzerland
- Diagnostic Department, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sebastian Carballo
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Xavier Roux
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- Department of Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Dina Zekry
- Department of Rehabilitation and Geriatrics, Division of Internal Medicine for the Aged, Geneva University Hospitals, Thônex, Switzerland
- Medical Faculty, Geneva, Switzerland
| | - Jérôme Stirnemann
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Garin
- Medical Faculty, Geneva, Switzerland
- Department of Internal Medicine, Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Department of General Internal Medicine, Division of General Internal Medicine, Riviera Chablais Hospitals, Rennaz, Switzerland
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Dayon L, Affolter M. Progress and pitfalls of using isobaric mass tags for proteome profiling. Expert Rev Proteomics 2020; 17:149-161. [PMID: 32067523 DOI: 10.1080/14789450.2020.1731309] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Quantitative proteomics using mass spectrometry is performed via label-free or label-based approaches. Labeling strategies rely on the incorporation of stable heavy isotopes by metabolic, enzymatic, or chemical routes. Isobaric labeling uses chemical labels of identical masses but of different fragmentation behaviors to allow the relative quantitative comparison of peptide/protein abundances between biological samples.Areas covered: We have carried out a systematic review on the use of isobaric mass tags in proteomic research since their inception in 2003. We focused on their quantitative performances, their multiplexing evolution, as well as their broad use for relative quantification of proteins in pre-clinical models and clinical studies. Current limitations, primarily linked to the quantitative ratio distortion, as well as state-of-the-art and emerging solutions to improve their quantitative readouts are discussed.Expert opinion: The isobaric mass tag technology offers a unique opportunity to compare multiple protein samples simultaneously, allowing higher sample throughput and internal relative quantification for improved trueness and precision. Large studies can be performed when shared reference samples are introduced in multiple experiments. The technology is well suited for proteome profiling in the context of proteomic discovery studies.
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Affiliation(s)
- Loïc Dayon
- Proteomics, Nestlé Institute of Food Safety & Analytical Sciences, Nestlé Research, Lausanne, Switzerland.,Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Michael Affolter
- Proteomics, Nestlé Institute of Food Safety & Analytical Sciences, Nestlé Research, Lausanne, Switzerland
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Gris T, Laplante P, Thebault P, Cayrol R, Najjar A, Joannette-Pilon B, Brillant-Marquis F, Magro E, English SW, Lapointe R, Bojanowski M, Francoeur CL, Cailhier JF. Innate immunity activation in the early brain injury period following subarachnoid hemorrhage. J Neuroinflammation 2019; 16:253. [PMID: 31801576 PMCID: PMC6894125 DOI: 10.1186/s12974-019-1629-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/31/2019] [Indexed: 01/01/2023] Open
Abstract
Background Aneurysmal subarachnoid hemorrhage (SAH) is a catastrophic disease with devastating consequences, including a high mortality rate and severe disabilities among survivors. Inflammation is induced following SAH, but the exact role and phenotype of innate immune cells remain poorly characterized. We investigated the inflammatory components of the early brain injury in an animal model and in SAH patients. Method SAH was induced through injection of blood in the subarachnoid space of C57Bl/6 J wild-type mice. Prospective blood collections were obtained at 12 h, days 1, 2, and 7 to evaluate the systemic inflammatory consequences of SAH by flow cytometry and enzyme-linked immunosorbent-assay (ELISA). Brains were collected, enzymatically digested, or fixed to characterize infiltrating inflammatory cells and neuronal death using flow cytometry and immunofluorescence. Phenotypic evaluation was performed at day 7 using the holding time and footprint tests. We then compared the identified inflammatory proteins to the profiles obtained from the plasma of 13 human SAH patients. Results Following SAH, systemic IL-6 levels increased rapidly, whereas IL-10 levels were reduced. Neutrophils were increased both in the brain and in the blood reflecting local and peripheral inflammation following SAH. More intracerebral pro-inflammatory monocytes were found at early time points. Astrocyte and microglia activation were also increased, and mice had severe motor deficits, which were associated with an increase in the percentage of caspase-3-positive apoptotic neurons. Similarly, we found that IL-6 levels in patients were rapidly increased following SAH. ICAM-1, bFGF, IL-7, IL-12p40, and MCP-4 variations over time were different between SAH patients with good versus bad outcomes. Moreover, high levels of Flt-1 and VEGF at admission were associated with worse outcomes. Conclusion SAH induces an early intracerebral infiltration and peripheral activation of innate immune cells. Furthermore, microglia and astrocytic activation are present at later time points. Our human and mouse data illustrate that SAH is a systemic inflammatory disease and that immune cells represent potential therapeutic targets to help this population of patients in need of new treatments.
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Affiliation(s)
- Typhaine Gris
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Patrick Laplante
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Paméla Thebault
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Romain Cayrol
- Department of Pathology and Cellular Biology, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, 5e étage, 2900, Boulevard Édouard-Montpetit, Montreal, Quebec, Canada
| | - Ahmed Najjar
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), 850 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Benjamin Joannette-Pilon
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Frédéric Brillant-Marquis
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Elsa Magro
- Neurosurgery Service of CHU Cavale Blanche, INSERM, Boulevard Tanguy Prigent, Finistère, 29200, Brest, Bretagne, France
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Departments of Medicine (Critical Care) and School of Epidemiology and Public Health, Division of Critical Care, The Ottawa Hospital, University of Ottawa, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Réjean Lapointe
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Michel Bojanowski
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), 850 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Charles L Francoeur
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine) and Department of Anesthesiology and Critical Care, CHU de Québec-Université Laval, (Hôpital de l'Enfant-Jésus), 1401, 18e rue, Room Z-204, Québec, G1J 1Z4, Canada
| | - Jean-François Cailhier
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada. .,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada. .,Nephrology Division, CHUM and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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12
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Moulder R, Bhosale SD, Goodlett DR, Lahesmaa R. Analysis of the plasma proteome using iTRAQ and TMT-based Isobaric labeling. MASS SPECTROMETRY REVIEWS 2018; 37:583-606. [PMID: 29120501 DOI: 10.1002/mas.21550] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/26/2017] [Indexed: 05/23/2023]
Abstract
Over the past decade, chemical labeling with isobaric tandem mass tags, such as isobaric tags for relative and absolute quantification reagents (iTRAQ) and tandem mass tag (TMT) reagents, has been employed in a wide range of different clinically orientated serum and plasma proteomics studies. In this review the scope of these works is presented with attention to the areas of research, methods employed and performance limitations. These applications have covered a wide range of diseases, disorders and infections, and have implemented a variety of different preparative and mass spectrometric approaches. In contrast to earlier works, which struggled to quantify more than a few hundred proteins, increasingly these studies have provided deeper insight into the plasma proteome extending the numbers of quantified proteins to over a thousand.
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Affiliation(s)
- Robert Moulder
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland
| | - Santosh D Bhosale
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland
| | | | - Riitta Lahesmaa
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland
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13
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Kowalczuk L, Matet A, Dor M, Bararpour N, Daruich A, Dirani A, Behar-Cohen F, Thomas A, Turck N. Proteome and Metabolome of Subretinal Fluid in Central Serous Chorioretinopathy and Rhegmatogenous Retinal Detachment: A Pilot Case Study. Transl Vis Sci Technol 2018; 7:3. [PMID: 29359109 PMCID: PMC5772832 DOI: 10.1167/tvst.7.1.3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/02/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To investigate the molecular composition of subretinal fluid (SRF) in central serous chorioretinopathy (CSCR) and rhegmatogenous retinal detachment (RRD) using proteomics and metabolomics. METHODS SRF was obtained from one patient with severe nonresolving bullous CSCR requiring surgical subretinal fibrin removal, and two patients with long-standing RRD. Proteins were trypsin-digested, labeled with Tandem-Mass-Tag and fractionated according to their isoelectric point for identification and quantification by tandem mass spectrometry. Independently, metabolites were extracted on cold methanol/ethanol, and identified by untargeted ultra-high performance liquid chromatography and high-resolution mass spectrometry. Bioinformatics analyses were conducted. RESULTS In total, 291 proteins and 651 metabolites were identified in SRF samples. Compared with RRD, 128 proteins (77 downregulated; 51 upregulated) and 76 metabolites (43 downregulated; 33 upregulated) differed in the SRF from CSCR. Protein and metabolites notably deregulated in CSCR were related to glycolysis/gluconeogenesis, inflammation (including serum amyloid P component, versican), alternative complement pathway (complement factor H and complement factor H-related protein), cellular adhesion, biliary acid metabolism (farnesoid X receptor/retinoid X receptor), and gluco- and mineralocorticoid systems (aldosterone, angiotensin, and corticosteroid-binding globulin). CONCLUSIONS Proteomics and metabolomics can be performed on SRF. A unique SRF sample from CSCR exhibited a distinct molecular profile compared with RRD. TRANSLATIONAL RELEVANCE This first comparative multiomics analysis of SRF improved the understanding of CSCR and RRD pathophysiology. It identified pathways potentially involved in the better photoreceptor preservation in CSCR, suggesting neuroprotective targets that will require additional confirmation.
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Affiliation(s)
- Laura Kowalczuk
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Alexandre Matet
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Marianne Dor
- OPTICS Laboratory, Department of Human Protein Science, University of Geneva, Geneva, Switzerland
| | | | - Alejandra Daruich
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Ali Dirani
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Francine Behar-Cohen
- Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Inserm, U1138, Team 17, From physiopathology of ocular diseases to clinical development, Université Paris Descartes Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France
| | - Aurélien Thomas
- Unit of Toxicology, CURML, Lausanne-Geneva, Switzerland
- Faculty of Biology and Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Natacha Turck
- OPTICS Laboratory, Department of Human Protein Science, University of Geneva, Geneva, Switzerland
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14
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Azurmendi L, Lapierre-Fetaud V, Schneider J, Montaner J, Katan M, Sanchez JC. Proteomic discovery and verification of serum amyloid A as a predictor marker of patients at risk of post-stroke infection: a pilot study. Clin Proteomics 2017; 14:27. [PMID: 28701906 PMCID: PMC5506582 DOI: 10.1186/s12014-017-9162-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022] Open
Abstract
Background Post-stroke infections occur in 20–36% of stroke patients and are associated with high morbidity and mortality rates. Early identification of patients at risk of developing an infection could improve care via an earlier treatment leading to a better outcome. We used proteomic tools in order to discover biomarkers able to stratify patients at risk of post-stroke infection. Methods The post hoc analysis of a prospective cohort study including 40 ischemic stroke patients included 21 infected and 19 non-infected participants. A quantitative, isobaric labeling, proteomic strategy was applied to the plasma samples of 5 infected and 5 non-infected patients in order to highlight any significantly modulated proteins. A parallel reaction monitoring (PRM) assay was applied to 20 additional patients (10 infected and 10 non-infected) to verify discovery results. The most promising protein was pre-validated using an ELISA immunoassay on 40 patients and at different time points after stroke onset. Results Tandem mass analysis identified 266 proteins, of which only serum amyloid A (SAA1/2) was significantly (p = 0.007) regulated between the two groups of patients. This acute-phase protein appeared to be 2.2 times more abundant in infected patients than in non-infected ones. These results were verified and validated using PRM and ELISA immunoassays, which showed that infected patients had significantly higher concentrations of SAA1/2 than non-infected patients at hospital admission, but also at 1, 3, and 5 days after admission. Conclusions The present study demonstrated that SAA1/2 is a promising predictor, at hospital admission, of stroke patients at risk of developing an infection. Further large, multicenter validation studies are needed to confirm these results. If confirmed, SAA1/2 concentrations could be used to identify the patients most at risk of post-stroke infections and therefore implement treatments more rapidly, thus reducing mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12014-017-9162-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Azurmendi
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Rue Michel Servet 1, 1211 Geneve 4, Switzerland
| | - V Lapierre-Fetaud
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Rue Michel Servet 1, 1211 Geneve 4, Switzerland
| | - J Schneider
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - J Montaner
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Katan
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Jean-Charles Sanchez
- Translational Biomarker Group, Department of Human Protein Sciences, University of Geneva, Rue Michel Servet 1, 1211 Geneve 4, Switzerland
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Hinman JD, Rost NS, Leung TW, Montaner J, Muir KW, Brown S, Arenillas JF, Feldmann E, Liebeskind DS. Principles of precision medicine in stroke. J Neurol Neurosurg Psychiatry 2017; 88:54-61. [PMID: 27919057 DOI: 10.1136/jnnp-2016-314587] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 01/22/2023]
Abstract
The era of precision medicine has arrived and conveys tremendous potential, particularly for stroke neurology. The diagnosis of stroke, its underlying aetiology, theranostic strategies, recurrence risk and path to recovery are populated by a series of highly individualised questions. Moreover, the phenotypic complexity of a clinical diagnosis of stroke makes a simple genetic risk assessment only partially informative on an individual basis. The guiding principles of precision medicine in stroke underscore the need to identify, value, organise and analyse the multitude of variables obtained from each individual to generate a precise approach to optimise cerebrovascular health. Existing data may be leveraged with novel technologies, informatics and practical clinical paradigms to apply these principles in stroke and realise the promise of precision medicine. Importantly, precision medicine in stroke will only be realised once efforts to collect, value and synthesise the wealth of data collected in clinical trials and routine care starts. Stroke theranostics, the ultimate vision of synchronising tailored therapeutic strategies based on specific diagnostic data, demand cerebrovascular expertise on big data approaches to clinically relevant paradigms. This review considers such challenges and delineates the principles on a roadmap for rational application of precision medicine to stroke and cerebrovascular health.
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Affiliation(s)
- Jason D Hinman
- Department of Neurology, Neurovascular Imaging Research Core and the UCLA Stroke Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Natalia S Rost
- Department of Neurology, Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas W Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Barcelona & IBIS Stroke Programme, Hospital Virgen Macarena-Rocio, Sevilla, Spain
| | - Keith W Muir
- Institute of Neuroscience & Psychology, Glasgow, UK
| | - Scott Brown
- Altair Biostatistics, St. Louis Park, Minnesota, USA
| | - Juan F Arenillas
- Stroke Unit, Department of Neurology and Medicine, Hospital Clínico Universitario, Universidad de Valladolid, Valladolid, Spain
| | | | - David S Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core and the UCLA Stroke Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Zhang Y, Kou X, Jiang N, Liu Y, Tay FR, Zhou Y. Effect of intraoral mechanical stress application on the expression of a force-responsive prognostic marker associated with system disease progression. J Dent 2016; 57:57-65. [PMID: 27979689 DOI: 10.1016/j.jdent.2016.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Malocclusion may be corrected nonsurgically by mechanical tooth movement. The plasma protein profiles of human subjects receiving the first phase of orthodontic treatment were examined to test the hypothesis that application of mechanical stresses to teeth induces systemic proteomic alterations. METHODS Tandem mass tag-based liquid chromatography-mass spectrometry (LC-MS/MS) was used to examine systemic proteomic alterations in subjects undergoing controlled stress application (N=10) and in volunteers not receiving treatment (N=7) at 3 time intervals within 24h. Proteins differentially expressed by the tooth movement group were functionally analyzed with "Gene Ontology" (GO) and "Search Tool to Retrieve Interacting Genes/proteins" (STRING) softwares. Enzyme-Linked Immunosorbent Assay and Western-blot were used to validate the in vivo protein alterations. An in vitro model consisting of human periodontal ligament cells (hPDLCs) under compression was used to validate the force-responsive characteristics of galectin-3 binding protein (LGALS3BP). RESULTS Sixteen out of the 294 proteins identified by LC-MS/MS were differentially expressed in the plasma of subjects receiving controlled mechanical stresses for moving teeth. Those proteins were clustered in biological processes related to acute inflammatory response and vesicle-related transportation. Serotransferrin, fibronectin and LGALS3BP were processed for confirmation in vivo; LGALS3BP was significantly increased in the tooth movement group. In vitro secretion of LGALS3BP in PDLCs was force-responsive. CONCLUSIONS Regional application of mechanical stresses stimulates systemic proteomic changes. Because serum LGALS3BP is over-expressed in different systemic diseases, including cancer, further work is needed to examine how systemic up-regulation of LGALS3BP affects the progression of those diseases.
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Affiliation(s)
- Yimei Zhang
- The Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoxing Kou
- The Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Nan Jiang
- The Center of Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Liu
- The Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Franklin R Tay
- College of Graduate Studies, Augusta University, Augusta, GA, USA.
| | - Yanheng Zhou
- The Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.
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Azurmendi L, Degos V, Tiberti N, Kapandji N, Sanchez P, Sarrafzadeh A, Puybasset L, Turck N, Sanchez JC. Measuring Serum Amyloid A for Infection Prediction in Aneurysmal Subarachnoid Hemorrhage. J Proteome Res 2015. [PMID: 26198378 DOI: 10.1021/acs.jproteome.5b00391] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of mortality and morbidity. Nosocomial infections, such as pneumonia or urinary tract infections, are among the main causes of worsening outcomes and death. The aim of this study was to discover a biomarker to predict infection in aSAH patients. For this purpose, the plasma of infected and noninfected patients was compared using quantitative mass spectrometry. The most interesting differentially expressed proteins were selected for validation by immunoassays on plasma samples taken from patients (n = 81) over 10 days of hospitalization. Predictive performances were established using Mann-Whitney U tests and receiver operating characteristic curves. Quantitative proteomics identified 17 significantly regulated proteins. Of these, levels of serum amyloid A (SAA) were significantly higher in infected patients (p < 0.007). ELISA confirmed that the concentrations were significantly higher (p < 0.002) already at hospital admission in patients who subsequently developed an infection during their hospitalization, (AUC of 76%) for a cutoff value of 90.9 μg/mL. Our data suggested that measuring SAA could be an efficient means of detecting patients susceptible of developing an infection during hospitalization after an aSAH. Its predictive capacity could lead to earlier antibiotherapy, improved patient management, and potentially better long-term outcomes.
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Affiliation(s)
- Leire Azurmendi
- Department of Human Protein Sciences, University of Geneva , Rue Michel Servet 1, CH-1211 Geneva, Switzerland
| | - Vincent Degos
- Department of Anesthesiology, Pitié-Salpêtrière University Hospital , 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Natalia Tiberti
- Department of Pathology, University of Sydney , Sydney NSW 2006, Australia
| | - Natacha Kapandji
- Department of Anesthesiology, Pitié-Salpêtrière University Hospital , 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Paola Sanchez
- Department of Anesthesiology, Pitié-Salpêtrière University Hospital , 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Asita Sarrafzadeh
- Department of Neurosurgery, Heidelberg University Hospital , Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Louis Puybasset
- Department of Anesthesiology, Pitié-Salpêtrière University Hospital , 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Natacha Turck
- Department of Human Protein Sciences, University of Geneva , Rue Michel Servet 1, CH-1211 Geneva, Switzerland
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, University of Geneva , Rue Michel Servet 1, CH-1211 Geneva, Switzerland
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