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Laishram A, Ruram A, Borgohain B, Laishram K. Serum Interleukin-6 as an Early Indicator of Trauma Complications. Cureus 2024; 16:e68606. [PMID: 39371766 PMCID: PMC11450521 DOI: 10.7759/cureus.68606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND Trauma is a major global health issue, associated with high mortality and complications like inapparent hypoxia, fat embolism syndrome (FES), sepsis, and multiple organ dysfunction syndrome (MODS). Early identification of high-risk patients is crucial but challenging. Serum interleukin-6 (IL-6), a key inflammatory cytokine, has shown potential as a biomarker for predicting adverse outcomes in trauma. IL-6 levels typically increase rapidly following trauma, peaking within 12 to 24 hours. Despite its potential role, there is limited research on the effectiveness of IL-6 as an early marker for trauma-related complications. This study aims to assess whether monitoring serum IL-6 levels at specific intervals after trauma can aid in early risk assessment and predict the development of these complications. MATERIALS AND METHODS This prospective observational cohort study at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) included 119 trauma patients aged 19-65 years, admitted within 12 hours of injury. Venous blood samples (5 mL each) were collected at 12 and 24 hours for IL-6 and C-reactive protein (CRP) analysis. Injury severity score (ISS) was assessed for all the patients upon arrival to the emergency department at NEIGRIHMS and was categorized as mild, moderate, severe, and very severe. Inapparent hypoxia, FES, sepsis, and MODS were assessed using pulse oximetry, Gurd's criteria, quick sequential organ failure assessment (qSOFA) score, and Marshall's multiple organ dysfunction score, respectively. RESULTS Among the participants, 21.85% developed complications; primarily inapparent hypoxia. Serum IL-6 levels were significantly elevated in individuals with complications at both 12 hours (p < 0.001) and 24 hours (p < 0.001) post-trauma. At the 12-hour mark, serum IL-6 demonstrated a sensitivity of 92.3% and a specificity of 78.5%, with a cut-off value of 37.26 pg/mL. By 24 hours, the sensitivity increased to 96.2% and the specificity to 87.1%, with a cut-off value of 55.08 pg/mL. Patients with MODS had the highest IL-6 levels, with medians of 270.87 pg/mL at 12 hours and 826.10 pg/mL at 24 hours. A strong correlation was observed between serum IL-6 at 24 hours and the ISS (rs = 0.725, p < 0.001). At 12 hours, there was a moderate correlation between serum IL-6 and CRP (rs = 0.488, p < 0.001). By 24 hours, this correlation strengthened to a strong level (rs = 0.749, p < 0.001). CONCLUSIONS The significant association of serum IL-6 levels with both ISS and CRP highlights its potential role in assessing trauma severity. The high sensitivity and specificity of IL-6 at the 24-hour make it a valuable biomarker for the early detection of trauma-related complications.
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Affiliation(s)
- Aparna Laishram
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Alice Ruram
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Bhaskar Borgohain
- Department of Orthopedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Kanchana Laishram
- Department of Orthopedics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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Adu-Amankwaah J, Adekunle AO, Tang Z, Bushi A, Tan R, Fu L, Gong Z, Ma Z, Mprah R, Ndzie Noah ML, Wowui PI, Ong'achwa Machuki J, Pan X, Li T, Sun H. Estradiol contributes to sex differences in resilience to sepsis-induced metabolic dysregulation and dysfunction in the heart via GPER-1-mediated PPARδ/NLRP3 signaling. Metabolism 2024; 156:155934. [PMID: 38762141 DOI: 10.1016/j.metabol.2024.155934] [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: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND AND AIM Clinically, septic males tend to have higher mortality rates, but it is unclear if this is due to sex differences in cardiac dysfunction, possibly influenced by hormonal variations. Cardiac dysfunction significantly contributes to sepsis-related mortality, primarily influenced by metabolic imbalances. Peroxisome proliferator-activated receptor delta (PPARδ) is a key player in cardiac metabolism and its activation has been demonstrated to favor sepsis outcomes. While estradiol (E2) is abundant and beneficial in females, its impact on PPARδ-mediated metabolism in the heart with regards to sex during sepsis remains unknown. METHODS AND RESULTS Here, we unveil that while sepsis diminishes PPARδ nuclear translocation and induces metabolic dysregulation, oxidative stress, apoptosis and dysfunction in the heart thereby enhancing mortality, these effects are notably more pronounced in males than females. Mechanistic experiments employing ovariectomized(OVX) mice, E2 administration, and G protein-coupled estrogen receptor 1(GPER-1) knockout (KO) mice revealed that under lipopolysaccharide (LPS)-induced sepsis, E2 acting via GPER-1 enhances cardiac electrical activity and function, promotes PPARδ nuclear translocation, and subsequently ameliorates cardiac metabolism while mitigating oxidative stress and apoptosis in females. Furthermore, PPARδ specific activation using GW501516 in female GPER-1-/- mice reduced oxidative stress, ultimately decreasing NLRP3 expression in the heart. Remarkably, targeted GPER-1 activation using G1 in males mirrors these benefits, improving cardiac electrical activity and function, and ultimately enhancing survival rates during LPS challenge. By employing NLRP3 KO mice, we demonstrated that the targeted GPER-1 activation mitigated injury, enhanced metabolism, and reduced apoptosis in the heart of male mice via the downregulation of NLRP3. CONCLUSION Our findings collectively illuminate the sex-specific cardiac mechanisms influencing sepsis mortality, offering insights into physiological and pathological dimensions. From a pharmacological standpoint, this study introduces specific GPER-1 activation as a promising therapeutic intervention for males under septic conditions. These discoveries advance our understanding of the sex differences in sepsis-induced cardiac dysfunction and also present a novel avenue for targeted interventions with potential translational impact.
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Affiliation(s)
- Joseph Adu-Amankwaah
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | | | - Ziqing Tang
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Aisha Bushi
- School of International Education, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Rubin Tan
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Lu Fu
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Zheng Gong
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Ziyu Ma
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Richard Mprah
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | | | | | | | - Xiuhua Pan
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Tao Li
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Hong Sun
- Department of Physiology, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China.
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Stangl F, Wagenlehner F, Schneidewind L, Kranz J. [Urosepsis: pathophysiology, diagnosis, and management-an update]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:543-550. [PMID: 38639782 DOI: 10.1007/s00120-024-02336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Urinary tract infections vary widely in their clinical spectrum, ranging from uncomplicated cystitis to septic shock. Urosepsis accounts for 9-31% of all cases of septicemia and is often associated with nosocomial infections. A major risk factor for urosepsis is the presence of obstructive uropathy, caused by conditions such as urolithiasis, tumors, or strictures. The severity and course of urosepsis depend on both the virulence of the pathogen and the patient's specific immune response. Prompt therapy, including antimicrobial treatment and eradication of the infection source, along with supportive measures for circulatory and respiratory stabilization, and adjunctive therapies such as hemodialysis and glucocorticoid therapy, is crucial. Due to demographic changes, an increase in cases of urosepsis is expected-thus, it is of utmost importance for urologists to be familiar with targeted diagnostics and effective treatment.
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Affiliation(s)
- Fabian Stangl
- Universitätsklinik für Urologie, Universität Bern, Bern, Schweiz
| | - Florian Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | | | - Jennifer Kranz
- Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
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Sedraoui S, Leduc-Gaudet JP, Mayaki D, Moamer A, Huck L, Gouspillou G, Petrof BJ, Hussain S. Lack of compensatory mitophagy in skeletal muscles during sepsis. J Physiol 2024; 602:2823-2838. [PMID: 38748778 DOI: 10.1113/jp286216] [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: 01/02/2024] [Accepted: 05/02/2024] [Indexed: 06/15/2024] Open
Abstract
Skeletal muscle dysfunction is a major problem in critically ill patients suffering from sepsis. This condition is associated with mitochondrial dysfunction and increased autophagy in skeletal muscles. Autophagy is a proteolytic mechanism involved in eliminating dysfunctional cellular components, including mitochondria. The latter process, referred to as mitophagy, is essential for maintaining mitochondrial quality and skeletal muscle health. Recently, a fluorescent reporter system called mito-QC (i.e. mitochondrial quality control) was developed to specifically quantify mitophagy levels. In the present study, we used mito-QC transgenic mice and confocal microscopy to morphologically monitor mitophagy levels during sepsis. To induce sepsis, Mito-QC mice received Escherichia coli lipopolysaccharide (10 mg kg-1 i.p.) or phosphate-buffered saline and skeletal muscles (hindlimb and diaphragm) were excised 48 h later. In control groups, there was a negative correlation between the basal mitophagy level and overall muscle mitochondrial content. Sepsis increased general autophagy in both limb muscles and diaphragm but had no effect on mitophagy levels. Sepsis was associated with a downregulation of certain mitophagy receptors (Fundc1, Bcl2L13, Fkbp8 and Phbb2). The present study suggests that general autophagy and mitophagy can be dissociated from one another, and that the characteristic accumulation of damaged mitochondria in skeletal muscles under the condition of sepsis may reflect a failure of adequate compensatory mitophagy. KEY POINTS: There was a negative correlation between the basal level of skeletal muscle mitophagy and the mitochondrial content of individual muscles. Mitophagy levels in limb muscles and the diaphragm were unaffected by lipopolysaccharide (LPS)-induced sepsis. With the exception of BNIP3 in sepsis, LPS administration induced either no change or a downregulation of mitophagy receptors in skeletal muscles.
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Affiliation(s)
- Sami Sedraoui
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montral, QC, Canada
| | - Jean-Philippe Leduc-Gaudet
- Department of Medical Biology, Faculty of Health Sciences, Université du Québec à Trois-Rivieres, Trois-Rivieres, QC, Canada
| | - Dominique Mayaki
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montral, QC, Canada
| | - Alaa Moamer
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montral, QC, Canada
| | - Laurent Huck
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montral, QC, Canada
| | - Gilles Gouspillou
- Département des Sciences de l'Activité Physique, Faculté des Sciences, Université du Québec à Montréal, Montréal, QC, Canada
| | - Basil J Petrof
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montral, QC, Canada
| | - Sabah Hussain
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, QC, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montral, QC, Canada
- Department of Critical Care Medicine, McGill University Health Centre, Montreal, QC, Canada
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Popotas A, Casimir GJ, Corazza F, Lefèvre N. Sex-related immunity: could Toll-like receptors be the answer in acute inflammatory response? Front Immunol 2024; 15:1379754. [PMID: 38835761 PMCID: PMC11148260 DOI: 10.3389/fimmu.2024.1379754] [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: 01/31/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
An increasing number of studies have highlighted the existence of a sex-specific immune response, wherein men experience a worse prognosis in cases of acute inflammatory diseases. Initially, this sex-dependent inflammatory response was attributed to the influence of sex hormones. However, a growing body of evidence has shifted the focus toward the influence of chromosomes rather than sex hormones in shaping these inflammatory sex disparities. Notably, certain pattern recognition receptors, such as Toll-like receptors (TLRs), and their associated immune pathways have been implicated in driving the sex-specific immune response. These receptors are encoded by genes located on the X chromosome. TLRs are pivotal components of the innate immune system, playing crucial roles in responding to infectious diseases, including bacterial and viral pathogens, as well as trauma-related conditions. Importantly, the TLR-mediated inflammatory responses, as indicated by the production of specific proteins and cytokines, exhibit discernible sex-dependent patterns. In this review, we delve into the subject of sex bias in TLR activation and explore its clinical implications relatively to both the X chromosome and the hormonal environment. The overarching objective is to enhance our understanding of the fundamental mechanisms underlying these sex differences.
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Affiliation(s)
- Alexandros Popotas
- Laboratory of Pediatrics, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Translational Research, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Jacques Casimir
- Laboratory of Pediatrics, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonology, Allergology and Cystic Fibrosis, Queen Fabiola Childrens University Hospital (Hôpital Universitaire des Enfants Reine Fabiola) – University Hospital of Brussels (Hôpital Universitaire de Bruxelles), Brussels, Belgium
| | - Francis Corazza
- Laboratory of Translational Research, Université Libre de Bruxelles, Brussels, Belgium
- Laboratory of Immunology, Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Lefèvre
- Laboratory of Pediatrics, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pulmonology, Allergology and Cystic Fibrosis, Queen Fabiola Childrens University Hospital (Hôpital Universitaire des Enfants Reine Fabiola) – University Hospital of Brussels (Hôpital Universitaire de Bruxelles), Brussels, Belgium
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Sharma N, Chen A, Heinen L, Liu R, Dwivedi DJ, Zhou J, Lalu MM, Mendelson AA, McDonald B, Kretz CA, Fox-Robichaud AE, Liaw PC. Impact of age on the host response to sepsis in a murine model of fecal-induced peritonitis. Intensive Care Med Exp 2024; 12:28. [PMID: 38457063 PMCID: PMC10923763 DOI: 10.1186/s40635-024-00609-8] [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: 12/15/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Despite older adults being more vulnerable to sepsis, most preclinical research on sepsis has been conducted using young animals. This results in decreased scientific validity since age is an independent predictor of poor outcome. In this study, we explored the impact of aging on the host response to sepsis using the fecal-induced peritonitis (FIP) model developed by the National Preclinical Sepsis Platform (NPSP). METHODS C57BL/6 mice (3 or 12 months old) were injected intraperitoneally with rat fecal slurry (0.75 mg/g) or a control vehicle. To investigate the early stage of sepsis, mice were culled at 4 h, 8 h, or 12 h to investigate disease severity, immunothrombosis biomarkers, and organ injury. Mice received buprenorphine at 4 h post-FIP. A separate cohort of FIP mice were studied for 72 h (with buprenorphine given at 4 h, 12 h, and then every 12 h post-FIP and antibiotics/fluids starting at 12 h post-FIP). Organs were harvested, plasma levels of Interleukin (IL)-6, IL-10, monocyte chemoattract protein (MCP-1)/CCL2, thrombin-antithrombin (TAT) complexes, cell-free DNA (CFDNA), and ADAMTS13 activity were quantified, and bacterial loads were measured. RESULTS In the 12 h time course study, aged FIP mice demonstrated increased inflammation and injury to the lungs compared to young FIP mice. In the 72 h study, aged FIP mice exhibited a higher mortality rate (89%) compared to young FIP mice (42%) (p < 0.001). Aged FIP non-survivors also exhibited a trend towards elevated IL-6, TAT, CFDNA, CCL2, and decreased IL-10, and impaired bacterial clearance compared to young FIP non-survivors. CONCLUSION To our knowledge, this is the first study to investigate the impact of age on survival using the FIP model of sepsis. Our model includes clinically-relevant supportive therapies and inclusion of both sexes. The higher mortality rate in aged mice may reflect increased inflammation and worsened organ injury in the early stage of sepsis. We also observed trends in impaired bacterial clearance, increase in IL-6, TAT, CFDNA, CCL2, and decreased IL-10 and ADAMTS13 activity in aged septic non-survivors compared to young septic non-survivors. Our aging model may help to increase the scientific validity of preclinical research and may be useful for identifying mechanisms of age-related susceptibility to sepsis as well as age-specific treatment strategies.
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Affiliation(s)
- Neha Sharma
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
| | - Alex Chen
- McMaster University, Hamilton, ON, Canada
| | | | - Ruth Liu
- McMaster University, Hamilton, ON, Canada
| | - Dhruva J Dwivedi
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ji Zhou
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Manoj M Lalu
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Clinical Epidemiology Program, Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Department of Cellular and Molecular Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Asher A Mendelson
- Section of Critical Care Medicine, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Braedon McDonald
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Colin A Kretz
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alison E Fox-Robichaud
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Patricia C Liaw
- Thrombosis and Atherosclerosis Research Institute (TaARI), 237 Barton St E., Room C5-107, Hamilton, ON, L8L 2X2, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
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Jiang W, Song L, Zhang Y, Ba J, Yuan J, Li X, Liao T, Zhang C, Shao J, Yu J, Zheng R. The influence of gender on the epidemiology of and outcome from sepsis associated acute kidney injury in ICU: a retrospective propensity-matched cohort study. Eur J Med Res 2024; 29:56. [PMID: 38229118 DOI: 10.1186/s40001-024-01651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
PURPOSES The influence of gender on the epidemiology of and outcome from SA-AKI in ICU has not been fully clarified. Our aim is to elucidate these differences. METHODS This study included adult patients with sepsis in MIMIC IV (V 2.2), and propensity matching analysis, cox regression and logistic regression were used to analyze gender differences in incidence, mortality and organ support rate. RESULTS Of the 24,467 patients included in the cohort, 18,128 were retained after propensity score matching. In the matched cohort, the incidence of SA-AKI in males is higher than that in females (58.6% vs. 56.2%; P = 0.001).males were associated with a higher risk of SA-AKI (OR:1.07(1.01-1.14), P = 0.026;adjusted OR:1.07(1.01-1.14), P < 0.033).In SA-AKI patients, males were associated with a lower risk of ICU mortality(HR:0.803(0.721-0.893), P < 0.001;adjusted HR:0.836(0.746-0.937), P = 0.002) and in-hospital mortality(HR: 0.820(0.748-0.899), P < 0.001;adjusted HR:0.853(0.775-0.938), P = 0.003).there were no statistically significant differences between male and female patients in 1-year all-cause mortality (36.9% vs. 35.8%, P = 0.12), kidney replacement therapy rate (7.8% vs.7.4%, P = 0.547), mechanical ventilation rate 64.8% vs.63.9%, P = 0.369), and usage of vasoactive drugs (55.4% vs. 54.6%, P = 0.418). CONCLUSIONS Gender may affect the incidence and outcomes of SA-AKI, further research is needed to fully understand the impact of gender on SA-AKI patients.
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Affiliation(s)
- Wei Jiang
- Medcial College, Yang Zhou University, Yangzhou, 225001, China
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Lin Song
- Medcial College, Yang Zhou University, Yangzhou, 225001, China
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Yaosheng Zhang
- School of Clinical and Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250000, China
| | - Jingjing Ba
- Department of Cardiology, the Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Jing Yuan
- Department of Echocardiography, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Xianghui Li
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Ting Liao
- Medcial College, Yang Zhou University, Yangzhou, 225001, China
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Chuanqing Zhang
- Medcial College, Yang Zhou University, Yangzhou, 225001, China
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jun Shao
- Medcial College, Yang Zhou University, Yangzhou, 225001, China
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Jiangquan Yu
- Medcial College, Yang Zhou University, Yangzhou, 225001, China.
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
| | - Ruiqiang Zheng
- Medcial College, Yang Zhou University, Yangzhou, 225001, China.
- Department of Critical Care Medicine, Clinical Medicine College, Yangzhou University & Intensive Care Unit, Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
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8
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Olson SA, Osborn BK, Cotton ME, Krocker JD, Koami H, White N, Cardenas JC. Fibrinogen Fragment X Mediates Endothelial Barrier Disruption via Suppression of VE-Cadherin. J Surg Res 2024; 293:639-646. [PMID: 37837820 PMCID: PMC10726297 DOI: 10.1016/j.jss.2023.09.027] [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: 03/01/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Major traumatic injury is associated with early hemorrhage-related and late-stage deaths due to multiple organ failure (MOF). While improvements to hemostatic resuscitation have significantly reduced hemorrhage-related deaths, the incidence of MOF among trauma patients remains high. Dysregulation of vascular endothelial cell (EC) barrier function is a central mechanism in the development of MOF; however, the mechanistic triggers remain unknown. Accelerated fibrinolysis occurs in a majority of trauma patients, resulting in high circulating levels of fibrin(ogen) degradation products, such as fragment X. To date, the relationship between fragment X and EC dysregulation and barrier disruption is unknown. The goal of this study was to determine the effects of fragment X on EC barrier integrity and expression of paracellular junctional proteins that regulate barrier function. METHODS Human lung microvascular endothelial cells (HLMVECs) were treated with increasing concentrations of fragment X (1, 10, and 100 μg/mL), and barrier function was monitored using the xCELLigence live-cell monitoring system. Quantitative PCR (qPCR) was performed to measure changes in EC expression of 84 genes. Immunofluorescent (IF) cytostaining was performed to validate qPCR findings. RESULTS Fragment X treatment significantly increased endothelial permeability over time (P < 0.05). There was also a significant reduction in VE-cadherin mRNA expression in fragment X-treated HLMVECs compared to control (P = 0.01), which was confirmed by IF staining. CONCLUSIONS Fragment X may induce EC hyperpermeability by reducing VE-cadherin expression. This suggests that a targeted approach to disrupting EC-fragment X interactions could mitigate EC barrier disruption, organ edema, and MOF associated with major trauma.
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Affiliation(s)
- Sarah A Olson
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baron K Osborn
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Madeline E Cotton
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Joseph D Krocker
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Hiroyuki Koami
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Nathan White
- Department of Emergency Medicine and Resuscitation Engineering Science Unit, University of Washington School of Medicine, Seattle, Washington
| | - Jessica C Cardenas
- Department of Surgery, Center for Translational Injury Research, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas.
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Bous M, Schmitt C, Hans MC, Weber R, Nourkami-Tutdibi N, Tenbruck S, Haj Hamoud B, Wagenpfeil G, Kaiser E, Solomayer EF, Zemlin M, Goedicke-Fritz S. Sex Differences in the Frequencies of B and T Cell Subpopulations of Human Cord Blood. Int J Mol Sci 2023; 24:11511. [PMID: 37511278 PMCID: PMC10380850 DOI: 10.3390/ijms241411511] [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: 06/09/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Cord blood represents a link between intrauterine and early extrauterine development. Cord blood cells map an important time frame in human immune imprinting processes. It is unknown whether the sex of the newborn affects the lymphocyte subpopulations in the cord blood. Nine B and twenty-one T cell subpopulations were characterized using flow cytometry in human cord blood from sixteen male and twenty-one female newborns, respectively. Except for transitional B cells and naïve B cells, frequencies of B cell counts across all subsets was higher in the cord blood of male newborns than in female newborns. The frequency of naïve thymus-negative Th cells was significantly higher in male cord blood, whereas the remaining T cell subpopulations showed a higher count in the cord blood of female newborns. Our study is the first revealing sex differences in the B and T cell subpopulations of human cord blood. These results indicate that sex might have a higher impact for the developing immune system, urging the need to expand research in this area.
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Affiliation(s)
- Michelle Bous
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Charline Schmitt
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Muriel Charlotte Hans
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Regine Weber
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Nasenien Nourkami-Tutdibi
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Sebastian Tenbruck
- Department of Gynaecology and Obstetrics, Saarland University Medical Center, 66421 Homburg, Germany
| | - Bashar Haj Hamoud
- Department of Gynaecology and Obstetrics, Saarland University Medical Center, 66421 Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics (IMBEI), Saarland University, Campus Homburg, 66421 Homburg, Germany
| | - Elisabeth Kaiser
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Gynaecology and Obstetrics, Saarland University Medical Center, 66421 Homburg, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Sybelle Goedicke-Fritz
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, 66421 Homburg, Germany
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Murhula G, Zeng F, Bugeme P, Cibogo N, Cikomola F, Miranda E, Pompermaier L. Sex-Related Mortality After Burns: A Scoping Review in the Sadc-Region. ANNALS OF BURNS AND FIRE DISASTERS 2023; 36:111-119. [PMID: 38681941 PMCID: PMC11042070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 05/01/2024]
Abstract
Findings on mortality by sex after burns in low- and middle-income countries (LMICs) are contradictory and, where differences have been described, the reasons are often based on speculation and not on the analysis of factors that could have affected the outcome, such as patient or injury characteristics or provided care. Since the paucity of studies on burns from single LMICs is notorious, merging data from neighboring countries with similar socio-economic backgrounds might provide a larger dataset, contributing to identifying recurrent causes. This scoping review aimed therefore to analyze differences in mortality after burns between the sexes, as well as to identify aspects that could explain possible differences, in countries belonging to the South African Development Community (SADC) region. Studies in English published between 2010 and 2020 were identified according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines by searching PubMed and/or Medline, Clinical Trials and Cochrane Library, and using the screening tool "Covidence". The 13 included studies could not consistently show association between sex and mortality after burns, but contradictory findings. In the case of differences in outcome between the sexes, explanations were mainly based on speculation (e.g., hormonal differences, self-harm intention), while rarely burn specific factors were reported and included in the analysis of the mortality risk. This study indicates the need for prospective burn specific data collection in LMICs that would contribute to identifying factors associated with death.
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Affiliation(s)
- G.B. Murhula
- Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - F.T.A. Zeng
- Université de Lubumbashi, Democratic Republic of Congo
| | - P.M. Bugeme
- Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - N. Cibogo
- Université Officielle de Bukavu, Bukavu, Democratic Republic of Congo
| | - F.G. Cikomola
- Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Hôpital Général Provincial de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - E. Miranda
- University of Southern California, Los Angeles, California, USA
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11
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Zhang L, Wan H, Zhang M, Lu W, Xu F, Dong H. Estrogen receptor subtype mediated anti-inflammation and vasorelaxation via genomic and nongenomic actions in septic mice. Front Endocrinol (Lausanne) 2023; 14:1152634. [PMID: 37265700 PMCID: PMC10230057 DOI: 10.3389/fendo.2023.1152634] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Aim Sepsis is a life-threatening disease with high mortality worldwide. Septic females have lower severity and mortality than the males, suggesting estrogen exerts a protective action, but nothing is known about the role of vascular endothelial estrogen receptor subtypes in this process. In the present study, we aimed to study the estrogen receptors on mesenteric arterioles in normal and sepsis mice and to elucidate the underlying mechanisms. Methods Sepsis was induced in mice by intraperitoneal injection of LPS. The changes in the expression and release of the serum and cell supernatant proinflammatory cytokines, including TNF-α, IL-1β and IL-6, were measured by qPCR and ELISA, and the functions of multiple organs were analyzed. The functional activities of mouse mesenteric arterioles were determined by a Mulvany-style wire myograph. The expression of phospholipase C (PLC) and inositol 1,4,5-trisphosphate receptor (IP3R) in endothelial cells were examined by Western blot and their functions were characterized by cell Ca2+ imaging. Results Septic female mice had higher survival rate than the male mice, and pretreatment with E2 for 5 days significantly improved the survival rate and inhibited proinflammatory cytokines in septic male mice. E2 ameliorated pulmonary, intestinal, hepatic and renal multiple organ injuries in septic male mice; and ER subtypes inhibited proinflammatory cytokines in endothelial cells via PLC/IP3R/Ca2+ pathway. E2/ER subtypes immediately induced endothelial-derived hyperpolarization (EDH)-mediated vasorelaxation via PLC/IP3R/Ca2+ pathway, which was more impaired in septic male mice. E2/ER subtypes could rescue the impaired acetylcholine (ACh)-induced EDH-mediated vasorelaxation in septic male mice. Conclusions E2 through ER subtypes mediates anti-inflammation and vasorelaxation via genomic and nongenomic actions in sepsis. Mechanistically, activation of endothelial ER subtypes reduces proinflammatory cytokines and induces EDH-mediated vasorelaxation via PLC/IP3R/Ca2+ pathway, leading to amelioration of sepsis-induced organ injury and survival rate.
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Affiliation(s)
- Luyun Zhang
- Department of Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hanxing Wan
- Department of Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mengting Zhang
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
| | - Wei Lu
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
| | - Feng Xu
- Department of Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hui Dong
- Department of Pediatric Intensive Care Unit, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Pharmacology, School of Pharmacy, Qingdao University Medical College, Qingdao, China
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12
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Shields CA, Wang X, Cornelius DC. Sex differences in cardiovascular response to sepsis. Am J Physiol Cell Physiol 2023; 324:C458-C466. [PMID: 36571442 PMCID: PMC9902216 DOI: 10.1152/ajpcell.00134.2022] [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: 03/29/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
Recently, there has been increased recognition of the importance of sex as a biological factor affecting disease and health. Many preclinical studies have suggested that males may experience a less favorable outcome in response to sepsis than females. The underlying mechanisms for these differences are still largely unknown but are thought to be related to the beneficial effects of estrogen. Furthermore, the immunosuppressive role of testosterone is also thought to contribute to the sex-dependent differences that are present in clinical sepsis. There are still significant knowledge gaps in this field. This mini-review will provide a brief overview of sex-dependent variables in relation to sepsis and the cardiovascular system. Preclinical animal models for sepsis research will also be discussed. The intent of this mini-review is to inspire interest for future considerations of sex-related variables in sepsis that should be addressed to increase our understanding of the underlying mechanisms in sepsis-induced cardiovascular dysfunction for the identification of therapeutic targets and improved sepsis management and treatment.
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Affiliation(s)
- Corbin A Shields
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Xi Wang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Denise C Cornelius
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
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13
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Webster SE, Tsuji NL, Clemente MJ, Holodick NE. Age-related changes in antigen-specific natural antibodies are influenced by sex. Front Immunol 2023; 13:1047297. [PMID: 36713434 PMCID: PMC9878317 DOI: 10.3389/fimmu.2022.1047297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Natural antibody (NAb) derived from CD5+ B-1 cells maintains tissue homeostasis, controls inflammation, aids in establishing long-term protective responses against pathogens, and provides immediate protection from infection. CD5+ B-1 cell NAbs recognize evolutionarily fixed epitopes, such as phosphatidylcholine (PtC), found on bacteria and senescent red blood cells. Anti-PtC antibodies are essential in protection against bacterial sepsis. CD5+ B-1 cell-derived NAbs have a unique germline-like structure that lacks N-additions, a feature critical for providing protection against infection. Previously, we demonstrated the repertoire and germline status of PtC+CD5+ B-1 cell IgM obtained from male mice changes with age depending on the anatomical location of the B-1 cells. More recently, we demonstrated serum antibody from aged female mice maintains protection against pneumococcal infection, whereas serum antibody from male mice does not provide protection. Results Here, we show that aged female mice have significantly more splenic PtC+CD5+ B-1 cells and more PtC specific serum IgM than aged male mice. Furthermore, we find both age and biological sex related repertoire differences when comparing B cell receptor (BCR) sequencing results of PtC+CD5+ B-1 cells. While BCR germline status of PtC+CD5+ B-1 cells from aged male and female mice is similar in the peritoneal cavity, it differs significantly in the spleen, where aged females retain germline configuration and aged males do not. Nucleic acid sensing toll-like receptors are critical in the maintenance of PtC+ B-1 cells; therefore, to begin to understand the mechanism of differences observed between the male and female PtC+CD5+ B-1 cell repertoire, we analyzed levels of cell-free nucleic acids and found increases in aged females. Conclusion Our results suggest the antigenic milieu differs between aged males and females, leading to differential selection of antigen-specific B-1 cells over time. Further elucidation of how biological sex differences influence the maintenance of B-1 cells within the aging environment will be essential to understand sex and age-related disparities in the susceptibility to bacterial infection and will aid in the development of more effective vaccination and/or therapeutic strategies specific for males and females.
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Affiliation(s)
- Sarah E. Webster
- Center for Immunobiology, Department of Investigative Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Naomi L. Tsuji
- Center for Immunobiology, Department of Investigative Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Michael J. Clemente
- Center for Immunobiology, Department of Investigative Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
- Flow Cytometry and Imaging Core, Center for Immunobiology, Department of Investigative Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nichol E. Holodick
- Center for Immunobiology, Department of Investigative Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
- Flow Cytometry and Imaging Core, Center for Immunobiology, Department of Investigative Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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14
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Otaka S, Ohbe H, Igeta R, Chiba T, Ikeda S, Shiga T. Factors Associated with an Increase in On-Site Time of Pediatric Trauma Patients in a Prehospital Setting: A Nationwide Observational Study in Japan. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1658. [PMID: 36360384 PMCID: PMC9688461 DOI: 10.3390/children9111658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
The factors that prolong the on-site time in pediatric trauma cases in a prehospital setting are unknown. We investigated these factors using a national trauma registry in Japan. We identified pediatric trauma patients aged ≤18 years, from January 2004 to May 2019. We categorized cases into shorter (≤13 min) and longer (>13 min) prehospital on-site time groups. We performed multivariable logistic regression analysis with multiple imputations to assess the factors associated with longer prehospital on-site time. Overall, 14,535 patients qualified for inclusion. The median prehospital on-site time was 13 min. In the multivariable logistic regression analysis, the longer prehospital on-site time was associated with higher age; suicide (Odds ratio [OR] 1.27; 95% confidence interval [CI] 1.03−1.57); violence (OR 1.74; 95%CI 1.27−2.38); higher revised trauma score, abbreviated injury scale > 3 in the spine (OR 1.25; 95%CI 1.04−1.50), upper extremity (OR 1.26; 95%CI 1.11−1.44), and lower extremity (OR 1.25; 95%CI 1.14−1.37); immobilization (OR 1.16; 95%CI 1.06−1.27); and comorbid mental retardation (OR 1.56; 95%CI 1.11−2.18). In light of these factors, time in the field could be reduced by having more pediatric emergency physicians and orthopedic surgeons available.
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Affiliation(s)
- Shunichi Otaka
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-8654, Japan
| | - Ryuhei Igeta
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan
- Graduate School of Medicine, International University of Health and Welfare, Chiba 324-8501, Japan
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15
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Xu K, Li H, Zhang B, Le M, Huang Q, Fu R, Croppi G, Qian G, Zhang J, Zhang G, Lu Y. Integrated transcriptomics and metabolomics analysis of the hippocampus reveals altered neuroinflammation, downregulated metabolism and synapse in sepsis-associated encephalopathy. Front Pharmacol 2022; 13:1004745. [PMID: 36147346 PMCID: PMC9486403 DOI: 10.3389/fphar.2022.1004745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Sepsis-associated encephalopathy (SAE) is an intricated complication of sepsis that brings abnormal emotional and memory dysfunction and increases patients’ mortality. Patients’ alterations and abnormal function seen in SAE occur in the hippocampus, the primary brain region responsible for memory and emotional control, but the underlying pathophysiological mechanisms remain unclear. In the current study, we employed an integrative analysis combining the RNA-seq-based transcriptomics and liquid chromatography/mass spectrometry (LC-MS)-based metabolomics to comprehensively obtain the enriched genes and metabolites and their core network pathways in the endotoxin (LPS)-injected SAE mice model. As a result, SAE mice exhibited behavioral changes, and their hippocampus showed upregulated inflammatory cytokines and morphological alterations. The omics analysis identified 81 differentially expressed metabolites (variable importance in projection [VIP] > 1 and p < 0.05) and 1747 differentially expressed genes (Foldchange >2 and p < 0.05) were detected in SAE-grouped hippocampus. Moreover, 31 compounds and 100 potential target genes were employed for the Kyoto Encyclopedia of Genes and Genomes (KEGG) Markup Language (KGML) network analysis to explore the core signaling pathways for the progression of SAE. The integrative pathway analysis showed that various dysregulated metabolism pathways, including lipids metabolism, amino acids, glucose and nucleotides, inflammation-related pathways, and deregulated synapses, were tightly associated with hippocampus dysfunction at early SAE. These findings provide a landscape for understanding the pathophysiological mechanisms of the hippocampus in the progression of SAE and pave the way to identify therapeutic targets in future studies.
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Affiliation(s)
- Kejia Xu
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Li
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing Zhang
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Meini Le
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Huang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rao Fu
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Gang Qian
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Zhang
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangming Zhang
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
- *Correspondence: Guangming Zhang, ; Yinzhong Lu,
| | - Yinzhong Lu
- Department of Anesthesiology and Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Guangming Zhang, ; Yinzhong Lu,
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16
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Xu J, Li S, Lui KY, Song X, Hu X, Cao L, Zhu Y, Huang F, Lin X, Cai C. The neutrophil-to-lymphocyte ratio: A potential predictor of poor prognosis in adult patients with trauma and traumatic brain injury. Front Surg 2022; 9:917172. [PMID: 36081584 PMCID: PMC9445209 DOI: 10.3389/fsurg.2022.917172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to determine the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) in critically ill trauma patients. Methods This retrospective study involved adult trauma patients from 335 intensive care units (ICUs) at 208 hospitals stored in the eICU database. The primary outcome was ICU mortality. The lengths of ICU and hospital stay were calculated as the secondary outcomes. The multivariable logistic regression model was used to identify independent predictors of mortality. To identify the effect of the NLR on survival, a 15-day survival curve was used. Results A total of 3,865 eligible subjects were enrolled in the study. Univariate analysis showed that patients in the group with a higher NLR were more likely to receive aggressive methods of care delivery: mechanical ventilation, vasopressor, and antibiotics ( P < 0.001 for all). The ICU, in-hospital, and 15-day mortality rates of the four groups increased in turn (P < 0.001 for all). The multivariable logistic Cox regression model indicated that a higher NLR was an independent risk factor of ICU mortality in trauma patients. ROC analysis showed that the NLR had better predictive capacity on the mortality of patients with traumatic brain injury (TBI) than those with trauma (AUC 0.725 vs. 0.681). An NLR > 7.44 was an independent risk factor for ICU death in patients with TBI (OR: 1.837, 95% CI: 1.045–3.229) and TBI victims whose NLR > 7.44 had a 15-day survival disadvantage (P = 0.005). Conclusion A high NLR is associated with a poor prognosis in trauma patients, even worse in patients with TBI. An NLR > 7.44 is an independent risk factor for death in patients with TBI.
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Affiliation(s)
- Jinghong Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shuhe Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ka Yin Lui
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaodong Song
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoguang Hu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lu Cao
- Department of Extracorporeal Circulation, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanping Zhu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fa Huang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center,Guangzhou, China
| | - Xiaobin Lin
- Department of Pharmacology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Changjie Cai
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Correspondence: Changjie Cai
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17
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Peng J, Tang R, Yu Q, Wang D, Qi D. No sex differences in the incidence, risk factors and clinical impact of acute kidney injury in critically ill patients with sepsis. Front Immunol 2022; 13:895018. [PMID: 35911764 PMCID: PMC9329949 DOI: 10.3389/fimmu.2022.895018] [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: 03/12/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSex-stratified medicine is an important aspect of precision medicine. We aimed to compare the incidence and risk factors of acute kidney injury (AKI) for critically ill men and women with sepsis. Furthermore, the short-term mortality was compared between men and women with sepsis associated acute kidney injury (SA-AKI).MethodThis was a retrospective study based on the Medical Information Mart for Intensive Care IV database. We used the multivariable logistic regression analysis to evaluate the independent effect of sex on the incidence of SA-AKI. We further applied three machine learning methods (decision tree, random forest and extreme gradient boosting) to screen for the risk factors associated with SA-AKI in the total, men and women groups. We finally compared the intensive care unit (ICU) and hospital mortality between men and women with SA-AKI using propensity score matching.ResultsA total of 6463 patients were included in our study, including 3673 men and 2790 women. The incidence of SA-AKI was 83.8% for men and 82.1% for women. After adjustment for confounders, no significant association was observed between sex and the incidence of SA-AKI (odds ratio (OR), 1.137; 95% confidence interval (CI), 0.949-1.361; p=0.163). The machine learning results revealed that body mass index, Oxford Acute Severity of Illness Score, diuretic, Acute Physiology Score III and age were the most important risk factors of SA-AKI, irrespective of sex. After propensity score matching, men had similar ICU and hospital mortality to women.ConclusionsThe incidence and associated risk factors of SA-AKI are similar between men and women, and men and women with SA-AKI experience comparable rates of ICU and hospital mortality. Therefore, sex-related effects may play a minor role in developing SA-AKI. Our study helps to contribute to the knowledge gap between sex and SA-AKI.
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Affiliation(s)
| | | | | | | | - Di Qi
- *Correspondence: Daoxin Wang, ; Di Qi,
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18
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Wang G, Jiang C, Fang J, Li Z, Cai H. Pentraxin-3 as a predictive marker of mortality in sepsis: an updated systematic review and meta-analysis. Crit Care 2022; 26:167. [PMID: 35676730 PMCID: PMC9175505 DOI: 10.1186/s13054-022-04032-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The purpose of this study was to clarify the prognostic value of Pentraxin-3 (PTX3) on the mortality of patients with sepsis. METHODS Publications published up to January 2021 were retrieved from PubMed, EMBASE, and the Cochrane library. Data from eligible cohort and case-control studies were extracted for the meta-analysis. Multivariate regression analysis was used to evaluate the correlation of the outcomes with sample size and male proportion. RESULTS A total of 17 studies covering 3658 sepsis patients were included. PTX3 level was significantly higher in non-survivor compared to survivor patients (SMD (95% CI): -1.06 (-1.43, -0.69), P < 0.001). Increased PTX3 level was significantly associated with mortality (HR (95% CI): 2.09 (1.55, 2.81), P < 0.001). PTX3 showed good predictive capability for mortality (AUC:ES (95% CI): 0.73 (0.70, 0.77), P < 0.001). The outcome comparing PTX3 level in non-survivors vs. survivors and the outcome of the association between PTX3 and mortality were associated with sample size but not male proportion. AUC was associated with both sample size and male proportion. CONCLUSIONS PTX3 level was significantly higher in non-survivor compared to survivor patients with sepsis. Elevated PTX3 level was significantly associated with mortality. Furthermore, the level of PTX3 might predict patient mortality.
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Affiliation(s)
- Guobin Wang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Chunyan Jiang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Junjun Fang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Zhitao Li
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Hongliu Cai
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China.
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Qi J, Xie Q, Li Z, Sun C. A Nomogram to Better Predict the In-Hospital Mortality of Trauma Patients with Sepsis in the Intensive Care Unit. Int J Clin Pract 2022; 2022:4134138. [PMID: 36134327 PMCID: PMC9481405 DOI: 10.1155/2022/4134138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Trauma has a high incidence and mortality worldwide, and sepsis is one of the main causes of mortality in trauma patients. Therefore, it is essential to identify the risk factors of in-hospital mortality for trauma patients with sepsis. METHODS Data were extracted from the Medical Information Mart for Intensive Care III database and divided into a training set and internal validation set, and another Chinese dataset was used as external validation set. Then, risk factors were estimated using univariate and multivariate logistic regression analyses in the training set. Finally, a nomogram was created to predict the probability of in-hospital mortality for trauma patients with sepsis. RESULTS A total of 503 patients were enrolled in our study (335 in the training set and 168 in the validation set). Multivariate logistic regression analysis revealed that age (1.047 [1.025-1.071]), respiratory rate (1.258 [1.135-1.394]), PTT (1.026 [1.008-1.044]), ventilation (6.703 [1.528-29.408]), and vasopressor use (3.682 [1.502-9.025]) were independent factors associated with in-hospital mortality. The nomogram for trauma-related sepsis predicted in-hospital mortality with AUC values of 0.8939 in the training set, 0.8200 in the internal validation set, and 0.7779 in the external validation set. CONCLUSIONS The new nomogram has a well predicted value for in-hospital mortality for patients with trauma and sepsis in intensive care units.
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Affiliation(s)
- Jing Qi
- Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qin Xie
- Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhenzhou Li
- Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chuanzheng Sun
- Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
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