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霍 锐, 戴 敏, 樊 艺, 周 竞, 李 莉, 祖 建. [Predictive value of miRNA-29a and miRNA-10a-5p for 28-day mortality in patients with sepsis-induced acute kidney injury]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:646-651. [PMID: 28539288 PMCID: PMC6780479 DOI: 10.3969/j.issn.1673-4254.2017.05.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the value of miR-29a and miR-10a-5p in predicting 28-day mortality in patients with sepsis-induced acute kidney injury. METHODS Seventy-four patients with sepsis-induced acute kidney injury (AKI) and 41 patients with sepsis but without AKI (control) were examined for serum levels of miR-29a and miR-10a-5p using RT-PCR. The patients were followed up for 28 days to record their survival. Pearson correlation analysis was used to test the correlations of miR-29a and miR-10a-5p with serum creatinine (Scr), cystatin C (Cys-C), and KIM-1 in patients with AKI. Multivariate logistic regression analysis was used to analyze the correlations of miR-29a, miR-10a-5p, Scr, Cys-C, KIM-1 and other risk factors with the 28-day mortality in patients with sepsis. The predictive value of these indicators for evaluating the prognosis of patients with sepsis was analyzed using ROC curve, and miR-29a combined with miR-10a-5p was assessed for their value in predicting the prognosis of the patients. RESULT During the follow-up for 28 days, 21 of the 74 (35.53%) AKI patients died. Compared with the survivors, the patients died within 28 days showed significantly increased serum levels of Scr , Cys-C, KIM-1, miR-29a, and miR-10a-5p (P<0.05). Pearson correlation analysis showed that miR-29a and miR-10a-5p were positively correlated with serum Scr, Cys-C, and KIM-1 levels; multivariate regression analysis identified miR-29a and miR-10a-5p as the independent risk factors for mortality in the septic patients. The ROC curve analysis showed that the area under the curve (AUC) of miR-29a and miR-10a-5p was 0.82 (95%CI: 0.71-0.89) and 0.75 (95%CI: 0.64-0.85), and that of Scr, Cys-C and KIM-1 was 0.72 (95%CI: 0.66-0.86) , 0.71 (95% CI: 0.63-0.84) and 0.81 (95% CI: 0.72-0.81), respectively. The AUC of miR-29a combined with miR-10a-5p was significantly greater than that of miR-29a, miR-10a-5p, Scr, Cys-C and KIM-1 alone (P<0.05). CONCLUSION miR-29a and miR-10a-5p have good predictive value in assessing the 28-day mortality of patients with sepsis.
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Affiliation(s)
- 锐 霍
- />重庆市中医院重症医学科,重庆 400000Department of Critical Care Medicine, Chongqing Chinese Medicine Hospital, Chongqing 400000, China
| | - 敏 戴
- />重庆市中医院重症医学科,重庆 400000Department of Critical Care Medicine, Chongqing Chinese Medicine Hospital, Chongqing 400000, China
| | - 艺 樊
- />重庆市中医院重症医学科,重庆 400000Department of Critical Care Medicine, Chongqing Chinese Medicine Hospital, Chongqing 400000, China
| | - 竞峥 周
- />重庆市中医院重症医学科,重庆 400000Department of Critical Care Medicine, Chongqing Chinese Medicine Hospital, Chongqing 400000, China
| | - 莉 李
- />重庆市中医院重症医学科,重庆 400000Department of Critical Care Medicine, Chongqing Chinese Medicine Hospital, Chongqing 400000, China
| | - 建 祖
- />重庆市中医院重症医学科,重庆 400000Department of Critical Care Medicine, Chongqing Chinese Medicine Hospital, Chongqing 400000, China
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Wu Q, Nie J, Wu FX, Zou XL, Chen FY. Prognostic Value of High-Sensitivity C-Reactive Protein, Procalcitonin and Pancreatic Stone Protein in Pediatric Sepsis. Med Sci Monit 2017; 23:1533-1539. [PMID: 28358790 PMCID: PMC5384617 DOI: 10.12659/msm.900856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background To investigate the prognostic value of procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), and pancreatic stone protein (PSP) in children with sepsis. Material/Methods A total of 214 patients with sepsis during hospitalization were enrolled. Serum levels of PCT, hs-CRP, and PSP were measured on day 1 of hospitalization and the survival rates of children were recorded after a follow-up of 28 days. Pearson’s correlation analysis was conducted to test the association of PCT, hs-CRP, and PSP with pediatric critical illness score (PCIS). Logistic regression models were used to analyze the risk factors contributing to patients’ death. The AUC was used to determine the value of PCT, hs-CRP, and PSP in the prognosis of patients with sepsis. Results The expression of PCT, hs-CRP, and PSP in the dying patients was higher than in the surviving patients (p<0.001). Pearson’s correlation analysis showed that serum PCT, hs-CRP, and PSP levels were negatively correlated with PCIS (p<0.001). Multivariate logistic regression revealed that PCT, hs-CRP, and PSP were independent risk factors for the prognosis of patients with sepsis (p<0.001). ROC analysis showed the AUC values of PCT, hs-CRP, and PSP were 0.83 (95% CI, 0.77–0.88), 0.76 (95% CI, 0.70–0.82), and 0.73 (95% CI, 0.67–0.79), respectively. The combined AUC value of PCT, hs-CRP, and PSP, was 0.92 (95% CI, 0.87–0.95), which was significantly increased compared with PCT, hs-CRP, or PSP (p<0.001). Conclusions The combination of serum PCT, hs-CRP, and PSP represents a promising biomarker of risk, and is a useful clinical tool for risk stratification of children with sepsis.
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Affiliation(s)
- Qiong Wu
- Department of Pediatrics, People's Hospital of China Three Gorges University, The 1st People's Hospital of Yichang, Yichang, Hubei, China (mainland)
| | - Jun Nie
- Department of Cardiothoracic Surgery, People's Hospital of China Three Gorges University, The 1st People's Hospital of Yichang, Yichang, Hubei, China (mainland)
| | - Fu-Xia Wu
- Department of Pediatrics, People's Hospital of China Three Gorges University, The 1st People's Hospital of Yichang, Yichang, Hubei, China (mainland)
| | - Xiu-Lan Zou
- Department of Endocrinology, People's Hospital of China Three Gorges University, The 1st People's Hospital of Yichang, Yichang, Hubei, China (mainland)
| | - Feng-Yi Chen
- Department of Pediatrics, People's Hospital of China Three Gorges University, The 1st People's Hospital of Yichang, Yichang, Hubei, China (mainland)
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Abstract
BACKGROUND Trauma represents one of the leading causes of death in children. Beside an injury pattern that differs from adult trauma patients, children seem to develop multiple organ dysfunction syndrome (MODS) less frequently. Compared to adult MODS, pediatric MODS has also been described to occur earlier in the posttraumatic course. METHOD Biomarkers for early identification of patients at high-risk for posttraumatic complications are of high clinical relevance. However, little is known from clinical studies about the relevance of biomarkers during the posttraumatic course. AIM Therefore, the purpose of this review is to summarize current knowledge on this topic in order to investigate the prognostic significance of different parameters.
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Gliddon T, Salman S, Robinson JO, Manning L. Modeling C-reactive protein kinetic profiles for use as a clinical prediction tool in patients with Staphylococcus aureus bacteremia. Biomark Med 2015; 9:947-55. [DOI: 10.2217/bmm.15.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We hypothesized that C-reactive protein (CRP) kinetics can be accurately modeled and might have clinical utility in a cohort of patients with Staphylococcus aureus bacteremia. Materials & methods: We constructed and validated a nonlinear mixed effects model using CRP values obtained during the first week of illness. Results: Hematological malignancy, prosthetic heart valves and metastatic seeding were identified as major covariates that influenced CRP kinetics. When considering the presence of metastatic infection as an ‘unknown’, the model could predict its presence through analysis of the observed CRP profile with an Area-under-the-Receiver-Operator-Characteristic curve of 0.81, indicating some diagnostic accuracy. Conclusion: We conclude that early CRP kinetics can be accurately modeled and can help identify patients with metastatic seeding in S. aureus bacteremia. Further validation is required.
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Affiliation(s)
- Thomas Gliddon
- Pathwest Laboratory Medicine, Nedlands, WA, Australia
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Sam Salman
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Harry Perkins Research Institute, School of Medicine & Pharmacology, University of Western Australia, Fiona Stanley Hospital, Western Australia, University of Western Australia, WA, Australia
| | - James Owen Robinson
- Pathwest Laboratory Medicine, Nedlands, WA, Australia
- Australian Collaborating Centre for Enterococcus & Staphylococcus Species (ACCESS) Typing & Research, School of Veterinary & Life Sciences, Murdoch University & School of Biomedical Sciences, Curtin University, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Laurens Manning
- Harry Perkins Research Institute, School of Medicine & Pharmacology, University of Western Australia, Fiona Stanley Hospital, Western Australia, University of Western Australia, WA, Australia
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Secco M, Tillou X, Desmonts A, Orczyk C, Le Gal S, Bensadoun H, Doerfler A. [Emergency nephrectomies: retrospective monocentric study, about eight cases]. Prog Urol 2013; 23:1400-6. [PMID: 24274944 DOI: 10.1016/j.purol.2013.06.003] [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: 03/01/2013] [Revised: 05/09/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Emergency nephrectomies are rare because of the improvement of the management of urinary tract infections and the development of radio-embolization. Few series of patients have been reported. The objective of our study is to assess the indication, the morbi-mortality and the outcome of the emergency nephrectomy performed in our hospital. PATIENTS Between January 2011 and November 2012, eight patients underwent an emergency nephrectomy at the University Hospital Center of Caen. The present review reports the characteristics of this emergency nephrectomy and their morbi-mortality. RESULTS Six women and two men were analyzed retrospectively between January 2011 and November 2012. All patients except one needed intensive care for a multiple-organ failure. All these eight emergency nephrectomies concerned a native kidney with a surgical approach as a lombotomy or subcostal laparotomy. Both patients survived. One patient need a renal dialysis support. CONCLUSION Emergency nephrectomy are rare. Uncontrolled urinary sepsis represents the main indication. Identifying the population at risk of evolution to the toxic shock is indispensable for a better and faster care and to reduce the mortality bound to the sepsis.
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Affiliation(s)
- M Secco
- Service d'urologie, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
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Meyer S, McGuire W, Gottschling S, Mohammed Shamdeen G, Gortner L. The role of vasopressin and terlipressin in catecholamine-resistant shock and cardio-circulatory arrest in children: Review of the literature. Wien Med Wochenschr 2011; 161:192-203. [DOI: 10.1007/s10354-010-0853-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 10/22/2010] [Indexed: 11/29/2022]
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Berger I, Wildhofen S, Lee A, Ponholzer A, Rauchenwald M, Zechner O, Stackl W, Madersbacher S. Emergency nephrectomy due to severe urosepsis: a retrospective, multicentre analysis of 65 cases. BJU Int 2009; 104:386-90. [DOI: 10.1111/j.1464-410x.2009.08414.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brunengraber LN, Robinson AV, Chwals WJ. Relationship of serum C-reactive protein and blood glucose levels with injury severity and patient morbidity in a pediatric trauma population. J Pediatr Surg 2009; 44:992-6. [PMID: 19433185 DOI: 10.1016/j.jpedsurg.2009.01.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 01/15/2009] [Indexed: 01/04/2023]
Abstract
PURPOSE Serum markers of inflammation and of glucose production are known to reflect the immediate metabolic response to injury. We hypothesized that monitoring of the early C-reactive protein (CRP) and blood glucose (BG) concentrations would correlate with clinical morbidity and outcome measures in pediatric trauma patients. METHODS A five-year retrospective chart review of pediatric trauma patients admitted to our Level I pediatric trauma center was conducted to establish the relationships between early (first 3 hospital days) serum CRP and BG concentrations, Injury Severity Score (ISS), and hospital length of stay (HLOS). Statistical significance (P < 0.05) was determined using Student's t-test. RESULTS Forty-two trauma patients (8.0 +/- 5.2 years) were evaluated. The early inflammatory response (CRP >or= 10 vs <10 mg/dl) was significantly correlated to the glycemic response (BG;121 +/- 24 vs 97.3 +/- 14.2 mg/dl, P < 0.05). Severely injured patients (ISS >or= 25 vs <25) were significantly more hyperglycemic (BG;156 +/- 56.9 vs 125 +/- 31.6 mg/dL, P = 0.003). Both increased inflammatory response (CRP;8.1 +/- 6.4 vs 2.5 +/- 3.5 mg/dL) and increased glycemic response (BG;111 +/- 15.9 vs 97.4 +/- 11.7 mg/dL) were independently and significantly associated with prolonged hospitalization (HLOS > 7 vs <or=7 days, P < 0.05). CONCLUSION This study establishes a significant relationship between the early inflammatory and glycemic injury response and the association of that response with pediatric trauma patient morbidity and outcome measures.
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Affiliation(s)
- Lisa N Brunengraber
- Division of Pediatric Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Abstract
This review aims to summarise the physiology of C-reactive protein (CRP), its possible roles and limitations as an inflammatory and infective marker in intensive care medicine, and also the emerging roles of CRP in the pathogenesis of cardiovascular and autoimmune diseases. Observational and animal studies on uses of CRP were retrieved from the PubMed database without any language restrictions. Quantitative data were not pooled because of the heterogeneity of patient characteristics and disparate ways in which CRP was studied. Serum CRP concentrations are determined by the synthetic rate of its production in the liver regulated predominantly by interleukin-6. It has a half-life of 19 hours and is relatively slow in its onset and offset in response to an acute inflammatory process when compared to procalcitonin. It has some favourable properties and limitations as an inflammatory marker. An elevated CRP concentration is not specific to infections and the absolute CRP concentrations cannot be used to differentiate between bacterial, fungal and severe viral infections. The dynamic response of CRP to therapy that aims to modify the underlying inflammatory process and the clinical context of a patient are of pivotal importance when CRP concentrations are interpreted. CRP is found to be a significant partaker and prognostic factor in a wide range of cardiovascular and chronic diseases. In summary, CRP concentration is an important prognostic factor of many acute and chronic diseases. Serial CRP measurements may be useful to reflect a patient's response to therapy that aims to modify the underlying inflammatory process.
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Affiliation(s)
- K. M. Ho
- Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Intensive Care, Royal Perth Hospital and Clinical Associate Professor, School of Population Health, University of Western Australia
| | - J. Lipman
- Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia, Australia
- Anaesthesiology and Critical Care, University of Queensland and Director, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland
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Abstract
Biomarkers of sepsis could allow early identification of high-risk patients, in whom aggressive interventions can be life-saving. Among those interventions are the immunomodulatory therapies, which will hopefully become increasingly available to clinicians. However, optimal use of such interventions will probably be patient specific and based on longitudinal profiles of such biomarkers. Modeling techniques that allow proper interpretation and classification of these longitudinal profiles, as they relate to patient characteristics, disease progression, and therapeutic interventions, will prove essential to the development of such individualized interventions. Once validated, these models may also prove useful in the rational design of future clinical trials and in the interpretation of their results. However, only a minority of mathematicians and statisticians are familiar with these newer techniques, which have undergone remarkable development during the past two decades. Interestingly, critical illness has the potential to become a key testing ground and field of application for these emerging modeling techniques, given the increasing availability of point-of-care testing and the need for titrated interventions in this patient population.
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Affiliation(s)
- Gilles Clermont
- CIRM (Center for Inflammation and Regenerative Modeling), Clinical Research, Investigation and Systems Modeling in Acute Illness (CRISMA) laboratory, Department of Critical Care Medicine, Terrace St, University of Pittsburgh Medical Center, Pittsburgh, Philadelphia 15261, USA
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Meyer S, Gortner L, McGuire W, Baghai A, Gottschling S. Vasopressin in catecholamine-refractory shock in children. Anaesthesia 2007; 63:228-234. [DOI: 10.1111/j.1365-2044.2007.05317.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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