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Zhong X, Niu Q, Yuan X. Predictive value of inflammatory factors on the efficacy of adjuvant Dexamethasone in the treatment of refractory purulent meningitis among pediatric patients. J Med Biochem 2024; 43:406-412. [PMID: 39139150 PMCID: PMC11318069 DOI: 10.5937/jomb0-37618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/15/2023] [Indexed: 08/15/2024] Open
Abstract
Background The aim of this study was to figure out the predictive value of inflammatory factors on the efficacy of Dexamethasone adjuvant therapy for refractory purulent meningitis in children. Methods In, this study, a regression analysis method was employed to select a sample of 38 children with refractory purulent meningitis, 40 children with purulent meningitis, and 40 healthy children who visited to Ganzhou People's Hospital for physical These participants were then assigned to the Dexamethasone, standard care and the control groups. The inflammatory factors in the three groups were compared, and a multivariate Logisitic regression was analysis was conducted to examine the predictive indicators and efficacy of Dexamethasone treatment in children with refractory purulent meningitis. Results The levels of CRP, TNF-a, IL-6, PCT and IL-1 were found to be significantly higher in the Dexamethasone group to both the standard care and the control (P < 0.05). Through multivariate Logisitic regression analysis, it was determined that CRP, TNF-a, IL-6, PCT, and IL-1 were reliable predictors of the efficacy of Dexamethasone treatment in children with refractory purulent meningitis. These biomarkers demonstrated good predictive performance, with CRP and IL-1 showing superior predictive performance. Conclusions Inflammatory factors have a certain predictive value for the efficacy of Dexamethasone adjuvant therapy for refractory purulent meningitis in pediatric patients.
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Affiliation(s)
- XiaoMei Zhong
- Ganzhou People's Hospital, Department of Paediatrics, Ganzhou City, China
| | - QingJun Niu
- Huaian Hospital, Department of Paediatrics, Huaian City, China
| | - XunLing Yuan
- Heilongjiang Provincial Hospital, Department of Paediatrics, Harbin City, China
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Chekrouni N, Kroon M, Drost EHGM, van Soest TM, Bijlsma MW, Brouwer MC, van de Beek D. Characteristics and prognostic factors of bacterial meningitis in the intensive care unit: a prospective nationwide cohort study. Ann Intensive Care 2023; 13:124. [PMID: 38055180 DOI: 10.1186/s13613-023-01218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with bacterial meningitis can be severely ill necessitating intensive care unit (ICU) treatment. Here, we describe clinical features and prognostic factors of adults with bacterial meningitis admitted to the ICU in a nationwide prospective cohort study. METHODS We prospectively assessed clinical features and outcome of adults (age > 16 years) with community-acquired bacterial meningitis included in the MeninGene study between March 1, 2006 and July 1, 2022, that were initially admitted to the ICU. We identified independent predictors for initial ICU admission and for unfavourable outcome (Glasgow Outcome Scale score between 1-4) by multivariable logistic regression. RESULTS A total of 2709 episodes of bacterial meningitis were included, of which 1369 (51%) were initially admitted to the ICU. We observed a decrease in proportion of patients being admitted to the ICU during the Covid-19 pandemic in 2020 (decreased to 39%, p = 0.004). Median age of the 1369 patients initially admitted to the ICU was 61 years (IQR 49-69), and the rates of unfavourable outcome (47%) and mortality (22%) were high. During the Covid-19 pandemic, we observed a trend towards an increase in unfavourable outcome. Prognostic factors predictive for initial ICU admission were younger age, immunocompromised state, male sex, factors associated with pneumococcal meningitis, and those indicative of systemic compromise. Independent predictors for unfavourable outcome in the initial ICU cohort were advanced age, admittance to an academic hospital, cranial nerve palsies or seizures on admission, low leukocyte count in blood, high C-reactive protein in blood, low CSF: blood glucose ratio, listerial meningitis, need for mechanical ventilation, circulatory shock and persistent fever. 204 of 1340 episodes (15%) that were initially not admitted to the ICU were secondarily transferred to the ICU. The rates of unfavourable outcome (66%) and mortality (30%) in this group were high. CONCLUSIONS The majority of patients with community-acquired bacterial meningitis are admitted to the ICU, and the unfavourable outcome and mortality rates of these patients remain high. Patients that are initially admitted to non-ICU wards but secondarily transferred to the ICU also had very high rates of unfavourable outcome.
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Affiliation(s)
- Nora Chekrouni
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merel Kroon
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Evelien H G M Drost
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Thijs M van Soest
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merijn W Bijlsma
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
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Abstract
There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.
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Dias SP, Brouwer MC, Boelen A, van de Beek D. Cerebrospinal fluid sex steroid hormones in bacterial meningitis. Medicine (Baltimore) 2022; 101:e30452. [PMID: 36086742 PMCID: PMC10980494 DOI: 10.1097/md.0000000000030452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Unfavorable outcome in bacterial meningitis is related to excessive inflammation and higher inflammatory markers have been reported in female than in male patients. Sex steroid hormones have immunomodulatory properties and can be found in the cerebrospinal fluid (CSF); however, their actions have not been studied in bacterial meningitis. We investigated the association between CSF sex steroid hormone levels and inflammatory parameters, disease severity, and outcome in pneumococcal meningitis. We identified adults with culture-proven pneumococcal meningitis in a prospective cohort study (2006-2014). We measured estradiol and testosterone in CSF using liquid chromatography-tandem mass spectrometry and sex hormone-binding globulin (SHBG) using an enzyme-linked immunoassay. Hormone levels were compared according to outcome, which was graded using the Glasgow Outcome Scale (a score of 5 indicating favorable, 1-4 unfavorable outcome). Correlation analysis was used to measure the association between hormone levels and inflammatory cytokines, chemokines, and complement factors as well as severity of illness, as measured by the Glasgow Coma Scale and the Dutch Meningitis Risk Score. We included 60 patients: 20 men, 20 premenopausal (<50 years), and 20 postmenopausal (>50 years) women. Twenty-one (35%) patients had an unfavorable outcome and 11 (18%) died. Cases with an unfavorable outcome exhibited higher estradiol (median 14.0 vs 5.0 pmol/L, P = .04) and lower SHBG (0.40 vs 1.0 nmol/L, P = .03) levels compared with those with a favorable outcome. Estradiol was positively correlated with C-reactive protein (R = 0.42, P = .001), CSF protein (R = 0.33, P = .01), and proinflammatory cytokine levels. CSF concentrations of the sex steroid hormone estradiol were associated with outcome and CSF inflammation. Understanding the dose and time-dependent interaction between sex steroid hormones and the inflammatory response in bacterial meningitis represents an important and understudied topic.
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Affiliation(s)
- Sara P. Dias
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, The Netherlands
- Department of Neurology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- ESCMID Study Group for Infections of the Brain” for SPD, MCB and DvdB
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, The Netherlands
- ESCMID Study Group for Infections of the Brain” for SPD, MCB and DvdB
| | - Anita Boelen
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef, The Netherlands
- ESCMID Study Group for Infections of the Brain” for SPD, MCB and DvdB
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Jaswal S, Sanders V, Pullarkat P, Teja S, Salter A, Watkins MP, Atagu N, Ludwig DR, Mhlanga J, Mellnick VM, Peterson LR, Bartlett NL, Kahl BS, Fehniger TA, Ghobadi A, Cashen AF, Mehta-Shah N, Ippolito JE. Metabolic Biomarkers Assessed with PET/CT Predict Sex-Specific Longitudinal Outcomes in Patients with Diffuse Large B-Cell Lymphoma. Cancers (Basel) 2022; 14:2932. [PMID: 35740596 PMCID: PMC9221486 DOI: 10.3390/cancers14122932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
In many cancers, including lymphoma, males have higher incidence and mortality than females. Emerging evidence demonstrates that one mechanism underlying this phenomenon is sex differences in metabolism, both with respect to tumor nutrient consumption and systemic alterations in metabolism, i.e., obesity. We wanted to determine if visceral fat and tumor glucose uptake with fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) could predict sex-dependent outcomes in patients with diffuse large B-cell lymphoma (DLBCL). We conducted a retrospective analysis of 160 patients (84 males; 76 females) with DLBCL who had imaging at initial staging and after completion of therapy. CT-based relative visceral fat area (rVFA), PET-based SUVmax normalized to lean body mass (SULmax), and end-of-treatment FDG-PET 5PS score were calculated. Increased rVFA at initial staging was an independent predictor of poor OS only in females. At the end of therapy, increase in visceral fat was a significant predictor of poor survival only in females. Combining the change in rVFA and 5PS scores identified a subgroup of females with visceral fat gain and high 5PS with exceptionally poor outcomes. These data suggest that visceral fat and tumor FDG uptake can predict outcomes in DLBCL patients in a sex-specific fashion.
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Affiliation(s)
- Shama Jaswal
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Vanessa Sanders
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Priyanka Pullarkat
- Washington University School of Medicine, St. Louis, MO 63110, USA; (P.P.); (N.A.)
| | - Stephanie Teja
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Marcus P. Watkins
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Norman Atagu
- Washington University School of Medicine, St. Louis, MO 63110, USA; (P.P.); (N.A.)
| | - Daniel R. Ludwig
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Joyce Mhlanga
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Vincent M. Mellnick
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
| | - Linda R. Peterson
- Department of Medicine, Division of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Nancy L. Bartlett
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Brad S. Kahl
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Todd A. Fehniger
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Armin Ghobadi
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Amanda F. Cashen
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Neha Mehta-Shah
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.T.); (M.P.W.); (N.L.B.); (B.S.K.); (T.A.F.); (A.G.); (A.F.C.)
| | - Joseph E. Ippolito
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; (S.J.); or (V.S.); (D.R.L.); (J.M.); (V.M.M.)
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
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Dias SP, Brouwer MC, van de Beek D. Sex-based differences in the response to dexamethasone in bacterial meningitis: Analysis of the European dexamethasone in adulthood bacterial meningitis study. Br J Clin Pharmacol 2020; 86:386-391. [PMID: 31692016 PMCID: PMC7015757 DOI: 10.1111/bcp.14163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/28/2019] [Accepted: 10/13/2019] [Indexed: 01/25/2023] Open
Abstract
Inflammatory markers have been found at higher concentrations in women than men with bacterial meningitis. To investigate sex‐based differences in the response to dexamethasone, we performed a post hoc analysis of a double‐blind, randomised multicentre trial of dexamethasone (10 mg, 4 times daily for 4 days) vs placebo in adults with bacterial meningitis. The primary outcome measure was the Glasgow outcome scale score at 8 weeks and interaction tests were used to examine subgroup differences. Between June 1993 and December 2001, 301 patients (56% male) were randomly assigned to a treatment group: 157 received dexamethasone and 144 placebo. Although dexamethasone reduced the risk of unfavourable outcome to a greater extent in women (relative risk [RR] 0.42, 95% confidence interval [CI] 0.21–0.86, P = .02) than men (RR 0.79, 95% CI 0.41–1.51, P = .55), on interaction testing (ratio of RR women:men 0.53, 95% CI 0.20–1.39, P = .19) patient sex was not a significant modifier of the effect of dexamethasone.
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Affiliation(s)
- Sara P Dias
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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