IL-10 Combined with NGAL Has Diagnostic Value for AECOPD Combined with AKI

Prognostic Value of Leukocyte-Based Risk Model for Acute Kidney Injury Prediction in Critically Ill Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

Purpose

Acute kidney injury (AKI) is a common complication of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and inflammation is the potential link between AKI and AECOPD. However, little is known about the incidence and risk stratification of AKI in critically ill AECOPD patients. In this study, we aimed to establish risk model based on white blood cell (WBC)-related indicators to predict AKI in critically ill AECOPD patients.

Material and Methods

For the training cohort, data were taken from the Medical Information Mart for eICU Collaborative Research Database (eICU-CRD) database, and for the validation cohort, data were taken from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The study employed logistic regression analysis to identify the major predictors of WBC-related biomarkers on AKI prediction. Subsequently, a risk model was developed by multivariate logistic regression, utilizing the identified significant indicators.

Results

Finally, 3551 patients were enrolled in training cohort, 926 patients were enrolled in validation cohort. AKI occurred in 1206 (33.4%) patients in training cohort and 521 (56.3%) patients in validation cohort. According to the multivariate logistic regression analysis, four WBC-related indicators were finally included in the novel risk model, and the risk model had a relatively good accuracy for AKI in the training set (C-index, 0.764, 95% CI 0.749-0.780) as well as in the validation set (C-index, 0.738, 95% CI: 0.706-0.770). Even after accounting for other models, the critically ill AECOPD patients in the high-risk group (risk score > 3.44) still showed an increased risk of AKI (odds ratio: 4.74, 95% CI: 4.07-5.54) compared to those in low-risk group (risk score ≤ 3.44). Moreover, the risk model showed outstanding calibration capability as well as therapeutic usefulness in both groups for AKI and ICU mortality and in-hospital mortality of critical ill AECOPD patients.

Conclusion

The novel risk model showed good AKI prediction performance. This risk model has certain reference value for the risk stratification of AECOPD complicated with AKI in clinically.

Pulmonary infection is associated with an increased IL-6 in acute exacerbation chronic obstructive pulmonary disease

Objective

Acute Exacerbation Chronic Obstructive Pulmonary Disease (AECOPD) is associated with an acute worsening of respiratory symptoms that have effects on lung function, quality of life and health economic burden. In addition, the development of pulmonary infections is a common complication of Chronic Obstructive Pulmonary Disease (COPD). In the pathophysiology of AECOPD, interleukin (IL)-6 is a pleiotropic cytokine that can be produced by inflammatory and primary lung epithelial cells in response to a variety of different stimuli. We aim to investigate the correlation between serum cytokine levels and AECOPD with pulmonary infection.

Methods

37 AECOPD patients diagnosed with pulmonary infection and 33 patients diagnosed with AECOPD only were selected. All COPD patients were diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Serum samples for C-reactive protein (CRP) and cytokines were obtained from the patients immediately after admission. Serum concentrations of cytokines were measured using a fluorescent bead immunoassay on a flow cytometer. Logistic regression was used to identify risk factors for AECOPD co-infection of the lungs.

Results

Serum characterization of our cohort showed patients with AECOPD and pulmonary infection had higher levels of IL-6 and IL-10 compared with the AECOPD group, and IL-6 was independently associated with AECOPD with pulmonary infection. ROC curve analysis showed that IL-6 was a useful predictor of the incidence of pulmonary infection in AECOPD patients.

Conclusions

Our findings highlight the role of IL-6 in the pathogenesis of AECOPD with pulmonary infection.

Changes in Thrombelastography in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and the Relationship with Lung Function

Purpose

To analyze the changes in thrombelastography (TEG) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the relationship with indicators related to lung function.

Methods

100 patients with AECOPD admitted to our hospital from May 2021 to May 2022 were selected as the AE group, and another 80 patients with a stable phase of COPD in the same period were selected as the SP group. Fresh blood specimens were collected from both groups, and TEG-related indicators (R value, K value, α-angle, MA value) were measured using the TEG technique, and lung function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) were measured using a lung function meter, and the correlation between TEG-related indicators and lung function-related indicators was analyzed.

Results

Patients in the AE group had lower R and K values and higher α-angle and MA values than those in the SP group, all with statistically significant differences (P < 0.05). Patients in the AE group had lower FEV1, FVC, FEV1/FVC, and FEV1% levels than those in the SP group, all with statistically significant differences (P < 0.05). Correlation analysis showed that the R value in TEG of AECOPD patients was positively correlated with pulmonary function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = 0.565, 0.529, 0.447, 0.527, all P < 0.001); K value was positively correlated with pulmonary function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = 0.512, 0.567, 0.459, 0.439, all P < 0.001); α-angle was inversely correlated with pulmonary function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = -0.498, -0.372, -0.408, -0.424, all P < 0.001); MA value was inversely correlated with lung function-related indicators (FEV1, FVC, FEV1/FVC, FEV1%) (r = -0.459, -0.429, -0.394, -0.403, all P < 0.001).

Conclusion

There is a correlation between TEG-related indicators and lung function-related indicators in AECOPD patients, both of which can guide the diagnosis and treatment process of the disease and are worthy of clinical promotion. The clinical registration number is EA2021086.

Bone Marrow Mesenchymal Stem Cell Transplantation in Combination with Nasal Continuous Positive Airway Pressure Improves Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

We aimed to explore the efficacy of bone marrow mesenchymal stem cell (BMSC) transplantation combined with nasal continuous positive airway pressure (nCPAP) for treating severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD). SD rat AECOPD model was established by injecting endotoxin and Staphylococcus aureus and then treated with nCPAP, BMSCs, or nCPAP combined with BMSCs (n = 20) and their conditions were evaluated with BBB score at 1 d, 3 d, 7 d, 14 d, 28 d after treatment along with analysis of apoptosis and BrdU-positive cells as well as NF200 expression by TUNEL kit staining and levels of Th1, Th7 and Th12 before and after treatment. As revealed by BBB score and HE staining, all treatments significantly alleviated the symptom of severe APEOPD (p < 0.05), while compared with nCPAP, the combined treatment exhibited higher efficacy. Besides, upon treatment, apoptosis and level of Th1, Th7 and Th12 was reduced but N200 absorbance value was elevated, with significant difference in combination group (p < 0.05). In conclusion, BMSC transplantation in combination with nCPAP alleviates severe AECOPD by reducing cell apoptosis, repairing cell damage, and regulating T-cell subsets.

Clinical application value of serum neutrophil gelatinase-associated lipocalin in neonatal sepsis

BACKGROUND

To explore the value of serum neutrophil gelatinase-associated lipocalin (sNGAL) in the diagnosis and follow up of neonatal late-onset sepsis.

METHODS

A total of 69 infants were enrolled in this prospective study, including 49 infants of late-onset neonatal sepsis in the observation group, and 20 infants without infection serving as the control group. The sNGAL, C-reactive protein (CRP), and procalcitonin (PCT) concentrations were determined in both groups and compared at different time points. A receiver operating characteristic (ROC) curve was drawn to evaluate the values of the 3 parameters in the forecast of neonatal late-onset sepsis.

RESULTS

The levels of sNGAL, CRP, and PCT were all increased obviously (P<0.05) in the observation group on the first and second day following onset, compared to the control group. The sNGAL level was associated with the time of treatment. Surprisingly, the sNGAL level started to drop in the observation group with effective treatment on the 7th day following onset. A correlation was found between the concentration of sNGAL and inflammatory markers, such as CRP and PCT, on the first day. The area under the ROC curve (AUC) for sNGAL, CRP, and PCT was: 0.964, 0.925, and 0.94, respectively.

CONCLUSIONS

Increased sNGAL levels could reflect the inflammatory status in the acute stage of neonatal sepsis. When combined with other sepsis markers, such as CRP and PCT, the sNGAL is a useful marker in the rapid diagnosis and follow up of neonatal sepsis.

Correlation and Diagnostic Value of Serum Cys-C, RBP4, and NGAL with the Condition of Patients with Traumatic Acute Kidney Injury

There is a lack of targeted biomarkers that can diagnose Acute Kidney Injury (AKI) early and accurately, which leads to deterioration of renal function and even death in patients who do not receive timely and effective treatment. In recent years, an increasing number of studies have shown that AKI-related markers such as cystatin C (Cys-C) and retinol-binding protein (RBP) can be used for early diagnosis of AKI to a certain extent. A total of 262 subjects were included in this study, of which 132 patients with traumatic AKI were enrolled in one group and named as the AKI group; 130 healthy subjects were enrolled in another group and named as the healthy group. AKI patients with different conditions were classified into AKI phase I, II, and III according to the KDIGO AKI diagnostic criteria, with 45, 59, and 28 in each group. In this study, we examined and compared serum Cys-C, RBP4, and neutrophil gelatinase-associated lipid transport protein (NGAL) levels between the AKI and healthy groups and between patients with AKI of different conditions, and the correlation and diagnostic value of three serum markers with the condition of traumatic AKI patients were also analyzed. The results showed that serum Cys-C, RBP4, and NGAL were significantly higher in the AKI group compared with the healthy group (P < 0.05), and the mean concentrations of the three serum markers increased as the severity of the disease increased, while correlation analysis showed that all three serum markers were positively correlated with serum Scr levels (P < 0.001). Further ROC curve analysis was performed, and the diagnostic values of serum Cys C, RBP4, and NGAL alone and in combination for traumatic AKI were 0.769, 0.741, 0.771, and 0.905, respectively. In short, serum Cys C, RBP4, NGAL have important value for the assessment and diagnosis of traumatic AKI patients.

Risk factors of postoperative acute kidney injury in patients with complex congenital heart disease and significance of early detection of serum transcription factor Nkx2.5

OBJECTIVE

This study was designed to investigate the risk factors of postoperative acute kidney injury (AKI) in patients with complex congenital heart disease (CHD) and the significance of early detection of serum transcription factor Nkx2.5.

METHODS

A total of 121 CHD patients admitted to the Shengli Clinical Medical College of Fujian Medical University were selected as study participants, among whom 69 patients with AKI after cardiac surgery were set as the research group (RG), and the rest of the 52 patients without AKI were set as the control group (CG). Cardiopulmonary bypass (CPB) duration, aortic occlusion time, postoperative creatinine (Cr) level and mechanical ventilation (MV) time were compared between the two groups. The expression and clinical significance of Nkx2.5 in the two groups were detected. Intensive Care Unit (ICU) residence time and total hospital stay were compared, and the risk factors were analyzed.

RESULTS

The RG presented remarkably longer CPB duration and aortic occlusion time, evidently higher postoperative Cr level and longer MV time, and observably lower Nkx2.5 level in comparison to the CG (all P<0.05). According to the analysis of receiver operating characteristic (ROC) curves, Nkx2.5 displayed a favorable diagnostic value in predicting the occurrence of CHD complicated with AKI. ICU residence time and total hospital stay were longer in the RG than in the CG (P<0.05). CPB time and aortic occlusion time were independent risk factors for AKI in CHD patients, while surgical methods and Nkx2.5 detection were independent protective factors (P<0.05).

CONCLUSIONS

CPB time, aortic occlusion time and surgical methods, as well as Nkx2.5 detection are independent factors affecting AKI in patients with CHD. Early detection of serum transcription factor Nkx2.5 is of particular importance for clinical diagnosis of CHD patients complicated with AKI.

Effects of pneumoperitoneum on kidney injury biomarkers: A randomized clinical trial

Background

Increased intra-abdominal pressure causes hemodynamic changes that may affect renal biomarkers.

Methods

This randomized, single-blind, single-center clinical trial recruited patients undergoing laparoscopic cholecystectomy at a tertiary care center in Brazil. They were randomly allocated to a standard intra-abdominal pressure group (P_10-12, 10–12 mm Hg) and a low intra-abdominal pressure group (P_6-8, 6–8 mm Hg). The primary outcome was the change in neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant.

Results

In total, 64 patients completed the study—33 were given standard pressure and 31 were given low pressure. There was no significant difference in the biomarker between the groups (P = 0.580), but there was a significant difference between the time points with elevation at T1 (P < 0.001). Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups.

Conclusions

In laparoscopic cholecystectomy, pneumoperitoneum increases NGAL and cystatin C levels intraoperatively, and the use of low-pressure pneumoperitoneum does not change the course of these biomarkers.

Change of Serum Inflammatory Cytokines Levels in Patients With Chronic Obstructive Pulmonary Disease, Pneumonia and Lung Cancer

OBJECTIVE

This study aimed to investigate the serum inflammatory cytokines levels in patients with COPD, pneumonia and lung cancer, and assess the correlation between the levels of inflammatory cytokines levels and development of these diseases.

METHODS

Two hundred thirty-two patients including 114 patients with pneumonia, 76 patients with chronic obstructive pulmonary disease (COPD) and 42 patients with lung cancer, and 62 age-matched healthy volunteers as controls were enrolled. The pro-inflammatory cytokine IL-6, IL-2, IFN-γ, TNF-α, anti-inflammatory cytokines IL-4 and IL-10 in serum were analyzed by flow cytometry microsphere array (CBA).

RESULTS

We found that the levels of TNF-α and IL-10 in patients with lung cancer, COPD and pneumonia were significantly higher than control group. The IL-6 in the lung cancer group were significantly increased compared with the controls and COPD group, pneumonia group. IFN-γ and IL-2 levels were lower in lung cancer compared with controls and COPD group, pneumonia group. TNF-α, IL-4 and IL-10 levels were increased in patients with COPD and pneumonia compared with controls. In addition, the concentrations of IFN-γ and IL-6 were increased in acute exacerbation COPD (AECOPD) group compared with stable COPD group.

CONCLUSION

In conclusion, elevated TNF-α and IL-10 levels in serum may be related with lung diseases including lung cancer, COPD and pneumonia. Additionally, IFN-γ and IL-6 might be potential biomarkers for the further deterioration of lung disease patients. The increased concentrations of IFN-γ and IL-6 might be used to predict the exacerbation of COPD.