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Han T, Jiang Y, Ge W, Lu Y, Liu R, Sun Z. 2,5-Dihydroxyacetophenone attenuates acute kidney injury induced by intra-abdominal infection in rats. Nephrology (Carlton) 2024. [PMID: 39054771 DOI: 10.1111/nep.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/17/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
AIMS As one of the most serious complications of sepsis, acute kidney injury (AKI) is pathologically associated with excessive inflammation. 2,5-Dihydroxyacetophenone (DHAP) is isolated from Radix rehmanniae praeparata and exhibit potent anti-inflammatory property. This research aimed at determining the role of DHAP in sepsis-associated AKI (SA-AKI) and the underlying mechanism. METHODS Plasma creatinine (Cre), blood urea nitrogen (BUN), tumour necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels of SA-AKI patients were detected to evaluate their clinical characteristics. SA-AKI rat models were established by using caecum ligation puncture (CLP) surgery. CLP-induced rats were administered via oral gavage with 20 or 40 mg DHAP after 2 h of CLP surgery. Subsequently, survival rates, serum indexes, histopathological changes, inflammatory factors, renal function indexes and extracellular regulated protein kinases (ERK) and nuclear factor-κB (NF-κB) signalling pathways were detected. RESULTS SA-AKI patients exhibited markedly higher levels of plasma Cre, BUN, TNF-α and IL-1β than healthy people. Compared with sham rats, CLP-induced septic rats showed significantly decreased survival rate, increased serum lactate dehydrogenase activity and serum lactate level, obvious renal histopathological injury, upregulated TNF-α, IL-1β and TGF-β1 levels, elevated serum creatinine, BUN and serum cystatin C concentrations, serum neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 levels and reduced renal artery blood flow. All the above CLP-induced changes in septic rats were mitigated after DHAP administration. Additionally, CLP-induced elevation in phosphorylated-ERK1/2 and nuclear NF-κB p65 protein levels was inhibited by DHAP treatment. CONCLUSION DHAP hinders SA-AKI progression in rat models by inhibiting ERK and NF-κB signalling pathways.
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Affiliation(s)
- Tao Han
- Department of Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Ye Jiang
- Department of Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Weixing Ge
- Department of Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yuyu Lu
- Department of Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Rongming Liu
- Department of Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Zunpeng Sun
- Department of Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
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Wu X, Yuan L, Xu J, Qi J, Zheng K. Normalized lactate load as an independent prognostic indicator in patients with cardiogenic shock. BMC Cardiovasc Disord 2024; 24:348. [PMID: 38987706 PMCID: PMC11234684 DOI: 10.1186/s12872-024-04013-8] [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: 11/29/2023] [Accepted: 06/26/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Early prognosis evaluation is crucial for decision-making in cardiogenic shock (CS) patients. Dynamic lactate assessment, for example, normalized lactate load, has been a better prognosis predictor than single lactate value in septic shock. Our objective was to investigate the correlation between normalized lactate load and in-hospital mortality in patients with CS. METHODS Data were extracted from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The calculation of lactate load involved the determination of the cumulative area under the lactate curve, while normalized lactate load was computed by dividing the lactate load by the corresponding period. Receiver Operating Characteristic (ROC) curves were constructed, and the evaluation of areas under the curves (AUC) for various parameters was performed using the DeLong test. RESULTS Our study involved a cohort of 1932 CS patients, with 687 individuals (36.1%) experiencing mortality during their hospitalization. The AUC for normalized lactate load demonstrated significant superiority compared to the first lactate (0.675 vs. 0.646, P < 0.001), maximum lactate (0.675 vs. 0.651, P < 0.001), and mean lactate (0.675 vs. 0.669, P = 0.003). Notably, the AUC for normalized lactate load showed comparability to that of the Sequential Organ Failure Assessment (SOFA) score (0.675 vs. 0.695, P = 0.175). CONCLUSION The normalized lactate load was an independently associated with the in-hospital mortality among CS patients.
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Affiliation(s)
- Xia Wu
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Lin Yuan
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Jiarui Xu
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jing Qi
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Keyang Zheng
- Centre of Hypertension, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
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3
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Chen M, Lv D. Prognostic value of serum lactate level for mortality in patients with acute kidney injury. Eur J Med Res 2024; 29:295. [PMID: 38778420 PMCID: PMC11110292 DOI: 10.1186/s40001-024-01886-5] [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: 02/11/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Serum lactate is associated with mortality in diverse kinds of patients. This study aimed to investigate whether serum lactate level may independently predict mortality in acute kidney injury (AKI) patients. METHODS A total of 4461 AKI patients were collected from the Medical Information Mart for Intensive Care (MIMIC III) database and followed up for 365 days. According to serum lactate tertiles, participants were divided into three groups (Q1-Q3) by: Q1 ≤ 1.60 mg/dl, Q2 = 1.61-2.70 mg/dl, and Q3 ≥ 2.71 mg/dl. We calculated the hazard ratio (HR) and 95% confidence intervals (Cls) for mortality across each tertile of lactate by using the Q1 as reference and constructed four models to adjust for the HR of mortality. RESULTS Nonsurvivors had significantly higher lactate compared with patients in the survival group. Mortality rate gradually elevated with the increase in serum lactate level (Q1: 29.30%, Q2: 33.40%, Q3: 37.40%). When compared with Q1 after adjustment of all confounders, the HRs of Q3 still was 1.20 (95% Cl 1.05-1.37). CONCLUSIONS This study demonstrated that high serum lactate levels were an independent predictor of mortality in AKI patients.
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Affiliation(s)
- Meng Chen
- Department of Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Dezhao Lv
- Department of Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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4
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Tang Y, Yin L, Yuan L, Lin X, Jiang B. Nucleolin myocardial-specific knockout exacerbates glucose metabolism disorder in endotoxemia-induced myocardial injury. PeerJ 2024; 12:e17414. [PMID: 38784400 PMCID: PMC11114111 DOI: 10.7717/peerj.17414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Background Sepsis-induced myocardial injury, as one of the important complications of sepsis, can significantly increase the mortality of septic patients. Our previous study found that nucleolin affected mitochondrial function in energy synthesis and had a protective effect on septic cardiomyopathy in mice. During sepsis, glucose metabolism disorders aggravated myocardial injury and had a negative effect on septic patients. Objectives We investigated whether nucleolin could regulate glucose metabolism during endotoxemia-induced myocardial injury. Methods The study tested whether the nucleolin cardiac-specific knockout in the mice could affect glucose metabolism through untargeted metabolomics, and the results of metabolomics were verified experimentally in H9C2 cells. The ATP content, lactate production, and oxygen consumption rate (OCR) were evaluated. Results The metabolomics results suggested that glycolytic products were increased in endotoxemia-induced myocardial injury, and that nucleolin myocardial-specific knockout altered oxidative phosphorylation-related pathways. The experiment data showed that TNF-α combined with LPS stimulation could increase the lactate content and the OCR values by about 25%, and decrease the ATP content by about 25%. However, interference with nucleolin expression could further decrease ATP content and OCR values by about 10-20% and partially increase the lactate level in the presence of TNF-α and LPS. However, nucleolin overexpression had the opposite protective effect, which partially reversed the decrease in ATP content and the increase in lactate level. Conclusion Down-regulation of nucleolin can exacerbate glucose metabolism disorders in endotoxemia-induced myocardial injury. Improving glucose metabolism by regulating nucleolin was expected to provide new therapeutic ideas for patients with septic cardiomyopathy.
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Affiliation(s)
- Yuting Tang
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, Hunan, China
- National Medicine Functional Experimental Teaching Center, Central South University, Changsha, Hunan, China
| | - Leijing Yin
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, Hunan, China
- National Medicine Functional Experimental Teaching Center, Central South University, Changsha, Hunan, China
| | - Ludong Yuan
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, Hunan, China
- National Medicine Functional Experimental Teaching Center, Central South University, Changsha, Hunan, China
| | - Xiaofang Lin
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, Hunan, China
- National Medicine Functional Experimental Teaching Center, Central South University, Changsha, Hunan, China
| | - Bimei Jiang
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
- Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, Hunan, China
- National Medicine Functional Experimental Teaching Center, Central South University, Changsha, Hunan, China
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5
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Yamaguti T, Auler Junior JOC, Dallan LAO, Galas FRBG, Cunha LCC, Piccioni MDA. Markers of Tissue Perfusion as Predictors of Adverse Outcomes in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery. Arq Bras Cardiol 2024; 121:e20230247. [PMID: 38597532 DOI: 10.36660/abc.20230247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/14/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Cardiac surgery patients may be exposed to tissue hypoperfusion and anaerobic metabolism. OBJECTIVE To verify whether the biomarkers of tissue hypoperfusion have predictive value for prolonged intensive care unit (ICU) stay in patients with left ventricular dysfunction who underwent coronary artery bypass surgery. METHODS After approval by the institution's Ethics Committee and the signing of informed consent, 87 patients with left ventricular dysfunction (ejection fraction < 50%) undergoing coronary artery bypass surgery were enrolled. Hemodynamic and metabolic biomarkers were collected at five time points: after anesthesia, at the end of the surgery, at ICU admission, and at six and twelve hours after. An analysis of variance for repeated measures followed by a Bonferroni post hoc test was used for repeated, continuous variables (hemodynamic and metabolic variables) to determine differences between the two groups over the course of the study period. The level of statistical significance adopted was 5%. RESULTS Thirty-eight patients (43.7%) who presented adverse outcomes were older, higher Euro score (p<0.001), and elevated ΔpCO2 as analyzed 12 hours after ICU admission (p<0.01), while increased arterial lactate concentration at 6 hours postoperatively was found to be a negative predictive factor (p<0.01). CONCLUSIONS Euro SCORE, six-hour postoperative arterial lactate, 12-hour postoperative ΔPCO2, and eRQ are independent predictors of adverse outcomes in patients with left ventricular dysfunction after cardiac surgery.
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Affiliation(s)
- Thiana Yamaguti
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - José Otavio Costa Auler Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Luís Alberto Oliveira Dallan
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Ligia Cristina Câmara Cunha
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
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6
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Whiley L, Lawler NG, Zeng AX, Lee A, Chin ST, Bizkarguenaga M, Bruzzone C, Embade N, Wist J, Holmes E, Millet O, Nicholson JK, Gray N. Cross-Validation of Metabolic Phenotypes in SARS-CoV-2 Infected Subpopulations Using Targeted Liquid Chromatography-Mass Spectrometry (LC-MS). J Proteome Res 2024; 23:1313-1327. [PMID: 38484742 PMCID: PMC11002931 DOI: 10.1021/acs.jproteome.3c00797] [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: 11/17/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/06/2024]
Abstract
To ensure biological validity in metabolic phenotyping, findings must be replicated in independent sample sets. Targeted workflows have long been heralded as ideal platforms for such validation due to their robust quantitative capability. We evaluated the capability of liquid chromatography-mass spectrometry (LC-MS) assays targeting organic acids and bile acids to validate metabolic phenotypes of SARS-CoV-2 infection. Two independent sample sets were collected: (1) Australia: plasma, SARS-CoV-2 positive (n = 20), noninfected healthy controls (n = 22) and COVID-19 disease-like symptoms but negative for SARS-CoV-2 infection (n = 22). (2) Spain: serum, SARS-CoV-2 positive (n = 33) and noninfected healthy controls (n = 39). Multivariate modeling using orthogonal projections to latent structures discriminant analyses (OPLS-DA) classified healthy controls from SARS-CoV-2 positive (Australia; R2 = 0.17, ROC-AUC = 1; Spain R2 = 0.20, ROC-AUC = 1). Univariate analyses revealed 23 significantly different (p < 0.05) metabolites between healthy controls and SARS-CoV-2 positive individuals across both cohorts. Significant metabolites revealed consistent perturbations in cellular energy metabolism (pyruvic acid, and 2-oxoglutaric acid), oxidative stress (lactic acid, 2-hydroxybutyric acid), hypoxia (2-hydroxyglutaric acid, 5-aminolevulinic acid), liver activity (primary bile acids), and host-gut microbial cometabolism (hippuric acid, phenylpropionic acid, indole-3-propionic acid). These data support targeted LC-MS metabolic phenotyping workflows for biological validation in independent sample sets.
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Affiliation(s)
- Luke Whiley
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute Harry
Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
| | - Nathan G. Lawler
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute Harry
Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
| | - Annie Xu Zeng
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
| | - Alex Lee
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
| | - Sung-Tong Chin
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
| | - Maider Bizkarguenaga
- Centro
de Investigación Cooperativa en Biociencias—CIC bioGUNE,
Precision Medicine and Metabolism Laboratory, Basque Research and
Technology Alliance, Bizkaia Science and
Technology Park, Building
800, 48160 Derio, Spain
| | - Chiara Bruzzone
- Centro
de Investigación Cooperativa en Biociencias—CIC bioGUNE,
Precision Medicine and Metabolism Laboratory, Basque Research and
Technology Alliance, Bizkaia Science and
Technology Park, Building
800, 48160 Derio, Spain
| | - Nieves Embade
- Centro
de Investigación Cooperativa en Biociencias—CIC bioGUNE,
Precision Medicine and Metabolism Laboratory, Basque Research and
Technology Alliance, Bizkaia Science and
Technology Park, Building
800, 48160 Derio, Spain
| | - Julien Wist
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute Harry
Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Chemistry
Department, Universidad del Valle, Cali 76001, Colombia
| | - Elaine Holmes
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute Harry
Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Department
of Metabolism Digestion and Reproduction, Faculty of Medicine, Imperial
College London, Sir Alexander Fleming Building, South Kensington, London SW7 2AZ, U.K.
| | - Oscar Millet
- Centro
de Investigación Cooperativa en Biociencias—CIC bioGUNE,
Precision Medicine and Metabolism Laboratory, Basque Research and
Technology Alliance, Bizkaia Science and
Technology Park, Building
800, 48160 Derio, Spain
| | - Jeremy K. Nicholson
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute Harry
Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Institute
of Global Health Innovation, Faculty Building South Kensington Campus, Imperial College London, London SW7 2AZ, U.K.
| | - Nicola Gray
- Australian
National Phenome Centre, Health Futures Institute Harry Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
- Centre
for Computational and Systems Medicine, Health Futures Institute Harry
Perkins Institute, Murdoch University, 5 Robin Warren Drive, Perth, WA 6150, Australia
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Rocha KN, da Silva JAF, de Jesus DP. Capillary electrophoresis with capacitively coupled contactless conductivity detection (C 4 D) for rapid and simple determination of lactate in sweat. Electrophoresis 2024; 45:392-399. [PMID: 38072648 DOI: 10.1002/elps.202300179] [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: 08/15/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 03/20/2024]
Abstract
An analytical method based on capillary electrophoresis (CE) using capacitively coupled contactless conductivity detection (C4 D) was developed and validated for fast, straightforward, and reliable determination of lactate in artificial and human sweat samples. The background electrolyte was composed of equimolar concentrations (10 mmol/L) of 2-(N-morpholino)ethanesulfonic acid and histidine, with 0.2 mmol/L of cetyltrimethylammonium bromide as electroosmotic flow inverter. The limit of detection and quantification were 3.1 and 10.3 µmol/L, respectively. Recoveries in the 97 to 118% range were obtained using sweat samples spiked with lactate at three concentration levels, indicating an acceptable accuracy. The intraday and interday precisions were 1.49 and 7.08%, respectively. The proposed CE-C4 D method can be a starting point for monitoring lactate concentrations in sweat samples for diagnostics, physiological studies, and sports performance assessment applications.
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Affiliation(s)
- Kionnys N Rocha
- Instituto de Química, Universidade Estadual de Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - José A Fracassi da Silva
- Instituto de Química, Universidade Estadual de Campinas, UNICAMP, Campinas, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia de Bioanalítica, Campinas, São Paulo, Brazil
| | - Dosil P de Jesus
- Instituto de Química, Universidade Estadual de Campinas, UNICAMP, Campinas, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia de Bioanalítica, Campinas, São Paulo, Brazil
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Ala-Nisula T, Halmetoja R, Leinonen H, Kurkela M, Lipponen HR, Sakko S, Karpale M, Salo AM, Sissala N, Röning T, Raza GS, Mäkelä KA, Thevenot J, Herzig KH, Serpi R, Myllyharju J, Tanila H, Koivunen P, Dimova EY. Metabolic characteristics of transmembrane prolyl 4-hydroxylase (P4H-TM) deficient mice. Pflugers Arch 2024:10.1007/s00424-024-02920-5. [PMID: 38396259 DOI: 10.1007/s00424-024-02920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Transmembrane prolyl 4-hydroxylase (P4H-TM) is an enigmatic enzyme whose cellular function and primary substrate remain to be identified. Its loss-of-function mutations cause a severe neurological HIDEA syndrome with hypotonia, intellectual disability, dysautonomia and hypoventilation. Previously, P4H-TM deficiency in mice was associated with reduced atherogenesis and lower serum triglyceride levels. Here, we characterized the glucose and lipid metabolism of P4h-tm-/- mice in physiological and tissue analyses. P4h-tm-/- mice showed variations in 24-h oscillations of energy expenditure, VO2 and VCO2 and locomotor activity compared to wild-type (WT) mice. Their rearing activity was reduced, and they showed significant muscle weakness and compromised coordination. Sedated P4h-tm-/- mice had better glucose tolerance, lower fasting insulin levels, higher fasting lactate levels and lower fasting free fatty acid levels compared to WT. These alterations were not present in conscious P4h-tm-/- mice. Fasted P4h-tm-/- mice presented with faster hepatic glycogenolysis. The respiratory rate of conscious P4h-tm-/- mice was significantly lower compared to the WT, the decrease being further exacerbated by sedation and associated with acidosis and a reduced ventilatory response to both hypoxia and hypercapnia. P4H-TM deficiency in mice is associated with alterations in whole-body energy metabolism, day-night rhythm of activity, glucose homeostasis and neuromuscular and respiratory functions. Although the underlying mechanism(s) are not yet fully understood, the phenotype appears to have neurological origins, controlled by brain and central nervous system circuits. The phenotype of P4h-tm-/- mice recapitulates some of the symptoms of HIDEA patients, making this mouse model a valuable tool to study and develop tailored therapies.
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Affiliation(s)
- Tuulia Ala-Nisula
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Riikka Halmetoja
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Henri Leinonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Margareta Kurkela
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Henna-Riikka Lipponen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Samuli Sakko
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Mikko Karpale
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Antti M Salo
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Niina Sissala
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Tapio Röning
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Ghulam S Raza
- Research Unit of Biomedicine and Internal Medicine, Biocenter Oulu, Medical Research Center and University Hospital, Oulu, Finland
| | - Kari A Mäkelä
- Research Unit of Biomedicine and Internal Medicine, Biocenter Oulu, Medical Research Center and University Hospital, Oulu, Finland
| | - Jérôme Thevenot
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine and Internal Medicine, Biocenter Oulu, Medical Research Center and University Hospital, Oulu, Finland
| | - Raisa Serpi
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Johanna Myllyharju
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
| | - Heikki Tanila
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Peppi Koivunen
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland.
| | - Elitsa Y Dimova
- Biocenter Oulu, Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Aapistie 7C, P.O. Box 5400, 90014, Oulu, Finland
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9
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Park SW, Yeo NY, Kang S, Ha T, Kim TH, Lee D, Kim D, Choi S, Kim M, Lee D, Kim D, Kim WJ, Lee SJ, Heo YJ, Moon DH, Han SS, Kim Y, Choi HS, Oh DK, Lee SY, Park M, Lim CM, Heo J. Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study. J Korean Med Sci 2024; 39:e53. [PMID: 38317451 PMCID: PMC10843974 DOI: 10.3346/jkms.2024.39.e53] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Worldwide, sepsis is the leading cause of death in hospitals. If mortality rates in patients with sepsis can be predicted early, medical resources can be allocated efficiently. We constructed machine learning (ML) models to predict the mortality of patients with sepsis in a hospital emergency department. METHODS This study prospectively collected nationwide data from an ongoing multicenter cohort of patients with sepsis identified in the emergency department. Patients were enrolled from 19 hospitals between September 2019 and December 2020. For acquired data from 3,657 survivors and 1,455 deaths, six ML models (logistic regression, support vector machine, random forest, extreme gradient boosting [XGBoost], light gradient boosting machine, and categorical boosting [CatBoost]) were constructed using fivefold cross-validation to predict mortality. Through these models, 44 clinical variables measured on the day of admission were compared with six sequential organ failure assessment (SOFA) components (PaO2/FIO2 [PF], platelets (PLT), bilirubin, cardiovascular, Glasgow Coma Scale score, and creatinine). The confidence interval (CI) was obtained by performing 10,000 repeated measurements via random sampling of the test dataset. All results were explained and interpreted using Shapley's additive explanations (SHAP). RESULTS Of the 5,112 participants, CatBoost exhibited the highest area under the curve (AUC) of 0.800 (95% CI, 0.756-0.840) using clinical variables. Using the SOFA components for the same patient, XGBoost exhibited the highest AUC of 0.678 (95% CI, 0.626-0.730). As interpreted by SHAP, albumin, lactate, blood urea nitrogen, and international normalization ratio were determined to significantly affect the results. Additionally, PF and PLTs in the SOFA component significantly influenced the prediction results. CONCLUSION Newly established ML-based models achieved good prediction of mortality in patients with sepsis. Using several clinical variables acquired at the baseline can provide more accurate results for early predictions than using SOFA components. Additionally, the impact of each variable was identified.
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Affiliation(s)
- Sang Won Park
- Department of Medical Informatics, School of Medicine, Kangwon National University, Chuncheon, Korea
- Institute of Medical Science, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Na Young Yeo
- Department of Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
| | - Seonguk Kang
- Department of Convergence Security, Kangwon National University, Chuncheon, Korea
| | - Taejun Ha
- Department of Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Korea
| | - Tae-Hoon Kim
- University-Industry Cooperation Foundation, Kangwon National University, Chuncheon, Korea
| | - DooHee Lee
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Dowon Kim
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Seheon Choi
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Minkyu Kim
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - DongHoon Lee
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - DoHyeon Kim
- Department of Research and Development, ZIOVISION Co. Ltd., Chuncheon, Korea
| | - Woo Jin Kim
- Department of Medical Informatics, School of Medicine, Kangwon National University, Chuncheon, Korea
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seung-Joon Lee
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yeon-Jeong Heo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Da Hye Moon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seon-Sook Han
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yoon Kim
- University-Industry Cooperation Foundation, Kangwon National University, Chuncheon, Korea
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, Korea
| | - Hyun-Soo Choi
- University-Industry Cooperation Foundation, Kangwon National University, Chuncheon, Korea
- Department of Computer Science and Engineering, Seoul National University of Science and Technology, Seoul, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - MiHyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeongwon Heo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
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Zeng J, Chen J, Zhang L, Chen L, Liang W, You Z, Lin K, Guo Y. Lactate dehydrogenase-to-albumin ratio: A superior inflammatory marker for predicting contrast-associated acute kidney injury after percutaneous coronary intervention. Clin Cardiol 2024; 47:e24219. [PMID: 38402549 PMCID: PMC10823551 DOI: 10.1002/clc.24219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/26/2024] Open
Abstract
PURPOSE Inflammation is commonly considered a mechanism underlying contrast-associated acute kidney injury (CA-AKI). This study aimed to explore the predictive capability of the novel inflammatory marker lactate dehydrogenase-to-albumin ratio (LAR) for CA-AKI following percutaneous coronary intervention (PCI), and further compare it with other common inflammatory biomarkers. METHODS This study enrolled 5,435 patients undergoing elective PCI. The primary outcome was CA-AKI, and the secondary outcome was all-cause mortality. All patients were grouped into three groups based on the LAR tertiles. RESULTS Three hundred fifteen patients (5.8%) experienced CA-AKI during hospitalization. The fully adjusted logistic regression suggested a significant increase in the risk of CA-AKI in LAR Tertile 3 (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.68-3.83, p < .001) and Tertile 2 (OR: 2.11, 95% CI: 1.42-3.20, p < .001) compared to Tertile 1. Additionally, receiver operating characteristic (ROC) analysis demonstrated that LAR exhibited significantly superior predictive capability for CA-AKI compared to other inflammatory biomarkers. Regarding the secondary outcome, multivariate COX regression analysis showed a positive correlation between elevated LAR levels and all-cause mortality. CONCLUSION In patients undergoing elective PCI, LAR was significantly independently associated with CA-AKI, and it stood out as the optimal inflammatory biomarker for predicting CA-AKI.
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Affiliation(s)
- Ji‐Lang Zeng
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Jun‐Han Chen
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Li‐Wei Zhang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Li‐Chuan Chen
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Wen‐Jia Liang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Zhebin You
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
- Fujian Key Laboratory of Geriatrics, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for GeriatricsFujian Medical UniversityFuzhouFujianChina
| | - Kai‐Yang Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
| | - Yansong Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for GeriatricsFujian Provincial Clinical Research Center for Severe Acute Cardiovascular DiseasesFuzhouChina
- Fujian Heart Failure Center AllianceFuzhouChina
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11
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Stevic I, Bolsover J, Moore R, Bhayana V. Long term stability of lactate in uncentrifuged sodium fluoride/potassium oxalate blood collection tubes. Ann Clin Biochem 2023:45632231213746. [PMID: 37903217 DOI: 10.1177/00045632231213746] [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: 11/01/2023]
Abstract
BACKGROUND Delayed time from collection to centrifugation may cause erroneously high lactate levels in vitro (from continued blood cell metabolism under anaerobic conditions in the collection tube) if not collected in appropriate collection devices, consequently increasing the risk for inappropriate patient care or harm. We undertook a study to determine the turnaround time for lactate testing in a tertiary care setting and also performed short- and long-term lactate stability studies in blood collected in sodium fluoride/potassium oxalate (NaF/KOx) collection tubes. METHODS The hospital lab information system was mined for 6 months to determine patient samples that may have exceeded the time from collection-to-receival in lab of 15-min. Lactate stability was evaluated in unspun NaF/KOx collection tubes at 15 min intervals for to 2 h; and separately at 2, 6, 12, 24, and 48-h post-collection. RESULTS A total of 8,929 plasma samples were collected in 6 months, and 1/3 were not received in the lab within 15 min from collection. In NaF/KOx additive, lactate levels had minor increases over 2 h, and incremental increases at an average rate of 0.0035 mmol/L/h over 48 h with maximum increase of 9.8% at 48 h. However, the average change across all time points were within local allowable performance goals (at ≤4 mmol/L ± 0.5 mmol/L; at >4 mmol/L ± 12%). CONCLUSION A small proportion of lactate specimens may experience delay in processing. Although lactate levels may incrementally increase over 48-h at room temperature in unspun NaF/KOx collection tubes, the changes may not be clinically impactful.
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Affiliation(s)
- Ivan Stevic
- Pathology and Laboratory Medicine (PaLM), London Health Sciences Centre, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Jade Bolsover
- Pathology and Laboratory Medicine (PaLM), London Health Sciences Centre, London, ON, Canada
| | - Rick Moore
- Pathology and Laboratory Medicine (PaLM), London Health Sciences Centre, London, ON, Canada
| | - Vipin Bhayana
- Pathology and Laboratory Medicine (PaLM), London Health Sciences Centre, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
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12
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He W, Fu X, Chen S. Advancing polytrauma care: developing and validating machine learning models for early mortality prediction. J Transl Med 2023; 21:664. [PMID: 37743498 PMCID: PMC10518974 DOI: 10.1186/s12967-023-04487-8] [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: 05/26/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Rapid identification of high-risk polytrauma patients is crucial for early intervention and improved outcomes. This study aimed to develop and validate machine learning models for predicting 72 h mortality in adult polytrauma patients using readily available clinical parameters. METHODS A retrospective analysis was conducted on polytrauma patients from the Dryad database and our institution. Missing values pertinent to eligible individuals within the Dryad database were compensated for through the k-nearest neighbor algorithm, subsequently randomizing them into training and internal validation factions on a 7:3 ratio. The patients of our institution functioned as external validation cohorts. The predictive efficacy of random forest (RF), neural network, and XGBoost models was assessed through an exhaustive suite of performance indicators. The SHapley Additive exPlanations (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME) methods were engaged to explain the supreme-performing model. Conclusively, restricted cubic spline analysis and multivariate logistic regression were employed as sensitivity analyses to verify the robustness of the findings. RESULTS Parameters including age, body mass index, Glasgow Coma Scale, Injury Severity Score, pH, base excess, and lactate emerged as pivotal predictors of 72 h mortality. The RF model exhibited unparalleled performance, boasting an area under the receiver operating characteristic curve (AUROC) of 0.87 (95% confidence interval [CI] 0.84-0.89), an area under the precision-recall curve (AUPRC) of 0.67 (95% CI 0.61-0.73), and an accuracy of 0.83 (95% CI 0.81-0.86) in the internal validation cohort, paralleled by an AUROC of 0.98 (95% CI 0.97-0.99), an AUPRC of 0.88 (95% CI 0.83-0.93), and an accuracy of 0.97 (95% CI 0.96-0.98) in the external validation cohort. It provided the highest net benefit in the decision curve analysis in relation to the other models. The outcomes of the sensitivity examinations were congruent with those inferred from SHAP and LIME. CONCLUSIONS The RF model exhibited the best performance in predicting 72 h mortality in adult polytrauma patients and has the potential to aid clinicians in identifying high-risk patients and guiding clinical decision-making.
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Affiliation(s)
- Wen He
- Reproductive Medicine Center, Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, No. 100, Minjiang Avenue, Quzhou, 324000, Zhejiang, China
| | - Xianghong Fu
- Reproductive Medicine Center, Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, No. 100, Minjiang Avenue, Quzhou, 324000, Zhejiang, China
| | - Song Chen
- Department of Orthopedics, Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, No. 100, Minjiang Avenue, Quzhou, 324000, Zhejiang, China.
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13
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Reintam Blaser A, Starkopf J, Björck M, Forbes A, Kase K, Kiisk E, Laisaar KT, Mihnovits V, Murruste M, Mändul M, Voomets AL, Tamme K. Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:44. [PMID: 37658356 PMCID: PMC10474684 DOI: 10.1186/s13017-023-00512-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Acute mesenteric ischaemia (AMI) is a disease with different pathophysiological mechanisms, leading to a life-threatening condition that is difficult to diagnose based solely on clinical signs. Despite widely acknowledged need for biomarkers in diagnosis of AMI, a broad systematic review on all studied biomarkers in different types of AMI is currently lacking. The aim of this study was to estimate the diagnostic accuracy of all potential biomarkers of AMI studied in humans. METHODS A systematic literature search in PubMed, The Cochrane Library, Web of Science and Scopus was conducted in December 2022. Studies assessing potential biomarkers of AMI in (at least 10) adult patients and reporting their diagnostic accuracy were included. Meta-analyses of biomarkers' sensitivity, specificity, and positive and negative likelihood ratios were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed with the QUADAS-2 tool. RESULTS Seventy-five studies including a total of 9914 patients assessed 18 different biomarkers in serum/plasma and one in urine (each reported in at least two studies), which were included in meta-analyses. None of the biomarkers reached a conclusive level for accurate prediction. The best predictive value overall (all studies with any type and stage of AMI pooled) was observed for Ischaemia-modified albumin (2 studies, sensitivity 94.7 and specificity 90.5), interleukin-6 (n = 4, 96.3 and 82.6), procalcitonin (n = 6, 80.1 and 86.7), and intestinal fatty acid-binding protein (I-FABP) measured in serum (n = 16, 73.9 and 90.5) or in urine (n = 4, 87.9 and 78.9). In assessment of transmural mesenteric ischaemia, urinary I-FABP (n = 2, 92.3 and 85.2) and D-dimer (n = 3, 87.6 and 83.6) showed moderate predictive value. Overall risk of bias was high, mainly because of selected study populations and unclear timings of the biomarker measurements after onset of symptoms. Combinations of biomarkers were rarely studied, not allowing meta-analyses. CONCLUSIONS None of the studied biomarkers had sufficient sensitivity and specificity to diagnose AMI, although some biomarkers showed moderate predictive accuracy. Future studies should focus on timing of measurements of biomarkers, distinguishing between early stage and transmural necrosis, and between different types of AMI. Additionally, studies on combinations of biomarkers are warranted. PROSPERO registration: CRD42022379341.
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Affiliation(s)
- Annika Reintam Blaser
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Joel Starkopf
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Martin Björck
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Alastair Forbes
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - Karri Kase
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Department of Surgery, Tartu University Hospital, Tartu, Estonia
| | - Ele Kiisk
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kaja-Triin Laisaar
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Vladislav Mihnovits
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Marko Murruste
- Department of Surgery, Tartu University Hospital, Tartu, Estonia
| | - Merli Mändul
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anna-Liisa Voomets
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Kadri Tamme
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
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Ray CC, Pollack MM, Gai J, Patel AK. The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients. Pediatr Crit Care Med 2023; 24:760-766. [PMID: 37171215 PMCID: PMC10523881 DOI: 10.1097/pcc.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To compare the relative associations of lactate, albumin, and the lactate-albumin ratio (LAR) measured early in disease course against mortality and prevalence of multiple organ dysfunction syndrome (MODS) in a general sample of critically ill pediatric patients. DESIGN Retrospective analysis of the Health Facts (Cerner Corporation, Kansas City, MO) national database. SETTING U.S. hospitals with PICUs. PATIENTS Children admitted to the ICU ( n = 648) from 2009 to 2018 who had lactate and albumin measured within 6 hours of admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 648 admissions were included, with an overall mortality rate of 10.8% ( n = 70) and a MODS prevalence of 29.3% ( n = 190). Compared with survivors, deaths had higher initial lactates (7.3 mmol/L [2.6-11.7 mmol/L] vs 1.9 mmol/L [1.2-3.1 mmol/L]; p < 0.01), lower initial albumins (3.3 g/dL [2.7-3.8 g/dL] vs 4.2 g/dL [3.7-4.7 g/dL]; p < 0.01), and higher LARs (2.2 [1.0-4.2] vs 0.5 [0.3-0.8]; p < 0.01), with similar trends in patients with MODS versus those without MODS. LAR demonstrated a higher odds ratio (OR) for death than initial lactate alone (2.34 [1.93-2.85] vs 1.29 [1.22-1.38]) and a higher OR for MODS than initial lactate alone (2.10 [1.73-2.56] vs 1.22 [1.16-1.29]). Area under the receiver operating characteristic (AUROC) curve of LAR for mortality was greater than initial lactate (0.86 vs 0.82; p < 0.01). The LAR AUROC for MODS was greater than the lactate AUROC (0.71 vs 0.66; p < 0.01). Trends of lactate, albumin, and LAR for mortality were consistent across several diagnostic subgroups (trauma, primary respiratory failure, toxicology), but not all. CONCLUSIONS LAR measured early in the course of critical illness is significantly associated with mortality and development of MODS when compared with initial lactate or initial albumin alone in critically ill pediatric patients.
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Affiliation(s)
- Christopher C Ray
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System, Washington, DC
| | - Murray M Pollack
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jiaxiang Gai
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Anita K Patel
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC
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15
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Butt W. The Lactate-Albumin Ratio Predicts Multiple Organ Dysfunction Syndrome and Death, But Is It Ready to Use? Pediatr Crit Care Med 2023; 24:785-787. [PMID: 37668501 DOI: 10.1097/pcc.0000000000003317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Warwick Butt
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Faculty of Medicine, Melbourne University, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
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16
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Bukofzer S, Harris G, Cable EE. OCE-205 in rats and non-human primates: Pharmacokinetic and pharmacodynamic analysis. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2023; 5:100163. [PMID: 37608843 PMCID: PMC10440361 DOI: 10.1016/j.crphar.2023.100163] [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: 03/24/2023] [Revised: 04/04/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
Treatment for complications associated with the hemodynamic consequences of decompensated cirrhosis remains suboptimal. Terlipressin, the latest pharmacological management of hepatorenal syndrome-acute kidney injury (HRS-AKI), targets the vasopressin system but has serious side effects. OCE-205 is a novel peptide designed to target the vasopressin receptor system as a mixed V1a agonist/antagonist, resulting in effective partial agonism without V2 agonism. We examined the in vivo pharmacokinetic/pharmacodynamic properties of OCE-205 in healthy rats and cynomolgus monkeys. OCE-205 was administered by IV or SC bolus injection; arginine vasopressin (AVP) or terlipressin were comparators. After IV OCE-205 administration in rats, mean plasma concentration decreased in a mostly linear manner to 2 mg/mL after 120 min, and for SC administration, slowly decreased to ∼50 ng/mL after 300 min. Compared with pre-test values, arterial blood pressure values significantly increased after all OCE-205 doses tested. For monkeys, the concentration after IV OCE-205 administration was mostly linear to 5 ng/mL after 180 min, and for SC administration, ∼3 ng/mL after 480 min. Subcutaneous OCE-205 administration increased mean arterial pressure (MAP) versus baseline, with ΔMAP in OCE-205-treated animals marked and long-lasting while terlipressin induced an increase from baseline in MAP, with negligible ΔMAP, on average, by 150 min after administration in all groups. AVP, but not OCE-205, significantly increased blood lactate concentrations. OCE-205 was well tolerated in adult male rats and cynomolgus monkeys following single-dose bolus administration. The preclinical results of OCE-205, with its demonstrated V1a selective partial agonist activity and potentially tolerable safety profile, suggest its potential utility for treatment of the cardiovascular complications of cirrhosis. Institutional protocol number Procedures were approved by the Ferring Research Institute (FRI) Institutional Animal Care and Use Committee (IACUC) on November 27, 2006 under protocol FRI 06-011, and by the Sinclair Research Center IACUC under protocol S11177.
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Affiliation(s)
| | - Geoff Harris
- Ferring Research Institute Inc., San Diego, CA, USA
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17
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Al-Qudsi O, Reynolds JM, Haney JC, Welsby IJ. Voxelotor as a Treatment of Persistent Hypoxia in the ICU. Chest 2023; 164:e1-e4. [PMID: 37423700 DOI: 10.1016/j.chest.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 07/11/2023] Open
Abstract
Hypoxia is encountered frequently in the ICU as a result of a wide range of pathologic characteristics. The oxygen-hemoglobin dissociation curve describes hemoglobin's affinity for a given Po2 and factors affecting uptake and offload. Research in manipulating this relationship between hemoglobin and oxygen is sparing. Voxelotor is a hemoglobin oxygen-affinity modulator that is approved by the US Food and Drug Association for use in the management of sickle cell disease. We present two patients without sickle cell disease who underwent treatment with this novel agent to assist with chronic hypoxia and weaning of mechanical support.
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Affiliation(s)
- Omar Al-Qudsi
- Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - John M Reynolds
- Division of Transplant Pulmonology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - John C Haney
- Division of Thoracic Transplant Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Ian J Welsby
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Muzaffar SN, Pradhan A, Siddiqui SS, Roy S, Suresh T. Monitoring Macro- and Microcirculation in the Critically Ill: A Narrative Review. Avicenna J Med 2023; 13:138-150. [PMID: 37799180 PMCID: PMC10550369 DOI: 10.1055/s-0043-1772175] [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] [Indexed: 10/07/2023] Open
Abstract
Circulatory shock is a common and important diagnosis in the critical care environment. Hemodynamic monitoring is quintessential in the management of shock. The currently used hemodynamic monitoring devices not only measure cardiac output but also provide data related to the prediction of fluid responsiveness, extravascular lung water, and also pulmonary vascular permeability. Additionally, these devices are minimally invasive and associated with fewer complications. The area of hemodynamic monitoring is progressively evolving with a trend toward the use of minimally invasive devices in this area. The critical care physician should be well-versed with current hemodynamic monitoring limitations and stay updated with the upcoming advances in this field so that optimal therapy can be delivered to patients in circulatory shock.
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Affiliation(s)
- Syed Nabeel Muzaffar
- Department of Critical Care Medicine, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Suhail Sarwar Siddiqui
- Department of Critical Care Medicine, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Shubhajeet Roy
- Faculty of Medical Sciences, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Timil Suresh
- Faculty of Medical Sciences, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
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19
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Kurniawati ER, Weerwind PW, Maessen JG. Understanding lactate and its clearance during extracorporeal membrane oxygenation for supporting refractory cardiogenic shock patients. BMC Cardiovasc Disord 2023; 23:305. [PMID: 37328823 PMCID: PMC10276462 DOI: 10.1186/s12872-023-03221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/30/2023] [Indexed: 06/18/2023] Open
Affiliation(s)
- E R Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, PO Box 5800, P. Debyelaan 25, 6202 AZ, Maastricht, the Netherlands.
| | - P W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, PO Box 5800, P. Debyelaan 25, 6202 AZ, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - J G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, PO Box 5800, P. Debyelaan 25, 6202 AZ, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
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20
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Priyanka A, Ganapathy U, Choudhary R, Arulprakasam S, Krishna C M R, Calairadjane J. A Comparative Study of Peri-Operative Fluid Therapy With Ringer Lactate and PlasmaLyte in Children Undergoing Intra-Abdominal Surgery: A Randomized Control Trial. Cureus 2023; 15:e39124. [PMID: 37332412 PMCID: PMC10273782 DOI: 10.7759/cureus.39124] [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] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Background In this study, we compared Ringer's lactate solution (RL) with PlasmaLyte (PL), a relatively new IV fluid, for perioperative fluid therapy in the pediatric population. Methods This prospective and interventional randomized comparative study was carried out after obtaining clearance from the Institutional Ethics Committee. The study period was from November 2016 to December 2017. Results Hemodynamic parameters such as SpO2, ETCO2, heart rate, blood pressure, temperature, and urine output were stable in both groups throughout the perioperative period without any statistically or clinically significant variations. Children receiving PL (group PL) had better acid-base status, serum electrolytes, and blood lactate profiles compared with children receiving RL (group RL), who had hyponatremia and increased blood lactate levels, which continued to increase in the immediate postoperative period. No significant differences in pH, pCO2, HCO3, serum potassium, serum chloride, blood urea, serum creatinine, or blood sugar were observed. Conclusions PL is better than RL for perioperative fluid therapy in children undergoing abdominal surgeries.
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Affiliation(s)
- Andal Priyanka
- Anesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Usha Ganapathy
- Anesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rajneesh Choudhary
- Anesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Santhosh Arulprakasam
- Anesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Rakhi Krishna C M
- Anesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Jeevasri Calairadjane
- Anesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
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21
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Yadigaroğlu M, Çömez VV, Gültekin YE, Ceylan Y, Yanık HT, Yadigaroğlu NÖ, Yücel M, Güzel M. Can lactate levels and lactate kinetics predict mortality in patients with COVID-19 with using qCSI scoring system? Am J Emerg Med 2023; 66:45-52. [PMID: 36682102 PMCID: PMC9832691 DOI: 10.1016/j.ajem.2023.01.019] [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: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION In this study, we aimed to investigate the relationship between blood lactate levels and lactate kinetics (lactate clearance and Δ lactate) for predicting mortality in patients with COVID-19 admitted to the emergency department. METHODS This study was performed as a retrospective study that included patients admitted to the emergency department between March 1st, 2020, and January 1st, 2022. Lactate levels were recorded at the first admission (0 h lactate) and the highest blood lactate levels in the first 24 h of follow-up (2nd highest lactate). Lactate kinetics were calculated. Clinical severity was determined according to the quick COVID Severity Index (qCSI). RESULTS 300 patients were included in the study. Lactate levels at admission were similar in groups with or without mortality, but 2nd highest lactate levels were found to be significantly higher in the group with mortality (p < 0.001). Lactate clearance and ∆ lactate levels were also found to be lower in the mortality group (p < 0.001). Lactate kinetics in patients in the clinically low severity group were lower in the mortality group (p = 0.02 and p = 0.039, respectively). In the low-intermediate and high-intermediate groups, 0-h lactate and 2nd highest lactate levels were found to be higher in the mortality group, and lactate kinetics were similar in the groups with and without mortality. In the group with high clinical severity, 2nd highest lactate levels were found to be higher in the group with mortality (p = 0.010). Lactate kinetics were also found to be significantly lower in the mortality group (p < 0.001). In the high qCSI group, based on ROC analysis, the AUC for 2nd highest lactate levels predicting mortality was 0.642 (95% CI: 0.548-0.728). The optimal cut-off value for mortality was greater than >2.4 mmol/L (60.6% sensitivity, 67.4% specificity). The AUC for lactate clearance was 0.748 (95% CI: 0.659-0.824). The lactate clearance cut-off value was ≤ -177.78% (49.3% sensitivity, 100% specificity). The AUC for ∆ lactate was 0.707 (95% CI: 0.616-0.787). The optimal ∆ lactate cut-off was ≤ -2 mmol/L (45.1% sensitivity, 93.5% specificity). CONCLUSION In COVID-19, 2nd highest blood lactate and lactate kinetics were found to be prognostic indicators of the disease. High 2nd highest lactate levels and low lactate kinetics in patients with high clinical severity were guiding physicians regarding the outcome of the disease.
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Affiliation(s)
- Metin Yadigaroğlu
- Department of Emergency Medicine, Samsun University, Faculty of Medicine, Samsun, Turkey
| | - Vecdi Vahdet Çömez
- Department of Emergency Medicine, Samsun Education and Research Hospital, Samsun, Turkey
| | - Yunus Emre Gültekin
- Department of Emergency Medicine, Samsun Education and Research Hospital, Samsun, Turkey
| | - Yasin Ceylan
- Department of Emergency Medicine, Samsun Education and Research Hospital, Samsun, Turkey
| | - Hüseyin Tufan Yanık
- Department of Emergency Medicine, Samsun Education and Research Hospital, Samsun, Turkey
| | | | - Murat Yücel
- Department of Emergency Medicine, Samsun University, Faculty of Medicine, Samsun, Turkey
| | - Murat Güzel
- Department of Emergency Medicine, Samsun Education and Research Hospital, Samsun, Turkey.
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22
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Boyarski A, Shlush N, Paz S, Eichler J, Alfonta L. Electrochemical characterization of a dual cytochrome-containing lactate dehydrogenase. Bioelectrochemistry 2023; 152:108406. [PMID: 36931144 DOI: 10.1016/j.bioelechem.2023.108406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
Flavin-dependent L-lactate dehydrogenase (LDH) from baker's yeast (Saccharomyces cerevisiae) reversibly catalyzes the oxidation of L-lactate to L-pyruvate. In this study, four different enzymatic constructs were generated, and their catalytic and electrochemical properties were compared. Specifically, a truncated form of the native enzyme that includes only the catalytic domain, the native enzyme that includes an intrinsic electron-transferring cytochrome b2, a novel artificial enzyme containing a minimal cytochrome c and a version of the enzyme containing a fusion between two cytochromes were designed. All four variants were successfully expressed in Escherichia coli and presented properly matured heme domains. Assessing in vitro biocatalytic performance as reflected by lactate oxidation revealed the fusion-containing enzyme to be ∼ 12 times more active than the native enzyme. Electrochemical studies of electrode drop-casted enzyme variants also showed the superior performance of the dual-cytochrome construct, which displayed a lower average redox-potential for lactate oxidation, oxygen insensitivity in the lactate oxidation potential range and a wider dynamic range for lactate sensing, relative to the native enzyme. Moreover, product inhibition of this variant occurred at much higher lactate concentrations than with the native enzyme. In addition, when lower potentials were scanned using cyclic voltammetry, lactate-dependent oxygen reduction was measured for the dual-cytochrome fusion enzyme.
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Affiliation(s)
- Anastasya Boyarski
- Department of Chemistry, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 8410501, Israel
| | - Noam Shlush
- Department of Life Sciences, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 8410501, Israel
| | - Shiraz Paz
- Department of Life Sciences, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 8410501, Israel
| | - Jerry Eichler
- Department of Life Sciences, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 8410501, Israel
| | - Lital Alfonta
- Department of Chemistry, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 8410501, Israel; Department of Life Sciences, Ben-Gurion University of the Negev, P.O.Box 653, Beer-Sheva 8410501, Israel.
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23
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Abstract
BACKGROUND Although serum lactate levels are widely accepted markers of haemodynamic instability, an alternative method to evaluate haemodynamic stability/instability continuously and non-invasively may assist in improving the standard of patient care. We hypothesise that blood lactate in paediatric ICU patients can be predicted using machine learning applied to arterial waveforms and perioperative characteristics. METHODS Forty-eight post-operative children, median age 4 months (2.9-11.8 interquartile range), mean baseline heart rate of 131 beats per minute (range 33-197), mean lactate level at admission of 22.3 mg/dL (range 6.3-71.1), were included. Morphological arterial waveform characteristics were acquired and analysed. Predicting lactate levels was accomplished using regression-based supervised learning algorithms, evaluated with hold-out cross-validation, including, basing prediction on the currently acquired physiological measurements along with those acquired at admission, as well as adding the most recent lactate measurement and the time since that measurement as prediction parameters. Algorithms were assessed with mean absolute error, the average of the absolute differences between actual and predicted lactate concentrations. Low values represent superior model performance. RESULTS The best performing algorithm was the tuned random forest, which yielded a mean absolute error of 3.38 mg/dL when predicting blood lactate with updated ground truth from the most recent blood draw. CONCLUSIONS The random forest is capable of predicting serum lactate levels by analysing perioperative variables, including the arterial pressure waveform. Thus, machine learning can predict patient blood lactate levels, a proxy for haemodynamic instability, non-invasively, continuously and with accuracy that may demonstrate clinical utility.
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24
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Troiano AT, Peel M, Cameron AI, Bast R, Flewelling L, Abbott J, Barron H. INVESTIGATING BLOOD LACTATE CONCENTRATION AS A PROGNOSTIC INDICATOR FOR BIRDS PRESENTING WITH BREVETOXICOSIS: 2020-2021. J Zoo Wildl Med 2023; 54:23-31. [PMID: 36971625 DOI: 10.1638/2022-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 03/29/2023] Open
Abstract
Large blooms of the dinoflagellate Karenia brevis cause annual harmful algal bloom events, or "red tides" on Florida's Gulf Coast. Each year, the Clinic for the Rehabilitation of Wildlife (CROW) is presented with hundreds of cases of aquatic birds that exhibit neurologic clinical signs due to brevetoxicosis. Double-crested cormorants (Phalacrocorax auratus) are the most common species seen, and typically present with a combination of ataxia, head tremors, knuckling, and/or lagophthalmos. Blood lactate levels are known to increase in mammals for a variety of reasons, including stress, hypoxia, sepsis, and trauma, but there is limited literature on blood lactate values in avian species. The objective of this study was to determine the prognostic value of blood lactate concentration on successful rehabilitation and release of birds presenting with clinical signs consistent with brevetoxicosis. Blood lactate levels were collected on intake, the morning after presentation and initial therapy, and prior to disposition (release or euthanasia) from 194 birds (including 98 cormorants) representing 17 species during the 2020-2021 red tide season. Overall, mean blood lactate at intake, the morning after intake, and predisposition was 2.9, 2.8, and 3.2 mmol/L, respectively, for released birds across all species (2.9, 2.9, and 3.2 mmol/L for released cormorants); 3.4, 3.4, and 6.5 mmol/L for birds that died (4.0, 3.5, and 7.9 mmol/L for cormorants that died); and 3.1, 3.5, and 4.7 mmol/L for birds that were euthanized (3.5, 4.7, and 4.9 mmol/L for cormorants that were euthanized). On average, birds that died or were euthanized had an elevated lactate at all time points as compared to those that were released, but these results were not statistically significant (P = 0.13). These results indicate that blood lactate levels do not appear to be useful as a prognostic indicator for successful release of birds, including double-crested cormorants, affected by brevetoxicosis.
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Affiliation(s)
| | - Melanie Peel
- Clinic for the Rehabilitation of Wildlife, Sanibel, FL 33957 USA
| | | | - Robin Bast
- Clinic for the Rehabilitation of Wildlife, Sanibel, FL 33957 USA
| | - Leanne Flewelling
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - Jay Abbott
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL 33701, USA
| | - Heather Barron
- Clinic for the Rehabilitation of Wildlife, Sanibel, FL 33957 USA
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25
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Validation of Sequential ROX-Index Score Beyond 12 Hours in Predicting Treatment Failure and Mortality in COVID-19 Patients Receiving Oxygen via High-Flow Nasal Cannula. Can Respir J 2023; 2023:7474564. [PMID: 36817550 PMCID: PMC9931457 DOI: 10.1155/2023/7474564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/25/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
Background High-flow nasal cannula (HFNC) is an oxygen delivery method shown to reduce the risk of intubation and mortality in patients with type 1 respiratory failure. The ROX-index score can predict HFNC failure. This study aims to evaluate sequential ROX-index assessments as predictors of HFNC failure and mortality. Methods Prospective observational single-center study including all adult patients with positive SARS-CoV-2 PCR placed under HFNC from 1st November 2020 to 31st May 2021, and patients with hemodynamic instability or unable to tolerate HFNC were excluded. The primary endpoint was successful HFNC de-escalation. Results In univariate analysis, HFNC de-escalation was associated with younger age (59.2 ± 14 vs. 67.7 ± 10.5 and p < 0.001), lower levels of serum lactate (1.1 vs. 1.5 and p=0.013), and higher ROX-index at 12 hrs (5.09 vs. 4.13 and p < 0.001). ROC curve analysis of ROX-index at 12 hrs yielded a c-statistic of 71.2% (95% CI 61.6-80.9 and p < 0.001). ROX-index at 12 hrs and age retained significance in multivariate analysis. Using an optimal cutoff point of 4.43, we calculated a sensitivity of 64.5% and specificity of 69.6%. In univariate survival analysis, older age (68.8 ± 9.7 vs. 58.9 ± 13.9 and p < 0.001), greater creatinine values (0.96 vs. 0.84 and p=0.022), greater SOFA score (p=0.039), and a lower 12 hrs ROX-index (4.22 vs. 4.95 and p=0.02) were associated with hospital mortality. The SOFA score and age retained significance in multivariate survival analysis. Conclusion ROX-index is proven to be a valuable and easy-to-use tool for clinicians in the assessment of COVID-19 patients under HFNC.
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26
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Rocha AC, Chagas JB, Andrade JV, Pinto C, Oliveira G, Dias AS, Carvalho L. The prognostic value of delta-lactate in critically ill children. J Paediatr Child Health 2023; 59:328-334. [PMID: 36479722 PMCID: PMC10107697 DOI: 10.1111/jpc.16294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/30/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
AIM This study aimed to test delta-lactate (ΔL) as a short-term risk stratification method in critically ill children. METHODS An exploratory study of patients admitted to paediatric intensive care unit (PICU) was conducted. ΔL was calculated as the difference between the maximum lactate concentrations on Days 1 and 2. According to the ΔL cutoff, two groups were considered: low mortality risk (LMR) - ΔL ≥ 0.05 mmol/L - and high mortality risk (HMR) - ΔL < 0.05 mmol/L. RESULTS Mortality, both during PICU stay and at 28 days, was statistically associated with elevated serum lactate on D1 and D2, per se. For the 93 cases with elevated lactate on Day 1, and a ΔL cutoff of 0.05 mmol/L, the area under the ROC curve was 0.698 (95% confidence interval, 0.47-0.93). HMR patients scored higher PIM3, were not discharged home until 28 days, counted fewer ventilation-free days and needed renal replacement therapy more often. CONCLUSION Elevated lactate levels at admission, as well as applying the optimal cutoff for ΔL, allowed to predict short-term mortality: if an increase or minimal decrease in lactate maximum levels occurred from D1 to D2, death was almost eight times more probable. In critically ill children, delta-lactate predicts short-term outcome.
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Affiliation(s)
- Ana C Rocha
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Joana B Chagas
- Pediatric Department, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra (HP-CHUC), Coimbra, Portugal
| | - Joana V Andrade
- Pediatric Intensive Care Unit, Hospital Pediátrico (HP-CHUC), Coimbra, Portugal
| | - Carla Pinto
- Pediatric Intensive Care Unit, Hospital Pediátrico (HP-CHUC), Coimbra, Portugal.,Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Guiomar Oliveira
- Pediatric Department, Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra (HP-CHUC), Coimbra, Portugal.,Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.,Child Development Center and Centro de Investigação e Formação Clínica, Hospital Pediátrico (HP-CHUC), Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Andrea S Dias
- Pediatric Intensive Care Unit, Hospital Pediátrico (HP-CHUC), Coimbra, Portugal.,Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Leonor Carvalho
- Pediatric Intensive Care Unit, Hospital Pediátrico (HP-CHUC), Coimbra, Portugal
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27
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Controls of Central and Peripheral Blood Pressure and Hemorrhagic/Hypovolemic Shock. J Clin Med 2023; 12:jcm12031108. [PMID: 36769755 PMCID: PMC9917827 DOI: 10.3390/jcm12031108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
The pressure exerted on the heart and blood vessels because of blood flow is considered an essential parameter for cardiovascular function. It determines sufficient blood perfusion, and transportation of nutrition, oxygen, and other essential factors to every organ. Pressure in the primary arteries near the heart and the brain is known as central blood pressure (CBP), while that in the peripheral arteries is known as peripheral blood pressure (PBP). Usually, CBP and PBP are correlated; however, various types of shocks and cardiovascular disorders interfere with their regulation and differently affect the blood flow in vital and accessory organs. Therefore, understanding blood pressure in normal and disease conditions is essential for managing shock-related cardiovascular implications and improving treatment outcomes. In this review, we have described the control systems (neural, hormonal, osmotic, and cellular) of blood pressure and their regulation in hemorrhagic/hypovolemic shock using centhaquine (Lyfaquin®) as a resuscitative agent.
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28
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Yahyapoor F, Keshani M, Sedaghat A, Feizi A, Clark CCT, Bagherniya M, Safarian M, Badpeyma M, Norouzy A. The effects of adjunctive treatment with L-carnitine on monitoring laboratory variables in ICU patients: a double-blinded randomized controlled clinical trial. Trials 2023; 24:3. [PMID: 36597167 PMCID: PMC9808964 DOI: 10.1186/s13063-022-07010-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Critically ill patients must be monitored constantly in intensive care units (ICUs). Among many laboratory variables, nutritional status indicators are a key role in the prognosis of diseases. We investigated the effects of L-carnitine adjunctive therapy on monitoring variables in critical illness. METHOD A prospective, double-blind, randomized controlled trial was implemented in a medical ICU. Participants were 54 patients, aged > 18 years, with multiple conditions, randomly assigned to receive 3 g L-carnitine per day or placebo, along with enteral feeding, for 1 week. Primary outcomes included monitoring variables related to nutritional status. RESULT Of 54 patients randomly assigned, 51 completed the trial. Serum albumin (Alb) (P-value: 0.001), total protein (P-value: 0.003), and calcium (Ca) (0.044) significantly increased in the intervention vs. control group. Alanine transaminase (ALT) (0.022), lactate (<0.001), creatinine (Cr) (0.005), and international normalized ratio (INR) (0.049) decreased meaningfully in the intervention vs. control group. CONCLUSION L-Carnitine supplementation in critically ill patients can improve several parameters including INR, Cr, ALT, lactate, Ca, Alb, and total protein. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT 20151108024938N2. This trial was approved by the Research Ethics Committee of Mashhad University of Medical Sciences (registration code: IR.MUMS.fm.REC.1396.671) (available at https://en.irct.ir/trial/30748 , May 2018).
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Affiliation(s)
- Farveh Yahyapoor
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Keshani
- grid.411036.10000 0001 1498 685XFood Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Sedaghat
- grid.411583.a0000 0001 2198 6209Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Awat Feizi
- grid.411036.10000 0001 1498 685XBiostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Cain C. T. Clark
- grid.8096.70000000106754565Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB UK
| | - Mohammad Bagherniya
- grid.411036.10000 0001 1498 685XFood Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XDepartment of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran ,grid.411036.10000 0001 1498 685XAnesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Safarian
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohaddeseh Badpeyma
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Norouzy
- grid.411583.a0000 0001 2198 6209Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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29
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Maraziti G, Marchini L, Barbieri G, Falcone M, Corradi F, Graziani M, Ghiadoni L, Becattini C. Arterial lactate as a risk factor for death in respiratory failure related to coronavirus disease 2019: an observational study. Ther Adv Respir Dis 2023; 17:17534666231186730. [PMID: 37646253 PMCID: PMC10469239 DOI: 10.1177/17534666231186730] [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: 12/13/2022] [Accepted: 06/22/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Arterial lactate is a recognized biomarker associated with death in critically ill patients. The prognostic role of arterial lactate in acute respiratory failure due to the novel coronavirus disease 2019 (COVID-19) is unclear. OBJECTIVES We aimed to investigate the prognostic role of arterial lactate levels at admission in patients with COVID-19-related acute respiratory failure. DESIGN AND METHODS Cohorts of consecutive patients admitted to nonintensive care units (ICU) at study centers for COVID-19-related respiratory failure were merged into a collaborative database. The prognostic role of lactate levels at admission was assessed for continuous values and values ⩾2.0 mmol/l, and lactate clearance at 24 h through delta-lactate (ΔLac). The study outcome was 30-day in-hospital death. Cox proportional regression model was used to assess independent predictors of the study outcome. RESULTS At admission, 14.6% of patients had lactate levels ⩾2 mmol/l. In-hospital death at 30 days occurred in 57 out of 206 patients; 22.3% and 56.7% with normal or ⩾ 2 mmol/l lactate at admission, respectively. The median lactate level was 1.0 [interquartile range (IQR) 0.8-1.3] mmol/l and 1.3 (IQR 1.0-2.1) mmol/l in survivors and nonsurvivors, respectively (p-value < 0.001). After adjusting for age, relevant comorbidities, acidemia, and the severity of respiratory failure, lactate ⩾2.0 mmol/l was associated with in-hospital death (HR 2.53, 95% CI 1.29-4.95, p-value 0.0066), while Δ Lac ⩾0 was not (HR 1.37, 95% CI 0.42-4.49). These results were confirmed in patients with a pO2/FiO2-ratio (P/F ratio) ⩽300 mmHg. CONCLUSIONS In our study, increased arterial lactate at admission was independently associated with in-hospital death at 30 days in non-ICU patients with acute respiratory failure related to COVID-19.
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Affiliation(s)
- Giorgio Maraziti
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia 06156, Italy
| | - Laura Marchini
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Greta Barbieri
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Emergency Medicine Department, Pisa University Hospital, Italy
| | - Marco Falcone
- Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Anaesthesia and Intensive Care Unit, Ospedali Galliera, Genova, Italy
| | - Mara Graziani
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Lorenzo Ghiadoni
- Emergency Medicine Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Cecilia Becattini
- Internal Cardiovascular and Emergency Medicine–Stroke Unit, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Kerslake R, Panfilov S, Mustafa N, Hall M, Kyrou I, Randeva HS, Karteris E, Godfrey R. Elevated Circulating Lactate Levels and Widespread Expression of Its Cognate Receptor, Hydroxycarboxylic Acid Receptor 1 (HCAR1), in Ovarian Cancer. J Clin Med 2022; 12:jcm12010217. [PMID: 36615018 PMCID: PMC9821497 DOI: 10.3390/jcm12010217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/07/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Augmented glycolysis in cancer cells is a process required for growth and development. The Warburg effect provides evidence of increased glycolysis and lactic acid fermentation in cancer cells. The lactate end-product of glycolysis is receiving growing traction for its role as a cell signalling molecule. Ovarian cancer (OvCa) is also characterised by altered glucose metabolism. We aim to explore circulating lactate levels in patients with high-grade serous OvCa (HGSOC) and to elucidate the expression of the lactate receptor hydroxycarboxylic acid receptor 1 (HCAR1) in OvCa. Methods: HCAR1 expression was detected in patient biopsy cores using immunohistochemistry, while lactate was measured from whole blood with a Biosen-C line clinic measuring system. Results: We noted significantly elevated lactate levels in OvCa patients (4.3 ± 1.9 mmol/L) compared with healthy controls (1.4 ± 0.6 mmol/L; p < 0.0001), with an AUC of 0.96. The HCAR1 gene is overexpressed in OvCa compared to healthy controls (p < 0.001). Using an OvCa tissue microarray (>75% expression in 100 patients), high protein expression was also recorded across all epithelial OvCa subtypes and ovarian normal adjacent tissue (NAT). Conclusions: Lactate monitoring is a simple, cost-efficient test that can offer point-of-care results. Our data suggest that the potential of circulating lactate as a screening biomarker in OvCa merits further research attention.
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Affiliation(s)
- Rachel Kerslake
- Division of Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
| | - Suzana Panfilov
- Division of Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
| | - Nashrah Mustafa
- Division of Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
| | - Marcia Hall
- Division of Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood HA6 2RN, UK
| | - Ioannis Kyrou
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece
| | - Harpal S. Randeva
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Emmanouil Karteris
- Division of Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
- Correspondence: (E.K.); (R.G.)
| | - Richard Godfrey
- Sport, Health and Exercise Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
- Correspondence: (E.K.); (R.G.)
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Sandal ÖS, Ceylan G, Sarı F, Atakul G, Çolak M, Topal S, Soydan E, Karaarslan ÜU, Ağın H. Could lactate clearance be a marker of mortality in pediatric intensive care unit? Turk J Med Sci 2022; 52:1771-1778. [PMID: 36945991 PMCID: PMC10390184 DOI: 10.55730/1300-0144.5522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hyperlactatemia is a common finding in critically ill patients and has significant prognostic implications. However, a single lactate measurement has not been correlated to mortality consistently. In this study, we aimed to correlate the clinical efficacy of lactate clearance for the prediction of mortality in pediatric intensive care unit patients. METHODS This retrospective observational study was performed in the pediatric intensive care unit in patients with lactate level >3 mmol/lt. Initial, 6th h, and 24th h lactate levels were recorded and lactate clearance was calculated using these values (lactate level at admission - level 6 h later × 100/lactate level at admission). RESULTS A total of 172 patients were included in the study. Forty-four out of 172 patients died. Median (IQR) lactate (mmol/L) at admission was low in those who survived in comparison to nonsurvivors 4.4 (3.1) vs. 5.75 (7.7) (p = 0.002). Clearance at 6th h was significantly lower in those who died (11.7%) than those who survived (36.7) (p = 0.001). 6th h lactate clearance level <20.7% predicted mortality with a sensitivity of 63.6% and specificity of 69.5% along with a positive predictive value of 41.8 and a negative predictive value of 84.8 (p = 0.004). Both lactate levels and lactate clearance values were significantly predictive factors for mortality (p < 0.05). Only a positive moderate correlation was found between the percentage of PRISM-IV % and 6th h lactate level. DISCUSSION The present study revealed that lactate clearance is a simple and rapid risk-stratification tool holding to be a potential biomarker of managing the treatment efficacy of children in the pediatric intensive care unit.
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Affiliation(s)
- Özlem Saraç Sandal
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Gökhan Ceylan
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Ferhat Sarı
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Gülhan Atakul
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Mustafa Çolak
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Sevgi Topal
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Ekin Soydan
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Ünal Utku Karaarslan
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
| | - Hasan Ağın
- Department of Pediatric Intensive Care Unit, Dr. Behçet Uz Pediatrics Training and Research Hospital, İzmir, Turkey
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Inkjet-printed flexible non-enzymatic lactate sensor with high sensitivity and low interference using a stacked NiOx/NiOx-Nafion nanocomposite electrode with clinical blood test verification. Talanta 2022; 249:123598. [DOI: 10.1016/j.talanta.2022.123598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/07/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
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Zhang GG, Hao JH, Yong Q, Nie QQ, Yuan GQ, Zheng ZQ, Li JQ. Lactate-to-albumin ratio is associated with in-hospital mortality in patients with spontaneous subarachnoid hemorrhage and a nomogram model construction. Front Neurol 2022; 13:1009253. [PMID: 36324387 PMCID: PMC9618723 DOI: 10.3389/fneur.2022.1009253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Subarachnoid hemorrhage (SAH) is a severe hemorrhagic stroke with high mortality. However, there is a lack of clinical tools for predicting in-hospital mortality in clinical practice. LAR is a novel clinical marker that has demonstrated prognostic significance in a variety of diseases. Methods Critically ill patients diagnosed and SAH with their data in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and the eICU Collaborative Research Database (eICU-CRD) were included in our study. Multivariate logistic regression was utilized to establish the nomogram. Results A total of 244 patients with spontaneous SAH in the MIMIC-IV database were eligible for the study as a training set, and 83 patients in eICU-CRD were included for external validation. Data on clinical characteristics, laboratory parameters and outcomes were collected. Univariate and multivariate logistic regression analysis identified age (OR: 1.042, P-value: 0.003), LAR (OR: 2.592, P-value: 0.011), anion gap (OR: 1.134, P-value: 0.036) and APSIII (OR: 1.028, P-value: < 0.001) as independent predictors of in-hospital mortality and we developed a nomogram model based on these factors. The nomogram model incorporated with LAR, APSIII, age and anion gap demonstrated great discrimination and clinical utility both in the training set (accuracy: 77.5%, AUC: 0.811) and validation set (accuracy: 75.9%, AUC: 0.822). Conclusion LAR is closely associated with increased in-hospital mortality of patients with spontaneous SAH, which could serve as a novel clinical marker. The nomogram model combined with LAR, APSIII, age, and anion gap presents good predictive performance and clinical practicability.
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Affiliation(s)
- Guo-Guo Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jia-Hui Hao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Yong
- Department of Internal Medicine, The Seventh Affiliated Hospital of University of South of China, Changsha, China
| | - Qian-Qian Nie
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gui-Qiang Yuan
- Department of Neurosurgery, Changshu No.2 People's Hospital, Changshu, China
| | - Zong-Qing Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Jin-Quan Li
| | - Jin-Quan Li
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Zong-Qing Zheng
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34
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Slatnick LR, Miller K, Scott HF, Loi M, Esbenshade AJ, Franklin A, Lee-Sherick AB. Serum lactate is associated with increased illness severity in immunocompromised pediatric hematology oncology patients presenting to the emergency department with fever. Front Oncol 2022; 12:990279. [PMID: 36276165 PMCID: PMC9583361 DOI: 10.3389/fonc.2022.990279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Determining which febrile pediatric hematology/oncology (PHO) patients will decompensate from severe infection is a significant challenge. Serum lactate is a well-established marker of illness severity in general adult and pediatric populations, however its utility in PHO patients is unclear given that chemotherapy, organ dysfunction, and cancer itself can alter lactate metabolism. In this retrospective analysis, we studied the association of initial serum lactate in febrile immunosuppressed PHO patients with illness severity, defined by the incidence of clinical deterioration events (CDE) and invasive bacterial infection (IBI) within 48 hours. Methods Receiver operating characteristic (ROC) curves were reported using initial lactate within two hours of arrival as the sole predictor for CDE and IBI within 48 hours. Using a generalized estimating equations (GEE) approach, the association of lactate with CDE and IBI within 48 hours was tested in univariate and multivariable analyses including covariates based on Quasi-likelihood under Independence Model Criterion (QIC). Additionally, the association of lactate with secondary outcomes (i.e., hospital length of stay (LOS), intensive care unit (PICU) admission, PICU LOS, non-invasive infection) was assessed. Results Among 897 encounters, 48 encounters had ≥1 CDE (5%), and 96 had ≥1 IBI (11%) within 48 hours. Elevated lactate was associated with increased CDE in univariate (OR 1.77, 95%CI: 1.48-2.12, p<0.001) and multivariable (OR 1.82, 95%CI: 1.43-2.32, p<0.001) analyses, longer hospitalization (OR 1.15, 95%CI: 1.07-1.24, p<0.001), increased PICU admission (OR 1.68, 95%CI: 1.41-2.0, p<0.001), and longer PICU LOS (OR 1.21, 95%CI: 1.04-1.4, p=0.01). Elevated lactate was associated with increased IBI in univariate (OR 1.40, 95%CI: 1.16-1.69, p<0.001) and multivariable (OR 1.49, 95%CI: 1.23-1.79, p<0.001) analyses. Lactate level was not significantly associated with increased odds of non-invasive infection (p=0.09). The QIC of the model was superior with lactate included for both CDE (305 vs. 325) and IBI (563 vs. 579). Conclusions These data demonstrated an independent association of elevated initial lactate level and increased illness severity in febrile PHO patients, suggesting that serum lactate could be incorporated into future risk stratification strategies for this population.
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Affiliation(s)
- Leonora Rose Slatnick
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, CO, United States
- *Correspondence: Leonora Rose Slatnick,
| | - Kristen Miller
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, CO, United States
| | - Halden F. Scott
- Department of Pediatrics, Section of Pediatric Emergency Medicine, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, CO, United States
| | - Michele Loi
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, CO, United States
- Department of Pediatrics, Division of Critical Care Medicine, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, CO, United States
| | - Adam J. Esbenshade
- Department of Pediatrics, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN, United States
| | - Anna Franklin
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, CO, United States
| | - Alisa B. Lee-Sherick
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado Anschutz Medical Center, Children’s Hospital Colorado, Aurora, CO, United States
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35
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Zhang H, Li Z, Zheng W, Zhang L, Yang T, Xie K, Yu Y. Risk stratification of patients with acute respiratory distress syndrome complicated with sepsis using lactate trajectories. BMC Pulm Med 2022; 22:339. [PMID: 36071432 PMCID: PMC9451114 DOI: 10.1186/s12890-022-02132-6] [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: 04/28/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Background No consensus has been reached on an optimal blood lactate evaluation system although several approaches have been reported in the literature in recent years. A group-based trajectory modeling (GBTM) method could better stratify patients with acute respiratory distress syndrome (ARDS) complicated with sepsis in the intensive care unit (ICU). Patients and methods 760 patients from the comprehensive ICU of Tianjin Medical University General Hospital with ARDS complicated with sepsis were eligible for analysis. Serial serum lactate levels were measured within 48 h of admission. In addition to the GBTM lactate groups, the initial lactate, peak lactate level, the area under the curve of serial lactate (lactate AUC), and lactate clearance were also considered for comparison. The short- and long-term outcomes were the 30- and 90-day mortality, respectively. Results Three lactate groups were identified based on GBTM, with group 3 exhibiting the worse short- [hazard ratio (HR) for 30-day mortality: 2.96, 95% confidence interval (CI) 1.79–4.87, P < 0.001] and long term (HR for 90-day mortality: 3.49, 95% CI 2.06–5.89, P < 0.001) outcomes followed by group 2 (HR for 30-day mortality: 2.05, 95% CI 1.48–2.84, P < 0.001 and HR for 90-day mortality: 1.99, 95% CI 1.48–2.67, P < 0.001). GBTM lactate groups exhibited significantly improved diagnostic performance of initial lactate + SOFA scores/APACHE II scores models. Based on the multivariable fractional polynomial interaction (MFPI) approach, GBTM lactate groups could better differentiate high-risk patients than the initial lactate groups in short- and long-term outcomes. Conclusions To the best of our knowledge, this is the first report that GBTM-based serial blood lactate evaluations significantly improve the diagnostic capacity of traditional critical care evaluation systems and bring many advantages over previously documented lactate evaluation systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02132-6.
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Affiliation(s)
- Haoyue Zhang
- The Graduate School, Tianjin Medical University, Tianjin, China.,Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ziping Li
- The Graduate School, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Weiqiang Zheng
- The Graduate School, Tianjin Medical University, Tianjin, China.,Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Linlin Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tianqi Yang
- The Graduate School, Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Keliang Xie
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China. .,Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China.
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36
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Comparison of lactate/albumin ratio to lactate and lactate clearance for predicting outcomes in patients with septic shock admitted to intensive care unit: an observational study. Sci Rep 2022; 12:13047. [PMID: 35906231 PMCID: PMC9338032 DOI: 10.1038/s41598-022-14764-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate and lactate clearance in predicting outcomes in patients with septic shock. This was a multi-center observational study of adult patients with septic shock, who admitted to intensive care units (ICUs) at Shohada and Imam Reza Hospitals, Tabriz, Iran, between Sept 2018 and Jan 2021. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to explore associations of the L/A ratio, lactate and lactate clearance on the primary (mortality) and secondary outcomes [ICU length of stay (LOS), duration of mechanical ventilation (MV), need of renal replacement therapy (RRT) and duration of using vasopressors] at baseline, 6 h and 24 h of septic shock recognition. Best performing predictive value for mortality were related to lactate clearance at 24 h, L/A ratio at 6 h and lactate levels at 24 h with (AUC 0.963, 95% CI 0.918-0.987, P < 0.001), (AUC 0.917, 95% CI 0.861-0.956, P < 0.001), and (AUC 0.904, 95% CI 0.845-0.946, P < 0.001), respectively. Generally, the lactate clearance at 24 h had better prognostic performance for mortality and duration of using vasopressor. However, the L/A ratio had better prognostic performance than serum lactate and lactate clearance for RRT, ICU LOS and MV duration.
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Kiers HD, Pickkers P, Kox M. Hypoxemia in the presence or absence of systemic inflammation does not increase blood lactate levels in healthy volunteers. J Crit Care 2022; 71:154116. [PMID: 35872501 DOI: 10.1016/j.jcrc.2022.154116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Elevated lactate levels are a sign of critical illness and may result from insufficient oxygen delivery. We investigated whether hypoxemia and/or systemic inflammation, results in increased lactate levels in healthy volunteers. MATERIALS AND METHODS 30 healthy volunteers were exposed to either 3.5 h of hypoxemia (FiO2 ± 11.5%), normoxemic endotoxemia (FiO2 21%, administration of 2 ng/kg endotoxin), or hypoxemic endotoxemia (n = 10 per group). Blood lactate, hemoglobin, SpO2, PaO2, PaCO2, pH, and hemodynamic parameters were serially measured. RESULTS Hypoxemic treatment resulted in lower SpO2 (81.7 ± 2.6 and 81.4 ± 2.4% in the hypoxemia and hypoxemic endotoxemia groups, respectively) and hyperventilation with a PaCO2 decrease of 0.8 ± 0.5 and 1.5 ± 0.6 kPa and an increase in pH. Arterial oxygen content (CaO2) decreased by 20.5 ± 2.9 and 23.5 ± 4.4%, respectively. Lactate levels were slightly, but significantly higher in both hypoxemic groups compared with the normoxemic endotoxemia group over time (p < 0.0001 for both groups), but remained below 2.3 mmol/L in all subjects. Whereas PaO2 and SpO2 did not correlate with lactate levels, PaCO2, pH and CaO2 did. CONCLUSIONS Hypoxemia, in the absence or presence of inflammation does not result in relevant increases of lactate. The small increases in lactate observed are likely to be due to hyperventilation-related decreases in glycolysis.
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Affiliation(s)
- H D Kiers
- Department of Intensive Care Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands.
| | - P Pickkers
- Department of Intensive Care Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands.
| | - M Kox
- Department of Intensive Care Medicine, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, the Netherlands.
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Saha T, Songkakul T, Knisely CT, Yokus MA, Daniele MA, Dickey MD, Bozkurt A, Velev OD. Wireless Wearable Electrochemical Sensing Platform with Zero-Power Osmotic Sweat Extraction for Continuous Lactate Monitoring. ACS Sens 2022; 7:2037-2048. [PMID: 35820167 DOI: 10.1021/acssensors.2c00830] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Wearable and wireless monitoring of biomarkers such as lactate in sweat can provide a deeper understanding of a subject's metabolic stressors, cardiovascular health, and physiological response to exercise. However, the state-of-the-art wearable and wireless electrochemical systems rely on active sweat released either via high-exertion exercise, electrical stimulation (such as iontophoresis requiring electrical power), or chemical stimulation (such as by delivering pilocarpine or carbachol inside skin), to extract sweat under low-perspiring conditions such as at rest. Here, we present a continuous sweat lactate monitoring platform combining a hydrogel for osmotic sweat extraction, with a paper microfluidic channel for facilitating sweat transport and management, a screen-printed electrochemical lactate sensor, and a custom-built wireless wearable potentiostat system. Osmosis enables zero-electrical power sweat extraction at rest, while continuous evaporation at the end of a paper channel allows long-term sensing from fresh sweat. The positioning of the lactate sensors provides near-instantaneous sensing at low sweat volume, and the custom-designed potentiostat supports continuous monitoring with ultra-low power consumption. For a proof of concept, the prototype system was evaluated for continuous measurement of sweat lactate across a range of physiological activities with changing lactate concentrations and sweat rates: for 2 h at the resting state, 1 h during medium-intensity exercise, and 30 min during high-intensity exercise. Overall, this wearable system holds the potential of providing comprehensive and long-term continuous analysis of sweat lactate trends in the human body during rest and under exercising conditions.
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Affiliation(s)
- Tamoghna Saha
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Tanner Songkakul
- Department of Electrical & Computer Engineering, North Carolina State University, 890 Oval Drive, Raleigh, North Carolina 27695, United States
| | - Charles T Knisely
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Murat A Yokus
- Department of Electrical & Computer Engineering, North Carolina State University, 890 Oval Drive, Raleigh, North Carolina 27695, United States
| | - Michael A Daniele
- Department of Electrical & Computer Engineering, North Carolina State University, 890 Oval Drive, Raleigh, North Carolina 27695, United States.,Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 911 Oval Drive, Raleigh, North Carolina 27695, United States
| | - Michael D Dickey
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Alper Bozkurt
- Department of Electrical & Computer Engineering, North Carolina State University, 890 Oval Drive, Raleigh, North Carolina 27695, United States
| | - Orlin D Velev
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina 27695, United States
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Ampatzidou F, Diplaris K, Drosos O, Drossos G. A comparison of postoperative blood lactate concentrations and kinetics in cardiac surgical patients being and not being administered metformin. JOURNAL OF MEDICAL SCIENCE 2022. [DOI: 10.20883/medical.e631] [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
Aim. Early discontinuation of metformin before cardiac surgery is advised by several national societies but no hard evidence exist supporting this practice. This precaution is mostly extrapolated by data on different clinical settings. The aim of this study is to investigate the impact of preoperative metformin use on lactate concentrations and lactate clearance during the first postoperative day after cardiac surgery.Methods. Among 367 consecutive patients who underwent elective on-pump cardiac surgery from January 2019 to October 2019, 109 were diabetics, 74 of which were treated with metformin. Data on lactate concentrations and clearance during the first postoperative day were prospectively collected on arrival, H6, H12 and H24 in the ICU and compared. A subgroup analysis focusing only on diabetic patients was also performed. Repeated measures multivariate analysis of variance (MANOVA) was used to investigate the data based on group, time and their interaction effects.Results. Lactate concentrations were the same for both groups upon arrival in the ICU. Interestingly, metformin users had lower lactate concentrations than non-users on the following measurements (p = 0.003 at 6 h and p = 0.01 at 24 h). No significant interaction was found between the two groups (p = 0.76). No difference was found between the two groups in terms of lactate clearance (p = 0.53). In the subgroup analysis no difference was found between metformin users and non-users neither on lactate concentrations (p = 0.61) nor on lactate clearance (p = 0.86).Conclusions. In a post cardiac surgery ICU setting, using metformin up until the night before surgery was not associated with increased postoperative lactate concentrations or impaired lactate clearance.
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Yang CC, Weng SF, Tseng KL, Ho CH. Clinical presentations and prognosis of metformin-associated lactic acidosis patients in the intensive care unit: A 20-year survey. Medicine (Baltimore) 2022; 101:e29918. [PMID: 35801742 PMCID: PMC9259133 DOI: 10.1097/md.0000000000029918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
METHODS We retrospectively analyzed 82 adult patients with MALA admitted to the ICU over 20 years. The association between the clinical parameters and mortality post-MALA was estimated using logistic regression analysis. RESULTS Patients with MALA admitted to the ICU presented with clinical symptoms mainly associated with the head (40.24%), chest (41.46%), and abdomen (35.37%). Additionally, the PLL distribution significantly varied with age, APACHE II = Acute Physiology and Chronic Health Evaluation II (APACHE II) score, various laboratory parameters like nadir arterial bicarbonate level, multiple treatment modalities such as renal replacement therapy, and mortality. The overall mortality rate was 17.07%. After adjustment of age and gender, the significant predictors of mortality were APACHE II score, PLL, vasoactive support, ventilator support, and cardiopulmonary resuscitation. CONCLUSIONS Despite MALA being a rare event, it is necessary to evaluate its clinical characteristics, especially the associated PLL and mortality. In the current study, higher levels of APACHE II score and PLL show a greater likelihood of mortality in MALA patients.
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Affiliation(s)
- Chun-Chieh Yang
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Ling Tseng
- Department of Respiratory Therapy, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- *Correspondence: Chung-Han Ho, Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan. (e-mail: )
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Norton C, Hassan U. Bioelectronic Sensor with Magnetic Modulation to Quantify Phagocytic Activity of Blood Cells Employing Machine Learning. ACS Sens 2022; 7:1936-1945. [PMID: 35709478 DOI: 10.1021/acssensors.2c00706] [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: 11/30/2022]
Abstract
Microbial infections result in activating an immune response in the human body, which triggers inflammatory pathways resulting in recognition and subsequent killing of the pathogens. Quantifying the blood cells' natural ability to kill pathogens, i.e., phagocytosis, is critical to demonstrating the effectiveness of an individual's response in combating pathogens. Current laboratory processes and equipment that can be used to monitor phagocytic activity are costly and time-consuming and require significant technical expertise to run such assays. Here, we design and develop a novel biosensing platform capable of quantifying the phagocytic ability of blood cells. The sensor design is composed of electronic sensing and magnetic modulation sub-systems that work in conjunction to monitor phagocytic activity in microfluidic channels. The phagocytes internalize the IgG-coated magnetic beads, and when infused into the sensor, their speed will be modulated using the quadrupole magnetic field configuration as they pass through microfluidic channels where microfabricated electrodes are placed. The electronic sensor will generate the voltage pulse for each passage of the phagocyte, whose distinct features are correlative to the phagocytic activity. We experimentally tested this device using 17 blood samples collected from patients at Robert Wood Johnson Medical Hospital. Further, we developed artificial neural networks (ANN) to improve the accuracy of the phagocytic activity detection. ANN model detected the phagocytic activity with 88.2% accuracy. This novel sensing platform can potentially be used to triage high risk patients and develop personalized theranostics for the septic patients in the future.
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Affiliation(s)
- Corey Norton
- Department of Electrical and Computer Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States
| | - Umer Hassan
- Department of Electrical and Computer Engineering, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, United States.,Global Health Institute, Rutgers, The State University of New Jersey, New Brunswick, New Jersey 08901, United States
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Głowacka J, Koncki R, Strzelak K. Multicommutation flow analysis system for non-enzymatic lactate determination based on light-driven photometric assay. Anal Chim Acta 2022; 1210:339878. [DOI: 10.1016/j.aca.2022.339878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/28/2022] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
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The Pyruvate Dehydrogenase Complex Mitigates LPS-Induced Endothelial Barrier Dysfunction by Metabolic Regulation. Shock 2022; 57:308-317. [PMID: 35759309 DOI: 10.1097/shk.0000000000001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ABSTRACT Sepsis is a fatal health issue induced by an aberrant host response to infection, and it correlates with organ damage and a high mortality rate. Endothelial barrier dysfunction and subsequent capillary leakage play major roles in sepsis-induced multiorgan dysfunction. Anaerobic glycolysis is the primary metabolic mode in sepsis and the pyruvate dehydrogenase complex (PDHC) serves as a critical hub in energy regulation. Therefore, it is important to understand the role of PDHC in metabolic regulation during the development of sepsis-induced endothelial barrier dysfunction.In present study, human umbilical vein endothelial cells (HUVECs) and C57 BL/6 mice were treated with lipopolysaccharide (LPS) as models of endotoxemia. LPS increased basal glycolysis, compensatory glycolysis, and lactate secretion, indicating increased glycolysis level in endothelial cells (ECs). Activation of PDHC with dichloroacetate (DCA) reversed LPS-induced glycolysis, allowing PDHC to remain in the active dephosphorylated state, thereby preventing lactic acid production and HUVECs monolayers barrier dysfunction, as assessed by transendothelial electrical resistance and Fluorescein Isothiocyanate-labeled dextran. The in vivo study also showed that the lactate level and vascular permeability were increased in LPS-treated mice, but pretreatment with DCA attenuated these increases. The LPS-treated HUVEC model showed that DCA reversed LPS-induced phosphorylation of pyruvate dehydrogenase E1α Ser293 and Ser300 to restore PDHC activity. Immunoprecipitation results showed that LPS treatment increased the acetylation level of PDH E1α in HUVECs.Our study suggested that activation of PDHC may represent a therapeutic target for treatment of LPS-induced endothelial barrier dysfunction.
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Xiao D, Hu C, Xu X, Lü C, Wang Q, Zhang W, Gao C, Xu P, Wang X, Ma C. A d,l-lactate biosensor based on allosteric transcription factor LldR and amplified luminescent proximity homogeneous assay. Biosens Bioelectron 2022; 211:114378. [PMID: 35617798 DOI: 10.1016/j.bios.2022.114378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/02/2022]
Abstract
Lactate, a hydroxycarboxylic acid commercially produced by microbial fermentation, is widely applied in diverse industrial fields. Lactate exists in two stereoisomeric forms (d-lactate and l-lactate). d-Lactate and l-lactate are often simultaneously present in many biological samples. Therefore, a biosensor able to detect both d- and l-lactate is required but previously unavailable. Herein, an allosteric transcription factor LldR from Pseudomonas aeruginosa PAO1, which responds to both d-lactate and l-lactate, was combined with amplified luminescent proximity homogeneous assay technology to develop a d,l-lactate biosensor. The proposed biosensor was optimized by mutation of DNA sequence in binding site of LldR. The optimized biosensor BLac-6 can accurately detect the concentration of lactate independent on ratio of the two isomers in pending test samples. The biosensor was also tentatively used in quantitative analysis of d-lactate, l-lactate, or d,l-lactate in fermentation samples produced by three recombinant strains of Klebsiella oxytoca. With its desirable properties, the biosensor BLac-6 may be a potential choice for monitoring the concentration of lactate during industrial fermentation.
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Affiliation(s)
- Dan Xiao
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China
| | - Chunxia Hu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China
| | - Xianzhi Xu
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China
| | - Chuanjuan Lü
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China
| | - Qian Wang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China
| | - Wen Zhang
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, PR China
| | - Chao Gao
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China
| | - Ping Xu
- State Key Laboratory of Microbial Metabolism, and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, PR China
| | - Xia Wang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China
| | - Cuiqing Ma
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, PR China.
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Bockholt R, Paschke S, Heubner L, Ibarlucea B, Laupp A, Janićijević Ž, Klinghammer S, Balakin S, Maitz MF, Werner C, Cuniberti G, Baraban L, Spieth PM. Real-Time Monitoring of Blood Parameters in the Intensive Care Unit: State-of-the-Art and Perspectives. J Clin Med 2022; 11:jcm11092408. [PMID: 35566534 PMCID: PMC9100654 DOI: 10.3390/jcm11092408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
The number of patients in intensive care units has increased over the past years. Critically ill patients are treated with a real time support of the instruments that offer monitoring of relevant blood parameters. These parameters include blood gases, lactate, and glucose, as well as pH and temperature. Considering the COVID-19 pandemic, continuous management of dynamic deteriorating parameters in patients is more relevant than ever before. This narrative review aims to summarize the currently available literature regarding real-time monitoring of blood parameters in intensive care. Both, invasive and non-invasive methods are described in detail and discussed in terms of general advantages and disadvantages particularly in context of their use in different medical fields but especially in critical care. The objective is to explicate both, well-known and frequently used as well as relatively unknown devices. Furtehrmore, potential future direction in research and development of realtime sensor systems are discussed. Therefore, the discussion section provides a brief description of current developments in biosensing with special emphasis on their technical implementation. In connection with these developments, the authors focus on different electrochemical approaches to invasive and non-invasive measurements in vivo.
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Affiliation(s)
- Rebecca Bockholt
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, 01309 Dresden, Germany; (R.B.); (S.P.); (L.H.); (A.L.)
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
| | - Shaleen Paschke
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, 01309 Dresden, Germany; (R.B.); (S.P.); (L.H.); (A.L.)
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
| | - Lars Heubner
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, 01309 Dresden, Germany; (R.B.); (S.P.); (L.H.); (A.L.)
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
| | - Bergoi Ibarlucea
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
- Institute for Materials Science and Max Bergmann Center of Biomaterials, Center for Advancing Electronics Dresden, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Alexander Laupp
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, 01309 Dresden, Germany; (R.B.); (S.P.); (L.H.); (A.L.)
| | - Željko Janićijević
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
- Institute of Radiopharmaceutical Cancer Research, Helmholtz Center Dresden Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Stephanie Klinghammer
- Institute for Materials Science and Max Bergmann Center of Biomaterials, Center for Advancing Electronics Dresden, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Sascha Balakin
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
- Institute for Materials Science and Max Bergmann Center of Biomaterials, Center for Advancing Electronics Dresden, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Manfred F. Maitz
- Leibniz-Institut für Polymerforschung Dresden e.V., 01069 Dresden, Germany; (M.F.M.); (C.W.)
| | - Carsten Werner
- Leibniz-Institut für Polymerforschung Dresden e.V., 01069 Dresden, Germany; (M.F.M.); (C.W.)
| | - Gianaurelio Cuniberti
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
- Institute for Materials Science and Max Bergmann Center of Biomaterials, Center for Advancing Electronics Dresden, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Larysa Baraban
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
- Institute of Radiopharmaceutical Cancer Research, Helmholtz Center Dresden Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Peter Markus Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, 01309 Dresden, Germany; (R.B.); (S.P.); (L.H.); (A.L.)
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), 01309 Dresden, Germany; (B.I.); (Ž.J.); (S.B.); (G.C.); (L.B.)
- Correspondence: ; Tel.: +49-351-4581-6006
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Madden J, Vaughan E, Thompson M, O' Riordan A, Galvin P, Iacopino D, Rodrigues Teixeira S. Electrochemical sensor for enzymatic lactate detection based on laser-scribed graphitic carbon modified with platinum, chitosan and lactate oxidase. Talanta 2022; 246:123492. [PMID: 35487014 DOI: 10.1016/j.talanta.2022.123492] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/01/2022] [Accepted: 04/15/2022] [Indexed: 12/20/2022]
Abstract
We developed a flexible laser scribed graphitic carbon based lactate biosensor fabricated using a low cost 450 nm laser. We demonstrated a facile fabrication method involving electrodeposition of platinum followed by two casting steps for modification with chitosan and lactate oxidase. The biosensor demonstrated chronoamperometric lactate detection within a linear range from 0.2 mM to 3 mM, (R2 > 0.99), with a limit of detection of 0.11 mM and a sensitivity of 35.8 μA/mM/cm2. The biosensor was successful in performing up to 10 consecutive measurements (one after the other) indicating good working stability (RSD <5%). Concerning storage stability, there was no decrease in signal response after 30 days of storage at 4 °C. Additionally, we demonstrate enzymatic lactate detection whilst the flexible polyimide substrates were fixed at a curvature (K) of 0.14 mm-1. No noticeable change in signal response was observed in comparison to calibrations obtained at a curvature of 0 mm-1, signifying potential opportunities for sensor attachment or integration with oral-care products such as mouth swabs. Both laser scribed graphitic carbon and Ag/AgCl modified-laser scribed graphitic carbon were successful as reference electrodes for chronoamperometric lactate measurements. Furthermore, using a three-electrode configuration on polyimide, lactate detection in both artificial saliva and sterile human serum samples was achieved for two spiked concentrations (0.5 mM and 1 mM).
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Affiliation(s)
- Julia Madden
- Tyndall National Institute, University College Cork, Lee Maltings, Cork, Ireland
| | - Eoghan Vaughan
- Tyndall National Institute, University College Cork, Lee Maltings, Cork, Ireland
| | | | - Alan O' Riordan
- Tyndall National Institute, University College Cork, Lee Maltings, Cork, Ireland
| | - Paul Galvin
- Tyndall National Institute, University College Cork, Lee Maltings, Cork, Ireland
| | - Daniela Iacopino
- Tyndall National Institute, University College Cork, Lee Maltings, Cork, Ireland.
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Heubner L, Mirus M, Vicent O, Güldner A, Tiebel O, Beyer-Westendorf J, Fries D, Spieth PM. Point of care coagulation management in anesthesiology and critical care. Minerva Anestesiol 2022; 88:615-628. [PMID: 35416466 DOI: 10.23736/s0375-9393.22.16380-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Point of care (POC) devices are increasingly used in the ICU and in anesthesia. Besides POC-devices for blood gas analysis, several devices are available for coagulation measurements. Although basic principles for thromboelastographic measurements are not novel, some promising developments were made during the last decade improving both user-friendliness and measurement reliability. For instance, POC measurements of activated clotting time (ACT) for heparin monitoring is still regarded as standard-of-care in cardiac interventions and surgery. In the field of anesthesia and intensive care medicine, POC-devices for thromboelastographic and platelet aggregation measurements are widely used. Their impact in case of bleeding and patient blood management for cardiothoracic and trauma surgery is well known. Moreover, there are promising concepts for anticoagulation monitoring including new oral anticoagulant drugs. Coagulation POC-devices may also identify patients at specific risk for thromboembolic events quickly. On the other hand, benefits of POC-devices need to be balanced against limitations, which include technical restrictions and operator related errors, mainly affecting reproducibility and interpretation of results. Therefore, it is recommendable to consider results of POC-coagulation testing in comparison to standard laboratory tests (SLT). Nevertheless, in urgent or emergency situations POC results enable fast decision making to optimize patient care.
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Affiliation(s)
- Lars Heubner
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany. -
| | - Martin Mirus
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Oliver Vicent
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Andreas Güldner
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Oliver Tiebel
- Institute of Clinical Chemistry, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Division of Hematology and Hemostasis, Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Dietmar Fries
- Department for General and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Peter M Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
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Prognostic Role of MELD-Lactate in Cirrhotic Patients' Short- and Long-Term Prognosis, Stratified by Causes of Cirrhosis. Can J Gastroenterol Hepatol 2022; 2022:8449579. [PMID: 35392026 PMCID: PMC8983169 DOI: 10.1155/2022/8449579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Recently, model for end-stage liver disease-lactate (MELD-LA) proved to be a superior predicting factor of inpatient mortality in patients with chronic liver disease. The study's objective was to evaluate the ability of MELD-LA to predict both short- and long-term mortality in critically ill cirrhotic patients stratified by causes of cirrhosis. MATERIALS AND METHODS This was a retrospective observational research of 469 cirrhotic patients entering intensive care unit. Clinical parameters and prognostic scores were measured and collected in the first 24 hours after entering intensive care unit. Follow-up duration was at least 5 years. Independent relationship between MELD-LA and mortality was evaluated by multivariate logistic regression analyses. Discrimination of scoring system was evaluated by the area under the receiver operating characteristic curve. Calibration of the score was evaluated by Hosmer-Lemeshow goodness of fit test for significance. RESULTS The MELD-LA score (odds ratio: 1.179, 95% confidence interval: 1.112-1.250, P < 0.001) was an independent risk factor for 15-day mortality. The area under the curve of MELD-LA was the highest (0.808, 95% confidence interval: 0.765-0.852) in predicting 15-day mortality and it had superior calibration. We found MELD-LA showed the best discrimination ability in cirrhotic patients caused by both alcohol and hepatitis (0.783, 95% confidence interval: 0.651-0.915) or alcohol alone (0.805, 95% confidence interval: 0.743-0.867). CONCLUSIONS MELD-LA performs better for predicting short-term prognosis in critically ill cirrhotic patients, especially caused by both alcohol and hepatitis or alcohol alone.
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Abstract
Neisseria gonorrhoeae is an obligate human pathogen that is the cause of the sexually transmitted disease gonorrhoea. Recently, there has been a surge in gonorrhoea cases that has been exacerbated by the rapid rise in gonococcal multidrug resistance to all useful antimicrobials resulting in this organism becoming a significant public health burden. Therefore, there is a clear and present need to understand the organism's biology through its physiology and pathogenesis to help develop new intervention strategies. The gonococcus initially colonises and adheres to host mucosal surfaces utilising a type IV pilus that helps with microcolony formation. Other adhesion strategies include the porin, PorB, and the phase variable outer membrane protein Opa. The gonococcus is able to subvert complement mediated killing and opsonisation by sialylation of its lipooligosaccharide and deploys a series of anti-phagocytic mechanisms. N. gonorrhoeae is a fastidious organism that is able to grow on a limited number of primary carbon sources such as glucose and lactate. The utilization of lactate by the gonococcus has been implicated in a number of pathogenicity mechanisms. The bacterium lives mainly in microaerobic environments and can grow both aerobically and anaerobically with the aid of nitrite. The gonococcus does not produce siderophores for scavenging iron but can utilize some produced by other bacteria, and it is able to successful chelate iron from host haem, transferrin and lactoferrin. The gonococcus is an incredibly versatile human pathogen; in the following chapter, we detail the intricate mechanisms used by the bacterium to invade and survive within the host.
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Affiliation(s)
- Luke R Green
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Joby Cole
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Ernesto Feliz Diaz Parga
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Jonathan G Shaw
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
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50
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Vassiliou AG, Tsipilis S, Keskinidou C, Vrettou CS, Jahaj E, Gallos P, Routsi C, Orfanos SE, Kotanidou A, Dimopoulou I. Lactate and Lactate-to-Pyruvate Ratio in Critically Ill COVID-19 Patients: A Pilot Study. J Pers Med 2022; 12:jpm12020171. [PMID: 35207659 PMCID: PMC8880262 DOI: 10.3390/jpm12020171] [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] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
A limited number of coronavirus disease-19 (COVID-19) cases may require treatment in an intensive care unit (ICU). Arterial blood lactate levels are routinely measured in the ICU to estimate disease severity, predict poor outcomes, and monitor therapeutic handlings. A number of studies have suggested that, simultaneously with lactate, pyruvate should also be measured, providing augmented prognostic ability, and a better understanding of the underlying metabolic alterations in ICU patients. Hence, the aim of the present study was to elucidate the relationship between lactate levels and the lactate-to-pyruvate (LP) ratio with the clinical outcome in mechanically ventilated COVID-19 patients. Lactate and pyruvate were serially measured during the first 24 h of ICU stay. A group of ICU non-COVID-19 patients was used as a comparison group. The majority of COVID-19 patients (82.5%) had normal lactate levels and a normal LP ratio on ICU admission (normal metabolic pattern). A small, yet significant, percentage of patients had either elevated lactate levels or a high LP ratio (abnormal metabolic pattern); these patients exhibited a significantly higher risk of ICU mortality compared to the patients with a normal metabolic pattern (72.7% vs. 34.6%, p = 0.04). In our critically ill COVID-19 patients, elevated lactate levels or high LP ratios on admission to the ICU could be associated with poor clinical outcome.
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Affiliation(s)
- Alice G. Vassiliou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Stamatios Tsipilis
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Chrysi Keskinidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Charikleia S. Vrettou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Edison Jahaj
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Parisis Gallos
- Computational Biomedicine Laboratory, Department of Digital Systems, University of Piraeus, 185 34 Piraeus, Greece;
| | - Christina Routsi
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Stylianos E. Orfanos
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian University of Athens, Evangelismos Hospital, 106 76 Athens, Greece; (A.G.V.); (S.T.); (C.K.); (C.S.V.); (E.J.); (C.R.); (S.E.O.); (A.K.)
- Correspondence: ; Tel.: +30-21-0723-5521
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