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Chaudhry SR, Kahlert UD, Kinfe TM, Lamprecht A, Niemelä M, Hänggi D, Muhammad S. Elevated Systemic IL-10 Levels Indicate Immunodepression Leading to Nosocomial Infections after Aneurysmal Subarachnoid Hemorrhage (SAH) in Patients. Int J Mol Sci 2020; 21:ijms21051569. [PMID: 32106601 PMCID: PMC7084744 DOI: 10.3390/ijms21051569] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Aneurysmal subarachnoid hemorrhage (SAH) is a highly complex disease with very high mortality and morbidity. About one-third of SAH patients suffer from systemic infections, predominantly pneumonia, that can contribute to excess mortality after SAH. Immunodepression is probably the most important mechanism leading to infections. Interleukin-10 (IL-10) is a master regulator of immunodepression, but it is still not clear if systemic IL-10 levels contribute to immunodepression, occurrence of infections and clinical outcome after SAH. Methods: This explorative study included 76 patients with SAH admitted to our neurointensive care unit within 24 h after ictus. A group of 24 patients without any known intracranial pathology were included as controls. Peripheral venous blood was withdrawn on day 1 and day 7 after SAH. Serum was isolated by centrifugation and stored at −80 °C until analysis. Serum IL-10 levels were determined by enzyme-linked immunoassay (ELISA). Patient characteristics, post-SAH complications and clinical outcome at discharge were retrieved from patients’ record files. Results: Serum IL-10 levels were significantly higher on day 1 and day 7 in SAH patients compared to controls. Serum IL-10 levels were significantly higher on day 7 in patients who developed any kind of infection, cerebral vasospasm (CVS) or chronic hydrocephalus. Serum IL-10 levels were significantly higher in SAH patients discharged with poor clinical outcome (modified Rankin Scale (mRS) 3–6 or Glasgow Outcome Scale (GOS) 1–3). Conclusion: Serum IL-10 might be an additional useful parameter along with other biomarkers to predict post-SAH infections.
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Affiliation(s)
- Shafqat Rasul Chaudhry
- Department of Neurosurgery, University Hospital Bonn, University of Bonn, Sigmund-Freud Str. 25, D-53105 Bonn, Germany; or
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk-Strasse 3, D-53121 Bonn, Germany
- College of Pharmaceutical Sciences, Shifa-Tameer-e-Millat University, Pitras Bukhari Road H-8/4, Islamabad 44000, Pakistan
| | - Ulf Dietrich Kahlert
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany; (U.D.K.); (D.H.)
| | - Thomas Mehari Kinfe
- Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Alf Lamprecht
- Department of Pharmaceutics, Institute of Pharmacy, University of Bonn, Gerhard-Domagk-Strasse 3, D-53121 Bonn, Germany
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland;
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany; (U.D.K.); (D.H.)
| | - Sajjad Muhammad
- Department of Neurosurgery, University Hospital Bonn, University of Bonn, Sigmund-Freud Str. 25, D-53105 Bonn, Germany; or
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany; (U.D.K.); (D.H.)
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland;
- Correspondence: ; Tel.: +49-(0)-211-811-9298
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Kinoshita K. Traumatic brain injury: pathophysiology for neurocritical care. J Intensive Care 2016; 4:29. [PMID: 27123305 PMCID: PMC4847183 DOI: 10.1186/s40560-016-0138-3] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/04/2016] [Indexed: 12/22/2022] Open
Abstract
Severe cases of traumatic brain injury (TBI) require neurocritical care, the goal being to stabilize hemodynamics and systemic oxygenation to prevent secondary brain injury. It is reported that approximately 45 % of dysoxygenation episodes during critical care have both extracranial and intracranial causes, such as intracranial hypertension and brain edema. For this reason, neurocritical care is incomplete if it only focuses on prevention of increased intracranial pressure (ICP) or decreased cerebral perfusion pressure (CPP). Arterial hypotension is a major risk factor for secondary brain injury, but hypertension with a loss of autoregulation response or excess hyperventilation to reduce ICP can also result in a critical condition in the brain and is associated with a poor outcome after TBI. Moreover, brain injury itself stimulates systemic inflammation, leading to increased permeability of the blood–brain barrier, exacerbated by secondary brain injury and resulting in increased ICP. Indeed, systemic inflammatory response syndrome after TBI reflects the extent of tissue damage at onset and predicts further tissue disruption, producing a worsening clinical condition and ultimately a poor outcome. Elevation of blood catecholamine levels after severe brain damage has been reported to contribute to the regulation of the cytokine network, but this phenomenon is a systemic protective response against systemic insults. Catecholamines are directly involved in the regulation of cytokines, and elevated levels appear to influence the immune system during stress. Medical complications are the leading cause of late morbidity and mortality in many types of brain damage. Neurocritical care after severe TBI has therefore been refined to focus not only on secondary brain injury but also on systemic organ damage after excitation of sympathetic nerves following a stress reaction.
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Affiliation(s)
- Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610 Japan
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McDunn JE, Husain KD, Polpitiya AD, Burykin A, Ruan J, Li Q, Schierding W, Lin N, Dixon D, Zhang W, Coopersmith CM, Dunne WM, Colonna M, Ghosh BK, Cobb JP. Plasticity of the systemic inflammatory response to acute infection during critical illness: development of the riboleukogram. PLoS One 2008; 3:e1564. [PMID: 18270561 PMCID: PMC2215774 DOI: 10.1371/journal.pone.0001564] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 12/12/2007] [Indexed: 11/25/2022] Open
Abstract
Background Diagnosis of acute infection in the critically ill remains a challenge. We hypothesized that circulating leukocyte transcriptional profiles can be used to monitor the host response to and recovery from infection complicating critical illness. Methodology/Principal Findings A translational research approach was employed. Fifteen mice underwent intratracheal injections of live P. aeruginosa, P. aeruginosa endotoxin, live S. pneumoniae, or normal saline. At 24 hours after injury, GeneChip microarray analysis of circulating buffy coat RNA identified 219 genes that distinguished between the pulmonary insults and differences in 7-day mortality. Similarly, buffy coat microarray expression profiles were generated from 27 mechanically ventilated patients every two days for up to three weeks. Significant heterogeneity of VAP microarray profiles was observed secondary to patient ethnicity, age, and gender, yet 85 genes were identified with consistent changes in abundance during the seven days bracketing the diagnosis of VAP. Principal components analysis of these 85 genes appeared to differentiate between the responses of subjects who did versus those who did not develop VAP, as defined by a general trajectory (riboleukogram) for the onset and resolution of VAP. As patients recovered from critical illness complicated by acute infection, the riboleukograms converged, consistent with an immune attractor. Conclusions/Significance Here we present the culmination of a mouse pneumonia study, demonstrating for the first time that disease trajectories derived from microarray expression profiles can be used to quantitatively track the clinical course of acute disease and identify a state of immune recovery. These data suggest that the onset of an infection-specific transcriptional program may precede the clinical diagnosis of pneumonia in patients. Moreover, riboleukograms may help explain variance in the host response due to differences in ethnic background, gender, and pathogen. Prospective clinical trials are indicated to validate our results and test the clinical utility of riboleukograms.
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Affiliation(s)
- Jonathan E. McDunn
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Kareem D. Husain
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Ashoka D. Polpitiya
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Anton Burykin
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Jianhua Ruan
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Qing Li
- Department of Mathematics, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - William Schierding
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Nan Lin
- Department of Mathematics, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - David Dixon
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Weixiong Zhang
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Craig M. Coopersmith
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - W. Michael Dunne
- Department of Molecular Microbiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Marco Colonna
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Bijoy K. Ghosh
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - J. Perren Cobb
- Center for Critical Illness and Health Engineering, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri, United States of America
- *E-mail:
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