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Emeriaud G, López-Fernández YM, Iyer NP, Bembea MM, Agulnik A, Barbaro RP, Baudin F, Bhalla A, Brunow de Carvalho W, Carroll CL, Cheifetz IM, Chisti MJ, Cruces P, Curley MAQ, Dahmer MK, Dalton HJ, Erickson SJ, Essouri S, Fernández A, Flori HR, Grunwell JR, Jouvet P, Killien EY, Kneyber MCJ, Kudchadkar SR, Korang SK, Lee JH, Macrae DJ, Maddux A, Modesto I Alapont V, Morrow BM, Nadkarni VM, Napolitano N, Newth CJL, Pons-Odena M, Quasney MW, Rajapreyar P, Rambaud J, Randolph AG, Rimensberger P, Rowan CM, Sanchez-Pinto LN, Sapru A, Sauthier M, Shein SL, Smith LS, Steffen K, Takeuchi M, Thomas NJ, Tse SM, Valentine S, Ward S, Watson RS, Yehya N, Zimmerman JJ, Khemani RG. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med 2023; 24:143-168. [PMID: 36661420 PMCID: PMC9848214 DOI: 10.1097/pcc.0000000000003147] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING Not applicable. PATIENTS Patients with or at risk for PARDS. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.
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Affiliation(s)
- Guillaume Emeriaud
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Yolanda M López-Fernández
- Pediatric Intensive Care Unit, Department of Pediatrics, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain
| | - Narayan Prabhu Iyer
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Melania M Bembea
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Florent Baudin
- Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Réanimation Pédiatrique, Lyon, France
| | - Anoopindar Bhalla
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Ira M Cheifetz
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mohammod J Chisti
- Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Pablo Cruces
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Departamento de Pediatría, Unidad de Paciente Crítico Pediátrico, Facultad de Ciencias de la Vida, Hospital El Carmen de Maipú, Santiago, Chile
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Heidi J Dalton
- Department of Pediatrics and Heart and Vascular Institute, INOVA Fairfax Medical Center, Falls Church, VA
| | - Simon J Erickson
- Department of Paediatric Critical Care, Perth Children's Hospital Western Australia, Perth, WA, Australia
| | - Sandrine Essouri
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Analía Fernández
- Pediatric Intensive Care Unit, Emergency Department, Hospital General de Agudos "C. Durand" Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Jocelyn R Grunwell
- Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Philippe Jouvet
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Elizabeth Y Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Martin C J Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sapna R Kudchadkar
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Departments of Pediatrics, Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven Kwasi Korang
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Hau Lee
- KK Women's and Children's Hospital, Singapore and Duke-NUS Medical School, Singapore
| | | | - Aline Maddux
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | | | - Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Natalie Napolitano
- Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christopher J L Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Martí Pons-Odena
- Immunological and Respiratory Disorders, Paediatric Critical Care Unit Research Group, Institut de Recerca Sant Joan de Déu, Pediatric Intensive Care and Intermediate Care Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | | | - Jerome Rambaud
- Departement of Pediatric and Neonatal Intensive Care, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, and Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA
| | - Peter Rimensberger
- Division of Neonatology and Paediatric Intensive Care, University of Geneva, Geneva, Switzerland
| | - Courtney M Rowan
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - L Nelson Sanchez-Pinto
- Departments of Pediatrics (Critical Care) and Preventive Medicine (Health & Biomedical Informatics), Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Anil Sapru
- Division of Pediatric Critical Care, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Michael Sauthier
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Steve L Shein
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lincoln S Smith
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA
| | - Katerine Steffen
- Department of Pediatrics, Division of Pediatric Critical Care, Stanford University, Palo Alto, CA
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Neal J Thomas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Sciences, Penn State University College of Medicine, Hershey, PA
| | - Sze Man Tse
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Stacey Valentine
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Shan Ward
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospitals, San Francisco and Oakland, CA
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute Seattle, WA
| | - Nadir Yehya
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jerry J Zimmerman
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
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Kohne JG, Carlton EF, Gorga SM, Gebremariam A, Quasney MW, Zimmerman J, Reeves SL, Barbaro RP. Oxygenation Severity Categories and Long-Term Quality of Life among Children who Survive Septic Shock. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1756307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Objectives This study aimed to test whether early oxygenation failure severity categories (absent/mild/moderate/severe) were associated with health-related quality of life (HRQL) deterioration among children who survived sepsis-related acute respiratory failure.
Methods We performed a secondary analysis of a study of community-acquired pediatric septic shock, Life After Pediatric Sepsis Evaluation. The primary outcome was an adjusted decline in HRQL ≥ 25% below baseline as assessed 3 months following admission. Logistic regression models were built to test the association of early oxygenation failure including covariates of age and nonrespiratory Pediatric Logistic Organ Dysfunction-2 score. Secondarily, we tested if there was an adjusted decline in HRQL at 6 and 12 months and functional status at 28 days.
Results We identified 291 children who survived to discharge and underwent invasive ventilation. Of those, that 21% (61/291) had mild oxygenation failure, 20% (58/291) had moderate, and 17% (50/291) had severe oxygenation failure. Fifteen percent of children exhibited a decline in HRQL of at least 25% from their baseline at the 3-month follow-up time point. We did not identify an association between the adjusted severity of oxygenation failure and decline in HRQL ≥ 25% at 3-, 6-, or 12-month follow-up. Children with oxygenation failure were more likely to exhibit a decline in functional status from baseline to hospital discharge, but results were similar across severity categories.
Conclusion Our findings that children of all oxygenation categories are at risk of HRQL decline suggest that those with mild lung injury should not be excluded from comprehensive follow-up, but more work is needed to identify those at the highest risk.
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Affiliation(s)
- Joseph G. Kohne
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Erin F. Carlton
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Stephen M. Gorga
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Acham Gebremariam
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Michael W. Quasney
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jerry Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington
| | - Sarah L. Reeves
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Ryan P. Barbaro
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor, Michigan
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Maddux AB, Zimmerman JJ, Banks RK, Reeder RW, Meert KL, Czaja AS, Berg RA, Sapru A, Carcillo JA, Newth CJL, Quasney MW, Mourani PM. Health Resource Use in Survivors of Pediatric Septic Shock in the United States. Pediatr Crit Care Med 2022; 23:e277-e288. [PMID: 35250001 PMCID: PMC9203867 DOI: 10.1097/pcc.0000000000002932] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate postdischarge health resource use in pediatric survivors of septic shock and determine patient and hospitalization factors associated with health resource use. DESIGN Secondary analyses of a multicenter prospective observational cohort study. SETTING Twelve academic PICUs. PATIENTS Children greater than or equal to 1 month and less than 18 years old hospitalized for community-acquired septic shock who survived to 1 year. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS For 308/338 patients (91%) with baseline and greater than or equal to one postdischarge survey, we evaluated readmission, emergency department (ED) visits, new medication class, and new device class use during the year after sepsis. Using negative binomial regression with bidirectional stepwise selection, we identified factors associated with each outcome. Median age was 7 years (interquartile range, 2-13), 157 (51%) had a chronic condition, and nearly all patients had insurance (private [n = 135; 44%] or government [n = 157; 51%]). During the year after sepsis, 128 patients (42%) were readmitted, 145 (47%) had an ED visit, 156 (51%) started a new medication class, and 102 (33%) instituted a new device class. Having a complex chronic condition was independently associated with readmission and ED visit. Documented infection and higher sum of Pediatric Logistic Organ Dysfunction--2 hematologic score were associated with readmission, whereas younger age and having a noncomplex chronic condition were associated with ED visit. Factors associated with new medication class use were private insurance, neurologic insult, and longer PICU stays. Factors associated with new device class use were preadmission chemotherapy or radiotherapy, presepsis Functional Status Scale score, and ventilation duration greater than or equal to 10 days. Of patients who had a new medication or device class, most had a readmission (56% and 61%) or ED visit (62% and 67%). CONCLUSIONS Children with septic shock represent a high-risk cohort with high-resource needs after discharge. Interventions and targeted outcomes to mitigate postdischarge resource use may differ based on patients' preexisting conditions.
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Affiliation(s)
- Aline B. Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Jerry J. Zimmerman
- Seattle Children’s Hospital, Seattle Research Institute, University of Washington School of Medicine, Seattle, WA
| | | | | | - Kathleen L. Meert
- Children’s Hospital of Michigan, Detroit, MI, Central Michigan University, Mt. Pleasant, MI
| | - Angela S. Czaja
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania
| | - Anil Sapru
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA
| | - Joseph A. Carcillo
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christopher J. L. Newth
- Department of Pediatrics, Section of Critical Care, University of Southern California, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Michael W. Quasney
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Peter M. Mourani
- Department of Pediatrics, Section of Critical Care, University of Arkansas for Medical Sciences and Arkansas Children’s Research Institute, Little Rock, AR
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Dahmer MK, Yang G, Zhang M, Quasney MW, Sapru A, Weeks HM, Sinha P, Curley MAQ, Delucchi KL, Calfee CS, Flori H, Matthay MA, Bateman ST, Berg MD, Borasino S, Bysani GK, Cowl AS, Bowens CD, Faustino VS, Fineman LD, Godshall AJ, Hirshberg EL, Kirby AL, McLaughlin GE, Medar SS, Oren PP, Schneider JB, Schwarz AJ, Shanley TP, Source LR, Truemper EJ, Vender Heyden MA, Wittmayer K, Zuppa AF, Wypij D. Identification of phenotypes in paediatric patients with acute respiratory distress syndrome: a latent class analysis. Lancet Respir Med 2022; 10:289-297. [PMID: 34883088 PMCID: PMC8897230 DOI: 10.1016/s2213-2600(21)00382-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous latent class analysis of adults with acute respiratory distress syndrome (ARDS) identified two phenotypes, distinguished by the degree of inflammation. We aimed to identify phenotypes in children with ARDS in whom developmental differences might be important, using a latent class analysis approach similar to that used in adults. METHODS This study was a secondary analysis of data aggregated from the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial and the Genetic Variation and Biomarkers in Children with Acute Lung Injury (BALI) ancillary study. We used latent class analysis, which included demographic, clinical, and plasma biomarker variables, to identify paediatric ARDS (PARDS) phenotypes within a cohort of children included in the RESTORE and BALI studies. The association of phenotypes with clinically relevant outcomes and the performance of paediatric data in adult ARDS classification algorithms were also assessed. FINDINGS 304 children with PARDS were included in this secondary analysis. Using latent class analysis, a two-class model was a better fit for the cohort than a one-class model (p<0·001). Latent class analysis identified two classes: class 1 (181 [60%] of 304 patients with PARDS) and class 2 (123 [40%] of 304 patients with PARDS), referred to as phenotype 1 and 2 hereafter. Phenotype 2 was characterised by higher concentrations of inflammatory biomarkers, a higher incidence of vasopressor use, and more frequent diagnosis of sepsis, consistent with the adult hyperinflammatory phenotype. All levels of severity of PARDS were observed across both phenotypes. Children with the hyperinflammatory phenotype (phenotype 2) had worse clinical outcomes than those with the hypoinflammatory phenotype (phenotype 1), with a longer duration of mechanical ventilation (median 10·0 days [IQR 6·3-21·0] for phenotype 2 vs 6·6 days [4·1-10·8] for phenotype 1, p<0·0001), and higher incidence of mortality (17 [13·8%] of 123 patients vs four [2·2%] of 181 patients, p=0·0001). When using adult phenotype classification algorithms in children, the soluble tumour necrosis factor receptor-1 (sTNFr1), vasopressor use, and interleukin (IL)-6 variables gave an area under the curve (AUC) of 0·956, and the sTNFr1, vasopressor use, and IL-8 variables gave an AUC of 0·954, compared with the gold standard of latent class analysis. INTERPRETATION Latent class analysis identified two phenotypes in children with ARDS with characteristics similar to those in adults, including worse outcomes among patients with the hyperinflammatory phenotype. PARDS phenotypes should be considered in design and analysis of future clinical trials in children. FUNDING US National Institutes of Health.
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Affiliation(s)
- Mary K Dahmer
- Department of Pediatrics, Division of Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Guangyu Yang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Michael W Quasney
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Anil Sapru
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA
| | - Heidi M. Weeks
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Pratik Sinha
- Department of Anesthesia, Washington University, St. Louis, MO
| | - Martha AQ Curley
- Department of Family and Community Health (School of Nursing), Division of Anesthesia and Critical Care Medicine (Perelman School of Medicine) University of Pennsylvania, Philadelphia, PA; Research Institute; Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kevin L Delucchi
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Carolyn S Calfee
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA
| | - Heidi Flori
- Department of Pediatrics, Division of Critical Care Medicine, University of Michigan, Ann Arbor, MI
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Farhat MH, Shadley JD, Halligan NL, Hall MW, Popova AP, Quasney MW, Dahmer MK. Differences in the Genomic Profiles of Immunoparalyzed and Nonimmunoparalyzed Children With Sepsis: A Pilot Study. Pediatr Crit Care Med 2022; 23:79-88. [PMID: 35119428 PMCID: PMC10993860 DOI: 10.1097/pcc.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Sepsis-induced immunoparalysis represents a pathologic downregulation of leukocyte function shown to be associated with adverse outcomes, although its mechanisms remain poorly understood. Our goal was to compare genome-wide gene expression profiles of immunoparalyzed and nonimmunoparalyzed children with sepsis to identify genes and pathways associated with immunoparalysis. DESIGN Prospective observational study. PATIENTS Twenty-six children with lower respiratory tract infection meeting criteria for sepsis, severe sepsis, or septic shock admitted to the PICU. SETTING Two tertiary care PICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Innate immune function was assayed ex vivo by measuring release of tumor necrosis factor-α from whole blood after incubation with lipopolysaccharide for 4 hours. Immunoparalysis was defined as a tumor necrosis factor-α production capacity less than 200 pg/mL. Ten of the 26 children were immunoparalyzed. There were 17 significant differentially expressed genes when comparing genome-wide gene expression profiles of immunoparalyzed and nonimmunoparalyzed children (false discovery rate < 0.05). Nine genes showed increased expression in immunoparalyzed children (+1.5- to +8.8-fold change). Several of these dampen the immune system. Eight showed decreased expression in immunoparalyzed children (-1.7- to -3.9-fold change), several of which are involved in early regulation and activation of immune function. Functional annotation clustering using differentially expressed genes with p value of less than 0.05 showed three clusters related to immunity with significant enrichment scores (2.2-4.5); the most significant gene ontology terms in these clusters were antigen processing and presentation and negative regulation of interleukin-6 production. Network analysis identified potential protein interactions that may be involved in the development of immunoparalysis in children. CONCLUSIONS In this exploratory analysis, immunoparalyzed children with sepsis showed increased expression of genes that dampen the immune system and decreased expression of genes involved in regulation and activation of the immune system. Analysis also implicated other proteins as potentially having as yet unidentified roles in the development of immunoparalysis.
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Affiliation(s)
- Mohamed Hani Farhat
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
| | - Jeffery D. Shadley
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
| | - Nadine L.N. Halligan
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
| | - Mark W. Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Antonia P. Popova
- Division of Pulmonology, Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
| | - Michael W. Quasney
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
| | - Mary K. Dahmer
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children’s Hospital, Ann Arbor, Michigan
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Monteiro ACC, Flori H, Dahmer MK, Sim MS, Quasney MW, Curley MAQ, Matthay MA, Sapru A. Thrombomodulin is associated with increased mortality and organ failure in mechanically ventilated children with acute respiratory failure: biomarker analysis from a multicenter randomized controlled trial. Crit Care 2021; 25:271. [PMID: 34344416 PMCID: PMC8330123 DOI: 10.1186/s13054-021-03626-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute respiratory failure (ARF) can progress to acute respiratory distress syndrome and death. Biomarkers may allow for risk stratification and prognostic enrichment in ARF. Thrombomodulin (TM) is a transmembrane antithrombotic mediator expressed in endothelial cells. It is cleaved into its soluble form (sTM) during inflammation and vascular injury. Levels of sTM correlate with inflammation and end organ dysfunction. METHODS This was a prospective observational study of 432 patients aged 2 weeks-17 years requiring invasive mechanical ventilation. It was ancillary to the multicenter clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE). After consent, patients had up to 3 plasma samples collected at 24-h intervals within 5 days after intubation. sTM was assayed by ELISA. The Hazard ratio (HR) for 90-day mortality was determined by Cox regression. Mixed effect models (MEM) were used to test for association with extrapulmonary multiorgan failure (MOF) and oxygenation index (OI). Age, race, sex and PRISM-III scores were used as confounding variables for multivariable analyses. RESULTS sTM values ranged from 16.6 to 670.9 ng/ml within 5 days after intubation. Higher sTM was associated with increased 90-day mortality (n = 432, adjusted HR = 1.003, p = 0.02) and worse OI in the first 5 days after intubation (n = 252, Estimate = 0.02, p < 0.01). Both initial and slope of sTM were associated with increased extrapulmonary MOF in unadjusted and adjusted analyses (Intercept, Estimate = 0.003, p < 0.0001; and slope, Estimate = 0.01, p = 0.0009, n = 386). CONCLUSIONS Plasma sTM is associated with mortality, severity of hypoxic respiratory failure and worsening extrapulmonary MOF in children with ARF. This suggests a role of vascular injury in the pathogenesis of ARF and provides potential applicability towards targeted therapies. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT00814099 . In healthy lung endothelium, thrombomodulin (TM) recruits thrombin to activate Protein-C (PC/APC), that inhibits plasminogen activator-1 (PAI-1) and thrombosis. In inflamed and damaged endothelium, TM is cleaved into its soluble form (sTM), precluding its usual regulation of thrombosis. In this study, we measured plasma sTM levels in pediatric patients with respiratory failure and found that sTM correlated with mortality and other clinical markers of poor outcomes.
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Affiliation(s)
- Ana Carolina Costa Monteiro
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, UCLA Ronald Reagan Hospital, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Heidi Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Myung Shin Sim
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Martha A Q Curley
- Division of Anesthesia and Critical Care Medicine (Perelman School of Medicine), Department of Family and Community Health (School of Nursing), University of Pennsylvania, Philadelphia, PA, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Anil Sapru
- Division of Pediatric Critical Care, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, USA
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7
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Ward SL, Dahmer MK, Weeks HM, Sapru A, Quasney MW, Curley MAQ, Liu KD, Matthay MA, Flori HR. Association of patient weight status with plasma surfactant protein D, a biomarker of alveolar epithelial injury, in children with acute respiratory failure. Pediatr Pulmonol 2020; 55:2730-2736. [PMID: 32725941 PMCID: PMC8087214 DOI: 10.1002/ppul.24990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES Alveolar epithelial injury is a key determinant of acute respiratory failure (ARF) severity. Plasma surfactant protein D (SP-D), a biomarker of alveolar epithelial injury, is lower in obese adults with ARF compared to their lean peers. We aimed to determine if children with ARF have similar variance in plasma SP-D associated with their weight status on admission. METHODS Plasma SP-D was measured on days 0, 1, or 2 in children (1-18 years) with ARF enrolled in the genetic variation and biomarkers in children with acute lung injury and RESTORE studies. Weight classification (underweight, normal, overweight, and obese) was based on body mass index or weight-for-height z-scores. Associations between weight group and SP-D on each day were tested. RESULTS Inclusion criteria were met in 212 subjects, 24% were obese. There were no differences among weight groups in SP-D levels on days 0 and 1. However, on day 2, there was a statistically significant linear trend for lower SP-D levels as weight increased in both the univariate analysis (P = .02) and when adjusting for age, ethnicity, and diagnosis of pediatric acute respiratory distress syndrome (P = .05). CONCLUSIONS Obesity was associated with lower plasma SP-D levels on day 2 of ARF. This finding may be explained by altered ARF pathogenesis in obese individuals or a reduced incidence of ventilator-induced lung injury.
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Affiliation(s)
- Shan L Ward
- Division of Critical Care, Department of Pediatrics, UCSF Benioff Children's Hospitals, San Francisco and Oakland, California
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Anil Sapru
- Division of Critical Care Medicine, Department of Pediatrics, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Martha A Q Curley
- Division of Anesthesia and Critical Care Medicine, Department of Family and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Kathleen D Liu
- Department of Medicine, UCSF Medical Center, San Francisco, California
| | - Michael A Matthay
- Department of Anesthesia, UCSF Medical Center, San Francisco, California.,UCSF Medical Center, Cardiovascular Research Institute, San Francisco, California
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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8
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Kohne JG, Dahmer MK, Weeks HM, Kaciroti N, Quasney MW, Sapru A, Curley MA, Matthay M, Flori H. Impact of Bilateral Infiltrates on Inflammatory Biomarker Levels and Clinical Outcomes of Children With Oxygenation Defect. Crit Care Med 2020; 48:e498-e504. [PMID: 32317601 PMCID: PMC10910885 DOI: 10.1097/ccm.0000000000004316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The 2015 definition for pediatric acute respiratory distress syndrome did not require the presence of bilateral infiltrates. We tested the hypothesis that pediatric patients meeting oxygenation criteria for pediatric acute respiratory distress syndrome but without bilateral infiltrates would have different inflammatory biomarker levels and clinical outcomes than those with bilateral infiltrates. DESIGN Secondary analysis of a prospective cohort study. SETTING Twenty-two PICUs. PATIENTS Four-hundred forty-six patients age 2 weeks to 17 years intubated for respiratory failure with oxygenation index greater than or equal to 4 or oxygenation saturation index greater than or equal to 5 on the day of intubation or the day after. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients with bilateral infiltrates, either on the day of intubation or within the following 2 days, were compared with children who never developed bilateral infiltrates. Two analyses were performed to test 1) whether bilateral infiltrates are associated with elevated interleukin-1 receptor antagonist or interleukin-8 and 2) whether bilateral infiltrates are associated with worse clinical outcomes. Patients with bilateral infiltrates more often had a primary diagnosis of pneumonia (41% vs 28%; p = 0.02) and less often asthma (8% vs 23%; p < 0.01). After controlling for age, gender, and primary diagnosis, interleukin-1 receptor antagonist was higher on study days 1 and 2 in patients with bilateral infiltrates. There was no difference in interleukin-8 levels. After adjusting for age, gender, Pediatric Risk of Mortality score, and severity of oxygenation defect, presence of bilateral infiltrates was associated with longer duration of mechanical ventilation in survivors (hazard ratio, 0.64; 95% CI, 0.49-0.82; p < 0.01); this association was independent of primary diagnosis. Overall mortality was 9%; mortality was higher in those without bilateral infiltrates (14% vs 8%; p = 0.04). CONCLUSIONS Children meeting pediatric acute respiratory distress syndrome oxygenation criteria with bilateral infiltrates on chest radiograph experience a more intense early inflammatory response. Bilateral infiltrates are associated with longer time on the ventilator independent of oxygenation defect severity.
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Affiliation(s)
- Joseph G. Kohne
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan
| | - Mary K. Dahmer
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan
| | - Heidi M. Weeks
- Department of Nutritional Sciences, School of Public Health, University of Michigan
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan; and Department of Biostatistics, University of Michigan School of Public Health
| | - Michael W. Quasney
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan
| | - Anil Sapru
- Department of Pediatrics, University of California, Los Angeles, CA
| | - Martha A.Q. Curley
- Division of Anesthesia and Critical Care Medicine, Department of Family and Community Health (School of Nursing), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Michael Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA
| | - Heidi Flori
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan
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9
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Dahmer MK, Flori H, Sapru A, Kohne J, Weeks HM, Curley MAQ, Matthay MA, Quasney MW. Surfactant Protein D Is Associated With Severe Pediatric ARDS, Prolonged Ventilation, and Death in Children With Acute Respiratory Failure. Chest 2020; 158:1027-1035. [PMID: 32275979 DOI: 10.1016/j.chest.2020.03.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/03/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Elevated surfactant protein D (SP-D) is a relatively specific indicator of lung injury and is associated with both acute and chronic lung disease in adults and respiratory distress syndrome in premature infants. The relationship between plasma SP-D and lung injury in children with acute respiratory failure is unclear. RESEARCH QUESTION Is plasma SP-D associated with lung injury or outcome in children with acute respiratory failure? STUDY DESIGN AND METHODS This was a prospective cohort study in children 2 weeks to 17 years of age with acute respiratory failure who participated in the BALI multi-center study. Analyses were done using SP-D levels in plasma from the first sample taken on either the day of intubation or one of the following 2 days. SP-D level was measured by enzyme-linked immunosorbent assay. RESULTS Plasma samples from 350 patients were used in the analysis; 233 had pediatric ARDS (PARDS). SP-D levels varied across primary diagnoses (P < .001). Elevated SP-D levels were associated with severe PARDS after adjusting for age, pediatric risk of mortality III (PRISM-III), and primary diagnosis (OR = 1.02; CI = 1.01-1.04; P = .011). Multivariable analyses also indicated that elevated SP-D levels were associated with death (OR = 1.02; CI = 1.01-1.04; P = .004), duration of mechanical ventilation (P = .012), PICU length of stay (P = .019), and highest oxygenation index (P = .040). SP-D levels also correlated with age (rs = 0.16, P = .002). INTERPRETATION Elevated plasma SP-D levels are associated with severe PARDS and poor outcomes in children with acute respiratory failure. Future studies will determine whether SP-D can be used to predict the degree of lung injury or response to treatment and whether SP-D is useful in identifying PARDS endotypes.
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Affiliation(s)
- Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Heidi Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Anil Sapru
- Department of Pediatrics, University of California, Los Angeles, CA
| | - Joseph Kohne
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Martha A Q Curley
- Department of Family and Community Health (School of Nursing), Division of Anesthesia and Critical Care Medicine (Perelman School of Medicine) University of Pennsylvania, and the Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
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10
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Holzemer NF, Hasvold JJ, Pohl KJ, Ashbrook MJ, Meert KL, Quasney MW. Human Metapneumovirus Infection in Hospitalized Children. Respir Care 2020; 65:650-657. [PMID: 32047124 DOI: 10.4187/respcare.07156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Most children are exposed to human metapneumovirus (HMPV) by the age of 5 y. This study aimed to describe the morbidity associated with HMPV infections in a cohort of children in the Midwest of the United States. METHODS This was a retrospective 2-center cohort study including children (0-17 y old) hospitalized with HMPV infections at 2 tertiary care pediatric hospitals from 2009 to 2013. Demographics, chronic medical conditions, viral coinfections, and hospitalization characteristics, including the need for respiratory support, high-flow nasal cannula, CPAP, bi-level positive airway pressure, invasive mechanical ventilation, pediatric ICU admission, acute kidney injury (AKI), use of extracorporeal membrane oxygenation, and length of stay, were collected. RESULTS In total, 131 subjects were included. Those with one or more comorbidities were older than their otherwise healthy counterparts, with a median age of 2.8 y (interquartile range [IQR] 1.1-7.0) compared to 1.3 y (IQR 0.6-2.0, P < .001), respectively. Ninety-nine (75.6%) subjects required respiratory support; 72 (55.0%) subjects required nasal cannula, simple face mask, or tracheostomy mask as their maximum support. Additionally, 1 (0.8%) subject required high-flow nasal cannula, 1 (0.8%) subject required CPAP, 2 (1.5%) subjects required bi-level positive airway pressure, 15 (11.5%) subjects required invasive mechanical ventilation, 4 (3.1%) subjects required high-frequency oscillatory or jet ventilation, and 4 (3.1%) subjects required extracorporeal membrane oxygenation. Fifty-one (38.9%) subjects required pediatric ICU admission, and 16 (12.2%) subjects developed AKI. Subjects with AKI were significantly older than those without AKI at 5.4 y old (IQR 1.6-11.7) versus 1.9 y old (IQR 0.7-3.5, P = .003). After controlling for the presence of at least one comorbidity and cystic fibrosis, each year increase in age led to a 16% increase in the odds of AKI (P = .01). The median length of stay for the entire cohort was 4.0 d (IQR 2.7-7.0). CONCLUSIONS Children hospitalized with HMPV may be at risk for AKI. Risk of HMPV-associated AKI appears to increase with age regardless of severity of respiratory illness or presence of comorbidities.
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Affiliation(s)
- Nicholas F Holzemer
- Department of Internal Medicine - Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jennifer J Hasvold
- Department of Internal Medicine, University of South Dakota, Rapid City, South Dakota
| | - Kyle J Pohl
- Provider Network of the Alaska Native Tribal Health Consortium, Anchorage, Alaska
| | - Matthew J Ashbrook
- Department of General Surgery, Naval Medical Center San Diego, San Diego, California
| | - Kathleen L Meert
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
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11
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Flori H, Sapru A, Quasney MW, Gildengorin G, Curley MAQ, Matthay MA, Dahmer MK. A prospective investigation of interleukin-8 levels in pediatric acute respiratory failure and acute respiratory distress syndrome. Crit Care 2019; 23:128. [PMID: 30995942 PMCID: PMC6471952 DOI: 10.1186/s13054-019-2342-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/04/2019] [Indexed: 12/27/2022]
Abstract
Background The association of plasma interleukin-8 (IL-8), or IL-8 genetic variants, with pediatric acute respiratory distress syndrome (PARDS) in children with acute respiratory failure at risk for PARDS has not been examined. The purpose of this study was to examine the association of early and sequential measurement of plasma IL-8 and/or its genetic variants with development of PARDS and other clinical outcomes in mechanically ventilated children with acute respiratory failure. Methods This was a prospective cohort study of children 2 weeks to 17 years of age with acute airways and/or parenchymal lung disease done in 22 pediatric intensive care units participating in the multi-center clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE). Plasma IL-8 levels were measured within 24 h of consent and 24 and 48 h later. DNA was purified from whole blood, and IL-8 single nucleotide polymorphisms, rs4073, rs2227306, and rs2227307, were genotyped. Results Five hundred forty-nine patients were enrolled; 480 had blood sampling. Plasma IL-8 levels ranged widely from 4 to 7373 pg/mL. Highest IL-8 levels were observed on the day of intubation with subsequent tapering. Levels of IL-8 varied significantly across primary diagnoses with the highest levels occurring in patients with sepsis and the lowest levels in those with asthma. Plasma IL-8 was strongly correlated with oxygenation defect and severity of illness. IL-8 was consistently higher in PARDS patients compared to those without PARDS; levels were 4–12 fold higher in non-survivors compared to survivors. On multivariable analysis, IL-8 was independently associated with death, duration of mechanical ventilation, and PICU length of stay on all days measured, but was not associated with PARDS development. There was no association between the IL-8 single nucleotide polymorphisms, rs4073, rs2227306, and rs2227307, and PARDS development or plasma IL-8 level. Conclusions When measured sequentially, plasma IL-8 was robustly associated with multiple, relevant clinical outcomes including mortality, but was not associated with PARDS development. The wide range of plasma IL-8 levels exhibited in this cohort suggests that further study into the heterogeneity of this patient population and its impact on individual responses to PARDS treatment is warranted. Electronic supplementary material The online version of this article (10.1186/s13054-019-2342-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heidi Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Dr, F6790/5243, Ann Arbor, MI, 48109, USA
| | - Anil Sapru
- Department of Pediatrics, University of California, Los Angeles, CA, USA
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Dr, F6790/5243, Ann Arbor, MI, 48109, USA
| | - Ginny Gildengorin
- Children's Hospital Oakland Research Institute, UCSF Benioff Children's Hospitals, Oakland, CA, USA
| | - Martha A Q Curley
- Department of Family and Community Health (School of Nursing), Division of Anesthesia and Critical Care Medicine (Perelman School of Medicine), University of Pennsylvania, Philadelphia, PA, USA.,Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Dr, F6790/5243, Ann Arbor, MI, 48109, USA.
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12
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Levy H, Jia S, Pan A, Zhang X, Kaldunski M, Nugent ML, Reske M, Feliciano RA, Quintero D, Renda MM, Woods KJ, Murkowski K, Johnson K, Verbsky J, Dasu T, Ideozu JE, McColley S, Quasney MW, Dahmer MK, Avner E, Farrell PM, Cannon CL, Jacob H, Simpson PM, Hessner MJ. Identification of molecular signatures of cystic fibrosis disease status with plasma-based functional genomics. Physiol Genomics 2018; 51:27-41. [PMID: 30540547 DOI: 10.1152/physiolgenomics.00109.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Although cystic fibrosis (CF) is attributed to dysfunction of a single gene, the relationships between the abnormal gene product and the development of inflammation and progression of lung disease are not fully understood, which limits our ability to predict an individual patient's clinical course and treatment response. To better understand CF progression, we characterized the molecular signatures of CF disease status with plasma-based functional genomics. Peripheral blood mononuclear cells (PBMCs) from healthy donors were cultured with plasma samples from CF patients ( n = 103) and unrelated, healthy controls ( n = 31). Gene expression levels were measured with an Affymetrix microarray (GeneChip Human Genome U133 Plus 2.0). Peripheral blood samples from a subset of the CF patients ( n = 40) were immunophenotyped by flow cytometry, and the data were compared with historical data for age-matched healthy controls ( n = 351). Plasma samples from another subset of CF patients ( n = 56) and healthy controls ( n = 16) were analyzed by multiplex enzyme-linked immunosorbent assay (ELISA) for numerous cytokines and chemokines. Principal component analysis and hierarchical clustering of induced transcriptional data revealed disease-specific plasma-induced PBMC profiles. Among 1,094 differentially expressed probe sets, 51 genes were associated with pancreatic sufficient status, and 224 genes were associated with infection with Pseudomonas aeruginosa. The flow cytometry and ELISA data confirmed that various immune modulators are relevant contributors to the CF molecular signature. This study provides strong evidence for distinct molecular signatures among CF patients. An understanding of these molecular signatures may lead to unique molecular markers that will enable more personalized prognoses, individualized treatment plans, and rapid monitoring of treatment response.
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Affiliation(s)
- Hara Levy
- Human Molecular Genetics Program, Stanley Manne Children's Research Institute of Chicago , Chicago, Illinois.,Division of Pulmonary Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Shuang Jia
- Division of Endocrinology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin.,Max McGee National Research Center for Juvenile Diabetes, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Amy Pan
- Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin.,Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Xi Zhang
- Human Molecular Genetics Program, Stanley Manne Children's Research Institute of Chicago , Chicago, Illinois.,Division of Pulmonary Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Mary Kaldunski
- Division of Endocrinology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin.,Max McGee National Research Center for Juvenile Diabetes, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Melodee L Nugent
- Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin.,Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Melissa Reske
- Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin
| | - Rachel A Feliciano
- Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin
| | - Diana Quintero
- Division of Pulmonology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Michael M Renda
- Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin
| | - Katherine J Woods
- Division of Pediatric Critical Care Medicine, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Kathy Murkowski
- Division of Pediatric Critical Care Medicine, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Keven Johnson
- Human Molecular Genetics Program, Stanley Manne Children's Research Institute of Chicago , Chicago, Illinois
| | - James Verbsky
- Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Trivikram Dasu
- Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Justin Eze Ideozu
- Human Molecular Genetics Program, Stanley Manne Children's Research Institute of Chicago , Chicago, Illinois.,Division of Pulmonary Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Susanna McColley
- Division of Pulmonary Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Michael W Quasney
- Division of Pediatric Critical Care Medicine, University of Michigan Medical School , Ann Arbor, Michigan
| | - Mary K Dahmer
- Division of Pediatric Critical Care Medicine, University of Michigan Medical School , Ann Arbor, Michigan
| | - Ellis Avner
- Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin.,Division of Nephrology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Philip M Farrell
- Department of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Carolyn L Cannon
- Division of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Howard Jacob
- Genomic Medicine, Institute for Biotechnology, Hudson Alpha, Huntsville, Alabama
| | - Pippa M Simpson
- Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin.,Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Martin J Hessner
- Division of Endocrinology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin.,Max McGee National Research Center for Juvenile Diabetes, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin.,Children's Research Institute of the Children's Hospital of Wisconsin , Milwaukee, Wisconsin
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13
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Kawai Y, DeMonbrun AG, Chambers RS, Nolan DA, Dolcourt BA, Malas NM, Quasney MW. A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate Posturing. Pediatrics 2017; 139:peds.2015-3779. [PMID: 27940505 DOI: 10.1542/peds.2015-3779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 11/24/2022] Open
Abstract
A 14-year-old previously healthy female was transferred from a local emergency department after being found unresponsive at home. Parental questioning revealed she had fever and pharyngitis 2 weeks before presentation. Past mental health history was negative, including concern for past or present suicidal ideation/attempts, suspected substance use, or toxic ingestion. In the emergency department, she was orotracheally intubated due to a Glasgow Coma Scale of 3. She was hemodynamically stable and euglycemic. Electrocardiogram showed sinus tachycardia. She underwent a noncontrast head computed tomography that was normal and subsequently underwent a lumbar puncture. She had a seizure and was given a loading dose of diazepam and fosphenytoin that led to cessation of extremity movements. She was subsequently transferred to the PICU for additional evaluation. Initial examination without sedation or analgesia demonstrated dilated and minimally responsive pupils, intermittent decorticate posturing, and bilateral lower extremity rigidity and clonus, consistent with a Glasgow Coma Scale of 5. Serum studies were unremarkable with the exception of mild leukocytosis. Chest radiograph only showed atelectasis. She was empirically started on antibiotics to cover for meningitis pending final cerebral spinal fluid test results. The pediatric neurology team was consulted for EEG monitoring, and the patient was eventually sent for computed tomography angiogram and magnetic resonance angiogram/venogram. We will review diagnostic evaluation and management of an adolescent patient with acute encephalopathy with decorticate posturing of unclear etiology.
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Affiliation(s)
- Yu Kawai
- Divisions of Pediatric Critical Care Medicine and
| | | | | | - Danielle A Nolan
- Pediatric Neurology, Department of Pediatrics and Communicable Diseases
| | - Bram A Dolcourt
- Division of Toxicology, Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Nasuh M Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, and.,Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; and
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Perez-Marques F, Simpson P, Yan K, Quasney MW, Halligan N, Merchant D, Dahmer MK. Association of polymorphisms in genes of factors involved in regulation of splicing of cystic fibrosis transmembrane conductance regulator mRNA with acute respiratory distress syndrome in children with pneumonia. Crit Care 2016; 20:281. [PMID: 27596159 PMCID: PMC5011993 DOI: 10.1186/s13054-016-1454-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/15/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous work has demonstrated a strong association between lung injury in African American children with pneumonia and a polymorphic (TG)mTn region in cystic fibrosis transmembrane conductance (CFTR) involved in the generation of a nonfunctional CFTR protein lacking exon 9. A number of splicing factors that regulate the inclusion/exclusion of exon 9 have been identified. The objective of this study was to determine whether genetic variants in these splicing factors were associated with acute respiratory distress syndrome (ARDS) in children with pneumonia. METHODS This is a prospective cohort genetic association study of lung injury in African American and non-Hispanic Caucasian children with community-acquired pneumonia evaluated in the emergency department or admitted to the hospital. Linkage-disequilibrium-tag single nucleotide polymorphisms (LD-tag SNPs) in genes of the following splicing factors (followed by gene name) involved in exon 9 skipping PTB1 (PTBP1), SRp40 (SFRS1), SR2/ASF (SFRS5), TDP-43 (TARDBP), TIA-1 (TIA1), and U2AF(65) (U2AF2) were genotyped. SNPs in the gene of the splicing factor CELF2 (CELF2) were selected by conservation score. Multivariable analysis was used to examine association between genotypes and ARDS. RESULTS The African American cohort (n = 474) had 29 children with ARDS and the non-Hispanic Caucasian cohort (n = 304) had 32 children with ARDS. In the African American group multivariable analysis indicated that three variants in CELF2, rs7068124 (p = 0.004), rs3814634 (p = 0.032) and rs10905928 (p = 0.044), and two in TIA1, rs2592178 (p = 0.005) and rs13402990 (p = 0.018) were independently associated with ARDS. In the non-Hispanic Caucasian group, a single variant in CELF2, rs2277212 (p = 0.014), was associated with increased risk of developing ARDS. CONCLUSIONS The data indicate that SNPs in CELF2 may be associated with the risk of developing ARDS in both African American and non-Hispanic Caucasian children with pneumonia and suggest that the potential role of the splicing factor CELF2 in ARDS should be explored further.
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Affiliation(s)
| | - Pippa Simpson
- Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI, USA.,Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ke Yan
- Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael W Quasney
- Division of Pediatric Critical Care, Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Dr, SPC 5243, Ann Arbor, MI, 48109-5243, USA
| | - Nadine Halligan
- Division of Pediatric Critical Care, Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Dr, SPC 5243, Ann Arbor, MI, 48109-5243, USA
| | - Daniel Merchant
- Section of Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary K Dahmer
- Division of Pediatric Critical Care, Department of Pediatrics and Communicable Diseases, University of Michigan, 1500 East Medical Center Dr, SPC 5243, Ann Arbor, MI, 48109-5243, USA.
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Chen J, Wilson ES, Dahmer MK, Quasney MW, Waterer GW, Feldman C, Wunderink RG. Lack of association of the caspase-12 long allele with community-acquired pneumonia in people of African descent. PLoS One 2014; 9:e89194. [PMID: 24586588 PMCID: PMC3935862 DOI: 10.1371/journal.pone.0089194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/15/2014] [Indexed: 11/19/2022] Open
Abstract
Community-acquired pneumonia (CAP) is a common cause of sepsis. Active full-length caspase-12 (CASP12L), confined to the people of African descent, has been associated with increased susceptibility to and mortality from severe sepsis. The objective of this study was to determine whether CASP12L was a marker for susceptibility and/or severity of CAP. We examined three CAP cohorts and two control populations: 241 adult Memphis African American CAP patients, 443 pediatric African American CAP patients, 90 adult South African CAP patients, 120 Memphis healthy adult African American controls and 405 adult Chicago African American controls. Clinical outcomes including mortality, acute respiratory distress syndrome (ARDS), septic shock or severe sepsis, need for mechanical ventilation, and S. pneumoniae bacteremia. Neither in the three individual CAP cohorts nor in the combined CAP cohorts, was mortality in CASP12L carriers significantly different from that in non-CASP12L carriers. No statistically significant association between genotype and any measures of CAP severity was found in any cohort. We conclude that the functional CASP12L allele is not a marker for susceptibility and/or severity of CAP.
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Affiliation(s)
- Jiwang Chen
- Department of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Esther S. Wilson
- Oakbrook Pediatrics, Summerville, South Carolina, United States of America
| | - Mary K. Dahmer
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Michael W. Quasney
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Grant W. Waterer
- Department of Medicine, Northwestern University, Chicago, Illinois, United States of America
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard G. Wunderink
- Department of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Levy H, Wang X, Kaldunski M, Jia S, Kramer J, Pavletich SJ, Reske M, Gessel T, Yassai M, Quasney MW, Dahmer MK, Gorski J, Hessner MJ. Transcriptional signatures as a disease-specific and predictive inflammatory biomarker for type 1 diabetes. Genes Immun 2012; 13:593-604. [PMID: 22972474 PMCID: PMC4265236 DOI: 10.1038/gene.2012.41] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The complex milieu of inflammatory mediators associated with many diseases is often too dilute to directly measure in the periphery, necessitating development of more sensitive measurements suitable for mechanistic studies, earlier diagnosis, guiding therapeutic decisions and monitoring interventions. We previously demonstrated that plasma samples from recent-onset type 1 diabetes (RO T1D) patients induce a proinflammatory transcriptional signature in freshly drawn peripheral blood mononuclear cells (PBMCs) relative to that of unrelated healthy controls (HC). Here, using cryopreserved PBMC, we analyzed larger RO T1D and HC cohorts, examined T1D progression in pre-onset samples, and compared the RO T1D signature to those associated with three disorders characterized by airway infection and inflammation. The RO T1D signature, consisting of interleukin-1 cytokine family members, chemokines involved in immunocyte chemotaxis, immune receptors and signaling molecules, was detected during early pre-diabetes and found to resolve post-onset. The signatures associated with cystic fibrosis patients chronically infected with Pseudomonas aeruginosa, patients with confirmed bacterial pneumonia, and subjects with H1N1 influenza all reflected immunological activation, yet each were distinct from one another and negatively correlated with that of T1D. This study highlights the remarkable capacity of cells to serve as biosensors capable of sensitively and comprehensively differentiating immunological states.
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Affiliation(s)
- H Levy
- The Department of Pediatrics, The Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Park SK, Dahmer MK, Quasney MW. MAPK and JAK-STAT signaling pathways are involved in the oxidative stress-induced decrease in expression of surfactant protein genes. Cell Physiol Biochem 2012; 30:334-46. [PMID: 22739240 DOI: 10.1159/000339068] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2012] [Indexed: 11/19/2022] Open
Abstract
Oxidative stress is generated by reactive oxygen species (ROS) including hydrogen peroxide (H(2)O(2)), hydroxyl radical (•OH ) and superoxide anion (O(2--)), which are produced as by-products of cellular metabolism. An imbalance in cellular redox status is a potent pathogenic factor that contributes to various chronic inflammatory diseases. In this study, we demonstrate that H(2)O(2 )decreases surfactant protein A, B and ABCA3 mRNA level, and increases SP-D mRNA level in human pulmonary lung epithelial cells. The decreased mRNA level of SP-A and SP-B were significant with a maximum inhibition of 79 and 87%, respectively by 150 µM H(2)O(2 )after 24 hrs of incubation. In addition, ABCA3 mRNA level was decreased with a maximum inhibition of 55% by 150 µM H(2)O(2 )after 12 hrs of incubation. In contrast, 150 µM H(2)O(2 )caused the SP-D mRNA level to increase to 200% of control after 8 hrs of incubation. The H(2)O(2)-induced gene repression or activation of SP-A, SP-B, SP-D and ABCA3 was blocked by pretreatment with the antioxidants N-acetyl-L-cysteine (NAC) and catalase. Furthermore, the inhibition of SP-A and SP-B was associated with reduced thyroid transcription factor -1 (TTF-1) DNA binding activity, and this reduced TTF-1 binding activity may be due to decreased TTF-1 protein expression level. The analyses of signal transduction pathways that may play a role in the regulation of gene expression by H(2)O(2 )using several specific inhibitors showed that U0126, an inhibitor of ERK1/2 upstream kinase MEK1/2, blocked both H(2)O(2)-induced inhibition of SP-A and SP-B gene expression, whereas SB203580, an inhibitor of p38 MAPK, partially blocked H(2)O(2)-mediated inhibition of SP-A gene expression but not SP-B expression. In contrast, AG-490, a specific inhibitor of JAK-STAT pathway, blocked H(2)O(2)-mediated inhibition of SP-B gene expression but not SP-A expression. Immunoblot analyses using specific phosphor-antibodies demonstrated that ERK1/2, p38 MAPK and STAT3 are phosphorylated by oxidative stress suggesting that H(2)O(2)-induced inhibition of SP-A and SP-B gene expression is associated with MAPK and JAKSTAT signaling pathway. These data, therefore, suggest that H(2)O(2 )affects SP-A and SP-B gene regulation by reducing TTF-1 DNA binding activity via MAPKs or STAT signaling pathways.
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Affiliation(s)
- Sang-Kyu Park
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53201, USA
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18
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Kelsey RM, Alpert BS, Dahmer MK, Krushkal J, Quasney MW. Alpha-adrenergic receptor gene polymorphisms and cardiovascular reactivity to stress in Black adolescents and young adults. Psychophysiology 2011; 49:401-12. [PMID: 22091949 DOI: 10.1111/j.1469-8986.2011.01319.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 09/26/2011] [Indexed: 01/11/2023]
Abstract
Cardiovascular reactivity to stress and α-adrenergic receptor (α-AR) function may contribute to the development of hypertension. As Black Americans have an increased risk of hypertension, we evaluated associations between α(1A) -AR (Arg492Cys), α(2A) -AR (-1291C/G), and α(2B) -AR (Ins/Del301-303) gene variants and cardiovascular reactivity in 500 normotensive Black youth. Heart rate, preejection period, total peripheral resistance, and blood pressure were measured during cold and psychological stress. The Arg492Cys polymorphism in the α(1A) -AR gene was associated with heart rate reactivity to stress, but the association depended on sex. The -1291C/G promoter polymorphism in the α(2A) -AR gene was associated with vascular reactivity to stress; vasoconstriction increased as a linear function of the number of copies of the variant G allele. Thus, specific associations emerged between genetic variations in α-Ars and cardiovascular reactivity in young Blacks.
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Affiliation(s)
- Robert M Kelsey
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38104, USA.
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Abstract
AIM To evaluate the association of angiotensin-converting enzyme (ACE) gene polymorphism with risk/severity of persistent pulmonary hypertension of the newborn (PPHN) among at risk infants. METHODS Infants ≥ 34 weeks with respiratory distress at birth were recruited. PPHN was diagnosed clinically and by cardiac echocardiogram. Control group consisted of infants with respiratory distress who did not develop PPHN. ACE genotyping (DD, II, DI genotypes) and serum ACE levels were determined. RESULTS A total of 120 infants were included (PPHN = 44; control = 76). Frequency of ACE DD genotype was not different between the two groups of infants (25% versus 33%). Among PPHN infants, severity of illness did not differ between genotypes. Mean (SD) serum ACE levels [15 (9) versus 24 (13) versus 29 (14) U/L] were positively associated with the number of D alleles and inversely associated with infants' gestational age (GA) and level of cardiovascular support. CONCLUSION Angiotensin-converting enzyme gene polymorphism did not impact the risk or severity of PPHN among infants ≥ 34 weeks GA.
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Affiliation(s)
- Lilia C De Jesus
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI 48201, USA.
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20
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Kelsey RM, Alpert BS, Dahmer MK, Krushkal J, Quasney MW. Beta-adrenergic receptor gene polymorphisms and cardiovascular reactivity to stress in Black adolescents and young adults. Psychophysiology 2010; 47:863-73. [PMID: 20374546 DOI: 10.1111/j.1469-8986.2010.01006.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiovascular reactivity to stress and beta-adrenergic receptor (beta-AR) function may contribute to the development of hypertension. As Black Americans have an increased risk of hypertension, we evaluated associations between beta(1)-AR (Arg389Gly) and beta(2)-AR (Arg16Gly, Gln27Glu) gene variants and cardiovascular reactivity in 500 Black youth. Heart rate, preejection period, total peripheral resistance, and blood pressure reactivity were measured during cold and psychological stress. The Arg389Gly polymorphism in the beta(1)-AR was associated with preejection period reactivity in males but not in females. The Arg16Gly polymorphism in the beta(2)-AR was associated with diastolic blood pressure reactivity only during video game stress. An association between the Gln27Glu polymorphism in the beta(2)-AR and vascular reactivity depended on sex. Thus, specific patterns of associations emerged between genetic variations in beta-ARs and cardiovascular reactivity in young Blacks.
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Affiliation(s)
- Robert M Kelsey
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee 38105, USA.
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21
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El Saleeby CM, Li R, Somes GW, Dahmer MK, Quasney MW, DeVincenzo JP. Surfactant protein A2 polymorphisms and disease severity in a respiratory syncytial virus-infected population. J Pediatr 2010; 156:409-14. [PMID: 19914637 DOI: 10.1016/j.jpeds.2009.09.043] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 08/10/2009] [Accepted: 09/15/2009] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine whether genetic variations within the surfactant protein A2 (SP-A2) gene are associated with respiratory syncytial virus (RSV) disease severity in infected children. STUDY DESIGN Naturally infected children aged < or =24 months were prospectively enrolled in 3 RSV seasons. SP-A2 genotyping was performed. Independent clinical predictors of disease severity were analyzed. The association of SP-A2 genetic diversity and disease severity was tested by using multivariate logistic regression models and 4 levels of disease gradation as outcome measures. RESULTS Homozygosity of the 1A(0) allele was protective against hospitalization (odds ratio [OR] = 0.15, P = .0010). This remained significant in African American patients (OR = 0.24, P = .042) and Caucasian patients (OR = 0.05, P = .021) after adjustment for other co-variates. Hospitalized children with the 1A(2) allele demonstrated significant protection from severe disease with univariate analyses, but only a trend for protection with multivariate analyses. Patients homozygous or heterozygous for an asparagine at amino acid position 9 were twice or more likely to need intensive care unit admission (OR = 2.15, P = .022), require intubation (OR = 3.04, P = .005), and have a hospitalization lasting > or =4 days (OR = 1.89, P = .02) compared with children homozygous for a threonine at this position. CONCLUSIONS SP-A2 polymorphisms are associated with the severity of RSV infection in infants.
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Affiliation(s)
- Chadi M El Saleeby
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital for Children, Boston, MA 02114, USA.
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22
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Abstract
Mutations in the gene coding for ATP-binding cassette protein A3 (ABCA3) are recognized as a genetic cause of lung disease of varying severity. Characterization of a number of mutant ABCA3 proteins has demonstrated that the mutations generally affect intracellular localization or the ability of the protein to hydrolyze ATP. A novel heterozygous mutation that results in the substitution of cysteine for arginine at amino acid 295 in ABCA3 was identified in a premature infant with chronic respiratory insufficiency and abnormal lamellar bodies. Sequencing of DNA performed in study participants demonstrated that this was a mutation and not a common variant. Plasmid vectors containing ABCA3 with the identified novel mutation tagged with green fluorescent protein on the carboxy terminus were generated. The effect of the mutation on protein function was characterized by examining the glycosylation state of the mutant protein in transiently transfected HEK293 cells and by examining ATP hydrolysis activity of the mutant protein with a vanadate-induced nucleotide trapping assay in stably transfected HEK293 cells. The ABCA3 protein containing the R295C mutation undergoes normal glycosylation and intracellular localization but has dramatically reduced ATP hydrolysis activity (12% of wild type). The identification of one copy of this novel mutation in a premature infant with chronic respiratory insufficiency suggests that ABCA3 haploinsufficiency together with lung prematurity may result in more severe, or more prolonged, respiratory failure.
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Affiliation(s)
- Sang-Kyu Park
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53201, USA
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Kazzi SNJ, Tromp G, Quasney MW, Buhimschi IA. Haplotypes of tumor necrosis factor gene and tracheal aspirate fluid levels of tumor necrosis factor-alpha in preterm infants. Pediatr Res 2008; 64:165-70. [PMID: 18645461 DOI: 10.1203/pdr.0b013e31817758f4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Individual variability in the production of tumor necrosis factor-alpha (TNF-alpha) has been attributed to genetic factors. We examined whether alleles of TNF gene (lymphotoxin-alpha+250, TNF-alpha-308, and TNF-alpha-238) affect tracheal aspirate fluid (TAF) levels of TNF-alpha among preterm infants at risk of bronchopulmonary dysplasia. TAF samples were collected within 48 h of birth and 7, 14, 21, and 28 d later. Haplotypes [designated using the nucleotide bases in the chromosome order (lymphotoxin-alpha+250, TNF-alpha-308, TNF-alpha-238)] of TNF were correlated with levels of TNF-alpha. Diplotypes of TNF (genotypes of haplotypes) classified as high, intermediate, or low based on their relation to TAF TNF-alpha levels were also correlated with TNF-alpha levels. The most frequent (and reference haplotype) was AGG. The GGG haplotype was associated with the lowest TAF TNF-alpha levels on day 7 among African American infants (p < 0.008). Sequential changes in levels of TNF-alpha correlated with infants' diplotype status [high (HH), intermediate (HL), low (LL)]. Fetal chorioamnionitis but not bronchopulmonary dysplasia was associated with infants' diplotypes (p < 0.005). Haplotypes of the TNF gene influence TAF levels of TNF-alpha. Diplotypes of TNF are associated with fetal chorioamnionitis.
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Affiliation(s)
- S Nadya J Kazzi
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Quasney MW. Angiotensin-converting enzyme genetic variation and lung injury: Are we genetically predisposed to develop acute respiratory distress syndrome?*. Crit Care Med 2006; 34:1261-2. [PMID: 16550082 DOI: 10.1097/01.ccm.0000208198.86333.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND The beta2-adrenergic receptor plays a central role in the bronchodilator response to beta2-agonists in patients with asthma. Genetic polymorphisms within the gene coding for this receptor influence responsiveness of the receptor. A number of these polymorphisms differ in frequency in the African American and white populations. OBJECTIVE To determine the frequency of specific beta2-adrenergic receptor polymorphisms in African American children with status asthmaticus and to examine whether a specific genotype is associated with the clinical response to therapy. DESIGN Cohort of African American children diagnosed with status asthmaticus. SETTING Tertiary care children's hospital. PATIENTS A total of 31 African American children with status asthmaticus. INTERVENTION Blood samples were obtained from children at admission. Genotypes were determined by polymerase chain reaction amplification and restriction enzyme digestion. MAIN OUTCOME MEASURES The requirement for admission to the pediatric intensive care unit, need for mechanical ventilation, institution of various therapies, and length of stay. RESULTS The genotypes of the polymorphic sites at amino acid positions 16 and 27 in the beta2-adrenergic receptor were determined. There were no significant differences between the various genotypes in the percentage of children requiring pediatric intensive care unit admission, mechanical ventilation, terbutaline treatment, or length of stay. However, in children heterozygous for Glu at position 27 of the beta2-adrenergic receptor, the percentage of patients requiring aminophylline treatment, in addition to beta2-agonist therapy, was significantly higher than that seen in patients homozygous for Gln at that position (5/10 [50%] vs. 1/21 [5%], respectively; p = .002). CONCLUSIONS African American children with status asthmaticus who have the Gln/Glu genotype at amino acid position 27 of the beta2-adrenergic receptor may benefit from aminophylline treatment in addition to beta2-agonist therapy.
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Affiliation(s)
- Lama Elbahlawan
- St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
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Kazzi SNJ, Quasney MW. Deletion allele of angiotensin-converting enzyme is associated with increased risk and severity of bronchopulmonary dysplasia. J Pediatr 2005; 147:818-22. [PMID: 16356438 DOI: 10.1016/j.jpeds.2005.07.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Revised: 07/01/2005] [Accepted: 07/18/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore whether the deletion (D) allele of angiotensin-converting enzyme (ACE) is associated with the risk or severity of bronchopulmonary dysplasia (BPD) among very low birth weight (BW) infants. STUDY DESIGN Infants with a BW < or = 1250 g were prospectively recruited. The D and I (insertion) alleles of ACE were determined using a polymerase chain reaction followed by restriction fragment length polymorphism analysis. RESULTS Infants with DD/DI genotype of ACE had a (mean +/- SD) birth weight (938 +/- 204 g vs 925 +/- 196 g) and gestational age (28 +/- 3 weeks vs 28 +/- 2 weeks), similar to infants with II genotype of ACE (P > .05). Infants with DD/DI genotype of ACE were more likely to have BPD than infants with II genotype (47% vs 22%, P = .025). Among infants with BPD, ACE DD/DI genotype was more common among infants with moderate or severe BPD compared with infants with mild BPD (74% vs 26%, P = .012). The number of D alleles of ACE correlated directly and positively with the severity of BPD (R = 0.23, P = .045). CONCLUSION The D allele of ACE is associated with an increased risk and severity of BPD among preterm infants.
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Affiliation(s)
- S Nadya J Kazzi
- Department of Pediatrics, Wayne State University, Detroit, Mich 48201, USA.
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Abstract
CONTEXT Wide variability exists in the susceptibility to and outcome from sepsis even within similar intensive care unit populations. Some of this variability in the host may be due to genetic variation in genes coding for components of the innate immune response. OBJECTIVE To review the evidence for a genetic influence on the susceptibility to and outcome from sepsis. DESIGN Literature review. PATIENTS Variety of adult and pediatric patients with various critical illnesses and infections. INTERVENTIONS None. MAIN OUTCOME MEASURES Susceptibility to clinical symptoms of sepsis and outcome as measured by severity of disease and mortality. RESULTS Polymorphisms in genes coding for proteins involved in the recognition of bacterial pathogens (Toll-like receptor 4, CD14, Fc(gamma)RIIa, and mannose-binding lectin) and the response to bacterial pathogens (tumor necrosis factor-alpha, interleukin (IL)-1alpha, IL-1beta, IL-1 receptor agonist, IL-6, IL-10, heat shock proteins, angiotensin I converting enzyme, plasminogen activator inhibitor-1) can influence the amount or function of the protein produced in response to bacterial stimuli. Evidence is discussed suggesting that some of these genetic polymorphisms influence the susceptibility to and outcome from sepsis. CONCLUSION Host genetic variability in the regulatory and coding regions of genes for components of the innate immune system may influence the susceptibility to and/or outcome from sepsis. The disparate results observed in many studies of polymorphisms in sepsis emphasize the need for future studies to be larger, to include the analysis of multiple polymorphisms, and to be better designed with respect to control populations to identify the degree of influence that genetic variability has on sepsis.
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Affiliation(s)
- Mary K Dahmer
- Department of Molecular Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
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Elbahlawan LM, Stidham GL, Bugnitz MC, Storgion SA, Quasney MW. Severe systemic reaction to Loxosceles reclusa spider bites in a pediatric population. Pediatr Emerg Care 2005; 21:177-80. [PMID: 15744197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To report 6 children who had severe systemic reaction after spider bites requiring pediatric intensive care unit admission and to describe their clinical presentation, hospital course, and outcome. METHODS A retrospective analysis was done to identify patients presenting with brown recluse spider bites. Charts of children admitted to the intensive care unit were reviewed. RESULTS Six previously healthy African-American children, aged 3 to 15 years, with brown recluse spider bites were admitted to the pediatric intensive care unit. All had fever, jaundice, and evidence of hemolytic anemia. Four of 6 children had hypotension. One child developed mental status changes, acute renal failure secondary to rhabdomyolysis, and hyperkalemia and required emergent hemodialysis. All children fully recovered. CONCLUSION Although most cases of brown recluse spider bites are benign requiring no intervention, severe systemic reactions may occur in the pediatric population resulting in admission to the pediatric intensive care unit. These systemic reactions may include hemolytic anemia, hypotension, and renal failure.
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Affiliation(s)
- Lama M Elbahlawan
- Division of Critical Care, Department of Pediatrics, University of Tennessee, and the Children's Foundation of Memphis Research Center, Memphis, TN 38103, USA
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30
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Kazzi SNJ, Kim UO, Quasney MW, Buhimschi I. Polymorphism of tumor necrosis factor-alpha and risk and severity of bronchopulmonary dysplasia among very low birth weight infants. Pediatrics 2004; 114:e243-8. [PMID: 15286263 DOI: 10.1542/peds.114.2.e243] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm infants with bronchopulmonary dysplasia (BPD) exhibit prolonged elevation of inflammatory indices in their tracheal aspirates. Tumor necrosis factor-alpha (TNF-alpha) is a central mediator of the inflammatory response. The adenine-containing alleles of TNF-alpha-308 and lymphotoxin-alpha+250 have been associated with increased levels of TNF-alpha, whereas the adenine allele of TNF-alpha-238 produces lower levels of TNF-alpha after stimulation. High levels of TNF-alpha may promote chronic inflammation by overwhelming counter-regulatory mechanisms and may lead to the development of BPD. Low levels of TNF-alpha may decrease the risk and/or severity of BPD. OBJECTIVE To determine whether alleles of TNF-alpha play a role in the susceptibility and/or severity of BPD among very low birth weight infants. METHODS Infants with birth weights of < or =1250 g were included. Genotypic analyses (polymerase chain reaction-restriction fragment length polymorphism assays) were performed with DNA extracted from whole-blood samples. RESULTS Infants who developed BPD (fraction of inspired oxygen at postconceptional age of 36 weeks of >0.21, n = 51) had a younger gestational age (mean +/- SD: 27 +/- 4 vs 29 +/- 2 weeks) and lower birth weight (853 +/- 184 vs 997 +/- 193 g) than did infants without BPD (n = 69). The genotypic distributions of lymphotoxin-alpha+250 and TNF-alpha-308 were comparable among the groups of infants. However, the AA and GA TNF-alpha-238 genotypes were much less likely to occur among infants with BPD than among infants without BPD. The adenine allele of TNF-alpha-238 was absent among infants with severe BPD and occurred significantly less often among infants with moderate or severe BPD, compared with infants with mild BPD. The number of adenine alleles of TNF-alpha-238 was correlated inversely with the severity of BPD (r = -.341). CONCLUSION The adenine allele of TNF-alpha-238 may reduce the risk and severity of BPD.
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Affiliation(s)
- S Nadya J Kazzi
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Hutzel Women's Hospital, 4707 St Antoine, Detroit, Michigan 48201, USA.
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Kazzi SNJ, Jacques SM, Qureshi F, Quasney MW, Kim UO, Buhimschi IA. Tumor necrosis factor-alpha allele lymphotoxin-alpha+250 is associated with the presence and severity of placental inflammation among preterm births. Pediatr Res 2004; 56:94-8. [PMID: 15128916 DOI: 10.1203/01.pdr.0000130474.12948.a4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Histologic inflammation of placenta has been associated with increased risk for bronchopulmonary dysplasia and periventricular leukomalacia among preterm infants. Tumor necrosis factor-alpha (TNF-alpha) plays a central role in the regulation of inflammation. Some alleles of TNF (LT-alpha+250, TNF-alpha-308, and TNF-alpha-238) have been associated with susceptibility and/or severity of many diseases characterized by inflammation and/or involving the immune system. To determine whether alleles of TNF-alpha affect the risk and/or the severity of chorioamnionitis, we examined the placentas of 101 preterm births (birth weight <or=1250 g) for the presence of inflammation. Maternal and fetal chorioamnionitis (MCA and FCA, respectively) were graded for severity and staged for location of inflammatory infiltrate. Analysis for TNF-alpha alleles was done using PCR-restriction fragment length polymorphism technique on DNA extracted from infants' whole blood. MCA and FCA were seen in 45 and 38 placentas, respectively (p = 0.64). Genotypes of TNF-alpha-308 did not affect the development or the severity of placental inflammation. However, the AA genotype of LT-alpha+250 occurred more often when MCA and FCA were present compared with placentas without inflammation (p = 0.016 and p = 0.007, respectively). The GA genotype of TNF-alpha-238 was more common in placentas with severe MCA than with mild MCA (p = 0.015). The number of A alleles of LT-alpha+250 (GG = 0, GA = 1, AA = 2) correlated directly and significantly with grades and stages of MCA and FCA (p < 0.05). The AA genotype of LT-alpha+250 is associated with the development of chorioamnionitis among preterm births. The A allele of LT-alpha+250 seems to worsen the degree of placental inflammation.
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Affiliation(s)
- S Nadya J Kazzi
- Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA.
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Quasney MW, Waterer GW, Dahmer MK, Kron GK, Zhang Q, Kessler LA, Wunderink RG. Association between surfactant protein B + 1580 polymorphism and the risk of respiratory failure in adults with community-acquired pneumonia. Crit Care Med 2004; 32:1115-9. [PMID: 15190959 DOI: 10.1097/01.ccm.0000124872.55243.5a] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pulmonary surfactant protein (SP)-B plays a vital role in the formation and function of surfactant in the lung. A genetic polymorphism (SP-B + 1580) is postulated to result in diminished activity of SP-B. The objective was to determine whether the SP-B + 1580 CC genotype is associated with an increased risk of respiratory failure and ARDS in adults with community-acquired pneumonia. DESIGN Prospective cohort of adults diagnosed with community-acquired pneumonia. SETTING Hospital system. PATIENTS We enrolled 402 adults > or = 18 yrs of age with community-acquired pneumonia; 158 were white, 243 were African American, and one was Asian. INTERVENTIONS Genotypic analysis was performed on DNA isolated from whole blood using polymerase chain reaction amplification and DdeI restriction enzyme digestion. MEASUREMENTS AND MAIN RESULTS We recorded the requirement for mechanical ventilation, the presence of acute respiratory distress syndrome (ARDS) or septic shock, and mortality. Sixty-three patients required mechanical ventilation, 12 patients developed ARDS, and 35 patients developed septic shock. Genotypic frequencies at the SP-B + 1580 site were T/T 183 of 402 (0.45), T/C 160 of 402 (0.40), and C/C 59 of 402 (0.15). Of the 59 patients who were C/C at the SP-B + 1580 site, 21 (0.356) required mechanical ventilation, compared with 26 of 160 patients (0.163) who were T/C and 16 of 183 (0.087) patients who were T/T (p < .001). ARDS developed in five of 59 (0.085) patients with the C/C genotype, compared with six of 160 (.038) patients with T/C and one of 183 patients with T/T (0.005, p < .009). Septic shock occurred in 12 of 59 (0.203) patients with the C/C genotype, compared with 13 of 160 (0.081) patients with T/C and ten of 183 (0.055) patients with T/T (p < .001). Mortality rate was not different between the three genotypes. CONCLUSION Carriage of the C allele at the SP-B + 1580 site is associated with ARDS, septic shock, and the need for mechanical ventilation in adults with community-acquired pneumonia.
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Affiliation(s)
- Michael W Quasney
- Division of Critical Care, Department of Pediatrics, University of Tennessee, Memphis, Children's Foundation Research Center of Memphis, Le Bonheur Children's Medical Center, 50 N. Dunlap, Memphis, TN 38103, USA.
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Yende S, Quasney MW, Tolley EA, Wunderink RG. Clinical relevance of angiotensin-converting enzyme gene polymorphisms to predict risk of mechanical ventilation after coronary artery bypass graft surgery. Crit Care Med 2004; 32:922-7. [PMID: 15071379 DOI: 10.1097/01.ccm.0000119427.02721.85] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Prolonged mechanical ventilation is a significant complication after coronary artery bypass graft surgery. Angiotensin-converting enzyme mediates ischemia-reperfusion injury, which is an important mechanism of postcoronary artery bypass graft complications. An insertion/deletion polymorphism within the angiotensin-converting enzyme gene is associated with variable concentrations of angiotensin-converting enzyme. Whether this polymorphism is associated with prolonged mechanical ventilation is not known. The primary objective was to determine whether the insertion/deletion angiotensin-converting enzyme gene polymorphism is associated with prolonged mechanical ventilation. The release of inflammatory mediators and risk of prolonged mechanical ventilation are higher after conventional coronary artery bypass graft compared with off-pump coronary artery bypass graft. Therefore, we examined the risk of prolonged mechanical ventilation for angiotensin-converting enzyme genotypes in patients undergoing conventional coronary artery bypass graft and off-pump coronary artery bypass graft separately. Tumor necrosis factor down-regulates angiotensin-converting enzyme concentrations, and functional polymorphisms within the tumor necrosis factor gene have been associated previously with prolonged mechanical ventilation. Therefore, we examined interactions between these polymorphisms. DESIGN Prospective observational cohort study. SETTING Tertiary care center. SUBJECTS Patients who underwent coronary artery bypass graft (with or without valve replacement surgery). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We measured angiotensin-converting enzyme genotype and time to extubate. Patients with the DD and DI genotypes were at higher risk of prolonged mechanical ventilation compared with those with the II genotypes (hazard ratio = 2.2 and 1.6, respectively, p =.0005). Interactions were seen between the angiotensin-converting enzyme genotypes with surgical technique and with tumor necrosis factor-308/lymphotoxin + 250 GG haplotype for prolonged mechanical ventilation (p =.078 and.0003, respectively). The association was stronger for those undergoing conventional coronary artery bypass graft, whereas neither angiotensin-converting enzyme genotype conferred higher risk to those undergoing off-pump coronary artery bypass graft. CONCLUSIONS Angiotensin-converting enzyme gene polymorphisms are associated with respiratory complications postcardiopulmonary bypass. The increased risk associated with genotype may be amenable to alternative surgical technique or pharmacologic manipulation.
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Affiliation(s)
- Sachin Yende
- Physician Research Network (SY), Methodist Healthcare Memphis, Memphis, TN, USA
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Kurachek SC, Newth CJ, Quasney MW, Rice T, Sachdeva RC, Patel NR, Takano J, Easterling L, Scanlon M, Musa N, Brilli RJ, Wells D, Park GS, Penfil S, Bysani KG, Nares MA, Lowrie L, Billow M, Chiochetti E, Lindgren B, Scanlon M. Extubation failure in pediatric intensive care: A multiple-center study of risk factors and outcomes. Crit Care Med 2003; 31:2657-64. [PMID: 14605539 DOI: 10.1097/01.ccm.0000094228.90557.85] [Citation(s) in RCA: 174] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine a contemporary failed extubation rate, risk factors, and consequences of extubation failure in pediatric intensive care units (PICUs). Three hypotheses were investigated: a) Extubation failure is in part disease specific; b) preexisting respiratory conditions predispose to extubation failure; and c) admission acuity scoring does not affect extubation failure. DESIGN Twelve-month prospective, observational, clinical study. SETTING Sixteen diverse PICUs in the United States. PATIENTS Patients were 2,794 patients from the newborn period to 18 yrs of age experiencing a planned extubation trial. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A descriptive statistical analysis was performed, and outcome differences of the failed extubation population were determined. The extubation failure rate was 6.2% (174 of 2,794; 95% confidence interval, 5.3-7.1). Patient features associated with extubation failure (p <.05) included age < or =24 months; dysgenetic condition; syndromic condition; chronic respiratory disorder; chronic neurologic condition; medical or surgical airway condition; chronic noninvasive positive pressure ventilation; the need to replace the endotracheal tube on admission to the PICU; and the use of racemic epinephrine, steroids, helium-oxygen therapy (heliox), or noninvasive positive pressure ventilation within 24 hrs of extubation. Patients failing extubation had longer pre-extubation intubation time (failed, 148.7 hrs, SD +/- 207.8 vs. success, 107.9 hrs, SD +/- 171.3; p <.001), longer PICU length of stay (17.5 days, SD +/- 15.6 vs. 7.6 days, SD +/- 11.1; p <.001), and a higher mortality rate than patients not failing extubation (4.0% vs. 0.8%; p <.001). Failure was found to be in part disease specific, and preexisting respiratory conditions were found to predispose to failure whereas admission acuity did not. CONCLUSION A variety of patient features are associated with an increase in extubation failure rate, and serious outcome consequences characterize the extubation failure population in PICUs.
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Affiliation(s)
- Stephen C Kurachek
- University of Minnesota Department of Pediatrics and Childrens Hospitals and Clinics, Minneapolis, USA
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Senogles SE, Heimert TL, Odife ER, Quasney MW. A region of the third intracellular loop of the short form of the D2 dopamine receptor dictates Gi coupling specificity. J Biol Chem 2003; 279:1601-6. [PMID: 14581469 DOI: 10.1074/jbc.m309792200] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The D2 dopamine receptor has two isoforms, the short form (D2s receptor) and the long form (D2l receptor), which differ by the presence of a 29-amino acid insert in the third cytoplasmic loop. Both the D2s and D2l receptors have been shown to couple to members of the G alpha(i) family of G proteins, but whether each isoform couples to specific G alpha(i) protein(s) remains controversial. In previous studies using G alpha(i) mutants resistant to modification by pertussis toxin (G alpha(i)PT), we demonstrated that the D2s receptor couples selectively to G alpha(i2)PT and that the D2l receptor couples selectively to G alpha(i3)PT (Senogles, S. E. (1994) J. Biol. Chem. 269, 23120-23127). In this study, two point mutations of the D2s receptor were created by random mutagenesis (R233G and A234T). The two mutant D2s receptors demonstrated pharmacological characteristics comparable with those of the wild-type D2s receptor, with similar agonist and antagonist binding affinities. We used human embryonic kidney 293 cells stably transfected with G alpha(i1)PT, G alpha(i2)PT, or G alpha(i3)PT to measure agonist-mediated inhibition of forskolin-stimulated cAMP accumulation before and after pertussis toxin treatment. The two mutant D2s receptors demonstrated a change in G(i) coupling specificity compared with the wild-type D2s receptor. Whereas the wild-type D2s receptor coupled predominantly to G alpha(i2)PT, mutant R233G coupled preferentially to G alpha(i3)PT, and mutant A234T coupled preferentially to G alpha(i1)PT. These results suggest that this region of the third cytoplasmic loop is crucial for determining G(i) protein coupling specificity.
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Affiliation(s)
- Susan E Senogles
- Department of Molecular Sciences, College of Medicine, University of Tennessee Health Science Center, 858 Madison Avenue, Suite G01, Memphis, TN 38163, USA.
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Waterer GW, Buckingham SC, Kessler LA, Quasney MW, Wunderink RG. Decreasing beta-lactam resistance in Pneumococci from the Memphis region: analysis of 2,152 isolates From 1996 to 2001. Chest 2003; 124:519-25. [PMID: 12907537 DOI: 10.1378/chest.124.2.519] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The Memphis region historically has had high pneumococcal antibiotic resistance rates. In recent years, we have seen a significant shift in antibiotic use away from beta-lactams toward the newer quinolones and macrolides. We hypothesized that these changes would cause a shift in pneumococcal antibiotic resistance patterns. DESIGN Retrospective cohort study. SETTING A large private hospital system. PATIENTS AND METHODS We analyzed the antibiotic susceptibility patterns of 2,152 pneumococcal isolates obtained in the Memphis area from 1996 to 2001. Isolates were categorized as invasive or noninvasive and antibiotic resistance was classified according to the 2000 guidelines of the National Committee for Clinical Laboratory Standards. RESULTS Over the study period, the proportion of penicillin-susceptible noninvasive pneumococcal isolates taken from children increased from 22 to 44% (p = 0.0004 [for trend across the 6-year period]). In noninvasive isolates taken from adults, penicillin susceptibility increased from 22 to 55% (p = 0.002), with a trend toward increasing sensitivity to cefotaxime (p = 0.02) in noninvasive isolates over the same period. The proportion of isolates with high-level penicillin resistance (ie, minimum inhibitory concentration, > or = 4 microg/mL) also decreased between 1996 and 2001 (p = 0.003). Clindamycin resistance in adult noninvasive isolates also declined (p = 0.002). The only adverse trend observed over this period was an increase in erythromycin resistance in noninvasive isolates from adults (p = 0.01). Resistance rates were significantly higher in children than in adults and were higher in noninvasive isolates than in invasive isolates. CONCLUSIONS The stabilization of beta-lactam resistance rates in our region suggests that a continuous increase in pneumococcal resistance to antibiotics is not inevitable and may be avoidable.
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Affiliation(s)
- Grant W Waterer
- Department of Medicine, University of Western Australia, Crawley, Australia
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Waterer GW, ElBahlawan L, Quasney MW, Zhang Q, Kessler LA, Wunderink RG. Heat shock protein 70-2+1267 AA homozygotes have an increased risk of septic shock in adults with community-acquired pneumonia. Crit Care Med 2003; 31:1367-72. [PMID: 12771604 DOI: 10.1097/01.ccm.0000063088.86079.03] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Heat shock protein (HSP)70-2 is an important immunomodulatory protein induced in response to inflammatory stimuli. We assessed whether HSP70-2+1267 genotype influenced the risk of septic shock in a prospective cohort study of community-acquired pneumonia and whether HSP70-2+1267 genotype is a better predictor of septic shock than the genotype at lymphotoxin-alpha +250. DESIGN Prospective cohort study. SETTING A large, nonprofit, private hospital system in Memphis, TN. PATIENTS Adults admitted with community-acquired pneumonia between 1998 and 2001. Septic shock was defined according to consensus criteria (American College of Chest Physicians/Society of Critical Care Medicine, 1992). INTERVENTIONS Blood sampling. MEASUREMENTS AND MAIN RESULTS A total of 343 subjects were enrolled; 30 had septic shock. HSP70-2+1267 and lymphotoxin-alpha +250 genotype was determined using polymerase chain reaction and restriction enzyme digestion. HSP70-2+1267 AA genotype was the strongest predictor of septic shock (p =.0005; relative risk, 3.5). Lymphotoxin-alpha +250 AA genotype was also associated with an increased risk of septic shock (p =.002; relative risk, 2.7). Logistic regression analysis found only age (p =.04) and HSP70-2+1267 genotype (p =.006) were predictors of septic shock. The greatest risk of septic shock was associated with carriage of the HSP70-2+1267 A/lymphotoxin-alpha +250 A haplotype (p <.0001). CONCLUSIONS HSP70-2+1267 genotype is a stronger predictor of septic shock in patients with community-acquired pneumonia than lymphotoxin-alpha +250 genotype.
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Yende S, Wunderink RG, Quasney MW, Sandiford TJ, Shukla N, Zhang Q, Yates CR. Pro12Ala Polymorphism in PPARγ Is Associated With Lower Risk of Mechanical Ventilation After Coronary Artery Bypass Graft Surgery (CABG. Chest 2003. [DOI: 10.1378/chest.124.4_meetingabstracts.103s-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Yende S, Quasney MW, Tolley E, Zhang Q, Wunderink RG. Association of tumor necrosis factor gene polymorphisms and prolonged mechanical ventilation after coronary artery bypass surgery. Crit Care Med 2003; 31:133-40. [PMID: 12545006 DOI: 10.1097/00003246-200301000-00021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Prolonged mechanical ventilation is a common complication after coronary artery bypass graft surgery. Tumor necrosis factor alpha is an important proinflammatory mediator in the post-coronary artery bypass graft inflammatory cascade. We attempted to study the effect of polymorphisms at the -308 site in the promoter region of the tumor necrosis factor gene (TNF-308) and the +250 site within the lymphotoxin-alpha gene (LT alpha+250) on the risk of prolonged mechanical ventilation after coronary artery bypass grafting. DESIGN Prospective observational study. SETTING Tertiary care center. PATIENTS A total of 400 patients undergoing coronary artery bypass grafting were enrolled. MEASUREMENTS The primary end point was time to extubate. Secondary end points were the percentages of patients extubated at 8, 24, and 48 hrs; the length of intensive care unit and hospital stay; the need for a rehabilitation facility; and 30-day mortality. Precollected blood was used for gene analysis. Genotyping was performed by polymerase chain reaction and restriction enzyme digestion. MAIN RESULTS Patients with an AA genotype at the LT alpha+250 site and those without the LT alpha+250G/-308TNFG haplotype had a shorter duration of mechanical ventilation (11.5 vs. 27.8 hrs and 11.2 vs. 29.4 hrs; =.039 and.01, respectively). The risk of prolonged mechanical ventilation at 8, 24, and 48 hrs was higher for patients with a GA or GG genotype at the LT alpha+250 site and the LT alpha+250G/TNF-308G haplotype. This association between genotype and duration of mechanical ventilation was more dramatic in patients undergoing conventional coronary artery bypass grafting than in those undergoing off-pump coronary artery bypass grafting. With Bayesian analysis, clinical criteria and genotype can be used sequentially to predict the risk of prolonged mechanical ventilation. CONCLUSIONS The LT alpha+250 and LT alpha+250G/TNF-308G haplotypes are associated with prolonged mechanical ventilation after coronary artery bypass graft. Preoperative genetic screening may guide intraoperative management to reduce postoperative complications.
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Affiliation(s)
- Sachin Yende
- Methodist Healthcare University Hospital, Memphis, TN, USA
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McArthur JA, Zhang Q, Quasney MW. Association between the A/A genotype at the lymphotoxin-alpha+250 site and increased mortality in children with positive blood cultures. Pediatr Crit Care Med 2002; 3:341-4. [PMID: 12780951 DOI: 10.1097/00130478-200210000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tumor necrosis factor-alpha has been implicated in the hemodynamic manifestations of sepsis. Genetic polymorphisms located in the first intron of the lymphotoxin-alpha gene have been associated with increased secretion of tumor necrosis factor-alpha. We hypothesized that bacteremic children with the high secretor genotype, AA, have higher levels of tumor necrosis factor-alpha and a worse outcome. METHODS Genotypic analysis was performed in children with bacteremia using polymerase chain reaction amplification and restriction enzyme digestion. The serum tumor necrosis factor-alpha levels were measured by enzyme-linked immunosorbent assay technique. RESULTS Genotypic frequencies at the lymphotoxin-alpha+250 site were 11 of 34 (0.32) AA, 16 of 34 (0.47) GA, and 7 of 34 (0.21) GG. Serum tumor necrosis factor-alpha levels were 324 +/- 124 pg/mL in bacteremic children with the AA genotype at the lymphotoxin-alpha+250 site compared with 92 +/- 59 pg/mL in bacteremic children with the AG genotype (p < .001) and 92 +/- 21 pg/mL in bacteremic children with the GG genotype (p < .001). Eight of 11 bacteremic children with the AA genotype died compared with 3 of 16 bacteremic children with the GA genotype (p < .001) and zero of seven bacteremic children with the GG genotype (p < .001). CONCLUSION The AA genotype at the lymphotoxin-alpha+250 site is associated with higher serum tumor necrosis factor-alpha levels and a higher mortality in children with bacteremia.
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Santos NMD, Ault BH, Gharavi AG, Kritchevsky SB, Quasney MW, Jackson EC, Fisher KA, Woodford SY, Mitchell BL, Gaber LW, Arheart KL, Wyatt RJ. Angiotensin-converting enzyme genotype and outcome in pediatric IgA nephropathy. Pediatr Nephrol 2002; 17:496-502. [PMID: 12172761 DOI: 10.1007/s00467-002-0916-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2002] [Revised: 04/18/2002] [Accepted: 04/19/2002] [Indexed: 11/27/2022]
Abstract
Angiotensin-converting enzyme (ACE) I/D polymorphism has been implicated as a genetic marker for progression of glomerular disease. Studies of ACE genotypes in adults with IgA nephropathy (IgAN) have yielded conflicting results. We performed ACE genotyping on 79 patients with IgAN diagnosed prior to age 18 years who had either progressed to end-stage renal disease (ESRD) or are now more than 5 years post biopsy. Mean follow-up was 14.8 years for those with normal renal function. Forty-three (54.4%) subjects had normal renal function and a normal urinalysis at last evaluation. Sixteen (20%) progressed to ESRD and 1 has chronic renal insufficiency. Kaplan-Meier survival curves for progression to ESRD did not differ significantly for the ACE DD, ID, and II genotype groups (P=0.095, log-rank test). By univariate analysis, presence of hypertension and degree of proteinuria at diagnosis, and unfavorable histology but not ACE genotype, was significantly associated with progression to ESRD. In the Cox proportional hazards model that included grade of proteinuria, the ACE D allele was a significant independent predictor of outcome with a hazard ratio of 2.37 (P=0.031). Our data, while inconclusive, suggest that the ACE D allele may associate with poor outcome in pediatric IgAN.
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Affiliation(s)
- Noel M Delos Santos
- Children's Foundation Research Center at the Le Bonheur Children's Medical Center, University of Tennessee Health Sciences Center, Memphis, USA
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Quasney MW, Waterer GW, Dahmer MK, Turner D, Zhang Q, Cantor RM, Wunderink RG. Intracellular adhesion molecule Gly241Arg polymorphism has no impact on ARDS or septic shock in community-acquired pneumonia. Chest 2002; 121:85S-86S. [PMID: 11893710 DOI: 10.1378/chest.121.3_suppl.85s] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael W Quasney
- Department of Pediatrics, Crippled Children's Foundation Research Center, University of Tennessee, Memphis, 38103, USA
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Wunderink RG, Waterer GW, Cantor RM, Quasney MW. Tumor Necrosis Factor Gene Polymorphisms and the Variable Presentation and Outcome of Community-Acquired Pneumonia. Chest 2002. [DOI: 10.1016/s0012-3692(15)35491-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wunderink RG, Waterer GW, Cantor RM, Quasney MW. Tumor necrosis factor gene polymorphisms and the variable presentation and outcome of community-acquired pneumonia. Chest 2002; 121:87S. [PMID: 11893712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Affiliation(s)
- Richard G Wunderink
- Methodist Le Bonheur Healthcare Foundation, University of Tennessee, Memphis, TN, USA.
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Buckingham SC, Quasney MW, Bush AJ, DeVincenzo JP. Respiratory syncytial virus infections in the pediatric intensive care unit: clinical characteristics and risk factors for adverse outcomes. Pediatr Crit Care Med 2001; 2:318-23. [PMID: 12793934 DOI: 10.1097/00130478-200110000-00006] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of infants admitted to a pediatric intensive care unit (PICU) with respiratory syncytial virus (RSV) infection, including the prevalence of indications for RSV passive antibody prophylaxis (as currently recommended by the American Academy of Pediatrics), and to identify risk factors that predict adverse outcomes among this population. DESIGN Retrospective medical record review. SETTING Tertiary care PICU. PATIENTS Children <2 yrs of age admitted to PICU for the management of RSV disease during the 1994-95, 1995-96, and 1996-97 RSV seasons. MEASUREMENTS AND MAIN RESULTS The medical records of 89 infants were reviewed. Of these, 55% were born before 36-wks gestation, 14% had chronic lung disease that required medical therapy within the previous 6 months, and 30% met at least one indication for RSV passive antibody prophylaxis. Seven infants had congenital heart disease, five had upper airway abnormalities, and six had various noncardiac congenital malformations. Logistic regression was used to determine which characteristics were associated with prolonged durations (>75th percentile) of mechanical ventilation, PICU stay, and hospital stay. Prolonged mechanical ventilation was associated with congenital heart disease (p = 0.014), chronic lung disease (p = 0.007), and noncardiac congenital malformations (p = 0.022). Only congenital heart disease was associated with prolonged PICU stay (p = 0.004) or prolonged hospital stay (p = 0.006). All of the infants with airway abnormalities had prolonged ventilator days, PICU days, and hospital days. Currently recommended indications for RSV passive antibody prophylaxis were not predictive of prolonged ventilation, PICU stay, or hospital stay. CONCLUSIONS A minority of infants admitted to our PICU for severe RSV disease meet currently recommended indications for RSV passive antibody prophylaxis. Risk factors that predict prolonged durations of ventilation, PICU stay, or hospital stay among this population include congenital heart disease, chronic lung disease, upper airway abnormalities, and noncardiac congenital malformations.
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Affiliation(s)
- S C Buckingham
- Department of Pediatrics, Division of Infectious Disease, University of Tennessee Health Science Center and Le Bonheur Children's Medical Center, Memphis, Tennessee 38103, USA.
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Quasney MW, Zhang Q, Sargent S, Mynatt M, Glass J, McArthur J. Increased frequency of the tumor necrosis factor-alpha-308 A allele in adults with human immunodeficiency virus dementia. Ann Neurol 2001; 50:157-62. [PMID: 11506397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Genetic polymorphisms in the regulatory regions of various cytokine genes influence the amount of cytokine produced in response to inflammatory stimuli. To determine whether such polymorphisms might play a role in human immunodeficiency virus (HIV) dementia, a disease process in which tumor necrosis factor (TNF)-alpha is believed to play a role, we analyzed HIV-infected adults with and without dementia and control populations for a polymorphic site located in the promoter region of the gene coding for TNF-alpha. The presence of the A allele at the TNF-alpha-308 site was overrepresented among adults with HIV dementia compared to those without dementia (0.28 vs 0.07; OR 5.5; 95% CI 1.8-17.0) and a healthy control population (0.28 vs 0.11). The increased frequency of the A allele in HlV-infected adults with dementia suggests that this locus may play a role in the pathophysiology of dementia and suggests a genetic predisposition for the development of HIV dementia.
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Affiliation(s)
- M W Quasney
- Department of Pediatrics, University of Tennessee, Memphis, USA.
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Waterer GW, Quasney MW, Cantor RM, Wunderink RG. Septic shock and respiratory failure in community-acquired pneumonia have different TNF polymorphism associations. Am J Respir Crit Care Med 2001; 163:1599-604. [PMID: 11401880 DOI: 10.1164/ajrccm.163.7.2011088] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Genetic factors are likely to contribute to the variable presentation of community-acquired pneumonia (CAP). The purpose of this prospective cohort study was to determine whether the LTalpha+250 (TNFbeta+250) and TNFalpha-308 gene polymorphisms are associated with different presentations of CAP. Septic shock (SS) was defined using American College of Chest Physicians/Society of Critical Care Medicine (ACCP-SCCM) criteria. Type I respiratory failure (T1RF) was defined as an O(2) saturation on room air of < 90% with a normal PCO(2). A total of 280 patients were genotyped; 31 had SS, 80 had T1RF. Genotype proportions are given in the order of AA/GA/ GG. The proportion of patients in each genotype developing SS was as follows: LTalpha+250 0.19/0.07/0.09 (p = 0.01 AA versus non-AA); TNFalpha-308 0.16/0.06/0.12 (p = NS). Carrying at least one AA (tumor necrosis factor [TNF] high secretor) genotype had an 18.0% risk of SS versus 6.8% (p = 0.006). GG homozygotes (TNF low secretors) at both loci had only a 2.9% risk of SS. Septic shock was associated with the LTalpha+250:TNFalpha-308 A:G haplotype but not the A:A haplotype, suggesting that LTalpha+250 is a marker, rather than a causative polymorphism. Carriage of the G:G haplotype had a significant protective effect against the development of septic shock (p = 0.011). T1RF was not associated with LTalpha+250 AA genotype. In the absence of septic shock, there was a significant trend to greater T1RF in patients with LTalpha+250 GG (TNFalpha hyposecretor) genotype (p = 0.03). Our finding of different genotype associations for SS and T1RF has important implications for immunotherapy in both CAP and sepsis, as well as for the definition of the systemic inflammatory response syndrome (SIRS).
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Affiliation(s)
- G W Waterer
- Department of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Australia
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Quasney MW, Bronstein DE, Cantor RM, Zhang Q, Stroupe C, Shike H, Bastian JF, Matsubara T, Fujiwara M, Akimoto K, Newburger JW, Burns JC. Increased frequency of alleles associated with elevated tumor necrosis factor-alpha levels in children with Kawasaki disease. Pediatr Res 2001; 49:686-90. [PMID: 11328953 DOI: 10.1203/00006450-200105000-00013] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Genetic polymorphisms influence the magnitude of the cytokine response after an inflammatory stimulus. To determine whether such polymorphisms might play a role in Kawasaki disease (KD), we analyzed white and Japanese children with KD and control populations for two polymorphic loci in which the A allele is associated with high tumor necrosis factor-alpha secretion. The lymphotoxin-alpha+250 A/A genotype was overrepresented among white children with KD compared with controls (0.59 versus 0.36; p = 0.013). The tumor necrosis factor-alpha-308 A/G genotype was overrepresented among whites with KD who had coronary artery abnormalities compared with those with normal echocardiograms (0.36 versus 0.09; p = 0.044). No significant difference was seen at either locus between Japanese children with KD and Japanese controls. The increased frequency of the high secretor alleles in white children with KD suggests that these loci may be related to susceptibility to KD and to outcome after disease.
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Affiliation(s)
- M W Quasney
- Division of Critical Care, Department of Pediatrics, Crippled Children's Foundation Research Center, LeBonheur Children's Medical Center, University of Tennessee, Memphis, Tennessee 38103, USA.
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Quasney MW, Goodman DM, Billow M, Chiu H, Easterling L, Frankel L, Habib D, Heitschmidt M, Kurachek S, Moler F, Montgomery V, Moss M, Murman S, Rice T, Richman B, Tilden S. Routine chest radiographs in pediatric intensive care units. Pediatrics 2001; 107:241-8. [PMID: 11158453 DOI: 10.1542/peds.107.2.241] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine whether interventions were performed based on portable routine morning chest x-rays (CXRs) in pediatric intensive care unit (PICU) patients and to identify patient subgroups for whom the routine CXR is most useful. DESIGN Prospective multiinstitutional study. Setting. PICUs of 15 tertiary care hospitals. Patients. PICU patients who received a routine morning CXR were included in the study. OUTCOME MEASURES Recorded data included: weight, diagnosis, presence of active cardiopulmonary problems, length of stay, and number and type of devices. The number and types of interventions based on the interpretation of the CXR were recorded. RESULTS Five hundred twelve routine CXRs were evaluated. The majority of the routine chest radiographs were obtained on patients who were admitted for cardiovascular disease (195/512; 38%) or respiratory failure (186/512; 36%), and 465/512 of the routine CXRs (91%) were performed on patients with one or more devices. Two hundred thirty-one of the 512 routine CXRs (45%) resulted in 1 or more interventions. One hundred fifty-five of the 284 routine CXRs (55%) obtained in children </=10 kg resulted in one or more interventions, compared with 61/152 (40%) and 15/76 (20%) of routine CXRs obtained in children 10 to 40 kg and >/=40 kg, respectively. The frequency of interventions increased from 19% in children with no devices to >50% in children with 2 or more devices. One or more interventions were performed in 27% of routine CXRs when no active cardiopulmonary problems were present, compared with 51% of routine CXRs when active cardiopulmonary problems were present. Diagnosis and length of intensive care unit stay at the time the routine CXR was obtained did not affect the percentage of CXRs that resulted in interventions. CONCLUSIONS Routine CXRs are more likely to result in interventions in the smaller, critically ill child with one or more devices and if active cardiopulmonary problems are present.
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Affiliation(s)
- M W Quasney
- Department of Pediatrics, Crippled Children's Foundation Research Center, Le Bonheur Children's Medical Center, University of Tennessee, Memphis, Tennessee 38103, USA.
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Quasney MW, Zhang Q, Sargent S, Mynatt M, Glass J, McArthur J. Increased frequency of the tumor necrosis factor-?-308 a allele in adults with human immunodeficiency virus dementia. Ann Neurol 2001. [DOI: 10.1002/ana.1284] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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