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Jing J, Wei Y, Dong X, Li D, Zhang C, Fang Z, Wang J, Wan X. Characteristics and Clinical Prognosis of Septic Patients With Persistent Lymphopenia. J Intensive Care Med 2024; 39:733-741. [PMID: 38225173 DOI: 10.1177/08850666241226877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background: Septic patients with persistent lymphopenia may be in an immunosuppressed state. Therefore, we evaluated and compared the clinical characteristics and outcomes of septic patients with persistent lymphopenia (≥2d) and those with nonpersistent lymphopenia. Methods: A retrospective cohort study was designed. A total of 1306 patients with sepsis who were attended to the First Affiliated Hospital of Dalian Medical University from March 2016 to August 2022 were included. The primary clinical outcome was 90d mortality. The secondary clinical outcomes were the length of stay, hospital mortality, 28d mortality, the incidence of secondary infection, and differences in clinical characteristics. Results: Among 1306 patients with sepsis, 913 (69.9%) patients developed persistent lymphopenia. Compared with patients with nonpersistent lymphopenia, patients with persistent lymphocytopenia were admitted to intensive care unit (75.7% vs 52.7%, P < .05), treated with mechanical ventilation (67.6% vs 39.2%, P < .05), positive rate of microbial culture pathogens (86.7% vs 71.2%, P < .05), SOFA [8.0 (6.0-10.0) vs 6.0 (4.0-8.0), P < .05], length of stay [17.0d (12.0-27.0) vs 13.0d (10.0-21.0), P < .05], hospital mortality (37.7% vs 24.2%, P < .05), 28d mortality (38.0% vs 22.9%, P < .05), and 90d mortality (51.2% vs 31.3%, P < .05) were higher. As the duration of lymphocytopenia increased, so did the mortality rate in hospital. In addition, the onset time of persistent lymphopenia was not associated with SOFA. But we found that the frequency of persistent lymphopenia during hospitalization was positively associated with SOFA. Conclusion: Septic patients with persistent lymphopenia have higher mortality, worse conditions, increased risk of secondary infection, and poor prognosis regardless of shock.
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Affiliation(s)
- Juanjuan Jing
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yushan Wei
- Department of Scientific Research, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xue Dong
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dandan Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenyang Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhiyao Fang
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jia Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xianyao Wan
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Cheng W, Zhang J, Li D, Lei X, Wang H, Cui N. CTLA-4 expression on CD4 + lymphocytes in patients with sepsis-associated immunosuppression and its relationship to mTOR mediated autophagic-lysosomal disorder. Front Immunol 2024; 15:1396157. [PMID: 39104530 PMCID: PMC11298341 DOI: 10.3389/fimmu.2024.1396157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
Background The aim of this study was to clarify the relationship between expression level of CTLA-4 on CD4+ T cells and sepsis-associated immunosuppression (SAI), and to elucidate the possible mechanism of mTOR pathway mediated autophagic-lysosomal disorder in regulating CTLA-4 expression. Methods We enrolled 63 sepsis patients admitted to our ICU between January 1 and June 30, 2023. Peripheral blood mononuclear cells were isolated from the patients within 24 hours of recruitment. Expression levels of mTOR, P62, LC3II, and CTLA-4 on circulating CD4+ T lymphocytes were quantitated using flow cytometry. The association of these markers and relationship between CTLA-4 expression and the incidence of SAI and 28-day mortality were comprehensively analyzed. Results Compared with non-immunosuppressed patients with sepsis, patients with SAI had a higher 28-day mortality rate (37.5% vs 13.0%, P=0.039) and higher CTLA-4 mean fluorescence intensity (MFI) on CD4+ T cells (328.7 versus 78.7, P<0.0001). CTLA-4 MFI on CD4+ cells was independently associated with the occurrence of SAI (95% confidence interval: 1.00-1.14, P=0.044). In patients with sepsis and SAI, non-survivors had higher CTLA-4 expression than survivors (sepsis: 427.5 versus 130.6, P=0.002; and SAI: 506.7 versus 225.2, P<0.0001). The sensitivity and specificity of CTLA-4 MFI at predicting 28-day mortality in patients with SAI was 100% and 80% respectively with the cutoff value of 328.7 and the area under the curve of 0.949. The MFI of mTOR, P62, and LC3II on CD4+ T cells were statistically higher in patients with SAI than in non-immunosuppressed patients (267.2 versus 115.9, P<0.0001; 314.8 versus 173.7, P<0.0001; and 184.7 versus 1123.5, P=0.012, respectively); P62 and LC3II were markedly higher in non-survivors than in survivors of sepsis (302.9 versus 208.9, P=0.039; and 244.3 versus 122.8, P<0.0001 respectively). The expression of CTLA-4 statistically correlated with that of LC3II in patients with sepsis, patients with SAI, and patients with SAI who did not survive (correlation coefficient: 0.69, 0.68, and 0.73, respectively, P<0.0001). Conclusions CTLA-4 overexpression on CD4+ T cells was markedly associated with the incidence of SAI and had great relevance to 28-day mortality. mTOR pathway mediated autophagic-lysosomal disorder showed significant association with CTLA-4 expression.
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Affiliation(s)
- Wei Cheng
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jiahui Zhang
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongkai Li
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xianli Lei
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hao Wang
- Department of Critical Care Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Na Cui
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Cui H, Yuan Z, Liang W, Cao B, Chen L, Cui J, Wei B. Safety and efficacy of minimally invasive gastrectomy for older patients with gastric cancer after neoadjuvant chemotherapy and immunotherapy: a propensity score-matched analysis. BMC Geriatr 2024; 24:606. [PMID: 39009976 PMCID: PMC11251346 DOI: 10.1186/s12877-024-05193-w] [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: 02/03/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The effect of neoadjuvant immunotherapy on minimally invasive gastrectomy (MIG) in older patients with gastric cancer remains controversial. This study aimed to evaluate the safety, and efficacy of MIG for older patients who underwent neoadjuvant chemotherapy and immunotherapy (NICT). METHODS The clinical data of 726 older patients aged over 65 years who underwent upfront MIG or MIG after NICT in the Department of General Surgery, Chinese PLA General Hospital First Medical Center between Jan 2020 and Nov 2023 were retrospectively analyzed. Propensity score-matched (PSM) analysis at a ratio of 1:2 was performed to reduce bias from confounding patient-related variables, short- and long-term outcomes were compared between the two groups. RESULTS The baseline characteristics were comparable between 61 patients in the NICT-MIG group and 114 patients in the MIG group after PSM (P > 0.05). The major pathological response (MPR) rate and pathological complete response (pCR) rate were 44.2% and 21.3%, respectively, in the NICT-MIG group. Patients in the NICT-MIG group had longer operation times (P = 0.005) and postoperative days (P = 0.030) than those in the MIG group. No significant differences were found in intraoperative bleeding, number of retrieved lymph nodes, first flatus day, R0 resection rate, overall postoperative complication (POC) morbidity, severe POC morbidity, 2-year overall, and recurrence-free survival between the MIG and NICT-MIG groups (P > 0.05). Multivariate logistic analysis revealed that an estimated blood loss > 200 mL (P = 0.010) and a lymphocyte-to-monocyte ratio (LMR) ≤ 3.25 (P = 0.006) were independent risk factors for POCs after MIG in older patients. CONCLUSION The safety, and efficacy of NICT-MIG were comparable to those of upfront MIG in older patients with GC. Patients with an estimated blood loss > 200 mL or an LMR ≤ 3.25 should be carefully evaluated for an increased risk of POCs in older patients who undergo MIG. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registration Number: ChiCTR2400086827).
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Affiliation(s)
- Hao Cui
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Wenquan Liang
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing, 100853, China
| | - Bo Cao
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing, 100853, China
| | - Lin Chen
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing, 100853, China
| | - Jianxin Cui
- School of Medicine, Nankai University, Tianjin, 300071, China.
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing, 100853, China.
| | - Bo Wei
- School of Medicine, Nankai University, Tianjin, 300071, China.
- Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing, 100853, China.
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Chen D, Zhou K, Tian R, Wang R, Zhou Z. Predictive value of the dynamics of absolute lymphocyte counts for 90-day mortality in ICU sepsis patients: a retrospective big data study. BMJ Open 2024; 14:e084562. [PMID: 38960455 PMCID: PMC11227848 DOI: 10.1136/bmjopen-2024-084562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES The objective of the study was to assess the clinical predictive value of the dynamics of absolute lymphocyte count (ALC) for 90-day all-cause mortality in sepsis patients in intensive care unit (ICU). DESIGN Retrospective cohort study using big data. SETTING This study was conducted using the Medical Information Mart for Intensive Care IV database V.2.0 database. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 90-day all-cause mortality. PARTICIPANTS Patients were included if they were diagnosed with sepsis on the first day of ICU admission. Exclusion criteria were ICU stay under 24 hours; the absence of lymphocyte count on the first day; extremely high lymphocyte count (>10×109/L); history of haematolymphatic tumours, bone marrow or solid organ transplants; survival time under 72 hours and previous ICU admissions. The analysis ultimately included 17 329 sepsis patients. RESULTS The ALC in the non-survivors group was lower on days 1, 3, 5 and 7 after admission (p<0.001). The ALC on day 7 had the highest area under the curve (AUC) value for predicting 90-day mortality. The cut-off value of ALC on day 7 was 1.0×109/L. In the restricted cubic spline plot, after multivariate adjustments, patients with higher lymphocyte counts had a better prognosis. After correction, in the subgroups with Sequential Organ Failure Assessment score ≥6 or age ≥60 years, ALC on day 7 had the lowest HR value (0.79 and 0.81, respectively). On the training and testing set, adding the ALC on day 7 improved all prediction models' AUC and average precision values. CONCLUSIONS Dynamic changes of ALC are closely associated with 90-day all-cause mortality in sepsis patients. Furthermore, the ALC on day 7 after admission is a better independent predictor of 90-day mortality in sepsis patients, especially in severely ill or young sepsis patients.
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Affiliation(s)
- Daonan Chen
- Shanghai General Hospital, Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Zhou
- Shanghai General Hospital, Department of Hematology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Tian
- Shanghai General Hospital, Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruilan Wang
- Shanghai General Hospital, Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Zhou
- Shanghai General Hospital, Department of Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Czech M, Cuellar-Rodriguez J, Patel BA, Groarke EM, Cowen EW, Turturice B, Beck DB, Wilson L, Goodspeed W, Darden I, Young NS, Hickstein D, Ombrello A, Hoffman P, Arikan EA, Sinaii N, Hathaway L, Castelo-Soccio L, Fike A, Kastner DB, Grayson PC, Ferrada MA. Opportunistic Infections, Mortality Risk, and Prevention Strategies in Patients With Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic (VEXAS) Syndrome. Open Forum Infect Dis 2024; 11:ofae405. [PMID: 39077052 PMCID: PMC11285395 DOI: 10.1093/ofid/ofae405] [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: 04/23/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024] Open
Abstract
Background VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a genetic disorder characterized by bone marrow failure and systemic inflammation, putting patients at risk for infections. This study comprehensively examines the prevalence of opportunistic infections in patients with VEXAS, evaluating their impact on clinical outcomes and potential preventive measures. Methods Patients with confirmed VEXAS were included. Survival analysis and logistic regression were used to identify associations between opportunistic infections and mortality. Infection rates (IRs) for Pneumocystis jirovecii pneumonia (PJP) and alphaherpesviruses were calculated over a prospective 8-month observation period in relationship to prophylaxis. Results Of 94 patients with VEXAS, 6% developed PJP; 15% had alphaherpesvirus reactivation, with varicella zoster virus (VZV) being the most common herpesvirus; and 10% contracted a nontuberculous mycobacterial (NTM) infection. Risk of death was significantly increased per month following a diagnosis of PJP (hazard ratio [HR], 72.41 [95% confidence interval {CI}, 13.67-533.70]) or NTM (HR, 29.09 [95% CI, 9.51-88.79]). Increased odds for death were also observed in patients with a history of herpes simplex virus (HSV) reactivation (odds ratio [OR], 12.10 [95% CI, 1.29-114.80]) but not in patients with VZV (OR, 0.89 [95% CI, .30-2.59]). Prophylaxis for PJP (IR, 0.001 vs 0 per person-day, P < .01) and VZV (IR, 0.006 vs 0 per person-day, P = .04) markedly decreased infection rates with a number needed to treat of 4 and 7, respectively. Conclusions Opportunistic infections are common in patients with VEXAS. Patients who develop PJP, HSV, or NTM are at increased risk for death. Prophylaxis against PJP and VZV is highly effective.
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Affiliation(s)
- Mary Czech
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Cuellar-Rodriguez
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Bhavisha A Patel
- National Heart, Blood, and Lung Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Emma M Groarke
- National Heart, Blood, and Lung Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Edward W Cowen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Benjamin Turturice
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David B Beck
- Department of Medicine and Department of Biochemistry and Molecular Pharmacology, New York University, New York, New York, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lorena Wilson
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wendy Goodspeed
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ivana Darden
- National Heart, Blood, and Lung Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Neal S Young
- National Heart, Blood, and Lung Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dennis Hickstein
- National Heart, Blood, and Lung Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amanda Ombrello
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Patrycjia Hoffman
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Evsen Apaydin Arikan
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ninet Sinaii
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Londa Hathaway
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alice Fike
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel B Kastner
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcela A Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Sauri-Suarez S, Quiñones S, De la Maza-Flores M, Marin-Contreras A, Playas-Pérez G, Bertado-Cortes B, Frias-Marquez F, Zuñiga-García G, Rodriguez-Leal F, Blaisdell-Vidal C, Gomez-Figueroa E. Early clinical effect of cladribine in patients with highly active multiple sclerosis in Mexico. Mult Scler J Exp Transl Clin 2024; 10:20552173241260156. [PMID: 39091340 PMCID: PMC11292702 DOI: 10.1177/20552173241260156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/22/2024] [Indexed: 08/04/2024] Open
Abstract
Background Cladribine shows efficacy in multiple sclerosis (MS), but Latin American (LATAM) real-world data is limited, despite potential sociodemographic variations. Objective Investigate baseline characteristics and clinical response in highly active MS patients in Mexico, identifying predictors of early treatment response. Method A multicenter cohort study analyzed retrospective data from individuals with "highly active" MS in the Cladribine Patient Support Program across 11 Mexican clinics. Criteria included one-year prior treatment with another disease-modifying treatment and recent relapse with specific MRI findings. Primary outcomes focused on achieving NEDA-3 status after 12 months. Results In the follow-up, 67.5% maintained NEDA-3 status. Baseline EDSS scores decreased significantly from 1.50 to 1.00 (p = 0.011), with no confirmed disability worsening. No significant differences were observed between NEDA-3 achievers and non-achievers in demographic and clinical variables. No severe adverse events were reported. Conclusion Cladribine showed early and effective control of active MS in Mexican patients, demonstrating a secure profile with minimal adverse events. This study provides valuable real-world evidence in the LATAM context.
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Affiliation(s)
- Sergio Sauri-Suarez
- ISSSTE National Medical Center 20 de noviembre, Mexico City, Mexico Internal Medicine Department, IMSS HGZ 1A Venados, Mexico City, Mexico
| | - Sandra Quiñones
- Department of Neurology, ISSSTE National Medical Center 20 de noviembre, Mexico City, Mexico
| | | | | | - Gil Playas-Pérez
- Department of Neurology, General Hospital of Mexico, Mexico City, Mexico
| | - Brenda Bertado-Cortes
- Department of Neurology, IMSS Siglo XXI National Medical Center, Mexico City, Mexico
| | | | - Gilberto Zuñiga-García
- Department of Neurology, ISSSTE Regional General Hospital “Gral. Ignacio Zaragoza”, Mexico City, Mexico
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Yamamoto S, Hashimoto T, Sano M, Kimura M, Sato O, Deguchi J. Absolute Lymphocyte Count Predicts Bypass Surgery Outcomes in Patients with Chronic Limb-Threatening Ischemia. Ann Vasc Dis 2024; 17:142-149. [PMID: 38919317 PMCID: PMC11196179 DOI: 10.3400/avd.oa.23-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/03/2024] [Indexed: 06/27/2024] Open
Abstract
Objectives: The aim of this study was to evaluate the relationship between absolute lymphocyte count (ALC) and outcomes of infrainguinal bypass surgery for chronic limb-threatening ischemia (CLTI). Methods: From 2004 to 2020, 209 limbs of 189 patients who underwent infrainguinal bypass surgery for CLTI and whose ALCs were available were included. Patients with survival >2 years and limb salvage >2 years were considered discriminant groups, and an ALC cut-off value was calculated. The relationship between preoperative ALC and outcomes was evaluated. Results: Survivorship of the higher ALC group was significantly higher than that of the lower ALC group (cut-off value 1030/μL, p = 0.0009). The limb salvage rate of the higher ALC group was significantly higher than that of the lower ALC group (cut-off value 1260/μL, p = 0.0081). In the dialysis patient group (103 limbs), the limb salvage rate of the higher ALC group was significantly higher than that of the lower ALC group (cut-off value 1170/μL, p = 0.026). ALC was independently associated with limb loss in multivariate analysis. Conclusion: ALC is promising as a predictor of outcomes after bypass surgery in CLTI. In particular, ALC is expected to be useful for limb prognosis in hemodialysis patients.
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Affiliation(s)
- Satoshi Yamamoto
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
- Department of Cardiovascular Surgery, Ome Medical Center, Ome, Tokyo, Japan
| | - Takuya Hashimoto
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masaya Sano
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masaru Kimura
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Osamu Sato
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Carlesse F, Paixão de Sousa da Silva AM, Sztajnbok J, Litivinov N, Peron K, Otsuka M, Volpe Arnoni M, Schirmer M, de Oliveira Costa P, Munhoz Cavalcanti de Albuquerque AL, Morales H, Lopez-Medina E, A. Portilla C, Valenzuela R, Motta F, Motta FA, de Almeida Junior JN, Santolaya ME, Lopes Colombo A. Landscape of Invasive Fusariosis in Pediatric Cancer Patients: Results of a Multicenter Observational Study From Latin America. Open Forum Infect Dis 2024; 11:ofae285. [PMID: 38872851 PMCID: PMC11170500 DOI: 10.1093/ofid/ofae285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Invasive fusariosis (IF) is a life-threatening opportunistic infection that affects vulnerable hosts. We conducted a multicenter and multinational retrospective study to characterize the natural history and clinical management of IF in pediatric cancer patients. We selected patients <18 years old who were sequentially hospitalized in 10 Latin American medical centers with a diagnosis of IF between 2002 and 2021. Data were collected using an electronic case report form complemented by a dictionary of terms. We assessed mortality rates at 30, 60, and 90 days. We collected data from 60 episodes of IF (median age, 9.8 years) that were mostly documented in patients with hematologic cancer (70%). Other risk conditions found were lymphopenia (80%), neutropenia (76.7%), and corticosteroid exposure (63.3%). IF was disseminated in 55.6% of patients. Skin lesions was present in 58.3% of our patients, followed by pulmonary involvement in 55%, sinusitis in 21.7%, bone/joint involvement in 6.7% and 1 case each of endocarditis and brain abscess. Positive blood and skin biopsy cultures were detected in 60% and 48.3% of cases, respectively. Fusarium solani complex was the most commonly identified agent (66.6%). The majority of patients received monotherapy within the first 72 hours (71.6%), either with voriconazole or amphotericin B formulation. The mortality rates at 30, 60, and 90 days were 35%, 41.6%, and 45%, respectively. An important factor affecting mortality rates appears to be disseminated disease. The high percentage of patients with fungal involvement in multiple organs and systems highlights the need for extensive workup for additional sites of infection in severely immunocompromised children.
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Affiliation(s)
- Fabianne Carlesse
- Instituto de Oncologia Pediátrica—IOP-GRAACC-UNIFESP, Departamento de Pediatria, São Paulo, Brazil
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jaques Sztajnbok
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Infectologia Emilio Ribas, Intensive Care Unit, Department of Emergency Medical Care, São Paulo, Brazil
| | - Nadia Litivinov
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karina Peron
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Marcelo Schirmer
- Instituto Nacional do Cancer—INCA, Department of Pediatrics, Rio de Janeiro, Brazil
| | | | | | - Hugo Morales
- Hospital Erasto Gaertner, Department of Pediatrics, Curitiba, Brazil
| | - Eduardo Lopez-Medina
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Carlos A. Portilla
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Romina Valenzuela
- Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Fabrizio Motta
- Santa Casa de Misericórdia de Porto Alegre, Department of Pediatrics, Porto Alegre, Brazil
| | | | - João Nobrega de Almeida Junior
- Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil
| | - Maria Elena Santolaya
- Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Arnaldo Lopes Colombo
- Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil
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9
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Rico-Feijoó J, Bermejo JF, Pérez-González A, Martín-Alfonso S, Aldecoa C. Influence of lymphopenia on long-term mortality in septic shock, a retrospective observational study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:368-378. [PMID: 38387503 DOI: 10.1016/j.redare.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND OBJECTIVE The diagnosis of infection, to diagnose septic shock, has been qualified by leukocyte counts and protein biomarkers. Septic shock mortality is persistently high (20%-50%), and rising in the long term. The definition of sepsis does not include leukocyte count, and lymphopenia has been associated with its mortality in the short term. Immunosuppression and increased mortality in the long term due to sepsis have not been demonstrated. The aim is to relate the occurrence of lymphopenia and its lack of recovery during septic shock with mortality at 2 years. PATIENTS AND METHODS Cohort of 332 elderly patients diagnosed with septic shock. Mortality at 28 days and 2 years was analysed according to leukocyte, neutrophil, and lymphocyte counts, and the ability to recover from lymphopenia (LRec). RESULTS A total of 74.1% of patients showed lymphopenia, and 73.5% did not improve during ICU stay. Mortality was 31.0% and 50.3% at 28 days and 2 years, respectively. Lymphopenia was a predictor of early mortality (OR 2.96) and LRec of late mortality (OR 3.98). Long-term mortality was associated with LRec (HR 1.69). CONCLUSIONS In elderly patients with septic shock, 28-day mortality is associated with lymphopenia and neutrophilia, and LRec with 2-year mortality; this may represent 2 distinct phenotypes of behaviour after septic shock.
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Affiliation(s)
- J Rico-Feijoó
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Gerencia Regional de Salud Valladolid Oeste, Valladolid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CiberES), CB22/06/00035, Instituto de Salud Carlos III, Madrid, Spain
| | - J F Bermejo
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, Gerencia Regional de Salud de Castilla y León, Salamanca, Spain; Universidad de Salamanca, Salamanca, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CiberES), CB22/06/00035, Instituto de Salud Carlos III, Madrid, Spain
| | - A Pérez-González
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Gerencia Regional de Salud Valladolid Oeste, Valladolid, Spain
| | - S Martín-Alfonso
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Gerencia Regional de Salud Valladolid Oeste, Valladolid, Spain
| | - C Aldecoa
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Gerencia Regional de Salud Valladolid Oeste, Valladolid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CiberES), CB22/06/00035, Instituto de Salud Carlos III, Madrid, Spain.
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10
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Lee CA, Schreiber S, Bressler B, Adams JW, Oh DA, Tang YQ, Zhang J, Komori HK, Grundy JS. Safety, Pharmacokinetics, and Pharmacodynamics of Etrasimod: Single and Multiple Ascending Dose Studies in Healthy Adults. Clin Pharmacol Drug Dev 2024; 13:534-548. [PMID: 38345530 DOI: 10.1002/cpdd.1379] [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: 10/05/2023] [Accepted: 12/27/2023] [Indexed: 04/25/2024]
Abstract
Etrasimod is an investigational, once-daily, oral, selective sphingosine 1-phosphate receptor 1,4,5 modulator in development for immune-mediated inflammatory diseases (IMIDs). Here, we report the human safety, pharmacokinetics, and pharmacodynamics of etrasimod obtained from both a single ascending dose (SAD; 0.1-5 mg) study and a multiple ascending dose (MAD; 0.35-3 mg once daily) study. Overall, 99 healthy volunteers (SAD n = 40, MAD n = 59) completed the 2 studies. Evaluated single and multiple doses were well tolerated up to 3 mg without severe adverse events (AEs). Gastrointestinal disorders were the most common etrasimod-related AEs. Over the evaluated single- and multiple-dose ranges, dose-proportional and marginally greater-than-dose-proportional etrasimod plasma exposure were observed, respectively. At steady state, etrasimod oral clearance and half-life mean values ranged from 1.0 to 1.2 L/h and 29.7 to 36.4 hours, respectively. Dose-dependent total peripheral lymphocyte reductions occurred following etrasimod single and multiple dosing. Etrasimod multiple dosing resulted in reductions from baseline in total lymphocyte counts ranging from 41.1% to 68.8% after 21 days. Lymphocyte counts returned to normal range within 7 days following treatment discontinuation. Heart rate lowering from pretreatment baseline on etrasimod dosing was typically mild, with mean reductions seen after the first dose of up to 19.5 bpm (5 mg dose). The favorable safety, pharmacokinetic, and pharmacodynamic properties of etrasimod in humans supported its further development and warranted its investigation for treatment of IMIDs.
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Affiliation(s)
- Caroline A Lee
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Stefan Schreiber
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
- Excellence Cluster Precision Medicine in Inflammation, Christian-Albrecht University of Kiel, Kiel, Germany
| | - Brian Bressler
- Department of Medicine, Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John W Adams
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Dooman Alexander Oh
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Yong Q Tang
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Jinkun Zhang
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | | | - John S Grundy
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
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11
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Tang G, Luo Y, Song H, Liu W, Huang Y, Wang X, Zou S, Sun Z, Hou H, Wang F. The immune landscape of sepsis and using immune clusters for identifying sepsis endotypes. Front Immunol 2024; 15:1287415. [PMID: 38707899 PMCID: PMC11066285 DOI: 10.3389/fimmu.2024.1287415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/01/2024] [Indexed: 05/07/2024] Open
Abstract
Background The dysregulated immune response to sepsis still remains unclear. Stratification of sepsis patients into endotypes based on immune indicators is important for the future development of personalized therapies. We aimed to evaluate the immune landscape of sepsis and the use of immune clusters for identifying sepsis endotypes. Methods The indicators involved in innate, cellular, and humoral immune cells, inhibitory immune cells, and cytokines were simultaneously assessed in 90 sepsis patients and 40 healthy controls. Unsupervised k-means cluster analysis of immune indicator data were used to identify patient clusters, and a random forest approach was used to build a prediction model for classifying sepsis endotypes. Results We depicted that the impairment of innate and adaptive immunity accompanying increased inflammation was the most prominent feature in patients with sepsis. However, using immune indicators for distinguishing sepsis from bacteremia was difficult, most likely due to the considerable heterogeneity in sepsis patients. Cluster analysis of sepsis patients identified three immune clusters with different survival rates. Cluster 1 (36.7%) could be distinguished from the other clusters as being an "effector-type" cluster, whereas cluster 2 (34.4%) was a "potential-type" cluster, and cluster 3 (28.9%) was a "dysregulation-type" cluster, which showed the lowest survival rate. In addition, we established a prediction model based on immune indicator data, which accurately classified sepsis patients into three immune endotypes. Conclusion We depicted the immune landscape of patients with sepsis and identified three distinct immune endotypes with different survival rates. Cluster membership could be predicted with a model based on immune data.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hongyan Hou
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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12
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Andersson NW, Thiesson EM, Lassaunière R, Hansen JV, Hviid A. SARS-CoV-2 Infection and Postacute Risk of Non-Coronavirus Disease 2019 Infectious Disease Hospitalizations: A Nationwide Cohort Study of Danish Adults Aged ≥50 Years. Clin Infect Dis 2024; 78:603-612. [PMID: 37740392 DOI: 10.1093/cid/ciad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Reports suggest that the potential long-lasting health consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may involve persistent dysregulation of some immune populations, but the potential clinical implications are unknown. We investigated the associated risk of hospitalization due to non-coronavirus disease 2019 (COVID-19) infectious diseases following the postacute phase of SARS-CoV-2 infection. METHODS By cross-linking data from the comprehensive Danish test and surveillance system for COVID-19 together with nationwide healthcare and demographic registers, we established a study cohort of 2 430 694 individuals aged ≥50 years, from 1 January 2021 to 10 December 2022, with no evidence of SARS-CoV-2 infection prior to study entry. Using Poisson regression, we compared the outcome rates of non-COVID-19 infectious disease hospitalizations following the acute phase of (a first) SARS-CoV-2 infection (defined as ≥29 days since the day of infection) in recovered individuals with rates among SARS-CoV-2-uninfected individuals. RESULTS Among 2 430 694 included individuals (mean age, 66.8 [standard deviation, 11.3] years), 930 071 acquired SARS-CoV-2 infection during follow-up totaling 4 519 913 person-years. The postacute phase of SARS-CoV-2 infection was associated with an incidence rate ratio (IRR) of 0.90 (95% confidence interval [CI]: .88-.92) for any infectious disease hospitalization. Findings (IRR [95% CI]) were similar for upper respiratory tract (1.08 [.97-1.20]), lower respiratory tract (0.90 [.87-.93]), influenza (1.04 [.94-1.15]), gastrointestinal (1.28 [.78-2.09]), skin (0.98 [.93-1.03]), urinary tract (1.01 [.96-1.08]), certain invasive bacterial (0.96 [.91-1.01]), and other (0.96 [.92-1.00]) infectious disease hospitalizations and in subgroups. CONCLUSIONS Our study does not support an increased susceptibility to non-COVID-19 infectious disease hospitalization following SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Ria Lassaunière
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Denmark
| | | | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Denmark
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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13
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QI C, TIAN P, LI W. [Progress on Neoadjuvant Immunotherapy for Resectable Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2024; 27:138-146. [PMID: 38453446 PMCID: PMC10918244 DOI: 10.3779/j.issn.1009-3419.2024.102.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 03/09/2024]
Abstract
In recent years, there has been a consensus regarding the enhancement of prognosis in patients with advanced non-small cell lung cancer (NSCLC) through the utilization of immune checkpoint inhibitors (ICIs). Numerous clinical studies have also demonstrated the substantial value of immunotherapy for resectable NSCLC patients. Nevertheless, there remain controversies surrounding the exploration of immune combination strategies, treatment-related side effects, prognostic biomarkers, as well as other issues in the neoadjuvant therapy setting. Consequently, this article presents a comprehensive overview of the recent advancements in neoadjuvant immunotherapy for resectable NSCLC, stimulating fresh perspectives and delving into its merits and challenges in clinical application.
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Morimoto M, Yokoya Y, Yoshida K, Kosako H, Hori Y, Mushino T, Tamura S, Ito R, Koyamada R, Yamashita T, Mori S, Mori N, Ohde S. Predictive Model for Occurrence of Febrile Neutropenia after Chemotherapy in Patients with Diffuse Large B-Cell Lymphoma: A Multicenter, Retrospective, Observational Study. Hematol Rep 2024; 16:76-88. [PMID: 38390940 PMCID: PMC10885064 DOI: 10.3390/hematolrep16010008] [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: 10/26/2023] [Revised: 12/29/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Febrile neutropenia (FN) is a major concern in patients undergoing chemotherapy for diffuse large B-cell lymphoma (DLBCL); however, the overall risk of FN is difficult to assess. This study aimed to develop a model for predicting the occurrence of FN in patients with DLBCL. In this multicenter, retrospective, observational analysis, a multivariate logistic regression model was used to analyze the association between FN incidence and pretreatment clinical factors. We included adult inpatients and outpatients (aged ≥ 18 years) diagnosed with DLBCL who were treated with chemotherapy. The study examined 246 patients. Considering FN occurring during the first cycle of chemotherapy as the primary outcome, a predictive model with a total score of 5 points was constructed as follows: 1 point each for a positive hepatitis panel, extranodal involvement, and a high level of soluble interleukin-2 receptor and 2 points for lymphopenia. The area under the receiver operating characteristic curve of this model was 0.844 (95% confidence interval: 0.777-0.911). Our predictive model can assess the risk of FN before patients with DLBCL start chemotherapy, leading to better outcomes.
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Affiliation(s)
- Masaya Morimoto
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
- Public Health, St. Luke's International University, Tokyo 104-0044, Japan
| | - Yuma Yokoya
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Kikuaki Yoshida
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Hideki Kosako
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yoshikazu Hori
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Emergency and Intensive Care Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Reiko Ito
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Ryosuke Koyamada
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Takuya Yamashita
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Shinichiro Mori
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Sachiko Ohde
- Public Health, St. Luke's International University, Tokyo 104-0044, Japan
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15
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Liu Y, Yang Y, Zhao C, Liu M, Xu D, Wu H, Lei J, Deng Y, Xie W, Huang J, Wu S, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Shen H, Wang Q, Zhang Y, Yan D, Wang L, Ma X. An immune window of opportunity to prevent spontaneous abortion: prepregnancy peripheral leukocytes and subsets were associated with a decreased risk of spontaneous abortion. Hum Reprod 2024; 39:326-334. [PMID: 38166353 DOI: 10.1093/humrep/dead261] [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: 07/11/2023] [Revised: 11/17/2023] [Indexed: 01/04/2024] Open
Abstract
STUDY QUESTION Do prepregnancy peripheral leukocytes (PPLs) and their subsets influence the risk of spontaneous abortion (SAB)? SUMMARY ANSWER PPLs and their subsets are associated with the risk of SAB. WHAT IS KNOWN ALREADY Compelling studies have revealed the crucial role of maternal peripheral leukocytes in embryo implantation and pregnancy maintenance. Adaptive changes are made by PPLs and their subsets after conception. STUDY DESIGN, SIZE, DURATION This population-based retrospective cohort study was based on data from the National Free Pre-pregnancy Check-up Project (NFPCP) in mainland China. Couples preparing for pregnancy within the next six months were provided with free prepregnancy health examinations and counseling services for reproductive health. The current study was based on 1 310 494 female NFPCP participants aged 20-49 who became pregnant in 2016. After sequentially excluding 235 456 participants lost to follow-up, with multiple births, and who failed to complete blood tests, a total of 1 075 038 participants were included in the primary analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS PPLs and their subset counts and ratios were measured. The main outcome was SAB. A multivariable logistic regression model was used to estimate the odds ratio (OR) and 95% CI of SAB associated with PPLs and their subsets, and restricted cubic spline (RCS) was used to estimate the nonlinear exposure-response relationship. MAIN RESULTS AND ROLE OF CHANCE Of the included pregnant participants, a total of 35 529 SAB events (3.30%) were recorded. Compared to participants with reference values of PPLs, the ORs (95% CIs) of leukopenia and leukocytosis for SAB were 1.14 (1.09-1.20) and 0.74 (0.69-0.79), respectively. The RCS result revealed a monotonous decreasing trend (Pnonlinear < 0.05). Similar relationships were observed for the neutrophil count and ratio, monocyte count, and middle-sized cell count and ratio. The lymphocyte ratio showed a positive and nonlinear relationship with the risk of SAB (Pnonlinear < 0.05). Both eosinophils and basophils showed positive relationships with the risk of SAB (eosinophil Pnonlinear > 0.05 and basophil Pnonlinear < 0.05). LIMITATIONS, REASONS FOR CAUTION Chemical abortion events and the cause of SAB were not collected at follow-up. Whether women with abnormal PPLs had recovered during periconception was not determined. WIDER IMPLICATIONS OF THE FINDINGS PPLs and their subsets are associated with the risk of SAB. Leukopenia and neutropenia screening in women preparing for pregnancy and developing a feasible PPL stimulation approach should be emphasized to utilize the immune window of opportunity to prevent SAB. STUDY FUNDING/COMPETING INTEREST(S) This study was approved by the Institutional Research Review Board of the National Health and Family Planning Commission. This study was supported by the National Key Research and Development Program of China (grants 2021YFC2700705 [Y.Y.] and 2016YFC100307 [X.M.]) and the National Natural Science Foundation of China (grant no. 82003472 [L.W.]). The funding source was not involved in the study design, data collection, analysis and interpretation of the data, writing the report, or the decision to submit this article for publication. No competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Youhong Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Meiya Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Die Xu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Hanbin Wu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
| | - Jueming Lei
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
| | - Yuzhi Deng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
| | - Wenlu Xie
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jiaxin Huang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Siyu Wu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the PRC, Beijing, China
| | - Long Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Centre, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
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Dieterlen MT, Messer EK, Klaeske K, Sieg F, Eifert S, Haunschild J, Jawad K, Saeed D, Dashkevich A, Borger MA. Pre-Implant Immune Status is Associated with Infection Risk After Left Ventricular Assist Device Implantation. J Inflamm Res 2024; 17:581-589. [PMID: 38318245 PMCID: PMC10840410 DOI: 10.2147/jir.s424879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/10/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose Infection is the most common complication after left ventricular assist device (LVAD) implantation. The immune status of LVAD patients is relevant for the incidence and severity of infection, but it is unknown if there is a predisposing immune status prior to LVAD implantation that contributes to an increased risk for infection in the post-implant period. We analyzed the pre-LVAD immune status in patients with infection within 3 months after LVAD implantation in comparison to infection-free patients. Patients and Methods Fifty-four consecutive LVAD patients were included in this study. According to their infectious history in the first 3 months after LVAD implantation, these patients were grouped into an infection (n=23) and an infection-free group (n=31). Pre-LVAD blood samples were obtained for flow cytometric analysis of immunological parameters including B cells, subsets of T, dendritic and natural killer cells. Patient-specific, clinical and laboratory data were recorded. Results Blood count analysis prior to LVAD implantation showed comparable counts of erythrocytes (p=0.19), platelets (p=0.33) and leukocytes (p=0.50) between patients with infection and infection-free patients in the post-implant period. Patients with infection in the first 3 months after LVAD implantation had lower concentrations of lymphocytes (p=0.02). Forty percent of the patients with infection showed more often pre-LVAD neutrophil-to-lymphocyte ratios (NLR) >7 than patients without infection in the first 3 months after LVAD implantation (14%, p=0.05). Patients with infection already had lower percentages of CD3+ T cells (p=0.03), CD19+ B cells (p<0.01), BDCA2+ pDCs (p=0.03) and BDCA4+ plasmacytoid DCs (pDCs) (p=0.05) prior to LVAD implantation than infection-free patients. Conclusion Our results demonstrated that patients with infection in the early post-implant period showed lower concentrations of lymphocytes, especially of CD3+ T cells and CD19+ B cells, decreased percentages of BDCA2+ and BDCA4+ pDCs, and had more often NLRs >7 indicating moderate-to-severe inflammation. Thus, we identified specific immunological changes pre-LVAD that could help to identify patients at risk for infection in the early post-implant period.
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Affiliation(s)
- Maja-Theresa Dieterlen
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Eva Katharina Messer
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Kristin Klaeske
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Franz Sieg
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Sandra Eifert
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Josephina Haunschild
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Khalil Jawad
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Diyar Saeed
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Alexey Dashkevich
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
| | - Michael Andrew Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, HELIOS Clinic, Leipzig, Germany
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Jiang J, Li Y, Wang Q, Zeng H, Yang W, Wu Y, Peng W, Pan P, Hu C, Deng P. Clinical implications of trichomonads detected in bronchoalveolar fluid by metagenomic next-generation sequencing: a multicenter retrospective study. Front Cell Infect Microbiol 2024; 14:1289231. [PMID: 38318165 PMCID: PMC10839053 DOI: 10.3389/fcimb.2024.1289231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background Pulmonary trichomoniasis is considered a neglected disease due to failures in recognizing it, stemming from insensitive microbial methods and a lack of specific clinical features. This study aims to analyze the clinical implications of trichomonads detected in bronchoalveolar lavage fluid (BALF) by metagenomic next-generation sequencing (mNGS). Methods This multicenter retrospective study included patients diagnosed with pneumonia, admitted to three tertiary hospitals in China from July 2018 to September 2022, with trichomonads detected in BALF through mNGS. The analysis covered demographics, comorbidities, symptoms, laboratory findings, mNGS results, clinical treatment, and outcomes of these patients. Results A total of 17 patients were enrolled, comprising 14 males and 3 females. Trichomonas tenax and Trichomonas vaginalis were detected by mNGS in BALF samples of 15 and 2 patients, respectively. Patients were categorized into two groups based on the presence of risk factors for trichomonad infection, including immunocompromised conditions, uncontrolled diabetes mellitus, oral/periodontal diseases, and aspiration. Among 11 patients with risk factors (Case 1-11), 4 received nitromidazoles as part of comprehensive treatment, achieving a 100% treatment success rate. The remaining 7 patients, who did not receive nitromidazoles, had only one achieving relief after broad-spectrum antimicrobial therapy, resulting in a 14.3% treatment success rate. For the 6 patients without any risk factors for trichomonad infection (Case 12-17), none received nitromidazoles during hospitalization. However, 4 out of these 6 patients (66.7%) eventually recovered. Conclusion mNGS proves to be an efficient tool for detecting trichomonads in BALF samples. Comprehensive analysis of clinical features and laboratory indicators is essential to distinguish between infection and colonization of trichomonads. Pulmonary trichomoniasis should not be overlooked when trichomonads are detected in BALF from patients with risk factors.
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Affiliation(s)
- Juan Jiang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
| | - Qiong Wang
- Department of Respiratory and Critical Care Medicine, Zhuzhou Second Hospital, Zhuzhou, China
| | - Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Yang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
| | - Yanhao Wu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
| | - Wenzhong Peng
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
| | - Pinhua Pan
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
| | - Chengping Hu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
| | - Pengbo Deng
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
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18
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Huang H, Huang Z, Chen M, Okamoto K. Evaluation of the therapeutic efficiency and efficacy of blood purification in the treatment of severe acute pancreatitis. PLoS One 2024; 19:e0296641. [PMID: 38181043 PMCID: PMC10769011 DOI: 10.1371/journal.pone.0296641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
This study aimed to evaluate the therapeutic efficacy and effect of blood purification (BP) therapy on severe acute pancreatitis (SAP). Information on 305 patients (BP group 68, control group 237) diagnosed with SAP was retrieved from the Medical Information Mart for Intensive Care IV (MIMIC IV) database. Firstly, the influence of BP treatment was preliminarily evaluated by comparing the outcome indicators of the two groups. Secondly, multiple regression analysis was used to screen the mortality risk factors to verify the impact of BP on the survival outcome of patients. Then, the effect of BP treatment was re-validated with baseline data. Finally, cox regression was used to make the survival curve after matching to confirm whether BP could affect the death outcome. The results indicated that the BP group had a lower incidence of shock (p = 0.012), but a higher incidence of acute kidney injury (AKI) (p < 0.001), with no differences observed in other outcome indicators when compared to the control group. It was also found that the 28-day survival curve of patients between the two groups was significantly overlapped (p = 0.133), indicating that BP treatment had no significant effect on the survival outcome of patients with SAP. Although BP is beneficial in stabilizing hemodynamics, it has no effect on short- and long-term mortality of patients. The application of this technology in the treatment of SAP should be done with caution until appropriate BP treatment methods are developed, particularly for patients who are not able to adapt to renal replacement therapy.
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Affiliation(s)
- Hongwei Huang
- Department of Intensive Care Medicine, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Nanning, Guangxi, China
| | - Zhongshi Huang
- Department of Intensive Care Medicine, Youjiang Medical College for Nationalities Affiliated Hospital, Baise, Guangxi, China
| | - Menghua Chen
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ken Okamoto
- Emergency and Intensive Care Unit, Juntendo University Urayasu Hospital, Urayasu, Japan
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19
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Elçioğlu ZC, Errington L, Metes B, Sendama W, Powell J, Simpson AJ, Rostron AJ, Hellyer TP. Pooled prevalence of lymphopenia in all-cause hospitalisations and association with infection: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:848. [PMID: 38042792 PMCID: PMC10693046 DOI: 10.1186/s12879-023-08845-1] [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: 04/25/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Lymphopenia is defined as a decrease below normal value (often 1.0 x 109 cells/L) of blood circulating lymphocyte count. In the general population, lymphopenia is associated with an increased risk of hospitalisation secondary to infection, independent of traditional clinical risk factors. In hospital, lymphopenia is associated with increased risk of healthcare-associated infection and mortality. By summarising lymphopenia's prevalence and impact on clinical outcomes, we can identify an at-risk population and inform future studies of immune dysfunction following severe illness. METHODS Peer-reviewed search strategy was performed on three databases. Primary objective was to summarise the pooled prevalence of lymphopenia. Primary outcome was infection including pre-existing lymphopenia as a risk factor for admission with infection and as an in-hospital risk factor for healthcare-associated infection. Secondary outcomes were length of stay and mortality. Mortality data extracted included in-hospital, 28/30-day ('early'), and 90-day/1-year ('late') mortality. Meta-analysis was carried out using random-effects models for each outcome measure. Heterogeneity was assessed using I2 statistic. Joanna Briggs Institute checklist for cohort studies was used to assess risk of bias. The protocol was published on PROSPERO. RESULTS Fifteen observational studies were included. The pooled prevalence of lymphopenia in all-cause hospitalisations was 38% (CI 0.34-0.42, I2= 97%, p< 0.01). Lymphopenia was not associated with an infection diagnosis at hospital admission and healthcare associated infection (RR 1.03; 95% CI 0.26-3.99, p=0.97, I2 = 55% and RR 1.31; 95% CI 0.78-2.20, p=0.31, I2=97%, respectively), but was associated with septic shock (RR 2.72; 95% CI 1.02-7.21, p=0.04, I2 =98%). Lymphopenia was associated with higher in-hospital mortality and higher 'early' mortality rates (RR 2.44; 95% CI 1.71-3.47, p < 0.00001, I2 = 89% and RR 2.05; 95% CI 1.64-2.56, p < 0.00001, I2 = 29%, respectively). Lymphopenia was associated with higher 'late' mortality (RR 1.59; 1.33-1.90, p < 0.00001, I2 = 0%). CONCLUSIONS This meta-analysis demonstrates the high prevalence of lymphopenia across all-cause hospitalisations and associated increased risk of septic shock, early and late mortality. Lymphopenia is a readily available marker that may identify immune dysfunctional patients. Greater understanding of immune trajectories following survival may provide insights into longer-term poor clinical outcomes.
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Affiliation(s)
- Z C Elçioğlu
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - L Errington
- Faculty of Medical Sciences Library, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - B Metes
- Faculty of Medical Sciences Library, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - W Sendama
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK
| | - J Powell
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - A J Simpson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK
| | - A J Rostron
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
- Integrated Critical Care Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, SR4 7TP, UK
| | - T P Hellyer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK.
- Department of Critical Care Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, NE1 4LP, UK.
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20
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Ghait M, Duduskar SN, Rooney M, Häfner N, Reng L, Göhrig B, Reuken PA, Bloos F, Bauer M, Sponholz C, Bruns T, Rubio I. The non-canonical inflammasome activators Caspase-4 and Caspase-5 are differentially regulated during immunosuppression-associated organ damage. Front Immunol 2023; 14:1239474. [PMID: 38106412 PMCID: PMC10722270 DOI: 10.3389/fimmu.2023.1239474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
The non-canonical inflammasome, which includes caspase-11 in mice and caspase-4 and caspase-5 in humans, is upregulated during inflammatory processes and activated in response to bacterial infections to carry out pyroptosis. Inadequate activity of the inflammasome has been associated with states of immunosuppression and immunopathological organ damage. However, the regulation of the receptors caspase-4 and caspase-5 during severe states of immunosuppression is largely not understood. We report that CASP4 and CASP5 are differentially regulated during acute-on-chronic liver failure and sepsis-associated immunosuppression, suggesting non-redundant functions in the inflammasome response to infection. While CASP5 remained upregulated and cleaved p20-GSDMD could be detected in sera from critically ill patients, CASP4 was downregulated in critically ill patients who exhibited features of immunosuppression and organ failure. Mechanistically, downregulation of CASP4 correlated with decreased gasdermin D levels and impaired interferon signaling, as reflected by decreased activity of the CASP4 transcriptional activators IRF1 and IRF2. Caspase-4 gene and protein expression inversely correlated with markers of organ dysfunction, including MELD and SOFA scores, and with GSDMD activity, illustrating the association of CASP4 levels with disease severity. Our results document the selective downregulation of the non-canonical inflammasome activator caspase-4 in the context of sepsis-associated immunosuppression and organ damage and provide new insights for the development of biomarkers or novel immunomodulatory therapies for the treatment of severe infections.
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Affiliation(s)
- Mohamed Ghait
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Shivalee N Duduskar
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Michael Rooney
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Norman Häfner
- Department of Gynecology, Jena University Hospital, Jena, Germany
| | - Laura Reng
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Bianca Göhrig
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Philipp A Reuken
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Frank Bloos
- Department for Anesthesiology & Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Michael Bauer
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Department for Anesthesiology & Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Christoph Sponholz
- Department for Anesthesiology & Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Tony Bruns
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Ignacio Rubio
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Department for Anesthesiology & Intensive Care Medicine, Jena University Hospital, Jena, Germany
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21
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Schellekens P, Van Loon E, Coemans M, Meyts I, Vennekens R, Kuypers D, Mekahli D, Bammens B. Leukopenia in autosomal dominant polycystic kidney disease: a single-center cohort of kidney transplant candidates with post-transplantation follow-up. Clin Kidney J 2023; 16:2578-2586. [PMID: 38046014 PMCID: PMC10689124 DOI: 10.1093/ckj/sfad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) has occasionally been associated with lower peripheral white blood cell (WBC) counts. This study aimed to investigate the peripheral blood cell counts in a large cohort of kidney transplant recipients before and after kidney transplantation and its potential impact on post-transplant outcomes. Methods This was a retrospective study with long-term follow-up data of 2090 patients who underwent a first kidney transplantation in the Leuven University Hospitals, of whom 392 had ADPKD. Results In total, 2090 patients who underwent a first kidney transplantation in the Leuven University Hospitals were included, of whom 392 had ADPKD. Both pre- and post-transplantation, ADPKD patients had significantly lower total WBC counts, and more specifically lower neutrophil, lymphocyte and eosinophil counts compared with the non-ADPKD patients. This observation was independent of potential confounders such as level of inflammation, smoking habit, vitamins and pre-transplant medication. Overall survival and kidney transplant survival were significantly better in ADPKD vs non-ADPKD transplant recipients and a longer time to first infection was observed. However, no association between blood cell counts and outcome differences was found. Conclusions In conclusion, this large single-center study reports a strong and independent association between ADPKD and lower peripheral WBC counts both before and after kidney transplantation. Considering the role of inflammation in disease progression, further investigation into the role of WBC in ADPKD is needed.
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Affiliation(s)
- Pieter Schellekens
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Cellular and Molecular Medicine, PKD Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Elisabet Van Loon
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Maarten Coemans
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Isabelle Meyts
- Department of Microbiology, Immunology and Transplantation, Laboratory of Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
- Department of Pediatrics, Pediatric Immunology, University Hospitals of Leuven, Leuven, Belgium
| | - Rudi Vennekens
- Department of Cellular and Molecular Medicine, VIB Centre for Brain and Disease Research, Laboratory of Ion Channel Research, KU Leuven, Leuven, Belgium
| | - Dirk Kuypers
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
| | - Djalila Mekahli
- Department of Cellular and Molecular Medicine, PKD Research Group, KU Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals of Leuven, Leuven, Belgium
| | - Bert Bammens
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals of Leuven, Leuven, Belgium
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22
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Demir AN, Kara Z, Sulu C, Uysal S, Zulfaliyeva G, Atar OA, Valikhanova N, Ozturk T, Ozkaya HM, Damci T, Gonen MS. The effect of radioiodine therapy on blood cell count in patients with differentiated thyroid cancer. Hormones (Athens) 2023; 22:595-602. [PMID: 37603221 DOI: 10.1007/s42000-023-00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE This study aimed to investigate the long-term effects of radioiodine treatment (RAI) on blood cell counts in patients with differentiated thyroid cancer (DTC) and to describe the characteristics of patients at high risk for blood cell count abnormalities. METHODS The study included patients with DTC who underwent RAI treatment between 2007 and 2017. Patients with regular complete blood counts for at least 5 years were included, while those with diseases or treatments that could influence blood count parameters were excluded. Blood cell count abnormalities were defined according to the Common Terminology Criteria for Adverse Events version 5.0, and factors influencing these abnormalities were examined. RESULTS A total of 225 patients were analyzed. The mean age at diagnosis was 45.8 ± 13.9 years, and 76.5% of patients were female. In the first year after RAI, leukocyte, neutrophil, and lymphocyte counts were significantly reduced compared with baseline values. The leukocyte and neutrophil counts returned to baseline values by the third year, while the decrease in lymphocytes continued until the fifth year. Blood cell count abnormalities developed in 16 patients (7.1%) within the first year after RAI. Risk factors for blood cell count abnormalities within the first year after RAI included male sex, older age, T4, N1, and M1 disease, as well as higher RAI doses. In logistic regression analysis, only RAI dose remained independently associated with blood cell count abnormalities. CONCLUSION These results suggest an association between RAI dose and blood cell count abnormalities, characterized by mild lymphopenia, and indicate that the risk of mild lymphopenia persists over time. Careful consideration should be given when planning high-dose RAI for patients at a high risk of blood cell count abnormalities, such as males with metastatic disease and of advanced age.
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Affiliation(s)
- Ahmet Numan Demir
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Zehra Kara
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Cem Sulu
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Serhat Uysal
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Guldana Zulfaliyeva
- Department of Internal Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Oznur Aydin Atar
- Department of Internal Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Nahida Valikhanova
- Department of Internal Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Tulin Ozturk
- Department of Medical Pathology, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Taner Damci
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Mustafa Sait Gonen
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey.
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23
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Massaro F, Andreozzi F, Vandevoorde C, Bron D. Supportive Care in Older Lymphoma Patients to Reduce Toxicity and Preserve Quality of Life. Cancers (Basel) 2023; 15:5381. [PMID: 38001641 PMCID: PMC10670135 DOI: 10.3390/cancers15225381] [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: 10/06/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
The treatment paradigm in older patients with malignant hemopathies is the choice between an effective conservative treatment that preserves quality of life and an intensive, potentially curative treatment with more toxicities. For each patient, it is important to determine the risk/benefit ratio. The patient should be involved in the discussion, sufficiently informed and able to express himself and his expectations in terms of quality of life. However, this informed consent is conditioned by the ability of the patient to understand the risks and benefits of the treatment. Decline in quality of life is an important parameter for older patients with cancer and many prospective trials have now confirmed the impact of different side effects of treatment, such as recurrent hospitalization, loss of autonomy in daily activities, loss of contact with grandchildren and loss of cognitive functions. Interventions oriented to vulnerabilities detected in the older patients (by comprehensive geriatric assessment) and an optimal approach, including preventive measures to reduce treatment-related toxicity and mortality, are directly correlated to improvement in quality of life.
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Affiliation(s)
| | | | | | - Dominique Bron
- Department of Hematology, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, 1070 Brussels, Belgium; (F.M.); (F.A.); (C.V.)
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24
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Kaufman RM, Marks DC, Flamand Y, Acker JP, Brown BL, Olafson C, Marschner S, Pandey S, Papari M, Petraszko T, Serrano K, Ward D, Bazin R. Risk factors for T-cell lymphopenia in frequent platelet donors: The BEST collaborative study. Transfusion 2023; 63:2072-2082. [PMID: 37818894 DOI: 10.1111/trf.17567] [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: 07/20/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Severe T-cell lymphopenia of uncertain clinical significance has been observed in frequent apheresis platelet donors. Two commonly used plateletpheresis instruments are the Trima Accel, which uses a leukoreduction system (LRS) chamber to trap leukocytes and the Fenwal Amicus, which does not use an LRS chamber. STUDY DESIGN AND METHODS We performed an international, multicenter, observational study comparing T-cell populations in frequent platelet donors collected exclusively using the Trima instrument (n = 131) or the Amicus instrument (n = 77). Age- and sex-matched whole blood donors (n = 126) served as controls. RESULTS CD4+ T-cell counts <200 cells/μL were found in 9.9% of frequent Trima (LRS+) platelet donors, 4.4% of frequent Amicus (LRS-) platelet donors, and 0 whole blood donors (p < .0001). CD4+ T-cell counts <200 cells/μL were only seen in platelet donors with ≥200 lifetime donations. In multivariable analysis, age, lifetime donations, and instrument (Trima vs. Amicus) were independent risk factors for lymphopenia. In 40 Trima platelet donors, a plasma rinseback procedure was routinely performed following platelet collections. No Trima platelet donors receiving plasma rinseback had a CD4+ T-cell count <200 cells/μL versus 13/91 Trima platelet donors not receiving plasma rinseback (p = .01). DISCUSSION Recurrent bulk lymphocyte removal appears to contribute to the development of T-cell lymphopenia in frequent, long-term platelet donors. Lymphopenia is more common when an LRS chamber is used during platelet collection but can occur without an LRS chamber. Blood centers using LRS chambers can mitigate donor lymphopenia by performing plasma rinseback.
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Affiliation(s)
- Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason P Acker
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Bethany L Brown
- American Red Cross, Biomedical Services, Medical and Scientific Office, Washington, DC, USA
| | - Carly Olafson
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Suchitra Pandey
- Department of Pathology, Stanford University School of Medicine and Stanford Blood Center, Palo Alto, California, USA
| | | | - Tanya Petraszko
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Serrano
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Dawn Ward
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Renée Bazin
- Héma-Québec, Medical Affairs and Innovation, Quebec City, Quebec, Canada
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Liu R, Li M, Zhang L, Wang Y, Li W, Liu S. T lymphocyte subsets and immunoglobulin and complement levels are associated with the infection status of patients with antineutrophil cytoplasmic antibody-associated vasculitis. Clin Exp Med 2023; 23:2877-2884. [PMID: 36808577 DOI: 10.1007/s10238-023-01021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Infection is the leading cause of death in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The aim of this study was to characterize the immunological features of infectious events occurring in patients with newly diagnosed AAV and to identify possible risk factors associated with infection. METHODS The T lymphocyte subsets, immunoglobulin, and complement levels of the groups were compared between infected group and the noninfected group. Further, regression analysis was conducted to determine the association of each variable with the risk of infection. RESULTS 280 patients with newly diagnosed AAV were enrolled. The average levels of CD3+ T cells (720.0 vs. 920.5, P < 0.001), CD3+CD4+ T cells (392.0 vs. 547.0, P < 0.001), and CD3+CD8+ T cells (248.0 vs. 335.0, P = 0.001), serum IgG (11.66 g/L vs. 13.59 g/L, P = 0.002), IgA (1.70 g/L vs. 2.44 g/L, P < 0.001), C3 (1.03 g/L vs. 1.09 g/L, P = 0.015), and C4 (0.24 g/L vs. 0.27 g/L, P < 0.001) were significantly lower in the infected group than in the noninfected group. The levels of CD3+CD4+ T cells (adjusted OR 0.997, P = 0.018), IgG (adjusted OR 0.804, P = 0.004), and C4 (adjusted OR 0.001, P = 0.013) were found independently associated with infection. CONCLUSIONS Patients of infected AAV and those without infection differ in T lymphocyte subsets and immunoglobulin and complement levels. Furthermore, CD3+CD4+ T cells counts and serum IgG and C4 levels were independent risk factors with infection in patients with newly diagnosed AAV.
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Affiliation(s)
- Rui Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengdi Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Shengyun Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Yamaguchi M, Sugiyama H, Nobata H, Kinashi H, Asai A, Kitamura F, Katsuno T, Ando M, Kubo Y, Banno S, Ito Y, Ishimoto T. Lymphopenia is a risk factor for severe infections in older patients with microscopic polyangiitis: a retrospective cohort study in Japan. Rheumatol Adv Pract 2023; 7:rkad073. [PMID: 37692053 PMCID: PMC10483030 DOI: 10.1093/rap/rkad073] [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: 04/24/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Previous studies have identified the predictors of severe infections in ANCA-associated vasculitis. However, lymphopenia has not been fully evaluated as a predictor of subsequent severe infections in patients with microscopic polyangiitis (MPA). The aim of this study was to assess the association between lymphopenia and severe infections requiring hospitalization after receiving immunosuppressive therapy for MPA. Methods This single-centre retrospective cohort study included 130 consecutive patients with newly diagnosed MPA from Aichi Medical University Hospital, Japan, who received immunosuppressive therapy between March 2004 and December 2020. The relationship between lymphopenia and subsequent severe infections was assessed using time-dependent multivariate Cox proportional hazard models adjusted for clinically relevant factors. Results During the follow-up period (median: 38 months; interquartile range: 15-63 months), 56 severe infectious episodes occurred in 51 patients (39.2%). Time-dependent multivariate Cox proportional hazard analyses identified older age [adjusted hazard ratio (HR) = 1.74 per 10 years, 95% CI: 1.13, 2.67], methylprednisolone pulse therapy (adjusted HR = 2.04, 95% CI: 1.03, 4.02), moderate lymphopenia (vs normal, adjusted HR = 7.17, 95% CI: 3.10, 16.6) and severe lymphopenia (vs normal, adjusted HR = 36.1, 95% CI: 11.8, 110.9) as significant predictors of severe infection. Conclusion Lymphopenia is a predictor of subsequent severe infections in patients with MPA who receive immunosuppressive therapy. These results suggest the importance of sustained infection surveillance, particularly in older patients who develop lymphopenia during strong immunosuppressive therapy.
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Affiliation(s)
- Makoto Yamaguchi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hirokazu Sugiyama
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hironobu Nobata
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroshi Kinashi
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Akimasa Asai
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Fumiya Kitamura
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, Okazaki, Aichi, Japan
| | - Masahiko Ando
- Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shogo Banno
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takuji Ishimoto
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Aichi, Japan
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Sherban A, Hussen R, Gafter-Gvili A, Atamna A, Bishara J, Raanani P, Ben Tikva Kagan K, Avni T. The Impact of Thrombocytopenia and Lymphopenia on Mortality in Patients Infected with Influenza Virus: A Retrospective Cohort Study. Acta Haematol 2023; 146:481-489. [PMID: 37557088 DOI: 10.1159/000533466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Influenza virus causes significant global annual morbidity and mortality. Thrombocytopenia is recognized as a poor prognostic factor in sepsis and is associated with mortality, while lymphopenia has been established as a poor prognostic factor in other viral infections. We aimed to assess the incidence of thrombocytopenia and lymphopenia in seasonal influenza and their effect on clinical outcomes. METHODS This single-center, retrospective, cohort study included consecutive adult patients, hospitalized in Rabin Medical Center between October 2017 and April 2018, with laboratory-confirmed influenza. Patients were grouped according to blood counts on admission: (1) thrombocytopenia (<150 K/mL), (2) lymphopenia (<0.5 K/mL), and (3) both thrombocytopenia and lymphopenia. Patients without thrombocytopenia and lymphopenia were designated as controls. The primary outcome was 30-day all-cause mortality. Risk factors were identified by univariable and multivariable analyses, using logistic regression and reported as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 625 patients were included, 112 (18%) had thrombocytopenia, 98 (15.6%) had lymphopenia, and 107 (17%) had both. The crude 30-day all-cause mortality was 7.6% (48/625). Mortality rates were 7.1% (8/112) for the thrombocytopenia group, 11.2% (11/98) for the lymphopenia group, and 14.9% (16/107) for patients with both versus 4.2% (13/308) in the control (p = 0.000 for all). In a multivariable regression model, significant thrombocytopenia (<100 K/μL) [OR 5.07 (95% CI 1.5-16.2)], age [OR 1.07 (95% CI 1.02-1.11)], time to oseltamivir [OR 1.006 (95% CI 1.002-1.11)], and significant respiratory support [OR 8.85 (3.4-22.6)] were associated with 30-day all-cause mortality. CONCLUSION Patients hospitalized with seasonal influenza and thrombocytopenia <100 K/mL on admission, have an increased 30-day all-cause mortality.
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Affiliation(s)
- Adi Sherban
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ragda Hussen
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Gafter-Gvili
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Hematology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Alla Atamna
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Internal Medicine Department C, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jihad Bishara
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pia Raanani
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Hematology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Kim Ben Tikva Kagan
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tomer Avni
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Gold R, Barnett M, Chan A, Feng H, Fujihara K, Giovannoni G, Montalbán X, Shi FD, Tintoré M, Xue Q, Yang C, Zhou H. Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method. Ther Adv Neurol Disord 2023; 16:17562864231180734. [PMID: 37465201 PMCID: PMC10350766 DOI: 10.1177/17562864231180734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/20/2023] [Indexed: 07/20/2023] Open
Abstract
Dimethyl fumarate (DMF) is a widely used oral disease-modifying therapy for multiple sclerosis (MS). Its efficacy and safety profiles are supported by over a decade of experience. Differences exist between Asia and Europe/United States in the prevalence and characteristics of MS; most data for DMF are derived from populations outside Asia. DMF was recently (2021) approved for use in China. The objectives of this review were to evaluate the evidence for DMF's profile, to provide an update to healthcare providers on current knowledge surrounding its use and to assess the relevance of existing data to use in China. This study used a modified Delphi method based on the insights of a scientific Steering Committee (SC), with a structured literature review conducted to assess the data of DMF. The literature review covered all papers in English (from 01 January 2011 to 21 February 2022) that include 'dimethyl fumarate' and 'multiple sclerosis', and their MeSH terms, on PubMed, supplemented by EMBASE and Citeline searches. Papers were categorized by topic and assessed for relevance and quality, before being used to formulate statements summarizing the literature on each subject. SC members voted on/revised statements, requiring ⩾80% agreement and ⩽10% disagreement for inclusion. Statements not reaching this level were discussed further until agreement was reached or until there was agreement to remove the statement. A total of 1030 papers were retrieved and used to formulate the statements and evidence summaries considered by the SC members. A total of 45 statements were agreed by the SC members. The findings support the positive efficacy and safety profile of DMF in treating patients with MS. Limited Chinese patient data are an ongoing consideration; however, based on current evidence, the statements are considered applicable to both the global and Chinese populations. DMF is a valuable addition to address unmet MS treatment needs in China. Registration: Not applicable.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, Ruhr University Bochum, Bochum 44791, Germany
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew Chan
- Department of Neurology, Inselspital (Bern University Hospital), University of Bern, Bern, Switzerland
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Gavin Giovannoni
- Department of Neurology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Xavier Montalbán
- Neurology Department, Multiple Sclerosis Center of Catalonia (Cemcat), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Fu-Dong Shi
- Department of Neurology, Institute of Neuroimmunology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mar Tintoré
- Neurology Department, Multiple Sclerosis Center of Catalonia (Cemcat), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Qun Xue
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunsheng Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Papežíková I, Piačková V, Dyková I, Baloch AA, Kroupová HK, Zusková E, Pojezdal Ľ, Minářová H, Syrová E, Banďouchová H, Hyršl P, Matějíčková K, Pikula J, Palíková M. Clinical and Laboratory Parameters of Carp Edema Virus Disease: A Case Report. Viruses 2023; 15:v15051044. [PMID: 37243132 DOI: 10.3390/v15051044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
In the present study, we describe a natural outbreak of carp edema virus disease (CEVD) in koi carp, concentrating on clinical manifestation, gross and microscopic pathology, immunological parameters, viral diagnostics, and phylogenetic analysis. Examination of white blood cell parameters showed increased monocyte and decreased lymphocyte counts in CEV-affected fish compared to healthy control fish. Regarding immune system functioning, the present work shows, for the first time, enhanced phagocytic activity in CEV-affected fish. Respiratory burst of phagocytes was strongly increased in diseased fish, the increase being attributed to an increased phagocyte count rather than enhancement of their metabolic activity. The present work also newly shows histopathological changes in the pancreatic tissue of diseased koi.
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Affiliation(s)
- Ivana Papežíková
- Department of Zoology, Fisheries, Hydrobiology and Apiculture, Mendel University in Brno, 613 00 Brno, Czech Republic
- Department of Ecology and Diseases of Zoo Animals, Game, Fish and Bees, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Veronika Piačková
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Centre of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25 Vodňany, Czech Republic
| | - Iva Dyková
- Department of Zoology, Fisheries, Hydrobiology and Apiculture, Mendel University in Brno, 613 00 Brno, Czech Republic
- Department of Botany and Zoology, Faculty of Science, Masaryk University Brno, 625 00 Brno, Czech Republic
| | - Ali Asghar Baloch
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Centre of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25 Vodňany, Czech Republic
| | - Hana Kocour Kroupová
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Centre of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25 Vodňany, Czech Republic
| | - Eliška Zusková
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Centre of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25 Vodňany, Czech Republic
| | - Ľubomír Pojezdal
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute Brno, 621 00 Brno-Medlánky, Czech Republic
| | - Hana Minářová
- Department of Zoology, Fisheries, Hydrobiology and Apiculture, Mendel University in Brno, 613 00 Brno, Czech Republic
- Department of Ecology and Diseases of Zoo Animals, Game, Fish and Bees, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute Brno, 621 00 Brno-Medlánky, Czech Republic
| | - Eva Syrová
- Department of Ecology and Diseases of Zoo Animals, Game, Fish and Bees, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute Brno, 621 00 Brno-Medlánky, Czech Republic
| | - Hana Banďouchová
- Department of Zoology, Fisheries, Hydrobiology and Apiculture, Mendel University in Brno, 613 00 Brno, Czech Republic
- Department of Ecology and Diseases of Zoo Animals, Game, Fish and Bees, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Pavel Hyršl
- Department of Experimental Biology, Masaryk University, 625 00 Brno, Czech Republic
| | - Kateřina Matějíčková
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute Brno, 621 00 Brno-Medlánky, Czech Republic
| | - Jiří Pikula
- Department of Zoology, Fisheries, Hydrobiology and Apiculture, Mendel University in Brno, 613 00 Brno, Czech Republic
- Department of Ecology and Diseases of Zoo Animals, Game, Fish and Bees, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Miroslava Palíková
- Department of Zoology, Fisheries, Hydrobiology and Apiculture, Mendel University in Brno, 613 00 Brno, Czech Republic
- Department of Ecology and Diseases of Zoo Animals, Game, Fish and Bees, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
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Jolles S, Giralt S, Kerre T, Lazarus HM, Mustafa SS, Ria R, Vinh DC. Agents contributing to secondary immunodeficiency development in patients with multiple myeloma, chronic lymphocytic leukemia and non-Hodgkin lymphoma: A systematic literature review. Front Oncol 2023; 13:1098326. [PMID: 36824125 PMCID: PMC9941665 DOI: 10.3389/fonc.2023.1098326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/04/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Patients with hematological malignancies (HMs), like chronic lymphocytic leukemia (CLL), multiple myeloma (MM), and non-Hodgkin lymphoma (NHL), have a high risk of secondary immunodeficiency (SID), SID-related infections, and mortality. Here, we report the results of a systematic literature review on the potential association of various cancer regimens with infection rates, neutropenia, lymphocytopenia, or hypogammaglobulinemia, indicative of SID. Methods A systematic literature search was performed in 03/2022 using PubMed to search for clinical trials that mentioned in the title and/or abstract selected cancer (CLL, MM, or NHL) treatments covering 12 classes of drugs, including B-lineage monoclonal antibodies, CAR T therapies, proteasome inhibitors, kinase inhibitors, immunomodulators, antimetabolites, anti-tumor antibiotics, alkylating agents, Bcl-2 antagonists, histone deacetylase inhibitors, vinca alkaloids, and selective inhibitors of nuclear export. To be included, a publication had to report at least one of the following: percentages of patients with any grade and/or grade ≥3 infections, any grade and/or grade ≥3 neutropenia, or hypogammaglobulinemia. From the relevant publications, the percentages of patients with lymphocytopenia and specific types of infection (fungal, viral, bacterial, respiratory [upper or lower respiratory tract], bronchitis, pneumonia, urinary tract infection, skin, gastrointestinal, and sepsis) were collected. Results Of 89 relevant studies, 17, 38, and 34 included patients with CLL, MM, and NHL, respectively. In CLL, MM, and NHL, any grade infections were seen in 51.3%, 35.9% and 31.1% of patients, and any grade neutropenia in 36.3%, 36.4%, and 35.4% of patients, respectively. The highest proportion of patients with grade ≥3 infections across classes of drugs were: 41.0% in patients with MM treated with a B-lineage monoclonal antibody combination; and 29.9% and 38.0% of patients with CLL and NHL treated with a kinase inhibitor combination, respectively. In the limited studies, the mean percentage of patients with lymphocytopenia was 1.9%, 11.9%, and 38.6% in CLL, MM, and NHL, respectively. Two studies reported the proportion of patients with hypogammaglobulinemia: 0-15.3% in CLL and 5.9% in NHL (no studies reported hypogammaglobulinemia in MM). Conclusion This review highlights cancer treatments contributing to infections and neutropenia, potentially related to SID, and shows underreporting of hypogammaglobulinemia and lymphocytopenia before and during HM therapies.
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Affiliation(s)
- Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom,*Correspondence: Stephen Jolles,
| | - Sergio Giralt
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Tessa Kerre
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Hillard M. Lazarus
- Department of Medicine, Hematology-Oncology, Case Western Reserve University, Cleveland, OH, United States
| | - S. Shahzad Mustafa
- Rochester Regional Health, Rochester, NY, United States,Department of Medicine, Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, United States
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro Medical School, Bari, Italy
| | - Donald C. Vinh
- Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Persistent inflammation-immunosuppression-catabolism syndrome in patients with systemic lupus erythematosus. Int Urol Nephrol 2023:10.1007/s11255-023-03479-3. [PMID: 36739569 PMCID: PMC9899504 DOI: 10.1007/s11255-023-03479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/19/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the clinical characteristics and prognosis of systemic lupus erythematosus (SLE) with persistent inflammation-immunosuppression-catabolism syndrome (PICS). METHODS We retrospectively analyzed patients with SLE who were admitted to the renal intensive care unit (ICU) for over 14 days at Jinling Hospital from July 2010 to July 2018. According to the diagnostic criteria of PICS, we divided the SLE patients into a PICS group and a non-PICS group. We performed a multivariate Cox regression analysis on the risk factors for death in these two groups by comparing the clinical features and prognosis. RESULTS A total of 96 SLE patients met the inclusion and exclusion criteria of this study, including 61 patients in the PICS group and 35 patients in the non-PICS group. The PICS group patients required a longer length of stay in ICU with higher inflammatory indicators (such as C-reactive protein, procalcitonin and interleukin-6) and lower immune levels (such as total, CD3 + , CD4 + , CD8 + and CD20 + lymphocytes) compared to the non-PICS group patients (P < 0.01). Hemoglobin, platelets, serum creatinine, serum blood urea nitrogen and SLE Disease Activity Index (SLE-DAI) score in the PICS group were lower than those in the non-PICS group (P < 0.05), suggesting severe hematological injury in the PICS group and relatively severe renal damage in the non-PICS group. The rates of PICS combined with sepsis, acute respiratory distress syndrome, mechanical ventilation, gram-positive bacteria, gram-negative bacteria, fungi and double infections were higher than those in the non-PICS group (P < 0.05). The 3-year survival rate was 50.82% in the PICS group and 85.71% in the non-PICS group. The 3-year renal survival rate was 32.79% in the PICS group and 51.43% in the non-PICS group. Multivariate Cox regression found that the total lymphocyte count during ICU admission was an independent risk factor for death in SLE patients with PICS. CONCLUSION Patients with SLE complicated with PICS had longer ICU stays, a lower level of SLE activity, a higher risk of secondary infection and a significantly lower survival rate than non-PICS patients.
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Godoy LA, Chen J, Ma W, Lally J, Toomey KA, Rajappa P, Sheridan R, Mahajan S, Stollenwerk N, Phan CT, Cheng D, Knebel RJ, Li T. Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives. Biomark Res 2023; 11:7. [PMID: 36650586 PMCID: PMC9847175 DOI: 10.1186/s40364-022-00444-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.
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Affiliation(s)
- Luis A Godoy
- Division of Thoracic Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Joy Chen
- Medical Student, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Weijie Ma
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Jag Lally
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Kyra A Toomey
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Prabhu Rajappa
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Roya Sheridan
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Shirish Mahajan
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Nicholas Stollenwerk
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
- Medical Service, Pulmonology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Chinh T Phan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
- Medical Service, Pulmonology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Danny Cheng
- Department of Radiology, Interventional Radiology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Robert J Knebel
- Department of Radiology, Interventional Radiology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Tianhong Li
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA.
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Balato G, Ascione T, Festa E, Di Gennaro D, Pandolfo G, Pagliano P. The Diagnostic Accuracy of Neutrophils to Lymphocytes Ratio, Platelets to Lymphocytes Ratio, Monocytes to Lymphocytes Ratio, and Platelets to Mean Platelet Volume Ratio in Diagnosing Periprosthetic Knee Infections. Are Gender-Specific Cutoff Values Needed? J Arthroplasty 2022; 38:918-924. [PMID: 36481284 DOI: 10.1016/j.arth.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to assess the most appropriate thresholds for neutrophils to lymphocytes ratio (NLR), platelets to lymphocytes ratio, monocytes to lymphocytes ratio (MLR), and platelets to mean platelet volume ratio in patients who had a suspected prosthetic knee infection. Furthermore, we evaluated the diagnostic accuracy of our proposed thresholds by men and women. METHODS A total of 261 consecutive patients affected by painful total knee arthroplasty were included. International Consensus Meeting diagnostic criteria were used to identify periprosthetic infections. Sensitivity, specificity, positive, and negative predictive values were calculated for each cutoff value obtained. The area under the receiver operating characteristic curve was evaluated. RESULTS NLR reported the best diagnostic accuracy. MLR and NLR reported higher area under the curves in men and women. We obtained an MLR value ≥0.30 (optimal cutoff value for men) and ≥0.17 (optimal cutoff value for women). In men, the sensitivity and the specificity were 0.71 and 0.77, respectively, versus 0.82 and 0.29, in women. For NLR, we obtained a value ≥2.52 (best cutoff value for men) and ≥2.46 (best cutoff value for women). These cutoffs reported a sensitivity and specificity of 0.71 and 0.88 versus 0.54 and 0.76 in men and women, respectively. CONCLUSION These biomarkers present a low diagnostic accuracy in periprosthetic joint infection detection. Men whose MLR and NLR were above cutoff values had a 77 and 88% probability of presenting a septic prosthetic failure. NLR of at least 2.46 was reasonably sensitive for women who have a periprosthetic knee infection. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Affiliation(s)
- Giovanni Balato
- Department of Public Health, Orthopedic Unit, "Federico II" University, Naples, Italy
| | - Tiziana Ascione
- Department of Medicine, Service of Infectious Disease, Cardarelli Hospital Naples, Naples, Italy
| | - Enrico Festa
- Department of Public Health, Orthopedic Unit, "Federico II" University, Naples, Italy
| | - Donato Di Gennaro
- Department of Public Health, Orthopedic Unit, "Federico II" University, Naples, Italy
| | - Giuseppe Pandolfo
- Department of Economics and Statistics, "Federico II" University, Naples, Italy
| | - Pasquale Pagliano
- Unit of Infectious Diseases, Department of Medicine and Surgery - University of Salerno - Baronissi, Italy
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Terrones-Campos C, Ledergerber B, Specht L, Vogelius IR, Helleberg M, Lundgren J. Risk of Bacterial, Viral, and Fungal Infections in Patients With Solid Malignant Tumors Treated With Curative Intent Radiation Therapy. Adv Radiat Oncol 2022; 7:100950. [PMID: 35677193 PMCID: PMC9168504 DOI: 10.1016/j.adro.2022.100950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/16/2022] [Indexed: 10/31/2022] Open
Abstract
Purpose The incidence, etiology, and association of infections with radiation therapy (RT)-induced lymphopenia in patients with solid tumors is not well elucidated. Methods and Materials We identified possible, probable, and definite infections caused by bacteria, fungi, and viruses, combining data on medication, microbiology, and diagnoses. Definite infections had either a diagnosis or a positive microbiological isolation. We analyzed the incidence and adjusted incidence-rate ratio of infections in the year after the start of RT among patients who received RT plus chemotherapy and RT monotherapy, by type of infection and according to the degree of RT-induced lymphopenia. Results A total of 4450 of 6334 (70.3%) patients experienced 11264 infections overall; 1424 (22.5%) patients developed 2104 definite infections in the first year after RT. Infections were more frequent among patients who received RT plus chemotherapy (2590 of 3469; incidence: 16.5 [95% confidence interval {CI}, 16.1-17.0], per 100 patient-years) compared with patients who received RT monotherapy (1860 of 2865; incidence: 12.7 [95% CI, 12.3-13.2]). The incidence of infection was highest in the first 3 months overall (28.2 vs 18.0 in patients who received RT plus chemotherapy compared with those who received RT monotherapy) and for definite infections (4.7 vs 3.8). The proportion of specific bacterial infections were similar among patients who received RT plus chemotherapy versus those who received RT monotherapy. Urinary tract infections were the most frequent (51.2% vs 56.2%), followed by pneumonias (24.1% vs 22.4%). Viral and fungal infections were more frequent among patients who received RT plus chemotherapy, but they were uncommon. In multivariable analyses, patients who received RT plus chemotherapy with a lymphopenia grade of 1-2 or ≥3 versus no lymphopenia at end of RT had an increased risk of bacterial infections 0 to 3 months after RT (incidence rate ratio, 1.45 [95% CI, 1.06-1.97] and 1.71 [95% CI, 1.26-2.34], respectively). Limiting to definite bacterial infections, the incidence rate ratio for lymphopenia grade ≥3 versus no lymphopenia was 2.66 (95% CI, 1.40-5.03). Conclusions The incidence of bacterial infections 0 to 3 months after RT plus chemotherapy for solid tumors was high, especially among patients with RT-induced lymphopenia grade 1-2 and ≥3.
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Affiliation(s)
- Cynthia Terrones-Campos
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bruno Ledergerber
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ivan Richter Vogelius
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Shields AM, Anantharachagan A, Arumugakani G, Baker K, Bahal S, Baxendale H, Bermingham W, Bhole M, Boules E, Bright P, Chopra C, Cliffe L, Cleave B, Dempster J, Devlin L, Dhalla F, Diwakar L, Drewe E, Duncan C, Dziadzio M, Elcombe S, Elkhalifa S, Gennery A, Ghanta H, Goddard S, Grigoriadou S, Hackett S, Hayman G, Herriot R, Herwadkar A, Huissoon A, Jain R, Jolles S, Johnston S, Khan S, Laffan J, Lane P, Leeman L, Lowe DM, Mahabir S, Lochlainn DJM, McDermott E, Misbah S, Moghaddas F, Morsi H, Murng S, Noorani S, O'Brien R, Patel S, Price A, Rahman T, Seneviratne S, Shrimpton A, Stroud C, Thomas M, Townsend K, Vaitla P, Verma N, Williams A, Burns SO, Savic S, Richter AG. Outcomes following SARS-CoV-2 infection in patients with primary and secondary immunodeficiency in the UK. Clin Exp Immunol 2022; 209:247-258. [PMID: 35641155 PMCID: PMC8807296 DOI: 10.1093/cei/uxac008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 12/29/2022] Open
Abstract
In March 2020, the United Kingdom Primary Immunodeficiency Network (UKPIN) established a registry of cases to collate the outcomes of individuals with PID and SID following SARS-CoV-2 infection and treatment. A total of 310 cases of SARS-CoV-2 infection in individuals with PID or SID have now been reported in the UK. The overall mortality within the cohort was 17.7% (n = 55/310). Individuals with CVID demonstrated an infection fatality rate (IFR) of 18.3% (n = 17/93), individuals with PID receiving IgRT had an IFR of 16.3% (n = 26/159) and individuals with SID, an IFR of 27.2% (n = 25/92). Individuals with PID and SID had higher inpatient mortality and died at a younger age than the general population. Increasing age, low pre-SARS-CoV-2 infection lymphocyte count and the presence of common co-morbidities increased the risk of mortality in PID. Access to specific COVID-19 treatments in this cohort was limited: only 22.9% (n = 33/144) of patients admitted to the hospital received dexamethasone, remdesivir, an anti-SARS-CoV-2 antibody-based therapeutic (e.g. REGN-COV2 or convalescent plasma) or tocilizumab as a monotherapy or in combination. Dexamethasone, remdesivir, and anti-SARS-CoV-2 antibody-based therapeutics appeared efficacious in PID and SID. Compared to the general population, individuals with PID or SID are at high risk of mortality following SARS-CoV-2 infection. Increasing age, low baseline lymphocyte count, and the presence of co-morbidities are additional risk factors for poor outcome in this cohort.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | | | - Gururaj Arumugakani
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Kenneth Baker
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sameer Bahal
- Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Malini Bhole
- The Dudley Group NHS Foundation Trust, Birmingham, UK
| | - Evon Boules
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Philip Bright
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Charu Chopra
- Department of Haematology & Immunology, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Lucy Cliffe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Betsy Cleave
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - John Dempster
- Specialist Allergy and Clinical Immunology, University College London Hospitals, London, UK
| | - Lisa Devlin
- Regional Immunology Service, The Royal Hospitals, Belfast, UK
| | - Fatima Dhalla
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lavanya Diwakar
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Elizabeth Drewe
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Christopher Duncan
- Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK
| | | | - Suzanne Elcombe
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Shuayb Elkhalifa
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Andrew Gennery
- Translational and Clinical Research Institute, Newcastle University, and Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Harichandrana Ghanta
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Sarah Goddard
- Department of Immunology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Sofia Grigoriadou
- Immunology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Scott Hackett
- Paediatric Immunology Department, University Hospitals of Birmingham, Birmingham, UK
| | - Grant Hayman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Richard Herriot
- Immunology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Archana Herwadkar
- Immunology Department, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Aarnoud Huissoon
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rashmi Jain
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Sarah Johnston
- Clinical Immunology, North Bristol NHS Trust, Bristol, UK
| | - Sujoy Khan
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - James Laffan
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Peter Lane
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Lucy Leeman
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David M Lowe
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Shanti Mahabir
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Elizabeth McDermott
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Siraj Misbah
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Hadeil Morsi
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sai Murng
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Sadia Noorani
- Clinical Immunology Department, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rachael O'Brien
- Department of Clinical Immunology, Frimley Park Hospital, Frimley, Surrey, UK
| | - Smita Patel
- Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arthur Price
- Clinical Immunology and Allergy Department, Leicester Royal Infirmary, Leicester, UK
| | - Tasneem Rahman
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | | | - Anna Shrimpton
- Clinical Immunology and Allergy Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Catherine Stroud
- Regional Department of Clinical Immunology & Allergy, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Moira Thomas
- Clinical Immunology Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Katie Townsend
- Clinical Immunology Service, South West London Immunodeficiency Centre, Epsom and St Helier University Hospital NHS Trust, London, UK
| | - Prashantha Vaitla
- Clinical Immunology and Allergy Department, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Nisha Verma
- Institute of Immunity and Transplantation, University College London, London, UK
| | - Anthony Williams
- Department of Allergy and Clinical Immunology, University Hospital Southampton NHS Trust, University of Southampton, Southampton, UK
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, UK.,Department of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Alex G Richter
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Festa E, Ascione T, Bernasconi A, Di Gennaro D, Basso MA, Guarino A, Balato G. Diagnostic Performance of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Platelet to Mean Platelet Volume Ratio in Periprosthetic Hip and Knee Infections: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092033. [PMID: 36140435 PMCID: PMC9497749 DOI: 10.3390/diagnostics12092033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 12/20/2022] Open
Abstract
The current literature on the diagnosis of periprosthetic joint infection provides controversial evidence on the diagnostic accuracy of MLR, NLR, PVR, and PLR. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of these biomarkers for the diagnosis of hip and knee prosthetic infection. According to the PRISMA flowchart, we searched MEDLINE, Scopus, and Web of Science, for studies on these ratios for diagnosing PJI. Sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio, and AUC were analyzed. We included 11 articles in our meta-analysis, including 7537 patients who underwent total hip and knee arthroplasties; among these, 1974 (26%) patients reported a joint infection. The pooled sensitivity and specificity were 0.72 and 0.74, respectively, for NLR, 0.72 and 0.77 for PVR, and 0.77 and 0.75 for PLR. The sensitivity of MLR ranges from 0.54 to 0.81, while the specificity ranges from 0.78 to 0.81. Regarding the evaluation of AUCs, the best diagnostic performance was achieved by MLR (AUC = 0.77) followed by PLR (AUC = 0.75), NLR (AUC = 0.73), and PVR (AUC = 0.70). This meta-analysis demonstrates a fair diagnostic accuracy of these ratios, thus not being useful as a screening tool.
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Affiliation(s)
- Enrico Festa
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
- Correspondence:
| | - Tiziana Ascione
- Service of Infectious Disease, Department of Medicine, Cardarelli Hospital Naples, 80131 Naples, Italy
| | - Alessio Bernasconi
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Donato Di Gennaro
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Morena Anna Basso
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Amedeo Guarino
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
| | - Giovanni Balato
- Orthopedic Unit, Department of Public Health, Federico II University Naples, 80131 Naples, Italy
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Diem L, Hammer H, Hoepner R, Pistor M, Remlinger J, Salmen A. Sex and gender differences in autoimmune demyelinating CNS disorders: Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein antibody associated disorder (MOGAD). INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:129-178. [PMID: 36038203 DOI: 10.1016/bs.irn.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Multiple sclerosis (MS), Neuromyelitis optica spectrum disorder (NMOSD) and Myelin-Oligodendrocyte-Glycoprotein antibody associated disorder (MOGAD) are demyelinating disorders of the central nervous system (CNS) of autoimmune origin. Here, we summarize general considerations on sex-specific differences in the immunopathogenesis and hormonal influences as well as key clinical and epidemiological elements. Gender-specific issues are widely neglected starting with the lacking separation of sex as a biological variable and gender comprising the sociocultural components. As for other autoimmune diseases, female preponderance is common in MS and NMOSD. However, sex distribution in MOGAD seems equal. As in MS, immunotherapy in NMOSD and MOGAD is crucial to prevent further disease activity. Therefore, we assessed data on sex differences of the currently licensed disease-modifying treatments for efficacy and safety. This topic seems widely neglected with only fragmented information resulting from post-hoc analyses of clinical trials or real-world post-marketing studies afflicted with lacking power and/or inherent sources of bias. In summary, biological hypotheses of sex differences including genetic factors, the constitution of the immune system and hormonal influences are based upon human and preclinical data, especially for the paradigmatic disease of MS whereas specific data for NMOSD and MOGAD are widely lacking. Epidemiological and clinical differences between men and women are well described for MS and to some extent for NMOSD, yet, with remaining contradictory findings. MOGAD needs further detailed investigation. Sex-specific analyses of safety and efficacy of long-term immunotherapies need to be addressed in future studies designed and powered to answer the pressing questions and to optimize and individualize treatment.
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Affiliation(s)
- Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Max Pistor
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Jana Remlinger
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland; Department of Biomedical Research and Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland.
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Wang N, Lu Y, Zheng J, Liu X. Of mice and men: Laboratory murine models for recapitulating the immunosuppression of human sepsis. Front Immunol 2022; 13:956448. [PMID: 35990662 PMCID: PMC9388785 DOI: 10.3389/fimmu.2022.956448] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Prolonged immunosuppression is increasingly recognized as the major cause of late phase and long-term mortality in sepsis. Numerous murine models with different paradigms, such as lipopolysaccharide injection, bacterial inoculation, and barrier disruption, have been used to explore the pathogenesis of immunosuppression in sepsis or to test the efficacy of potential therapeutic agents. Nonetheless, the reproducibility and translational value of such models are often questioned, owing to a highly heterogeneric, complex, and dynamic nature of immunopathology in human sepsis, which cannot be consistently and stably recapitulated in mice. Despite of the inherent discrepancies that exist between mice and humans, we can increase the feasibility of murine models by minimizing inconsistency and increasing their clinical relevance. In this mini review, we summarize the current knowledge of murine models that are most commonly used to investigate sepsis-induced immunopathology, highlighting their strengths and limitations in mimicking the dysregulated immune response encountered in human sepsis. We also propose potential directions for refining murine sepsis models, such as reducing experimental inconsistencies, increasing the clinical relevance, and enhancing immunological similarities between mice and humans; such modifications may optimize the value of murine models in meeting research and translational demands when applied in studies of sepsis-induced immunosuppression.
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Affiliation(s)
- Ning Wang
- West China Biopharm Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yongling Lu
- Medical Research Center, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Jiang Zheng
- Medical Research Center, Southwest Hospital, Army Military Medical University, Chongqing, China
- *Correspondence: Jiang Zheng, ; Xin Liu,
| | - Xin Liu
- Medical Research Center, Southwest Hospital, Army Military Medical University, Chongqing, China
- *Correspondence: Jiang Zheng, ; Xin Liu,
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Pei F, Song W, Wang L, Liang L, Gu B, Chen M, Nie Y, Liu Y, Zhou Y, Guan X, Wu J. Lymphocyte trajectories are associated with prognosis in critically ill patients: A convenient way to monitor immune status. Front Med (Lausanne) 2022; 9:953103. [PMID: 35991659 PMCID: PMC9386077 DOI: 10.3389/fmed.2022.953103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundImmunosuppression is a risk factor for poor prognosis of critically ill patients, but current monitoring of the immune status in clinical practice is still inadequate. Absolute lymphocyte count (ALC) is not only a convenient biomarker for immune status monitoring but is also suitable for clinical application. In this study, we aimed to explore different trajectories of ALC, and evaluate their relationship with prognosis in critically ill patients.MethodsWe retrospectively enrolled 10,619 critically ill patients admitted to a general intensive care unit (ICU) with 56 beds from February 2016 to May 2020. Dynamic ALC was defined as continuous ALC from before ICU admission to 5 days after ICU admission. Initial ALC was defined as the minimum ALC within 48 h after ICU admission. Group-based trajectory modeling (GBTM) was used to group critically ill patients according to dynamic ALC. Multivariate cox regression model was used to determine the independent association of trajectory endotypes with death and persistent inflammation, immunosuppression, catabolism syndrome (PICS).ResultsA total of 2022 critically ill patients were unsupervisedly divided into four endotypes based on dynamic ALC, including persistent lymphopenia endotype (n = 1,211; 58.5%), slowly rising endotype (n = 443; 22.6%), rapidly decreasing endotype (n = 281; 14.5%) and normal fluctuation endotype (n = 87; 4.4%). Among the four trajectory endotypes, the persistent lymphopenia endotype had the highest incidence of PICS (24.9%), hospital mortality (14.5%) and 28-day mortality (10.8%). In multivariate cox regression model, persistent lymphopenia was associated with increased risk of 28-day mortality (HR: 1.54; 95% CI: 1.06–2.23), hospital mortality (HR: 1.66; 95% CI: 1.20–2.29) and PICS (HR: 1.79; 95% CI: 1.09–2.94), respectively. Sensitivity analysis further confirmed that the ALC trajectory model of non-infected patients and non-elderly patients can accurately distinguished 91 and 90% of critically ill patients into the same endotypes as the original model, respectively.ConclusionThe ALC trajectory model is helpful for grouping critically ill patients, and early persistent lymphopenia is associated with poor prognosis. Notably, persistent lymphopenia may be a robust signal of immunosuppression in critically ill patients.
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Affiliation(s)
- Fei Pei
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Wenliang Song
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Luhao Wang
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Liqun Liang
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Bin Gu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Minying Chen
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Yao Nie
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Yishan Liu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Yu Zhou
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
- *Correspondence: Xiangdong Guan,
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Clinical Research Center for Critical Care Medicine, Guangzhou, China
- Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Jianfeng Wu,
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Psihogios A, Madampage C, Faught BE. Contemporary nutrition-based interventions to reduce risk of infection among elderly long-term care residents: A scoping review. PLoS One 2022; 17:e0272513. [PMID: 35917358 PMCID: PMC9345473 DOI: 10.1371/journal.pone.0272513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Elderly long-term care residents (ELTCRs) face considerable burden of infection, especially evident during the COVID-19 pandemic. The nutritional status of the host can influence susceptibility to infection by altering immune system integrity, therefore, nutrition-based interventions may be a viable complement to existing infection prevention measures. Objective This scoping review sought to identify nutritional interventions and factors that have the strongest evidence to benefit ELTCRs, and thus best poised for rigorous clinical trial evaluation and subsequent implementation. Methods A database search of OVID-Medline, OVID-Embase, and Web of Science was performed from 2011 to 2021 to identify nutritional intervention studies which attribute to changes in infection in contemporary ELTCR settings. Articles were screened in duplicate and data extraction completed by a single reviewer, while a second reviewer verified the data which was fitted to identify evidence for nutritional interventions related to reducing rates of infection among ELTCRs. Results The search identified 1018 studies, of which 11 (nine clinical trials and two observational cohort studies) satisfied screening criteria. Interventions that significantly reduced risk of infection included whey protein (any infection), Black Chokeberry (urinary tract infection), and vitamin D (acute respiratory tract infection, skin and soft tissue infection). Both zinc and a dedicated meal-plan significantly improved lymphocyte parameters. Vitamin D deficiency was associated with the development of respiratory tract infections. Probiotic and soy-based protein interventions did not significantly affect risk of infection or lymphocyte parameters, respectively. Conclusion The current scoping review was effective in identifying the use of nutrition-based interventions for infection prevention among ELTCRs. In this study, some nutrition-based interventions were observed to significantly influence the risk of infection among ELTCRs. Nutritional interventions such as vitamin D (preventing deficiency/insufficiency), Black Chokeberry juice, zinc gluconate, whey protein, and varied and nutrient dense meal plans may be suitable for future rigorous clinical trial evaluation.
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Affiliation(s)
- Athanasios Psihogios
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Claudia Madampage
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Brent E. Faught
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
- * E-mail:
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Development of Lymphopenia during Therapy with Immune Checkpoint Inhibitors Is Associated with Poor Outcome in Metastatic Cutaneous Melanoma. Cancers (Basel) 2022; 14:cancers14133282. [PMID: 35805052 PMCID: PMC9265779 DOI: 10.3390/cancers14133282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
Predictive markers for immune checkpoint inhibitor (ICI) therapy are needed. Thus, baseline blood counts have been investigated as biomarkers, showing that lymphopenia at the start of therapy with (ICI) is associated with a worse outcome in metastatic melanoma. We investigated the relationship between the occurrence of lymphopenia under ICI and disease outcome. Patients with metastatic melanoma who had undergone therapy with ICI were identified in our database. Only patients with a normal lymphocyte count at baseline were included in this retrospective study. Progression-free survival (PFS) and overall survival (OS) were compared between patients in which lymphopenia occurred during ICI therapy and those who did not develop lymphopenia. In total, 116 patients were analyzed. Lymphopenia occurred in 42.2% of patients, with a mean onset after 17 weeks (range 1-180 weeks). The occurrence of lymphopenia during immunotherapy was significantly associated with a shorter PFS and OS. Patients who developed lymphopenia (n = 49) had a mean PFS of 13.3 months (range 1-67 months) compared to 16.9 months (range 1-73 months) for patients who did not develop lymphopenia (n = 67; p = 0.025). Similarly, patients with lymphopenia had a significantly shorter OS of 28.1 months (range 2-70 months) compared with 36.8 months (range 4-106 months) in patients who did not develop lymphopenia (p = 0.01). Patients with metastatic melanoma who develop lymphopenia during ICI therapy have a worse prognosis with significantly shorter PFS and OS compared with patients who do not develop lymphopenia.
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Chiang KC, Kalantar-Zadeh K, Gupta A. Thymic Dysfunction and Atrophy in COVID-19 Disease Complicated by Inflammation, Malnutrition and Cachexia. Nutr Health 2022; 28:199-206. [PMID: 35234100 PMCID: PMC8891908 DOI: 10.1177/02601060221083160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: The current COVID-19 pandemic has put millions of people, especially children at risk of protein-energy malnutrition (PEM) by pushing them into poverty and disrupting the global food supply chain. The thymus is severely affected by nutritional deficiencies and is known as a barometer of malnutrition. Aim: The present commentary provides a novel perspective on the role of malnutrition-induced thymic dysfunction, involution and atrophy on the risk and severity of disease in children during the COVID-19 pandemic. Methods: A review of pertinent indexed literature including studies examining the effects of malnutrition on the thymus and immune dysfunction in COVID-19. Results: Protein-energy malnutrition and micronutrient deficiencies of zinc, iron and vitamin A are known to promote thymic dysfunction and thymocyte loss in children. Malnutrition- and infection-induced thymic atrophy and immune dysfunction may increase the risk of first, progression of COVID-19 disease to more severe forms including development of multisystem inflammatory syndrome in children (MIS-C); second, slow the recovery from COVID-19 disease; and third, increase the risk of other infections. Furthermore, malnourished children may be at increased risk of contracting SARS-CoV-2 infection due to socioeconomic conditions that promote viral transmission amongst contacts and create barriers to vaccination. Conclusion: National governments and international organizations including WHO, World Food Program, and UNICEF should institute measures to ensure provision of food and micronutrients for children at risk in order to limit the health impact of the ongoing COVID-19 pandemic.
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Affiliation(s)
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension
and Kidney Transplantation and Department of Medicine,
University of
California Irvine (UCI) School of Medicine,
USA
| | - Ajay Gupta
- Charak
Foundation, Orange, CA, USA
- Division of Nephrology, Hypertension
and Kidney Transplantation and Department of Medicine,
University of
California Irvine (UCI) School of Medicine,
USA
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Stappers S, van der Graaff D, Hoffman I, Moorkens W, Hantson I, Stappaerts I, Nowé V, Vervliet L. Systemic lupus erythematosus presenting as non-resolving pneumonia: a case report. Acta Clin Belg 2022; 77:616-623. [PMID: 34027835 DOI: 10.1080/17843286.2021.1925817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) is a rheumatological disorder with a heterogeneous clinical presentation and disease course. Case presentationWe report a case concerning a young woman with pleuropneumonia, non-responsive to conventional antibiotic therapy, who was, upon further inquiry and passage of time, diagnosed with SLE. Key pointsBy means of this case, we would like to emphasize the clinical implications and prognostic significance of lymphopenia in patients with SLE. Moreover, we attempt to make the reader aware of some of the protean manifestations of SLE and we would like to raise suspicion of acute lupus pneumonitis by demonstrating a case of a young female with non-resolving pneumonia.
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Affiliation(s)
- Sofie Stappers
- Department of Internal Medicine, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | | | - Ilse Hoffman
- Department of Rheumatology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Walter Moorkens
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Inge Hantson
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Inge Stappaerts
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Vicky Nowé
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
| | - Liesbeth Vervliet
- Department of Pneumology, GZA Sint-Vincentius Hospital, Antwerp, Belgium
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Thrombolysis in stroke patients with elevated inflammatory markers. J Neurol 2022; 269:5405-5419. [PMID: 35622132 PMCID: PMC9468078 DOI: 10.1007/s00415-022-11173-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 11/07/2022]
Abstract
Objective To investigate the prognostic value of white blood cell count (WBC) on functional outcome, mortality and bleeding risk in stroke patients treated with intravenous thrombolysis (IVT). Methods In this prospective multicenter study from the TRISP registry, we assessed the association between WBC on admission and 3-month poor outcome (modified Rankin Scale 3–6), mortality and occurrence of symptomatic intracranial hemorrhage (sICH; ECASS-II-criteria) in IVT-treated stroke patients. WBC was used as continuous and categorical variable distinguishing leukocytosis (WBC > 10 × 109/l) and leukopenia (WBC < 4 × 109/l). We calculated unadjusted/ adjusted odds ratios with 95% confidence intervals (OR [95% CI]) with logistic regression models. In a subgroup, we analyzed the association of combined leukocytosis and elevated C-reactive protein (CRP > 10 mg/l) on outcomes. Results Of 10,813 IVT-treated patients, 2527 had leukocytosis, 112 leukopenia and 8174 normal WBC. Increasing WBC (by 1 × 109/l) predicted poor outcome (ORadjusted 1.04[1.02–1.06]) but not mortality and sICH. Leukocytosis was independently associated with poor outcome (ORadjusted 1.48[1.29–1.69]) and mortality (ORadjusted 1.60[1.35–1.89]) but not with sICH (ORadjusted 1.17[0.94–1.45]). Leukopenia did not predict any outcome. In a subgroup, combined leukocytosis and elevated CRP had the strongest association with poor outcome (ORadjusted 2.26[1.76–2.91]) and mortality (ORadjusted 2.43[1.86–3.16]) when compared to combined normal WBC and CRP. Conclusion In IVT-treated patients, leukocytosis independently predicted poor functional outcome and death. Bleeding complications after IVT were not independently associated with leukocytosis. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11173-0.
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Fajgenbaum DC, Pierson SK, Kanhai K, Bagg A, Alapat D, Lim MS, Lechowicz MJ, Srkalovic G, Uldrick TS, van Rhee F. The disease course of Castleman disease patients with fatal outcomes in the ACCELERATE registry. Br J Haematol 2022; 198:307-316. [PMID: 35507638 PMCID: PMC9544190 DOI: 10.1111/bjh.18214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/02/2022]
Abstract
Castleman disease (CD) describes a group of rare, potentially fatal lymphoproliferative disorders. To determine factors associated with mortality in CD, we analysed data from deceased patients in the ACCELERATE registry and compared them with matched controls. We analysed demographic, treatment and laboratory data from all deceased CD patients, matched controls and a subgroup of idiopathic multicentric Castleman disease (iMCD) patients. Of the 140 patients in ACCELERATE with a confirmed CD diagnosis, 10 had died. There were 72 patients with confirmed iMCD; six were deceased. The deceased CD cohort had more hospitalisations per year, higher overall hospitalisations and more days hospitalised per month, and received more treatment regimens per year than the matched‐control group. Analysis of laboratory values showed a significantly decreased absolute lymphocyte count at months 3 and 6 in the deceased cohort compared with controls. Among iMCD patients, there was a higher proportion of iMCD‐TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction and organomegaly) cases in the deceased group. The deceased iMCD group had significantly lower immunoglobulin M, international normalised ratio and platelet count. These data demonstrate that there may be differences between patients who have fatal and non‐fatal outcomes, and provide preliminary suggestions for parameters to evaluate further.
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Affiliation(s)
- David C Fajgenbaum
- Center for Cytokine Storm Treatment & Laboratory, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sheila K Pierson
- Center for Cytokine Storm Treatment & Laboratory, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karan Kanhai
- Medical Affairs, EUSA Pharma, Hemel Hempstead, UK
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daisy Alapat
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gordan Srkalovic
- Sparrow Herbert-Herman Cancer Center, Michigan State University College of Human Medicine, Lansing, Michigan, USA
| | - Thomas S Uldrick
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Frits van Rhee
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Imabayashi H, Miyake A, Chiba K. A novel approach for identifying serological markers indicative of surgical-site infection following spine surgery: Postoperative lymphopenia is a risk factor. J Orthop Sci 2022; 27:588-593. [PMID: 34049755 DOI: 10.1016/j.jos.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/20/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postoperative lymphopenia (PL) after spine surgery is reported to be an indicator of surgical-site infection (SSI). PL without SSI is often encountered, resulting in a treatment dilemma. We focused on PL, so as to improve the accuracy of detecting SSI. METHODS In total, 329 patients underwent spine surgery, including nine patients presenting with SSI. The complete blood cell counts, differential counts, and C-reactive protein (CRP) level were measured pre-surgery and on postoperative days 2, 7, and 14. The relationships between PL and SSI were evaluated, and PL and non-PL conditions were compared among all cases. We then divided the patients into two groups: PL and non-PL, and determined the useful serological markers using receiver operating characteristic curves. RESULTS Sixty-one patients presented with PL, including four with SSI. However, PL was not directly suggested as a biomarker of SSI (p = 0.067). We revealed PL as a risk factor for SSI (p = 0.004, Odds ratio: 7.54). Among all cases, the lymphocyte count and CRP level differed significantly between the PL and non-PL groups at all perioperative time-points. The white blood cell count, neutrophil count, and CRP levels on postoperative day 7 significantly differed between the SSI and non-SSI cases in the PL group. The area under the curve (AUC) for CRP was greater than that of the other parameters. The neutrophil count was only effective as a marker in the non-PL group. The combination of two cutoff values (CRP: 3.7 mg/dL (PL group) and neutrophil count: 6172/μL (non-PL group)) presented high specificity (87.2%) and sensitivity (88.9%), while only one cutoff value (CRP: 2.9 mg/dL) had a specificity of 77.4% and sensitivity of 77.8%. CONCLUSIONS Approximately one-fifth of patients developed PL post-surgery, which was a risk factor for SSI, with constant high inflammation. Grouping based on PL and establishing diagnostic cutoff values are more appropriate than establishing only one cutoff value for overall cases.
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Affiliation(s)
- Hideaki Imabayashi
- Department of Orthopedic Surgery, Saiseikai Central Hospital, Mita 1-4-17, Minato-ku, Tokyo, 108-0073, Japan.
| | - Atsushi Miyake
- Orthopedic Department, National Defense College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kazuhiro Chiba
- Orthopedic Department, National Defense College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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47
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Chan SHT, Yu T, Zhang Z, Chang LY, Guo C, Bo Y, Tam T, Lau AKH, Lao XQ. Total and differential white blood cell count and cause-specific mortality in 436 750 Taiwanese adults. Nutr Metab Cardiovasc Dis 2022; 32:937-947. [PMID: 35078679 DOI: 10.1016/j.numecd.2021.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/04/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS White blood cell (WBC) count is an easily obtainable biomarker of systematic inflammation. Our study aimed to investigate the associations of differential WBC count with all-cause and cause-specific mortality in a general Asian population. METHODS AND RESULTS Cox proportional hazards model was used to evaluate the associations of WBC count with mortality separately for men and women, with adjustment for multiple variables including age, smoking, and other lifestyle factors. Stratified analyses by age, smoking, diabetes, and hypertension were conducted to explore potential effect modification. Elevated WBC count was significantly associated with increased mortality risk. The adjusted hazard ratios of total WBC (10th decile compared to decile of lowest risk) for all-cause mortality were 1.42 (95% CI: 1.33, 1.53) for men and 1.54 (95% CI: 1.42, 1.68) for women. Similar risks were observed for neutrophils, monocytes, and neutrophil/lymphocyte (NL) ratio. The highest deciles of neutrophils, monocytes, and NL ratio were also positively associated with risk of cardiovascular/cerebrovascular, cancer, and respiratory mortality after adjusting for covariates. Results for all-cause mortality remained statistically significant for participants who were <60 years old, non-smokers, non-diabetic, and non-hypertensive. CONCLUSIONS Total and differential WBC counts (neutrophils, monocytes, and NL ratios) are positively associated with increased risk of all-cause mortality, cardiovascular and cerebrovascular, cancer, and respiratory mortality among Taiwanese adults.
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Affiliation(s)
- Shin Heng Teresa Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tsung Yu
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Zilong Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ly-Yun Chang
- Institute of Sociology, Academia Sinica, Taipei, Taiwan
| | - Cui Guo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yacong Bo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tony Tam
- Department of Sociology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexis K H Lau
- Division of Environment and Sustainability, The Hong Kong University of Science and Technology, Hong Kong SAR, China; Department of Civil and Environmental Engineering, The Hong Kong University of Science and Technology, Hong Kong SAR, China.
| | - Xiang Qian Lao
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Baïsse A, Daix T, Hernandez Padilla AC, Jeannet R, Barraud O, Dalmay F, François B, Vignon P, Lafon T. High prevalence of infections in non-COVID-19 patients admitted to the Emergency Department with severe lymphopenia. BMC Infect Dis 2022; 22:295. [PMID: 35346082 PMCID: PMC8960225 DOI: 10.1186/s12879-022-07295-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background In the Emergency Department (ED), early and accurate recognition of infection is crucial to prompt antibiotic therapy but the initial presentation of patients is variable and poorly characterized. Lymphopenia is commonly associated with bacteraemia and poor outcome in intensive care unit patients. The objective of this retrospective study was to assess the prevalence of community-acquired infection in a cohort of unselected patients admitted to the ED with undifferentiated symptoms and severe lymphopenia. Methods This is a retrospective single-center study conducted over a 1 year-period before the COVID-19 pandemic. Consecutive adult patients admitted to the ED with severe lymphopenia (lymphocyte count < 0.5 G/L) were studied. Patients with hematological or oncological diseases, HIV infection, hepato-cellular deficiency, immunosuppression, or patients over 85 years old were excluded. Diagnoses of infection were validated by an independent adjudication committee. The association between various parameters and infection was assessed using a multivariate logistic regression analysis. Results Of 953 patients admitted to the ED with severe lymphopenia, 245 were studied (148 men; mean age: 63 ± 19 years). Infection was confirmed in 159 patients (65%) (bacterial: 60%, viral: 30%, other: 10%). Only 61 patients (25%) were referred to the ED for a suspected infection. In the univariate analysis, SIRS criteria (OR: 5.39; 95%CI: 3.04–9.70; p < 0.001) and temperature ≥ 38.3 °C (OR: 10.95; 95%CI: 5.39–22.26; p < 0.001) were strongly associate with infection. In the multivariate analysis, only SIRS criteria (OR: 2.4; 95%CI: 1.48–3.9; p < 0.01) and fever (OR: 3.35; 95%CI: 1.26–8.93; p = 0.016) were independently associated with infection. Conclusions The prevalence of underlying infection is high in patients admitted to the ED with lymphopenia, irrespective of the reason for admission. Whether lymphopenia could constitute a valuable marker of underlying infection in this clinical setting remains to be confirmed prospectively in larger cohorts. Trial registration: No registration required as this is a retrospective study. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07295-5.
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Patil SM, Hilker ED. Aeromonas hydrophila Community-Acquired Bacterial Pneumonia With Septic Shock in a Chronic Lymphocytic Leukemia Patient Due to Absolute Neutropenia and Lymphopenia. Cureus 2022; 14:e23345. [PMID: 35475099 PMCID: PMC9018926 DOI: 10.7759/cureus.23345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 12/03/2022] Open
Abstract
Aeromonas hydrophila is a gram-negative (GN) bacillus with an opportunistic potential in immunocompromised patients. They are ubiquitary in fresh and brackish water capable of infecting healthy and immunosuppressed patients. Clinical manifestations vary in healthy hosts compared to immunocompromised patients. Community-acquired bacterial pneumonia (CABP) is an infrequent clinical presentation of A. hydrophila infection, even in immunosuppressed patients. It is also an uncommon cause of nosocomial and drowning-related pneumonia. Although a rare cause of CABP, the clinical course is fulminant with higher mortality due to lower clinical suspicion. Here, we present an immunocompromised 63-year-old Caucasian male with chronic lymphocytic leukemia (CLL) presenting with acute A. hydrophila CABP with septic shock due to absolute neutropenia and lymphopenia.
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50
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Barbieri MA, Sorbara EE, Battaglia A, Cicala G, Rizzo V, Spina E, Cutroneo PM. Adverse Drug Reactions with Drugs Used in Multiple Sclerosis: An Analysis from the Italian Pharmacovigilance Database. Front Pharmacol 2022; 13:808370. [PMID: 35281926 PMCID: PMC8904918 DOI: 10.3389/fphar.2022.808370] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Given the importance of inflammation at the onset of multiple sclerosis (MS), therapy is mainly based on the use of anti-inflammatory drugs including disease modifying therapies (DMTs). Considering the recent approval of some DMTs, pharmacovigilance becomes a fundamental tool for the acquisition of new safety data. The aim of the study was to analyze adverse drug reactions (ADRs) related to the use of drugs approved for MS. All national publicly-available aggregated ADR reports recorded from 2002 to 2020 into the Reports of Adverse Reactions of Medicines (RAM) system and all complete Sicilian data reported into the Italian spontaneous reporting system (SRS) database having as suspected drugs interferon β-1a (IFN β-1a), interferon β-1b (IFN β-1b), peginterferon β-1a (PEG-IFN β-1a), glatiramer acetate (GA), natalizumab (NTZ), fingolimod (FNG), teriflunomide (TRF), dimethyl fumarate (DMF), alemtuzumab (Alem), ocrelizumab (OCZ), or cladribine (Cladr), were collected. Descriptive analyses of national, publicly-available aggregated data and full-access regional data were performed to assess demographic characteristics and drug-related variables followed by a more in-depth analysis of all Sicilian ADRs with a case-by-case assessment and a disproportionality analysis of unexpected ADRs. A total of 13,880 national reports have been collected from 2002 to 2020: they were mainly not serious ADRs (67.9% vs. 26.1%) and related to females (71.7% vs. 26.3%) in the age group 18–65 years (76.5%). The most reported ADRs were general and administration site conditions (n = 6,565; 47.3%), followed by nervous (n = 3,090; 22.3%), skin (n = 2,763; 19.9%) and blood disorders (n = 2,180; 15.7%). Some unexpected Sicilian ADRs were shown, including dyslipidemia for FNG (n = 10; ROR 28.5, CI 14.3–59.6), NTZ (n = 5; 10.3, 4.1–25.8), and IFN β-1a (n = 4; 8.7, 3.1–24.1), abortion and alopecia for NTZ (n = 9; 208.1, 73.4–590.1; n = 3; 4.9, 1.5–15.7), and vitamin D deficiency for GA (n = 3; 121.2, 30.9–475.3). Moreover, breast cancer with DMF (n = 4, 62.8, 20.5–191.9) and hypothyroidism with Cladr (n = 3; 89.2, 25.9–307.5) were also unexpected. The reporting of drugs-related ADRs in MS were mostly reported in the literature, but some unknown ADRs were also found. However, further studies are necessary to increase the awareness about the safety profiles of new drugs on the market.
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Affiliation(s)
| | | | - Alessandro Battaglia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Centre, University Hospital of Messina, Messina, Italy
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