1
|
Shi J, Zhuo Y, Wang TQ, Lv CE, Yao LH, Zhang SY. Procalcitonin and C-reactive protein as diagnostic biomarkers in COVID-19 and Non-COVID-19 sepsis patients: a comparative study. BMC Infect Dis 2024; 24:45. [PMID: 38172766 PMCID: PMC10765878 DOI: 10.1186/s12879-023-08962-x] [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: 09/08/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND This study aimed to assess and compare procalcitonin (PCT) and C-reactive protein (CRP) levels between COVID-19 and non-COVID-19 sepsis patients. Additionally, we evaluated the diagnostic efficiency of PCT and CRP in distinguishing between Gram-positive (GP) and Gram-negative (GN) bacterial infections. Moreover, we explored the associations of PCT with specific pathogens in this context. METHODS The study included 121 consecutive sepsis patients who underwent blood culture testing during the COVID-19 epidemic. PCT and CRP were measured, and reverse transcriptase-polymerase chain reaction (RT-PCR) was employed for the detection of COVID-19 nucleic acid. The Mann-Whitney U-test was used to compare PCT and CRP between the COVID-19 and non-COVID-19 groups. Receiver operating characteristic (ROC) curves were generated to compare PCT and CRP levels in the GN group versus the GP group for assessing the diagnostic efficiency. The kruskal-Wallis H test was applied to assess the impact of specific pathogen groups on PCT concentrations. RESULTS A total of 121 sepsis patients were categorized into a COVID-19 group (n = 25) and a non-COVID-19 group (n = 96). No significant differences in age and gender were observed between the COVID-19 and non-COVID-19 groups. The comparison of biomarkers between these groups showed no statistically significant differences. The optimal cut-off values for PCT and CRP in differentiating between GP and GN infections were 1.03 ng/mL and 34.02 mg/L, respectively. The area under the ROC curve was 0.689 (95% confidence interval (CI) 0.591-0.786) for PCT and 0.611 (95% CI 0.505-0.717) for CRP. The diagnostic accuracy was 69.42% for PCT and 58.69% for CRP. The study found a significant difference in PCT levels among specific groups of pathogens (P < 0.001), with the highest levels observed in Escherichia coli infections. The frequency of Staphylococcus spp. positive results was significantly higher (36.0%) in COVID-19 compared to non-COVID-19 sepsis patients (P = 0.047). CONCLUSION Sepsis patients with COVID-19 revealed a significantly higher culture positivity for staphylococcus spp. than the non-COVID-19 group. Both PCT and CRP showed moderate diagnostic efficiency in differentiating between GP and GN bacterial infections. PCT showed potential utility in identifying E. coli infections compared to other pathogens.
Collapse
Affiliation(s)
- Jing Shi
- Department of Anesthesiology, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian, 355200, China
| | - Ying Zhuo
- Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian, 355200, China
| | - Ting-Qiang Wang
- Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian, 355200, China
| | - Chun-E Lv
- Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian, 355200, China
| | - Ling-Hui Yao
- Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian, 355200, China
| | - Shi-Yan Zhang
- Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian, 355200, China.
| |
Collapse
|
2
|
Xu HG, Tian M, Pan SY. Clinical utility of procalcitonin and its association with pathogenic microorganisms. Crit Rev Clin Lab Sci 2021; 59:93-111. [PMID: 34663176 DOI: 10.1080/10408363.2021.1988047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this review, we summarize the relationship of PCT with pathogens, evaluate the clinical utility of PCT in the diagnosis of clinical diseases, condition monitoring and evaluation, and guiding medical decision-making, and explore current knowledge on the mechanisms by which pathogens cause changes in PCT levels. The lipopolysaccharides of the microorganisms stimulate cytokine production in host cells, which in turn stimulates production of serum PCT. Pathogens have different virulence mechanisms that lead to variable host inflammatory responses, and differences in the specific signal transduction pathways result in variable serum PCT concentrations. The mechanisms of signal transduction have not been fully elucidated. Further studies are necessary to ascertain the PCT fluctuation range of each pathogen. PCT levels are helpful in distinguishing between certain pathogens, in deciding if antibiotics are indicated, and in monitoring response to antibiotics.
Collapse
Affiliation(s)
- Hua-Guo Xu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Tian
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shi-Yang Pan
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
3
|
Meini S, Sozio E, Bertolino G, Sbrana F, Ripoli A, Pallotto C, Viaggi B, Andreini R, Attanasio V, Rescigno C, Atripaldi L, Leonardi S, Bernardo M, Tascini C. D-Dimer as Biomarker for Early Prediction of Clinical Outcomes in Patients With Severe Invasive Infections Due to Streptococcus Pneumoniae and Neisseria Meningitidis. Front Med (Lausanne) 2021; 8:627830. [PMID: 33937280 PMCID: PMC8081958 DOI: 10.3389/fmed.2021.627830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; no current clinical measure adequately reflects the concept of dysregulated response. Coagulation plays a pivotal role in the normal response to pathogens (immunothrombosis), thus the evolution toward sepsis-induced coagulopathy could be individuate through coagulation/fibrinolysis-related biomarkers. We focused on the role of D-dimer assessed within 24 h after admission in predicting clinical outcomes in a cohort of 270 patients hospitalized in a 79 months period for meningitis and/or bloodstream infections due to Streptococcus pneumoniae (n = 162) or Neisseria meningitidis (n = 108). Comparisons were performed with unpaired t-test, Mann-Whitney-test or chi-squared-test with continuity correction, as appropriate, and multivariable logistic regression analysis was performed with Bayesian model averaging. In-hospital mortality was 14.8% for the overall population, significantly higher in S. pneumoniae than in N. meningitidis patients: 19.1 vs. 8.3%, respectively (p = 0.014). At univariable logistic regression analysis the following variables were significantly associated with in-hospital mortality: pneumococcal etiology, female sex, age, ICU admission, SOFA score, septic shock, MODS, and D-dimer levels. At multivariable analysis D-dimer showed an effect only in N. meningitidis subgroup: as 500 ng/mL of D-dimer increased, the probability of unfavorable outcome increased on average by 4%. Median D-dimer was significantly higher in N. meningitidis than in S. pneumoniae patients (1,314 vs. 1,055 ng/mL, p = 0.009). For N. meningitidis in-hospital mortality was 0% for D-dimer <500 ng/mL, very low (3.5%) for D-dimer <7,000 ng/mL, and increased to 26.1% for D-dimer >7,000 ng/mL. Kaplan-Meier analysis of in-hospital mortality showed for N. meningitidis infections a statistically significant difference for D-dimer >7,000 ng/mL compared to values <500 ng/mL (p = 0.021) and 500-3,000 ng/mL (p = 0.002). For S. pneumoniae the mortality risk resulted always high, over 10%, irrespective by D-dimer values. In conclusion, D-dimer is rapid to be obtained, at low cost and available everywhere, and can help stratify the risk of in-hospital mortality and complications in patients with invasive infections due to N. meningitidis: D-dimer <500 ng/mL excludes any further complications, and a cut-off of 7,000 ng/mL seems able to predict a significantly increased mortality risk from much <10% to over 25%.
Collapse
Affiliation(s)
- Simone Meini
- Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy
| | - Emanuela Sozio
- Infectious Disease Unit, Department of Medicine, University of Udine, Udine, Italy
| | | | | | | | - Carlo Pallotto
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda Unità Sanitaria Locale Toscana Centro, Florence, Italy.,Section of Infectious Diseases, Department of Medicine, University of Perugia, Perugia, Italy
| | - Bruno Viaggi
- Neuro Intensive Care Unit, Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Roberto Andreini
- Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Carolina Rescigno
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Luigi Atripaldi
- Central Laboratory, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Silvia Leonardi
- Central Laboratory, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Mariano Bernardo
- Central Laboratory, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Carlo Tascini
- Infectious Disease Unit, Department of Medicine, University of Udine, Udine, Italy.,First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| |
Collapse
|
4
|
Thabet P, Joshi A, MacDonald E, Hutton B, Cheng W, Stevens A, Kanji S. Clinical and pharmacokinetic/dynamic outcomes of prolonged infusions of beta-lactam antimicrobials: An overview of systematic reviews. PLoS One 2021; 16:e0244966. [PMID: 33481817 PMCID: PMC7822342 DOI: 10.1371/journal.pone.0244966] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/19/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This overview of reviews aims to map and compare of objectives, methods, and findings of existing systematic reviews to develop a greater understanding of the information available about prolonged beta-lactam infusions in hospitalized patients with infection. DESIGN Overview of systematic reviews. DATA SOURCES Medline, Embase, PROSPERO and the Cochrane Library were systematically searched from January, 1990 to June, 2019 using a peer reviewed search strategy. Grey literature was also searched for relevant reviews. ELIGIBILITY CRITERIA FOR SELECTING REVIEWS Systematic reviews were sought that compared two or more infusion strategies for intravenous beta-lactam antimicrobials and report clinical cure or mortality. Populations of included reviews were restricted to hospitalized patients with infection, without restrictions on age, infection type, or disease. DATA EXTRACTION AND ANALYSIS Abstract screening, data extraction, quality and risk of bias assessment were conducted by two independent reviewers. Overlap between reviews was assessed using a modified corrected covered area. Overview findings are reported in accordance with Cochrane's recommendation for overview conduct. Clinical outcomes extracted included survival, clinical cure, treatment failure, microbiological cure, length of stay, adverse events, cost, and emergence of resistance. RESULTS The search strategy identified 3327 unique citations from which 21 eligible reviews were included. Reviews varied by population, intervention and outcomes studied. Between reviews, overlap of primary studies was generally high, methodologic quality generally low and risk of bias variable. Nine of 14 reviews that quantitatively evaluated mortality and clinical cure identified a benefit with prolonged infusions of beta lactams when compared with intermittent infusions. Evidence of mortality and clinical cure benefit was greater among critically ill patients when compared to less sick patients and lower in randomized controlled trials when compared with observational studies. CONCLUSIONS Findings from our review demonstrate a consistent and reproducible lack of harm with prolonged infusions of beta-lactam antibiotics with variability in effect size and significance of benefits. Despite 21 systematic reviews addressing prolonged infusions of beta-lactams, this overview supports the continued need for a definitive systematic review given variability in populations, interventions and outcomes in the current systematic reviews. Subsequent systematic reviews should have more rigorous and transparent methods, only include RCTs and evaluate the proposed benefits found in various subgroup-analyses-i.e. high risk of mortality. TRIAL REGISTRATION Prospero registry, CRD42019117118.
Collapse
Affiliation(s)
| | - Anchal Joshi
- University of Waterloo, Waterloo, Ontario, Canada
| | | | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Canada
| | - Wei Cheng
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Salmaan Kanji
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Canada
- * E-mail:
| |
Collapse
|
5
|
Black LP, Puskarich MA, Henson M, Miller T, Reddy ST, Fernandez R, Guirgis FW. Quantitative and Qualitative Assessments of Cholesterol Association With Bacterial Infection Type in Sepsis and Septic Shock. J Intensive Care Med 2020; 36:808-817. [PMID: 32578468 DOI: 10.1177/0885066620931473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reduced cholesterol levels are associated with increased organ failure and mortality in sepsis. Cholesterol levels may vary by infection type (gram negative vs positive), possibly reflecting differences in cholesterol-mediated bacterial clearance. METHODS This was a secondary analysis of a combined data set of 2 prospective cohort studies of adult patients meeting Sepsis-3 criteria. Infection types were classified as gram negative, gram positive, or culture negative. We investigated quantitative (levels) and qualitative (dysfunctional high-density lipoprotein [HDL]) cholesterol differences. We used multivariable logistic regression to control for disease severity. RESULTS Among 171 patients with sepsis, infections were gram negative in 67, gram positive in 46, and culture negative in 47. Both gram-negative and gram-positive infections occurred in 11 patients. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and HDL cholesterol (HDL-C) levels were lower for culture-positive sepsis at enrollment (TC, P < .001; LDL-C, P < .001; HDL-C, P = .011) and persisted after controlling for disease severity. Similarly, cholesterol levels were lower among culture-positive patients at 48 hours (TC, P = .012; LDL-C, P = .029; HDL-C, P = .002). Triglyceride (TG) levels were lower at enrollment (P =.033) but not at 48 hours (P = .212). There were no differences in dysfunctional HDL. Among bacteremic patients, cholesterol levels were lower at enrollment (TC, P = .010; LDL-C, P = .010; HDL-C, P ≤ .001; TG, P = .005) and at 48 hours (LDL-C, P = .027; HDL-C, P < .001; TG, P = .020), except for 48 hour TC (P = .051). In the bacteremia subgroup, enrollment TC and LDL-C were lower for gram-negative versus gram-positive infections (TC, P = .039; LDL-C, P = .023). CONCLUSION Cholesterol levels are significantly lower among patients with culture-positive sepsis and bacteremia.
Collapse
Affiliation(s)
- Lauren Page Black
- Department of Emergency Medicine, 137869University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Michael A Puskarich
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.,Department of Emergency Medicine, 5635University of Minnesota, Minneapolis, MN, USA
| | - Morgan Henson
- Department of Emergency Medicine, 137869University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Taylor Miller
- Department of Emergency Medicine, 137869University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Srinivasa T Reddy
- Department of Medicine, Molecular & Medical Pharmacology, University of California, Los Angeles, CA, USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL, USA.,Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Faheem W Guirgis
- Department of Emergency Medicine, 137869University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| |
Collapse
|
6
|
Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies. J Clin Med 2019; 8:jcm8091337. [PMID: 31470569 PMCID: PMC6780948 DOI: 10.3390/jcm8091337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022] Open
Abstract
Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools.
Collapse
|
7
|
Gottschalk RA, Dorrington MG, Dutta B, Krauss KS, Martins AJ, Uderhardt S, Chan W, Tsang JS, Torabi-Parizi P, Fraser ID, Germain RN. IFN-mediated negative feedback supports bacteria class-specific macrophage inflammatory responses. eLife 2019; 8:46836. [PMID: 31385572 PMCID: PMC6684266 DOI: 10.7554/elife.46836] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/25/2019] [Indexed: 01/07/2023] Open
Abstract
Despite existing evidence for tuning of innate immunity to different classes of bacteria, the molecular mechanisms used by macrophages to tailor inflammatory responses to specific pathogens remain incompletely defined. By stimulating mouse macrophages with a titration matrix of TLR ligand pairs, we identified distinct stimulus requirements for activating and inhibitory events that evoked diverse cytokine production dynamics. These regulatory events were linked to patterns of inflammatory responses that distinguished between Gram-positive and Gram-negative bacteria, both in vitro and after in vivo lung infection. Stimulation beyond a TLR4 threshold and Gram-negative bacteria-induced responses were characterized by a rapid type I IFN-dependent decline in inflammatory cytokine production, independent of IL-10, whereas inflammatory responses to Gram-positive species were more sustained due to the absence of this IFN-dependent regulation. Thus, disparate triggering of a cytokine negative feedback loop promotes tuning of macrophage responses in a bacteria class-specific manner and provides context-dependent regulation of inflammation dynamics.
Collapse
Affiliation(s)
- Rachel A Gottschalk
- Lymphocyte Biology Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Michael G Dorrington
- Signaling Systems Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Bhaskar Dutta
- Lymphocyte Biology Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Kathleen S Krauss
- Lymphocyte Biology Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Andrew J Martins
- Systems Genomics and Bioinformatics Unit, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Stefan Uderhardt
- Lymphocyte Biology Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Waipan Chan
- Lymphocyte Biology Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - John S Tsang
- Systems Genomics and Bioinformatics Unit, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Parizad Torabi-Parizi
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, United States
| | - Iain Dc Fraser
- Signaling Systems Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Ronald N Germain
- Lymphocyte Biology Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| |
Collapse
|
8
|
Bassetti M, Russo A, Righi E, Dolso E, Merelli M, D'Aurizio F, Sartor A, Curcio F. Role of procalcitonin in predicting etiology in bacteremic patients: Report from a large single-center experience. J Infect Public Health 2019; 13:40-45. [PMID: 31248812 DOI: 10.1016/j.jiph.2019.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/29/2019] [Accepted: 06/08/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Procalcitonin (PCT) is routinely used for an early recognition of severe infections and for promoting appropriate use of antibiotics. However, limited data correlating values of PCT with etiology of infection has been reported. METHODS During 2016, all positive blood cultures (BC) were retrospectively extracted in a 1100-beds Italian tertiary-care hospital. PCT and C-reactive protein (CRP) values were recorded within 24h from BC collection. Primary endpoint of the study was to investigate the correlation between PCT and CRP values and the occurrence of bloodstream infections (BSI) caused by bacteria or fungi. RESULTS During the study period, 1296 positive BC were included: 712 (54.9%) due to Gram-positive (GP), 525 (40.5%) due to Gram-negative (GN) strains, and 59 (4.6%) caused by fungi. Among GN isolates, enterobacteriaceae were reported in 453 (86.3%) cases. PCT values were higher in patients with GN etiology (26.1±14.2ng/mL) compared to GP (6.9±4.5) and fungi (3.3±2.4). Mean values for CRP in GN, GP, and fungi were not different. Receiver Operating Characteristic (ROC) curves showed an area under curve (AUC) of 0.71 for PCT and 0.51 for CRP among GN isolates; an AUC of 0.7 for PCT and 0.52 for CRP among enterobacteriaceae. Lower AUC for PCT were reported for GP and fungi. CONCLUSIONS PCT showed moderate performance in early detection (within 24h) of Gram-negative infections, especially those caused by enterobacteriaceae. Further prospective studies are mandatory to confirm these observations.
Collapse
Affiliation(s)
- Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy.
| | - Alessandro Russo
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elda Righi
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elisabetta Dolso
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Maria Merelli
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Federica D'Aurizio
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Assunta Sartor
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Francesco Curcio
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| |
Collapse
|
9
|
Leng Y, Chen C, Zhang Y, Luo C, Liu B. Ability of serum procalcitonin to distinguish focus of infection and pathogen types in patients with bloodstream infection. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:135. [PMID: 31157256 DOI: 10.21037/atm.2019.03.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Serum procalcitonin (PCT) is a widely recognized inflammatory marker which can distinguish systemic bacterial infection from other types of infections. The ability of PCT levels to distinguish different pathogens from different focus of infection is contradictory. Methods This study included 551 patients with bloodstream infection (BSI) diagnosed with positive blood culture (BC) during Jan 2013 and May 2018. The patients were divided into two groups with or without definite focus of infection. In this study, we analyzed PCT levels induced by Gram-positive bacteria, Gram-negative bacteria and fungal infection. Relationship of time between PCT peak and BC collection, and the impact of antibiotics usage on PCT peak distribution were examined. Results For patients without definite focus of infection, the serum PCT values of Gram-negative bacteria were higher than that of Gram-positive bacteria (P<0.05). A cut-off value of 7.54 ng/mL for PCT showed a sensitivity of 88.3%. For patients with definite focus of infection, the serum PCT values of Gram-negative bacteria were significantly higher than Gram-positive bacteria in patients with lower respiratory tract (P=0.003), abdominal (P=0.039), urinary tract infection (P=0.025), but not in patients with upper respiratory tract infection (P=0.664). The PCT values between multidrug-resistant organism (MDRO) and sensitive bacteria were not statistically significant (P>0.05) among all patients. Moreover, among patients who use antibiotics before BC collection, the longer antibiotics used, the higher trend of the proportion for PCT peak distribution after BC collection. The higher proportion of antibiotics combined before BC collection, the lower proportion of PCT peak distribution appeared before BC collection, and the higher the proportion of PCT peak distribution appeared after BC collection. Conclusions PCT value is determined by many factors. PCT value is related to not only Gram-positive bacteria or Gram-negative bacteria, but also related to specific pathogens, and specific of infection sites etc. The use of Antibiotics is also an important factor of PCT value.
Collapse
Affiliation(s)
- Yinzhi Leng
- Department of Infection Management Office, Nanjing Hospital of Chinese Medicine, Nanjing 210001, China.,Department of Infection Management Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Caiyun Chen
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yongxiang Zhang
- Department of Infection Management Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Can Luo
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Bo Liu
- Department of Infection Management Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| |
Collapse
|
10
|
Bassetti M, Russo A, Righi E, Dolso E, Merelli M, D’Aurizio F, Sartor A, Curcio F. Role of procalcitonin in bacteremic patients and its potential use in predicting infection etiology. Expert Rev Anti Infect Ther 2018; 17:99-105. [DOI: 10.1080/14787210.2019.1562335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessandro Russo
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elda Righi
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elisabetta Dolso
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Maria Merelli
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Federica D’Aurizio
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Assunta Sartor
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Francesco Curcio
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| |
Collapse
|
11
|
Cabral L, Afreixo V, Meireles R, Vaz M, Frade JG, Chaves C, Caetano M, Almeida L, Paiva JA. Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn Patients. J Burn Care Res 2018; 40:112-119. [DOI: 10.1093/jbcr/iry058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Luís Cabral
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Portugal
- Autonomous Section of Health Sciences (SACS), University of Aveiro, Portugal
| | - Vera Afreixo
- CIDMA—Center for Research and Development in Mathematics and Applications, iBiMED—Institute for Biomedicine, Department of Mathematics, University of Aveiro, Portugal
| | - Rita Meireles
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Portugal
| | - Miguel Vaz
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Portugal
| | - João-Gonçalo Frade
- Clinical Pathology Department, Coimbra University Hospital Centre (CHUC), Portugal
- Escola Superior de Saúde, Instituto Politécnico de Leiria, Portugal
| | - Catarina Chaves
- Clinical Pathology Department, Coimbra University Hospital Centre (CHUC), Portugal
| | - Marisa Caetano
- Pharmacy Department, Coimbra University Hospital Centre (CHUC), Portugal
| | - Luís Almeida
- MedinUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal
| | - José-Artur Paiva
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar São João, Porto, Portugal
- Grupo de Infecção e Sépsis, Faculty of Medicine, University of Porto, Portugal
| |
Collapse
|
12
|
Thomas-Rüddel DO, Poidinger B, Kott M, Weiss M, Reinhart K, Bloos F. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:128. [PMID: 29753321 PMCID: PMC5949148 DOI: 10.1186/s13054-018-2050-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/23/2018] [Indexed: 12/14/2022]
Abstract
Background This study aimed to evaluate the accuracy of procalcitonin (PCT) serum concentrations to diagnose Gram-negative bacteremia and the association of PCT serum concentrations with more specific pathogens and the focus of infection. Methods Secondary analysis of the prospectively collected patient-level dataset from a cluster randomized quality improvement trial was performed. The trial included sepsis patients with organ dysfunction treated in the participating intensive care units from 2011 to 2015. Test performance for the prediction of Gram-negative bacteremia was assessed by receiver operating curve analysis. Independent effects of specific pathogen groups and foci of infection on PCT concentrations were assessed by linear logistic regression models. Results Blood cultures (BC) and PCT concentrations had been taken in 4858 of 6561 documented patients. PCT was significantly higher in Gram-negative bacteremia compared to Gram-positive bacteremia or candidemia (p < 0.001). The area under the curve was 0.72 (95% confidence interval 0.71–0.74) for the prediction of Gram-negative bacteremia compared to all other blood culture results including negative blood cultures. The optimized cutoff value was 10 ng/ml (sensitivity 69%, specificity 35%). PCT differed significantly between specific groups of pathogens (p < 0.001) with highest concentrations in Escherichia coli, Streptococcus species and other Enterobacteriaceae. PCT was highest in urogenital followed by abdominal infection and lowest in respiratory infection (p < 0.001). In a linear regression model, Streptococci, E. coli and other Enterobacteriaceae detected from BC were associated with three times higher PCT values. Urogenital or abdominal foci of infection were associated with twofold increased PCT values independent of the pathogen. Conclusions Serum PCT concentrations are higher in patients with Gram-negative bacteremia than in patients with Gram-positive bacteremia or candidemia. However, the discriminatory power of this difference is too low to guide therapeutic decisions. Variations in PCT serum concentrations are not determined solely by Gram-negative or Gram-positive bacteria but are also affected by distinct groups of pathogens and different foci of infection. Trial registration ClinicalTrials.gov, NCT01187134. Registered on 23 August 2010. Electronic supplementary material The online version of this article (10.1186/s13054-018-2050-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Daniel O Thomas-Rüddel
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. .,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Bernhard Poidinger
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Matthias Kott
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Manfred Weiss
- Clinic of Anaesthesiology, University Hospital Medical School, Ulm, Germany
| | - Konrad Reinhart
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Frank Bloos
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | | |
Collapse
|
13
|
Barber AE, Fleming BA, Mulvey MA. Similarly Lethal Strains of Extraintestinal Pathogenic Escherichia coli Trigger Markedly Diverse Host Responses in a Zebrafish Model of Sepsis. mSphere 2016; 1:e00062-16. [PMID: 27303721 PMCID: PMC4894679 DOI: 10.1128/msphere.00062-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/29/2016] [Indexed: 02/06/2023] Open
Abstract
In individuals with sepsis, the infecting microbes are commonly viewed as generic inducers of inflammation while the host background is considered the primary variable affecting disease progression and outcome. To study the effects of bacterial strain differences on the maladaptive immune responses that are induced during sepsis, we employed a novel zebrafish embryo infection model using extraintestinal pathogenic Escherichia coli (ExPEC) isolates. These genetically diverse pathogens are a leading cause of sepsis and are becoming increasingly dangerous because of the rise of multidrug-resistant strains. Zebrafish infected with ExPEC isolates exhibit many of the pathophysiological features seen in septic human patients, including dysregulated inflammatory responses (cytokine storms), tachycardia, endothelial leakage, and progressive edema. However, only a limited subset of ExPEC isolates can trigger a sepsis-like state and death of the host when introduced into the bloodstream. Mirroring the situation in human patients, antibiotic therapy reduced ExPEC titers and improved host survival rates but was only effective within limited time frames that varied, depending on the infecting pathogen. Intriguingly, we find that phylogenetically distant but similarly lethal ExPEC isolates can stimulate markedly different host transcriptional responses, including disparate levels of inflammatory mediators. These differences correlate with the amounts of bacterial flagellin expression during infection, as well as differential activation of Toll-like receptor 5 by discrete flagellar serotypes. Altogether, this work establishes zebrafish as a relevant model of key aspects of human sepsis and highlights the ability of genetically distinct ExPEC isolates to induce divergent host responses independently of baseline host attributes. IMPORTANCE Sepsis is a life-threatening systemic inflammatory condition that is initiated by the presence of microorganisms in the bloodstream. In the United States, sepsis due to ExPEC and other pathogens kills well over a quarter of a million people each year and is associated with tremendous health care costs. A high degree of heterogeneity in the signs and symptomology of sepsis makes this disease notoriously difficult to effectively diagnose and manage. Here, using a zebrafish model of sepsis, we find that similarly lethal but genetically distinct ExPEC isolates can elicit notably disparate host responses. These variances are in part due to differences in the levels and types of flagellin that are expressed by the infecting ExPEC strains. A better understanding of the variable impact that bacterial factors like flagellin have on host responses during sepsis could lead to improved diagnostic and therapeutic approaches to these often deadly infections. Podcast: A podcast concerning this article is available.
Collapse
Affiliation(s)
- Amelia E Barber
- Division of Microbiology and Immunology, Pathology Department, University of Utah, Salt Lake City, Utah, USA
| | - Brittany A Fleming
- Division of Microbiology and Immunology, Pathology Department, University of Utah, Salt Lake City, Utah, USA
| | - Matthew A Mulvey
- Division of Microbiology and Immunology, Pathology Department, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
14
|
Eidt MV, Nunes FB, Pedrazza L, Caeran G, Pellegrin G, Melo DAS, Possuelo L, Jost RT, Dias HB, Donadio MVF, Oliveira JR. Biochemical and inflammatory aspects in patients with severe sepsis and septic shock: The predictive role of IL-18 in mortality. Clin Chim Acta 2015; 453:100-6. [PMID: 26683353 DOI: 10.1016/j.cca.2015.12.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sepsis is a major health care problem, with a significant mortality rate in intensive care units. We evaluated biochemical and inflammatory markers in patients with severe sepsis and septic shock and its association of with mortality rates. METHODS Critically ill patients with diagnoses of sepsis - severe sepsis group (n=23) and septic shock group (n=25), and a control group (n=17) were recruited within 24h of entry into the ICU. Serum levels of inflammatory mediators were measured (IL-1β, IL-6, IL-8, IL-10, TNF-α, IL-18 and nitric oxide). We have also collected clinical parameters and laboratorial tests to estimate severity and organ dysfunction (APACHE II, SOFA, lactate). These results were compared between survivors and no survivors. RESULTS IL-18 was directly related to mortality independently of other inflammatory mediators, especially IL-1β, although the inflammatory pathway is closely linked to inflammasome activation and both have simultaneous release in the infectious process. Mortality was directly proportional to IL-18 plasma levels, which did not occur with other inflammatory mediators. CONCLUSIONS IL-18 is an important predictor of mortality in humans with both severe sepsis and septic shock, independent of IL-1β.
Collapse
Affiliation(s)
- Michelle V Eidt
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Fernanda Bordignon Nunes
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil
| | - Leonardo Pedrazza
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Gabriela Caeran
- Universidade de santa Cruz do Sul, UNISC, Santa Cruz do Sul, RS, Brazil
| | - Giovana Pellegrin
- Universidade de santa Cruz do Sul, UNISC, Santa Cruz do Sul, RS, Brazil
| | - Denizar A S Melo
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Lia Possuelo
- Universidade de santa Cruz do Sul, UNISC, Santa Cruz do Sul, RS, Brazil
| | - Renan Trevisan Jost
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Henrique Bregolin Dias
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Márcio V F Donadio
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil
| | - Jarbas R Oliveira
- Laboratório de Pesquisa em Biofísica Celular e Inflamação, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, RS, Brazil.
| |
Collapse
|
15
|
Abstract
Background: Prediction of the species of pathogen among patients with sepsis within hours would be helpful in accelerating proper treatment. As a potential method of shortening the time to identification, this study considered the usefulness of measuring procalcitonin (PCT) to predict blood culture (BC) results. Methods: The authors retrospectively analyzed the data of patients with a diagnosis of sepsis in their hospital from December 2012 to December 2013. The authors analyzed all diagnostic episodes consisting of BC and PCT concentration. The diagnostic performance of PCT to predict gram-negative bacteremia was tested using a receiver operative characteristic curve. Logistic regression was constructed using the presence of gram-negative bacteria as the dependent variable. Results: A total of 262 diagnostic episodes met the inclusion criteria. According to BC classifications, a significantly higher value of PCT was observed in bloodstream infections caused by gram-negative bacteria (26.7 ng/mL, 0.09–188.3) than that in bloodstream infections caused by gram-positive bacteria (0.84 ng/mL, 0.05–18.79) or Candida spp. (1.12 ng/mL, 0.07–49.68). A cutoff value of ≥3.39 ng/mL for PCT showed a sensitivity of 80%, a specificity of 71%, a positive predictive value of 35%, a negative predictive value of 91% and an area under the curve of 0.73 for gram-negative bacteremia identification by BC. Among the 122 diagnostic episodes with positive BC results, a cutoff value of ≥6.47 ng/mL for PCT yielded a sensitivity of 74%, a specificity of 81%, a positive predictive value of 82%, a negative predictive value of 75% and an area under the curve of 0.81 for gram-negative bacteremia identification. Conclusions: PCT may represent a useful tool for differentiating gram-positive from gram-negative bloodstream infection with a significantly higher PCT level indicating gram-negative bacteremia.
Collapse
|
16
|
Plotkowski MC, Estato V, Santos SA, da Silva MCA, Miranda AS, de Miranda PE, Pinho V, Tibiriça E, Morandi V, Teixeira MM, Vianna A, Saliba AM. Contribution of the platelet activating factor signaling pathway to cerebral microcirculatory dysfunction during experimental sepsis by ExoU producing Pseudomonas aeruginosa. Pathog Dis 2015; 73:ftv046. [PMID: 26187894 DOI: 10.1093/femspd/ftv046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 12/18/2022] Open
Abstract
Intravital microscopy was used to assess the involvement of ExoU, a Pseudomonas aeruginosa cytotoxin with phospholipase A2 activity, in dysfunction of cerebral microcirculation during experimental pneumosepsis. Cortical vessels from mice intratracheally infected with low density of the ExoU-producing PA103 P. aeruginosa strain exhibited increased leukocyte rolling and adhesion to venule endothelium, decreased capillar density and impaired arteriolar response to vasoactive acetylcholine. These phenomena were mediated by the platelet activating factor receptor (PAFR) pathway because they were reversed in mice treated with a PAFR antagonist prior to infection. Brains from PA103-infected animals exhibited a perivascular inflammatory infiltration that was not detected in animals infected with an exoU deficient mutant or in mice treated with the PAFR antagonist and infected with the wild type bacteria. No effect on brain capillary density was detected in mice infected with the PAO1 P. aeruginosa strain, which do not produce ExoU. Finally, after PA103 infection, mice with a targeted deletion of the PAFR gene exhibited higher brain capillary density and lower leukocyte adhesion to venule endothelium, as well as lower increase of systemic inflammatory cytokines, when compared to wild-type mice. Altogether, our results establish a role for PAFR in mediating ExoU-induced cerebral microvascular failure in a murine model of sepsis.
Collapse
Affiliation(s)
- Maria Cristina Plotkowski
- Department of Microbiology, Immunology and Parasitology, State University of Rio de Janeiro, 20551-30 Rio de Janeiro, Brazil
| | - Vanessa Estato
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, Rio de Janeiro, 21045-900, Brazil
| | - Sabrina Alves Santos
- Department of Microbiology, Immunology and Parasitology, State University of Rio de Janeiro, 20551-30 Rio de Janeiro, Brazil
| | | | - Aline Silva Miranda
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Pedro Elias de Miranda
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Vanessa Pinho
- Department of Morphology, Federal University of Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Eduardo Tibiriça
- Laboratory of Cardiovascular Investigation, Oswaldo Cruz Institute, Rio de Janeiro, 21045-900, Brazil
| | - Verônica Morandi
- Department of Cell Biology, State University of Rio de Janeiro, Rio de Janeiro, 20550-013, Brazil
| | - Mauro Martins Teixeira
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, 31270-901, Brazil
| | - Albanita Vianna
- Department of Pathology, State University of Rio de Janeiro, Rio de Janeiro, 22551-030, Brazil
| | - Alessandra Mattos Saliba
- Department of Microbiology, Immunology and Parasitology, State University of Rio de Janeiro, 20551-30 Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Cytokine profile in severe Gram-positive and Gram-negative abdominal sepsis. Sci Rep 2015; 5:11355. [PMID: 26079127 PMCID: PMC4468818 DOI: 10.1038/srep11355] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/18/2015] [Indexed: 12/12/2022] Open
Abstract
Sepsis is a principal cause of death in critical care units worldwide and consumes considerable healthcare resources. The aim of our study was to determine whether the early cytokine profile can discriminate between Gram-positive and Gram-negative bacteraemia (GPB and GNB, respectively) and to assess the prognostic value regarding outcome in critically ill patients with severe abdominal sepsis. The outcome measure was hospital mortality. Blood samples were obtained from 165 adult patients with confirmed severe abdominal sepsis. Levels of the proinflammatory mediators TNF-α, IL-8, IL-12 and IFN-γ and the anti-inflammatory mediators IL-1ra, IL-4, IL-10 and TGF-β1 were determined and correlated with the nature of the bacteria isolated from the blood culture and outcome. The cytokine profile in our study indicated that the TNF-α levels were 2-fold, IL-8 were 3.3-fold, IFN-γ were 13-fold, IL-1ra were 1.05-fold, IL-4 were 1.4-fold and IL-10 were 1.83-fold higher in the GNB group compared with the GPB group. The TNF-α levels were 4.7-fold, IL-8 were 4.6-fold, IL-1ra were 1.5-fold and IL-10 were 3.3-fold higher in the non-survivors compared with the survivors.
Collapse
|
18
|
Hagar JA, Powell DA, Aachoui Y, Ernst RK, Miao EA. Cytoplasmic LPS activates caspase-11: implications in TLR4-independent endotoxic shock. Science 2013; 341:1250-3. [PMID: 24031018 DOI: 10.1126/science.1240988] [Citation(s) in RCA: 937] [Impact Index Per Article: 85.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Inflammatory caspases, such as caspase-1 and -11, mediate innate immune detection of pathogens. Caspase-11 induces pyroptosis, a form of programmed cell death, and specifically defends against bacterial pathogens that invade the cytosol. During endotoxemia, however, excessive caspase-11 activation causes shock. We report that contamination of the cytoplasm by lipopolysaccharide (LPS) is the signal that triggers caspase-11 activation in mice. Specifically, caspase-11 responds to penta- and hexa-acylated lipid A, whereas tetra-acylated lipid A is not detected, providing a mechanism of evasion for cytosol-invasive Francisella. Priming the caspase-11 pathway in vivo resulted in extreme sensitivity to subsequent LPS challenge in both wild-type and Tlr4-deficient mice, whereas Casp11-deficient mice were relatively resistant. Together, our data reveal a new pathway for detecting cytoplasmic LPS.
Collapse
Affiliation(s)
- Jon A Hagar
- Department of Microbiology and Immunology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | | | | |
Collapse
|
19
|
Richards EP, Crumet N, Gilbert DN. Fever Control in Septic Shock: Import of Microorganisms and Antimicrobial Therapy. Am J Respir Crit Care Med 2013; 187:1273-4. [DOI: 10.1164/rccm.201207-1315le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
20
|
Zhang D, Li Y, Liu Y, Xiang X, Dong Z. Paclitaxel ameliorates lipopolysaccharide-induced kidney injury by binding myeloid differentiation protein-2 to block Toll-like receptor 4-mediated nuclear factor-κB activation and cytokine production. J Pharmacol Exp Ther 2013; 345:69-75. [PMID: 23318472 DOI: 10.1124/jpet.112.202481] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Recent studies suggest that paclitaxel, an anticancer agent, may modulate the injury and inflammatory responses in normal tissues. However, the underlying mechanism is not fully understood. Here we have examined the effect of paclitaxel on lipopolysaccharide (LPS)-induced acute kidney injury (AKI) in mice and further studied the mechanism. At relatively low doses, paclitaxel protected against LPS-induced AKI and improved animal survival. The beneficial effects of paclitaxel were accompanied by the downregulation of tumor necrosis factor-α, interleukin-1, and interleukin-6 production. In cultured renal tubular HK-2 cells, paclitaxel decreased the DNA-binding activity of nuclear factor-κB (NF-κB) during LPS treatment, inhibited the degradation of the inhibitor of κB-α, and blocked the expression and activation of NF-κB p65. At the upstream level, paclitaxel reduced LPS-induced association of myeloid differentiation protein-2 (MD-2) with Toll-like receptor 4 (TLR4). In an in vitro assay, paclitaxel was shown to directly bind recombinant MD-2. The inhibitory effect of paclitaxel on NF-κB activation and cytokine expression disappeared in MD-2 knockdown cells, indicating that paclitaxel acts through MD-2. Collectively, these results suggest that paclitaxel may bind MD-2 to block MD-2/TLR4 association during LPS treatment, resulting in the suppression of NF-κB activation and inhibition of proinflammatory cytokine production.
Collapse
Affiliation(s)
- Dongshan Zhang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | | | | | | | | |
Collapse
|
21
|
Xu XJ, Tang YM, Liao C, Song H, Yang SL, Xu WQ, Shi SW, Zhao N. Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock. Intensive Care Med 2012. [PMID: 23179333 DOI: 10.1007/s00134-012-2752-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We performed a prospective study to evaluate the ability of inflammatory cytokines in discriminating gram-negative from gram-positive bacteremia in septic shock. METHODS During the study period, the serum inflammatory cytokine levels were measured at the onset of septic shock by flow cytometry in pediatric hematology/oncology patients with septic shock. RESULTS One hundred episodes of septic shock were enrolled. Of 97 episodes of monomicrobial infection, 73.2 % were caused by gram-negative bacteremia and 26.8 % by gram-positive bacteremia. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α were closely related to the pediatric index of mortality 2 (PIM2) score and mortality. However, although the PIM2 score and mortality were comparable, the IL-6, IL-10, and TNF-α levels were significantly higher in patients with gram-negative bacteremia (GNB) than those with gram-positive bacteremia (median levels, pg/mL: IL-6: 784.1 vs. 254.4, P = 0.001; IL-10: 192.2 vs. 19.7, P < 0.001; TNF-α: 4.2 vs. 2.0, P < 0.001). Of the three cytokines, IL-10 was the most useful biomarker for GNB prediction in the derivation cohort and a cutoff value of 50 pg/mL showed a sensitivity of 70.8 % and a specificity of 80.0 %, with a positive predictive value of 89.5 %. When this cutoff value was applied to the validation cohort, the sensitivity, specificity, and positive predictive value were 80.9, 75.0, and 90.5 %, respectively. CONCLUSIONS Flow cytometry-based inflammatory cytokine measurement is a helpful adjuvant approach for early and quick discrimination of gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock which might be useful for evaluating the severity of shock and the selection and/or timely withdrawal or switch of antibiotics.
Collapse
Affiliation(s)
- Xiao-Jun Xu
- Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Brodská H, Malíčková K, Adámková V, Benáková H, Šťastná MM, Zima T. Significantly higher procalcitonin levels could differentiate Gram-negative sepsis from Gram-positive and fungal sepsis. Clin Exp Med 2012; 13:165-70. [PMID: 22644264 DOI: 10.1007/s10238-012-0191-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 05/07/2012] [Indexed: 12/26/2022]
Abstract
Procalcitonin (PCT) levels can distinguish between infectious and non-infectious systemic inflammatory response. However, there are some differences between Gram-negative (G-), Gram-positive (G+), and fungal bloodstream infections, particularly in different cytokine profiles, severity and mortality. The aim of current study was to examine whether PCT levels can serve as a distinguishing mark between G+, G-, and fungal sepsis as well. One hundred and sixty-six septic patients with positive blood cultures were examined on C-reactive protein (CRP) and PCT on the same date of blood culture evaluation. The median (interquartile range, IQR) of CRP and PCT in G+, G-, and fungal cohorts and comparison of measured values between groups were made using the Kruskal-Wallis test with subsequent Bonferroni's corrections, with p < 0.05. In 83/166 (50 %) of blood cultures, G+ microbes, 78/166 (47 %) G- rods, and 5/166 (3 %) fungi were detected. PCT concentrations (ng/ml) were significantly higher in G- compared to other cohorts: 8.90 (1.88; 32.60) in G-, 0.73 (0.22; 3.40) in G+, and 0.58 (0.35; 0.73) in fungi (p < 0.00001). CRP concentrations did not differ significantly in groups. Significantly higher PCT levels could differentiate G- sepsis from G+ and fungemia. In contrast to CRP, PCT is a good discriminative biomarker in different bloodstream infections.
Collapse
Affiliation(s)
- Helena Brodská
- Institute of Clinical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U nemocnice 2, 12000, Prague 2, Czech Republic
| | | | | | | | | | | |
Collapse
|
23
|
Emonet S, Schrenzel J. How could rapid bacterial identification improve the management of septic patients? Expert Rev Anti Infect Ther 2012; 9:707-9. [PMID: 21905779 DOI: 10.1586/eri.11.84] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
The protective effect of thymoquinone against sepsis syndrome morbidity and mortality in mice. Int Immunopharmacol 2011; 11:250-4. [DOI: 10.1016/j.intimp.2010.11.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/01/2010] [Accepted: 11/23/2010] [Indexed: 11/16/2022]
|
25
|
Abstract
OBJECTIVE To describe relevant pathogen-related characteristics and their impact on sepsis pathogenesis and prognosis. DATA SOURCE Current literature regarding genomic bacterial load and virulence factors, with an emphasis on the impact of these factors on pathophysiology and prognosis of sepsis. DATA EXTRACTION AND SYNTHESIS The current paradigm on sepsis pathophysiology and management overlooks aspects concerning the nature and characteristics of the infecting pathogen. Our findings suggest that evaluation of genomic bacterial load might be useful to assess severity and predict prognosis in septic patients; its use during treatment for monitoring clinical response is another interesting potential application. Virulence factors identification might help to develop pathogen-specific therapeutic strategies for higher-risk septic patients. CONCLUSIONS The recognition of the importance of quantifying the pathogen has major clinical implications and will open up a new field of exploration of therapies targeted at anticipating development and appropriate treatment in severe sepsis. The improved detection and understanding of bacterial virulence factors may lead to specific therapies.
Collapse
|
26
|
Abstract
Infectious diseases continue to impact human morbidity and mortality. Every individual is vulnerable to microbial infections regardless of socioeconomic status, gender, age group or ethnic background. There has been an explosion of international air travel with an estimated 2 billion passengers travelling on commercial airlines every year. The rapid expansion of globalization and mass tourism has facilitated the spread of disease-causing pathogens from one continent to another at unprecedented rates.
Collapse
Affiliation(s)
- F.P. Nijkamp
- Faculteit Farmacie, Rijksuniversiteit Utrecht, Utrecht, Netherlands
| | - Michael J. Parnham
- Diseases "Dr. Fran Mihaljevic", Research & Clinical Immunology Unit, University Hospital for Infectious, Mirogojska cesta 8, Zagreb, 10000 Croatia
| |
Collapse
|
27
|
A randomized, double-blind, placebo-controlled trial of TAK-242 for the treatment of severe sepsis. Crit Care Med 2010; 38:1685-94. [PMID: 20562702 DOI: 10.1097/ccm.0b013e3181e7c5c9] [Citation(s) in RCA: 356] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate whether TAK-242, a small-molecule inhibitor of Toll-like receptor-4-mediated signaling, suppresses cytokine levels and improves 28-day all-cause mortality rates in patients with severe sepsis. DESIGN Randomized, double-blind, placebo-controlled trial. SETTING A total of 93 intensive care units worldwide. PATIENTS A total of 274 patients with severe sepsis and shock or respiratory failure. INTERVENTIONS Patients were randomly assigned to receive a 30-min loading dose followed by 96-hr infusions of placebo, TAK-242 1.2 mg/kg/day, or TAK-242 2.4 mg/kg/day. MEASUREMENTS AND MAIN RESULTS The primary pharmacodynamic end point was change in serum interleukin-6 levels relative to baseline, with 28-day all-cause mortality rate the primary clinical end point. The trial was terminated because of a lack of effect of TAK-242 in suppressing serum interleukin-6 levels. A total of 274 subjects were randomly assigned and treated. Clinical parameters at baseline were balanced across the three groups. TAK-242 did not suppress interleukin-6 as measured by 0- to 96.5-hr area under the interleukin-6 concentration curve at either dose. Specifically, the area under the effect curve increased by 9% and 26.9% in the TAK-242 1.2 and 2.4 mg/kg/day groups, respectively, which was not statistically different from placebo (p = .63 and .15, respectively). The 28-day mortality rate was 24% in the placebo, 22% in the low-dose, and 17% in the high-dose group (p = .26 for placebo vs. high dose). A nonsignificant reduction in mortality rate was observed in a subset of patients with both shock and respiratory failure (placebo [n = 51], 33%, vs. high dose [n = 52], 19%, p = .10). Transient, dose-related increases in methemoglobin levels were observed with TAK-242 treatment in 30.1% of the patients. CONCLUSIONS TAK-242 failed to suppress cytokine levels in patients with sepsis and shock or respiratory failure. Treatment with TAK-242 resulted in mild increases in serum methemoglobin levels but was otherwise well tolerated. Although observed mortality rates in patients with both shock and respiratory failure were lower with the 2.4 mg/kg/day dose, differences were not significant.
Collapse
|
28
|
A FQHPSFI peptide selectively binds to LPS-activated alveolar macrophages and inhibits LPS-induced MIP-2 production. Inflamm Res 2010; 59:627-34. [PMID: 20186460 DOI: 10.1007/s00011-010-0175-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 12/24/2009] [Accepted: 02/10/2010] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The goal of this study was to identify peptides selectively binding to lipopolysaccharide (LPS)-activated alveolar macrophages (AMs) and to characterize their effects on the production of LPS-induced cytokines. METHODS A phage display library was sequentially screened by binding phages to unmanipulated AMs and then to LPS-activated AMs. Individual phage clones were identified by cell-based ELISA. Positive phage clones were characterized by DNA sequencing and bioinformatics analysis. Binding specificity of the selected phage to LPS-activated AMs was tested using immunofluorescent staining. The selected candidate peptide was chemically synthesized to determine whether it could modulate LPS-induced cytokine production in AMs. RESULTS Twenty-two out of 40 phage clones selected randomly after four rounds of biopanning bound selectively to LPS-activated AMs, and 12 of them displayed novel peptides. A phage clone displaying FQHPSFI peptide bound effectively to LPS-activated AMs, but not to other cells tested. Furthermore, the synthetic FQHPSFI peptide, but not seven point mutants tested, competitively inhibited the binding of the phage clone to LPS-activated AMs. Importantly, the FQHPSFI peptide significantly inhibited LPS-stimulated microphage inflammatory protein 2 (MIP-2) production in vitro. CONCLUSIONS Our data demonstrate that phage display technology is a powerful tool for the identification of bioactive peptides. The identified FQHPSFI peptide may be used for the modulation of LPS-stimulated MIP-2 production in AMs.
Collapse
|
29
|
Fang Y, Zhang L, Zhou GQ, Wang ZF, Feng K, Lou ZY, Pang W, Li L, Ling Y, Li YX, Liu BC. TRAF6 polymorphisms not associated with the susceptibility to and severity of sepsis in a Chinese population. World J Emerg Med 2010; 1:169-175. [PMID: 25214962 PMCID: PMC4129682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 08/23/2010] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The tumor necrosis factor recepter associated factor (TRAF) 6 is an important intracellular adapter protein that plays a pivotal role in activating multiple inflammatory and immune related processes induced by cytokines. TRAF6 represents a strong candidate susceptibility factor for sepsis. We investigated whether polymorphisms at the TRAF6 gene are associated with the susceptibility to and severity of sepsis. METHODS A hospital-based case-control study was conducted with 255 patients with sepsis and 260 controls who were recruited from Zhengzhou, China. Haplotype tagging single nucleotide polymorphisms (htSNPs) were selected from the HapMap database and genotyped using the SNPstream genotyping platform. The associations with the susceptibility and disease severity of sepsis were estimated by logistic regression, and adjusted for age, sex, smoking, drinking, chronic diseases status, APACHEII score and critical illness status. RESULTS A total of 13 TRAF6 SNPs were tagged by 7 htSNPs. Five htSNPs (rs5030490, rs5030411, rs5030416, rs5030445 and rs3740961) were genotyped in the case control study. Genotype frequencies of the htSNPs were conformed to the Hardy-Weinberg equilibrium in both patients and controls. No significant association was found between the 5 htSNPs and the susceptibility to and severity of sepsis. Compared with the main haplotype -11120A/-10688T/-9423A/805G/12967G, no certain haplotype was associated with the significantly susceptibility to or severity of sepsis. CONCLUSION TRAF6 gene polymorphisms might not play a major role in mediating the susceptibility to and severity of sepsis in the Chinese population. A larger population-based case-control study is warranted.
Collapse
Affiliation(s)
- Yu Fang
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Lu Zhang
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Gang-qiao Zhou
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Zhi-fu Wang
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Kai Feng
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Zhi-yi Lou
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Wei Pang
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Lei Li
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Yan Ling
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Yu-xia Li
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| | - Bao-chi Liu
- Department of Emergency and Neurology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China (Fang Y, Zhang L, Lou ZY, Pang W); State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Radiation Medicine, Beijing 100850, China (Zhou GQ, Wang ZF); Laboratory Center, Chinese PLA 306 Hospital, Beijing 100101, China (Feng K); Department of Microbial Genomics, Beijing Institute of Biotechnology, Beijing 100071, China(Ling Y, Li YX); Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China (Li L, Liu BC)
| |
Collapse
|
30
|
Bitzer-Quintero OK, Dávalos-Marín AJ, Ortiz GG, Meza ARDA, Torres-Mendoza BM, Robles RG, Huerta VC, Beas-Zárate C. Antioxidant activity of tryptophan in rats under experimental endotoxic shock. Biomed Pharmacother 2010; 64:77-81. [DOI: 10.1016/j.biopha.2009.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 07/02/2009] [Indexed: 11/29/2022] Open
|
31
|
The inhibition of lipopolysaccharide-induced tumor necrosis factor-α and nitric oxide production by Clostridium perfringens α-toxin and its relation to α-toxin-induced intracellular ceramide generation. Int J Med Microbiol 2009; 299:554-62. [DOI: 10.1016/j.ijmm.2009.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 03/04/2009] [Accepted: 04/19/2009] [Indexed: 11/18/2022] Open
|
32
|
Abstract
PURPOSE OF REVIEW To present the recent findings obtained in clinical and experimental studies examining microcirculatory alterations in sepsis, their link to mitochondrial dysfunction, and current knowledge regarding the impact of these alterations on the outcome of septic patients. RECENT FINDINGS Interlinked by a mutual cascade effect and driven by the host-pathogen interaction, microcirculatory and mitochondrial functions are impaired during sepsis. Mitochondrial respiration seems to evolve during the course of sepsis, demonstrating a change from reversible to irreversible inhibition. The spatiotemporal heterogeneity of microcirculatory and mitochondrial dysfunction suggests that these processes may be compartmentalized. Although a causal relationship between mitochondrial and microcirculatory dysfunction and organ failure in sepsis is supported by an increasing number of studies, adaptive processes have also emerged as part of microcirculatory and mitochondrial alterations. Treatments for improving or preserving microcirculatory, mitochondrial function, or both seem to yield a better outcome in patients. SUMMARY Even though there is evidence that microcirculatory and mitochondrial dysfunction plays a role in the development of sepsis-induced organ failure, their interaction and respective contribution to the disease remains poorly understood. Future research is necessary to better define such relationships in order to identify therapeutic targets and refine treatment strategies.
Collapse
|
33
|
Belknap J, Moore J, Crouser E. Sepsis—From human organ failure to laminar failure. Vet Immunol Immunopathol 2009; 129:155-7. [DOI: 10.1016/j.vetimm.2008.11.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Abstract
Sepsis is caused by infection, and knowing what type of organism is causing the infection certainly matters in terms of both epidemiology and selecting antibiotic therapy. Although there is considerable laboratory evidence that micro-organisms initiate sepsis in different ways, the clinical consequences are usually indistinguishable. New drugs that target specific points in the activation pathway are starting to emerge, and these will require us to be much more accurate in how we diagnose sepsis.
Collapse
Affiliation(s)
- Jonathan Cohen
- Division of Clinical Medicine, Brighton & Sussex Medical School, Brighton Falmer BN1 9PX, UK.
| |
Collapse
|