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Bochennek K, Hogardt M, Lehrnbecher T. Immune signatures, testing, and management of febrile neutropenia in pediatric cancer patients. Expert Rev Clin Immunol 2023; 19:267-277. [PMID: 36635981 DOI: 10.1080/1744666x.2023.2168646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Infectious complications, particularly invasive bacterial and fungal infections, are still a major cause of morbidity in pediatric cancer patients and are associated with significant mortality. Over the last few years, there has been much effort in defining risk groups to tailor antimicrobial therapy, and in establishing pediatric-specific guidelines for antimicrobial strategies. AREAS COVERED This review provides a critical overview of defining risk groups for infection, diagnostic work-up, antimicrobial prophylaxis, empirical therapy, and treatment of established infections. EXPERT OPINION To date, no generalizable risk prediction model has been established for pediatric cancer patients. There is growing interest in defining the impact of the individual genetic background on infectious complications. New diagnostic tools have been developed over the last few years, but they need to be validated in pediatric cancer patients. International, pediatric-specific guidelines for antimicrobial prophylaxis, empirical therapy, and treatment of established infections have recently been published and will harmonize antimicrobial strategies in the future.
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Affiliation(s)
- Konrad Bochennek
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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2
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The Prognostic Utility of Lymphocyte-Based Measures and Ratios in Chemotherapy-Induced Febrile Neutropenia Patients following Granulocyte Colony-Stimulating Factor Therapy. Medicina (B Aires) 2022; 58:medicina58111508. [DOI: 10.3390/medicina58111508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives: Chemotherapy-induced febrile neutropenia is the most widespread oncologic emergency with high morbidity and mortality rates. Herein we present a retrospective risk factor identification study to evaluate the prognostic role of lymphocyte-based measures and ratios in a cohort of chemotherapy-induced febrile neutropenia patients following granulocyte colony-stimulating factor (G-CSF) therapy. Materials and Methods: The electronic medical records at our center were utilized to identify patients with a first attack of chemotherapy-induced febrile neutropenia and were treated accordingly with G-CSF between January 2010 to December 2020. Patients’ demographics and disease characteristics along with laboratory tests data were extracted. Prognosis-related indicators were the absolute neutrophil count (ANC) at admission and the following 6 days besides the length of stay and mortality rate. Results: A total of 80 patients were enrolled, which were divided according to the absolute lymphocyte count at admission into two groups, the first includes lymphopenia patients (n = 55) and the other is the non-lymphopenia group (n = 25) with a cutoff point of 700 lymphocytes/μL. Demographics and baseline characteristics were generally insignificant among the two groups but the white blood cell count was higher in the non-lymphopenia group. ANC, neutrophils percentage and ANC difference in reference to admission among the two study groups were totally insignificant. The same insignificant pattern was observed in the length of stay and the mortality rate. Univariate analysis utilizing the ANC difference compared to the admission day as the dependent variable, revealed no predictability role in the first three days of follow up for any of the variables included. However, during the fourth day of follow up, both WBC (OR = 0.261; 95% CI: 0.075, 0.908; p = 0.035) and lymphocyte percentage (OR = 1.074; 95% CI: 1.012, 1.141; p = 0.019) were marginally significant, in which increasing WBC was associated with a reduction in the likelihood of ANC count increase, compared to the lymphocyte percentage which exhibited an increase in the likelihood. In comparison, sequential ANC difference models demonstrated lymphocyte percentage (OR = 0.961; 95% CI: 0.932, 0.991; p = 0.011) and monocyte-to-lymphocyte ratio (OR = 7.436; 95% CI: 1.024, 54.020; p = 0.047) reduction and increment in the enhancement of ANC levels, respectively. The fifth day had WBC (OR = 0.790; 95% CI: 0.675, 0.925; p = 0.003) to be significantly decreasing the likelihood of ANC increment. Conclusions: we were unable to determine any concrete prognostic role of lymphocyte-related measures and ratios. It is plausible that several limitations could have influenced the results obtained, but as far as our analysis is concerned ALC role as a predictive factor for ANC changes remains questionable.
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Elbakkoush AA, Khaleel A, Mohamed ANA, Alathamneh A. Pathway analysis of sepsis-induced changes gene expression. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sepsis reaction is a response to an infection composed of genetic elements. This research aims to better understand how sepsis affects the molecular pathways in whole blood samples.
Methods
Whole blood samples from healthy controls (n = 18), sepsis nonsurvivors (n = 9), and sepsis survivors (n = 26) were retrieved from the gene expression omnibus (GEO) collection of the national center for biotechnology information (NCBI) (accession number GSE54514). The NCBI's GEO2R program was used to determine differential expression, and the ingenuity pathway analysis (IPA) software was utilized to do a pathway analysis.
Results
In sepsis patients, 2672 genes were substantially differently expressed (p value 0.05). One thousand three hundred four genes were overexpressed, and one thousand three hundred sixty-eight were under-expressed. The inhibition of ARE-mediated mRNA degradation pathway and the Pl3K/AKT signaling spliceosomal cycle were the most significant canonical pathways identified by ingenuity pathway analysis (IPA). The IPA upstream analysis predicted the ESR1, SIRT1, and PTPRR proteins, and the drugs filgrastim and fluticasone were top transcriptional regulators.
Conclusions
The inhibition of ARE-mediated mRNA degradation pathway and the Pl3K/AKT signaling spliceosomal cycle were highlighted as essential pathways of inflammation by IPA, indicating widespread cancer owing to sepsis. Our data imply that sepsis considerably influences gene pathways in whole blood samples, pointing to possible targets for sepsis treatment.
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Sinha P, Delucchi KL, Chen Y, Zhuo H, Abbott J, Wang C, Wickersham N, McNeil JB, Jauregui A, Ke S, Vessel K, Gomez A, Hendrickson CM, Kangelaris KN, Sarma A, Leligdowicz A, Liu KD, Matthay MA, Ware LB, Calfee CS. Latent class analysis-derived subphenotypes are generalisable to observational cohorts of acute respiratory distress syndrome: a prospective study. Thorax 2022; 77:13-21. [PMID: 34253679 PMCID: PMC8688287 DOI: 10.1136/thoraxjnl-2021-217158] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/01/2021] [Indexed: 01/03/2023]
Abstract
RATIONALE Using latent class analysis (LCA), two subphenotypes of acute respiratory distress syndrome (ARDS) have consistently been identified in five randomised controlled trials (RCTs), with distinct biological characteristics, divergent outcomes and differential treatment responses to randomised interventions. Their existence in unselected populations of ARDS remains unknown. We sought to identify subphenotypes in observational cohorts of ARDS using LCA. METHODS LCA was independently applied to patients with ARDS from two prospective observational cohorts of patients admitted to the intensive care unit, derived from the Validating Acute Lung Injury markers for Diagnosis (VALID) (n=624) and Early Assessment of Renal and Lung Injury (EARLI) (n=335) studies. Clinical and biological data were used as class-defining variables. To test for concordance with prior ARDS subphenotypes, the performance metrics of parsimonious classifier models (interleukin 8, bicarbonate, protein C and vasopressor-use), previously developed in RCTs, were evaluated in EARLI and VALID with LCA-derived subphenotypes as the gold-standard. RESULTS A 2-class model best fit the population in VALID (p=0.0010) and in EARLI (p<0.0001). Class 2 comprised 27% and 37% of the populations in VALID and EARLI, respectively. Consistent with the previously described 'hyperinflammatory' subphenotype, Class 2 was characterised by higher proinflammatory biomarkers, acidosis and increased shock and worse clinical outcomes. The similarities between these and prior RCT-derived subphenotypes were further substantiated by the performance of the parsimonious classifier models in both cohorts (area under the curves 0.92-0.94). The hyperinflammatory subphenotype was associated with increased prevalence of chronic liver disease and neutropenia and reduced incidence of chronic obstructive pulmonary disease. Measurement of novel biomarkers showed significantly higher levels of matrix metalloproteinase-8 and markers of endothelial injury in the hyperinflammatory subphenotype, whereas, matrix metalloproteinase-9 was significantly lower. CONCLUSION Previously described subphenotypes are generalisable to unselected populations of non-trauma ARDS.
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Affiliation(s)
- Pratik Sinha
- Department of Anesthesiology, Washington University in St Louis, St Louis, Missouri, USA
| | - Kevin L Delucchi
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Yue Chen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Hanjing Zhuo
- Department of Anesthesiology, University of California San Francisco, San Francisco, California, USA
| | - Jason Abbott
- Department of Anesthesiology, University of California San Francisco, San Francisco, California, USA
| | - Chunxue Wang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nancy Wickersham
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Brennan McNeil
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alejandra Jauregui
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Serena Ke
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kathryn Vessel
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Antonio Gomez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Carolyn M Hendrickson
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Kirsten N Kangelaris
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- University of California San Francisco, San Francisco, California, USA
| | - Aartik Sarma
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, California, USA
| | | | - Kathleen D Liu
- Department of Anesthesiology, University of California San Francisco, San Francisco, California, USA
| | - Michael A Matthay
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carolyn S Calfee
- Department of Anesthesiology, University of California San Francisco, San Francisco, California, USA
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, California, USA
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, USA
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5
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de Lucio Delgado A, Villegas Rubio JA, Rey Galan C, Prieto García B, González Expósito MDLR, Solís Sánchez G. Biomarkers and Fever in Children with Cancer: Kinetics and Levels According to Final Diagnosis. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111027. [PMID: 34828740 PMCID: PMC8625602 DOI: 10.3390/children8111027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/23/2021] [Accepted: 11/04/2021] [Indexed: 01/01/2023]
Abstract
We investigated the kinetics of CRP, PCT, IL-6 and MR-proADM in a cohort of consecutive febrile patients with cancer in order to test the hypothesis that higher plasma concentrations and the absence of a rapid decrease in peak values would be associated with disease severity. (1) Method: A prospective descriptive and analytical study of patients with cancer and fever (≤18 years of age) at a University Hospital was carried out between January 2018 and December 2019. Information collected: sex, age, diagnosis, date and symptoms at diagnosis and medical history. The episodes were classified into three groups: bacterial infection, non-bacterial infection and systemic inflammatory response syndrome (SIRS). (2) Results: One hundred and thirty-four episodes were included. Bacterial infection criteria were met in 38 episodes. Biomarkers were measured at four different points: baseline, at 12–24 h, at 25–48 h and at 49–72 h. All the biomarkers evaluated decreased after the peak level was reached. IL-6 and MR-proADM showed a trend towards higher levels in the SIRS group although this rise was statistically significant only for IL-6 (p < 0.005). Bacterial infections more frequently presented values of PCT above the cut-off point (>0.5 ng/mL) at 12–24 h. (3) Conclusion: In our experience, IL-6 kinetics is faster than PCT kinetics and both are faster than CRP in patients with fever and cancer who present a good outcome. Patients with a good evolution show a rapid increase and decrease of PCT and particularly of IL-6 levels.
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Affiliation(s)
- Ana de Lucio Delgado
- Pediatric Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
- Correspondence:
| | | | - Corsino Rey Galan
- Pediatric Intensive Care, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Belen Prieto García
- Clinical Biochemistry, Laboratory of Medicine, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | | | - Gonzalo Solís Sánchez
- Service of the Neonatology Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
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6
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Doerflinger M, Haeusler GM, Li-Wai-Suen CSN, Clark JE, Slavin M, Babl FE, Allaway Z, Mechinaud F, Smyth GK, De Abreu Lourenco R, Phillips B, Pellegrini M, Thursky KA. Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia. Front Immunol 2021; 12:641879. [PMID: 34093531 PMCID: PMC8173204 DOI: 10.3389/fimmu.2021.641879] [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: 12/15/2020] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives Febrile neutropenia (FN) causes treatment disruption and unplanned hospitalization in children with cancer. Serum biomarkers are infrequently used to stratify these patients into high or low risk for serious infection. This study investigated plasma abundance of cytokines in children with FN and their ability to predict bacteraemia. Methods Thirty-three plasma cytokines, C-reactive protein (CRP) and procalcitonin (PCT) were measured using ELISA assays in samples taken at FN presentation (n = 79) and within 8–24 h (Day 2; n = 31). Optimal thresholds for prediction of bacteraemia were identified and the predictive ability of biomarkers in addition to routinely available clinical variables was assessed. Results The median age of included FN episodes was 6.0 years and eight (10%) had a bacteraemia. On presentation, elevated PCT, IL-10 and Mip1-beta were significantly associated with bacteraemia, while CRP, IL-6 and IL-8 were not. The combination of PCT (≥0.425 ng/ml) and IL-10 (≥4.37 pg/ml) had a sensitivity of 100% (95% CI 68.8–100%) and specificity of 89% (95% CI 80.0–95.0%) for prediction of bacteraemia, correctly identifying all eight bacteraemia episodes and classifying 16 FN episodes as high-risk. There was limited additive benefit of incorporating clinical variables to this model. On Day 2, there was an 11-fold increase in PCT in episodes with a bacteraemia which was significantly higher than that observed in the non-bacteraemia episodes. Conclusion Elevated PCT and IL-10 accurately identified all bacteraemia episodes in our FN cohort and may enhance the early risk stratification process in this population. Prospective validation and implementation is required to determine the impact on health service utilisation.
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Affiliation(s)
- Marcel Doerflinger
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute for Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Gabrielle M Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, VIC, Australia
| | - Connie S N Li-Wai-Suen
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute for Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia
| | - Julia E Clark
- Queensland Children's Hospital, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Franz E Babl
- Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Emergency Department, Royal Children's Hospital, Parkville, VIC, Australia.,Paediatric Emergency Medicine Centre of Research Excellence, ED Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Zoe Allaway
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, VIC, Australia
| | - Francoise Mechinaud
- Unité D'hématologie Immunologie Pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, Paris, France
| | - Gordon K Smyth
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute for Medical Research, Parkville, VIC, Australia.,School of Mathematics and Statistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Bob Phillips
- Leeds Children's Hospital, Leeds General Infirmary, Leeds, United Kingdom
| | - Marc Pellegrini
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute for Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, VIC, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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7
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Griffiths EA, Alwan LM, Bachiashvili K, Brown A, Cool R, Curtin P, Geyer MB, Gojo I, Kallam A, Kidwai WZ, Kloth DD, Kraut EH, Lyman GH, Mukherjee S, Perez LE, Rosovsky RP, Roy V, Rugo HS, Vasu S, Wadleigh M, Westervelt P, Becker PS. Considerations for Use of Hematopoietic Growth Factors in Patients With Cancer Related to the COVID-19 Pandemic. J Natl Compr Canc Netw 2020; 19:1-4. [PMID: 32871558 PMCID: PMC9730290 DOI: 10.6004/jnccn.2020.7610] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022]
Abstract
Hematopoietic growth factors, including erythrocyte stimulating agents (ESAs), granulocyte colony-stimulating factors, and thrombopoietin mimetics, can mitigate anemia, neutropenia, and thrombocytopenia resulting from chemotherapy for the treatment of cancer. In the context of pandemic SARS-CoV-2 infection, patients with cancer have been identified as a group at high risk of morbidity and mortality from this infection. Our subcommittee of the NCCN Hematopoietic Growth Factors Panel convened a voluntary group to review the potential value of expanded use of such growth factors in the current high-risk environment. Although recommendations are available on the NCCN website in the COVID-19 Resources Section (https://www.nccn.org/covid-19/), these suggestions are provided without substantial context or reference. Herein we review the rationale and data underlying the suggested alterations to the use of hematopoietic growth factors for patients with cancer in the COVID-19 era.
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Affiliation(s)
| | - Laura M. Alwan
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington
| | - Kimo Bachiashvili
- O’Neal Comprehensive Cancer Center at the University of Alabama, Birmingham, Alabama
| | - Anna Brown
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Rita Cool
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Curtin
- UC San Diego Moores Cancer Center, La Jolla, California
| | - Mark B. Geyer
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ivana Gojo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Avyakta Kallam
- University of Nebraska Medical Center, Fred & Pamela Buffett Cancer Center, Omaha, Nebraska
| | - Wajih Z. Kidwai
- Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut
| | | | - Eric H. Kraut
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Gary H. Lyman
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington
| | - Sudipto Mukherjee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | | | - Vivek Roy
- Mayo Clinic Cancer Center; Jacksonville, Florida
| | - Hope S. Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Sumithira Vasu
- The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Martha Wadleigh
- Dana Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Peter Westervelt
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, Missouri
| | - Pamela S. Becker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington
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8
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Z Oikonomakou M, Gkentzi D, Gogos C, Akinosoglou K. Biomarkers in pediatric sepsis: a review of recent literature. Biomark Med 2020; 14:895-917. [PMID: 32808806 DOI: 10.2217/bmm-2020-0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Sepsis remains the leading cause of death in infants and children worldwide. Prompt diagnosis and monitoring of infection is pivotal to guide therapy and optimize outcomes. No single biomarker has so far been identified to accurately diagnose sepsis, monitor response and predict severity. We aimed to assess existing evidence of available sepsis biomarkers, and their utility in pediatric population. C-reactive protein and procalcitonin remain the most extensively evaluated and used biomarkers. However, biomarkers related to endothelial damage, vasodilation, oxidative stress, cytokines/chemokines and cell bioproducts have also been identified, often with regard to the site of infection and etiologic pathogen; still, with controversial utility. A multi-biomarker model driven by genomic tools could establish a personalized approach in future disease management.
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Affiliation(s)
| | - Despoina Gkentzi
- Department of Pediatrics, University Hospital of Patras, Rio 26504, Greece
| | - Charalambos Gogos
- Department of Internal Medicine & Infectious Diseases, University Hospital of Patras, Rio 26504, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Patras, Rio 26504, Greece
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9
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Siegmund M, Pagel J, Scholz T, Rupp J, Härtel C, Lauten M. Pro-inflammatory cytokine ratios determine the clinical course of febrile neutropenia in children receiving chemotherapy. Mol Cell Pediatr 2020; 7:5. [PMID: 32519027 PMCID: PMC7283414 DOI: 10.1186/s40348-020-00097-2] [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: 03/03/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Febrile neutropenia is a common and serious complication during treatment of childhood cancer. Empirical broad-spectrum antibiotics are usually administered until neutrophil cell count recovery. It was the aim of this study to investigate cytokine profiles as potential biomarkers using in-vitro sepsis models to differentiate between distinct clinical courses of febrile neutropenia (FN). Methods We conducted an observational study in FN episodes of pediatric oncology patients. Courses of neutropenia were defined as severe in case of proven blood stream infection or clinical evidence of complicated infection. We collected blood samples at various time points from the onset of FN and stimulated ex vivo with lipopolysaccharide (LPS) and Staphylococcus epidermidis (SE) for 24 h. Twenty-seven cytokine levels were measured in the whole blood culture supernatants by a multiplex immunoassay system. Results Forty-seven FN episodes from 33 children were investigated. IL-8, IL-1β, and MCP-1 expression increased significantly over time. IL-8, MIP-1α, MIP-1β, MCP-1, and TNF-α showed significantly lower concentration in patients with a clinically severe course of the FN. Conclusions Distinct patterns of cytokine profiles seem to be able to determine infectious FN and to predict the severity of its clinical course. If these data can be verified in a multi-centre setting, this may finally lead to an individualized treatment strategy facilitating antibiotic stewardship in these patients.
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Affiliation(s)
- Mira Siegmund
- Department of Pediatrics, Pediatric Hematology and Oncology, University of Lübeck, 23538, Lübeck, Germany
| | - Julia Pagel
- Department of Pediatrics, Pediatric Hematology and Oncology, University of Lübeck, 23538, Lübeck, Germany.,Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Tasja Scholz
- Department of Pediatrics, Pediatric Hematology and Oncology, University of Lübeck, 23538, Lübeck, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany.,German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Christoph Härtel
- Department of Pediatrics, Pediatric Hematology and Oncology, University of Lübeck, 23538, Lübeck, Germany
| | - Melchior Lauten
- Department of Pediatrics, Pediatric Hematology and Oncology, University of Lübeck, 23538, Lübeck, Germany.
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10
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Lopreiato M, Cocchiola R, Falcucci S, Leopizzi M, Cardone M, Di Maio V, Brocco U, D'Orazi V, Calvieri S, Scandurra R, De Marco F, Scotto d'Abusco A. The Glucosamine-derivative NAPA Suppresses MAPK Activation and Restores Collagen Deposition in Human Diploid Fibroblasts Challenged with Environmental Levels of UVB. Photochem Photobiol 2019; 96:74-82. [PMID: 31769510 DOI: 10.1111/php.13185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022]
Abstract
The ultraviolet (UV) component of solar radiation is the driving force of life on earth, but it can cause photoaging and skin cancer. In this study, we investigated the effects of the glucosamine-derivative 2-(N-Acetyl)-L-phenylalanylamido-2-deoxy-β-D-glucose (NAPA) on human primary fibroblasts (FBs) stimulated in vitro with environmental levels of UVB radiation. FBs were irradiated with 0.04 J cm-2 UVB dose, which resulted a mild dosage as shown by the cell viability and ROS production measurement. This environmental UVB dose induced activation of MAP kinase ERK 1/2, the stimulation of c-fos and at lower extent of c-jun, and in turn AP-1-dependent up-regulation of pro-inflammatory factors IL-6 and IL-8 and suppression of collagen type I expression. On the contrary, 0.04 J cm-2 UVB dose was not able to stimulate metalloprotease production. NAPA treatment was able to suppress the up-regulation of IL-6 and IL-8 via the inhibition of MAP kinase ERK phosphorylation and the following AP-1 activation, and was able to attenuate the collagen type I down-regulation induced by the UVBs. Taken together, our results show that NAPA, considering its dual action on suppression of inflammation and stimulation of collagen type I production, represents an interesting candidate as a new photoprotective and photorepairing agents.
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Affiliation(s)
| | - Rossana Cocchiola
- Department of Biochemical Sciences, Sapienza University of Roma, Roma, Italy
| | - Susanna Falcucci
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, Roma, Italy
| | - Martina Leopizzi
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino-Sapienza University, Latina, Italy
| | - Michele Cardone
- Department of Dermatology and Venereology, Sapienza University of Roma, Policlinico Umberto I, Roma, Italy
| | - Valeria Di Maio
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino-Sapienza University, Latina, Italy
| | - Umberto Brocco
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, Roma, Italy
| | - Valerio D'Orazi
- Department of Surgical Sciences, Sapienza University of Roma, Roma, Italy
| | - Stefano Calvieri
- Department of Dermatology and Venereology, Sapienza University of Roma, Policlinico Umberto I, Roma, Italy
| | - Roberto Scandurra
- Department of Biochemical Sciences, Sapienza University of Roma, Roma, Italy
| | - Federico De Marco
- Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, Roma, Italy
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11
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Costa RT, Araújo ORD, Brunialti MKC, Assunção MSC, Azevedo LCP, Freitas F, Salomão R. T helper type cytokines in sepsis: time-shared variance and correlation with organ dysfunction and hospital mortality. Braz J Infect Dis 2019; 23:79-85. [PMID: 31112675 PMCID: PMC9425672 DOI: 10.1016/j.bjid.2019.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/23/2019] [Accepted: 04/28/2019] [Indexed: 01/02/2023] Open
Abstract
Objective We evaluated the kinetics of cytokines belonging to the T helper1 (Th1), Th2, and Th17 profiles in septic patients, and their correlations with organ dysfunction and hospital mortality. Methods This was a prospective observational study in a cohort of septic patients admitted to the intensive care units (ICU) of three Brazilian general hospitals. A total of 104 septic patients and 53 health volunteers (controls) were included. Plasma samples were collected within the first 48 h of organ dysfunction or septic shock (0D), after seven (D7) and 14 days (D14) of follow-up. The following cytokines were measured by flow cytometry: Interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-10, IL-12/23p40, IL-17, IL-21, tumor necrosis factor-α (TNF-α), granulocyte-macrophage colony stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF). Results IL-6, IL-8, G-CSF and IL-10 concentrations were higher in septic patients than in controls (p < 0.001), while IL-12/23p40 presented higher levels in the controls (p = 0.003). IL-6, IL-8 and IL-17 correlated with Sequential [Sepsis-related] Organ Failure Assessment (SOFA) D0, D1 and D3 (except for IL-6 at D0). IL-8 was associated with renal and cardiovascular dysfunction. In a mixed model analysis, IL-10 estimated means were lower in survivors than in deceased (p = 0.014), while IL-21 had an estimated mean of 195.8 pg/mL for survivors and 98.5 for deceased (p = 0.03). Cytokines were grouped in four factors according to their kinetics over the three dosages (D0, D7, D14). Group 1 encompassed IL-6, IL-8, IL-10, IL-1β, and G-CSF while Group 3 encompassed IL-17 and IL-12/23p40. Both correlated with SOFA (D0) (p = 0.039 and p = 0.003, respectively). IL-21 (Group 4) was higher in those who survived. IL-2, TNF-α and GM-CSF (Group 2) showed no correlation with outcomes. Conclusion Inflammatory and anti-inflammatory cytokines shared co-variance in septic patients and were related to organ dysfunctions and hospital mortality.
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Affiliation(s)
- Ramon Teixeira Costa
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departmento de Medicina, São Paulo, SP, Brazil; AC Camargo Cancer Center, Unidade de Cuidados Intensivos, São Paulo, SP, Brazil
| | - Orlei Ribeiro de Araújo
- Instituto de Oncologia Pediátrica (IOP), Grupo de Apoio ao Adolescente e a Criança com Cancer (GRAACC), São Paulo, SP, Brazil
| | | | | | | | - Flávio Freitas
- Universidade Federal de São Paulo, Hospital São Paulo, Unidade de Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | - Reinaldo Salomão
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departmento de Medicina, São Paulo, SP, Brazil.
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12
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Downes KJ, Fitzgerald JC, Schriver E, Boge CLK, Russo ME, Weiss SL, Balamuth F, Kubis SE, Tolomeo P, Bilker WB, Han JH, Lautenbach E, Coffin SE, Gerber JS. Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study. J Pediatric Infect Dis Soc 2018; 9:36-43. [PMID: 30476186 PMCID: PMC7317158 DOI: 10.1093/jpids/piy113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/18/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. METHODS We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3-9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods. RESULTS We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm's cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30-0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression. CONCLUSIONS Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.
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Affiliation(s)
- Kevin J Downes
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania,Correspondence: K. J. Downes, MD, Division of Infectious Diseases, Children’s Hospital of Philadelphia, 2716 South Street, Suite 10360, Philadelphia, PA 19146 ()
| | - Julie C Fitzgerald
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Schriver
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Craig L K Boge
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael E Russo
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fran Balamuth
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sherri E Kubis
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer H Han
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ebbing Lautenbach
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan E Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship Research Group, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
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