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Mannina C, Kini A, Carbone A, Neibart E, Bossone E, Prandi FR, Tadros R, Esposito G, Erbel R, Sharma SK, Lerakis S. Management of Systemic Inflammatory Response Syndrome after Cardiovascular Interventions. Diagnostic, Prognostic and Therapeutic Implications. Am J Cardiol 2024:S0002-9149(24)00270-4. [PMID: 38649128 DOI: 10.1016/j.amjcard.2024.04.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
A substantial number of patients may experience a systemic inflammatory response syndrome (SIRS) and related adverse events after transcatheter aortic valve implantation and endovascular aortic aneurysm repair. Although a clear etiology has not been established, endothelial disruption and tissue-ischemic response secondary to the foreign material may represent the trigger events. A latency period (0-48 hours) may occur between the initial injury and onset of symptoms mirroring an initial local response followed by a systemic response. Clinical presentation can be mild or severe depending on external triggers and patient's characteristics. Diagnosis is challenging because it simulates an infection, but lack of response to antibiotics, negative cultures are supportive of SIRS. Increased in-hospital stay, readmissions, major cardiovascular events, and reduced durability of the device used are the main complications. Treatment includes non-steroidal anti-inflammatory drugs or corticosteroids. In conclusion, further studies are warranted to fully explore pathophysiologic mechanisms underpinning SIRS as well as the possibility to enhance device material immune compatibility in order to reduce the host tissue's inflammatory reaction.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Andreina Carbone
- Unit of Cardiology, University Hospital "Luigi Vanvitelli", Naples, Italy; Department of Public Health, Federico II University, Naples, Italy
| | - Eric Neibart
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Eduardo Bossone
- Department of Public Health, Federico II University, Naples, Italy
| | - Francesca Romana Prandi
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Rami Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Fuster Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York.
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Duan M, Cao L, Lu M, Zhang T, Ji Q, Guo X, Guo Z, Wu Q, Liu Y, Gong J, Zhu W, Li Y. Prophylactic Intra-abdominal Drainage is Associated With Lower Postoperative Complications in Patients With Crohn's Disease: A Randomized Controlled Trial. Surg Innov 2024; 31:157-166. [PMID: 38339842 DOI: 10.1177/15533506241232598] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Prophylactic intraoperative drains have been shown not superior for patients underwent intestinal surgery. However, for patients with Crohn's disease (CD), this needs further exploration. METHODS In this pilot study, CD patients were randomly assigned to drain (n = 50) and no-drain (n = 50) groups. The primary endpoint was the rate of postoperative prolonged ileus (PPOI). The secondary endpoints were postoperative abdominal ascites, postoperative systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) levels. RESULTS The incidences of PPOI and postoperative abdominal ascites were significantly lower in the drain group (12% vs 44%; 0% vs 24%, both P < .05). Postoperative SIRS incidence and CRP levels were significantly increased in the no-drain group [36% vs 10%; 54.9 vs 34.3 mg/L, both P < .05]. In multivariate analysis, prophylactic drainage was the independent protective factor for PPOI and postoperative LOS. CONCLUSIONS Prophylactic drainage may be associated with improved clinical outcomes in CD patients.
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Affiliation(s)
- Ming Duan
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lei Cao
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Mengjie Lu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tenghui Zhang
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Ji
- Department of Anesthesiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing, China
| | - Xian Guo
- Department of Anesthesiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing, China
| | - Zhen Guo
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qiong Wu
- Department of Scientific Research and Training, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing, China
| | - Yuxiu Liu
- Data and Statistics Division, Department of Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yi Li
- Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Prasad PA, Esmaili AM, Oreper S, Beagle AJ, Hubbard C, Raffel KE, Abe‐Jones Y, Fang MC, Liu KD, Matthay MA, Kangelaris KN. Timing of antibiotic treatment identifies distinct clinical presentations among patients presenting with suspected septic shock. J Am Coll Emerg Physicians Open 2024; 5:e13149. [PMID: 38596320 PMCID: PMC11002635 DOI: 10.1002/emp2.13149] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/11/2024] Open
Abstract
Objective Recent clinical guidelines for sepsis management emphasize immediate antibiotic initiation for suspected septic shock. Though hypotension is a high-risk marker of sepsis severity, prior studies have not considered the precise timing of hypotension in relation to antibiotic initiation and how clinical characteristics and outcomes may differ. Our objective was to evaluate antibiotic initiation in relation to hypotension to characterize differences in sepsis presentation and outcomes in patients with suspected septic shock. Methods Adults presenting to the emergency department (ED) June 2012-December 2018 diagnosed with sepsis (Sepsis-III electronic health record [EHR] criteria) and hypotension (non-resolving for ≥30 min, systolic blood pressure <90 mmHg) within 24 h. We categorized patients who received antibiotics before hypotension ("early"), 0-60 min after ("immediate"), and >60 min after ("late") treatment. Results Among 2219 patients, 55% received early treatment, 13% immediate, and 32% late. The late subgroup often presented to the ED with hypotension (median 0 min) but received antibiotics a median of 191 min post-ED presentation. Clinical characteristics notable for this subgroup included higher prevalence of heart failure and liver disease (p < 0.05) and later onset of systemic inflammatory response syndrome (SIRS) criteria compared to early/immediate treatment subgroups (median 87 vs. 35 vs. 20 min, p < 0.0001). After adjustment, there was no difference in clinical outcomes among treatment subgroups. Conclusions There was significant heterogeneity in presentation and timing of antibiotic initiation for suspected septic shock. Patients with later treatment commonly had hypotension on presentation, had more hypotension-associated comorbidities, and developed overt markers of infection (eg, SIRS) later. While these factors likely contribute to delays in clinician recognition of suspected septic shock, it may not impact sepsis outcomes.
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Affiliation(s)
- Priya A. Prasad
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Armond M. Esmaili
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Sandra Oreper
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Colin Hubbard
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Katie E. Raffel
- Division of Hospital MedicineSchool of MedicineUniversity of ColoradoDenverColoradoUSA
| | - Yumiko Abe‐Jones
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Margaret C. Fang
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kathleen D. Liu
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Division of NephrologyDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michael A. Matthay
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Cardiovascular Research InstituteUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kirsten N. Kangelaris
- Division of Hospital MedicineDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Cortellini S, DeClue AE, Giunti M, Goggs R, Hopper K, Menard JM, Rabelo RC, Rozanski EA, Sharp CR, Silverstein DC, Sinnott-Stutzman V, Stanzani G. Defining sepsis in small animals. J Vet Emerg Crit Care (San Antonio) 2024; 34:97-109. [PMID: 38351524 DOI: 10.1111/vec.13359] [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] [Received: 10/23/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To discuss the definitions of sepsis in human and veterinary medicine. DESIGN International, multicenter position statement on the need for consensus definitions of sepsis in veterinary medicine. SETTING Veterinary private practice and university teaching hospitals. ANIMALS Dogs and cats. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sepsis is a life-threatening condition associated with the body's response to an infection. In human medicine, sepsis has been defined by consensus on 3 occasions, most recently in 2016. In veterinary medicine, there is little uniformity in how sepsis is defined and no consensus on how to identify it clinically. Most publications rely on modified criteria derived from the 1991 and 2001 human consensus definitions. There is a divergence between the human and veterinary descriptions of sepsis and no consensus on how to diagnose the syndrome. This impedes research, hampers the translation of pathophysiology insights to the clinic, and limits our abilities to optimize patient care. It may be time to formally define sepsis in veterinary medicine to help the field move forward. In this narrative review, we present a synopsis of prior attempts to define sepsis in human and veterinary medicine, discuss developments in our understanding, and highlight some criticisms and shortcomings of existing schemes. CONCLUSIONS This review is intended to serve as the foundation of current efforts to establish a consensus definition for sepsis in small animals and ultimately generate evidence-based criteria for its recognition in veterinary clinical practice.
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Affiliation(s)
- Stefano Cortellini
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, UK
| | - Amy E DeClue
- Fetch Specialty and Emergency Veterinary Center, Greenville, South Carolina, USA
| | - Massimo Giunti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Robert Goggs
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Julie M Menard
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Elizabeth A Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
| | - Deborah C Silverstein
- Department of Clinical Studies and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Clarkin-Breslin RC, Brainard BM. Point-of-care and traditional erythrocyte sedimentation rate, point-of-care rheometry, and cell-free DNA concentration in dogs with or without systemic inflammation. J Vet Diagn Invest 2024; 36:177-186. [PMID: 38372154 DOI: 10.1177/10406387241226971] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
RBC aggregation and deformability characteristics are altered by inflammatory, microcirculatory, and hemorheologic disease. These changes can be indirectly evaluated using the erythrocyte sedimentation rate (ESR). Newer point-of-care devices employ syllectometry to evaluate RBC rheology, which can give information beyond the ESR. We evaluated 2 point-of-care rheometers (iSED and MIZAR; Alcor Scientific) in 52 dogs presented to a university teaching hospital. Whole blood samples were analyzed for correlation between the ESR using the Westergren (ESRw) method (measured at 1 h and 24 h) and the predicted ESR using iSED. Plasma fibrinogen and cell-free DNA concentrations were also measured as probable markers of inflammation. The iSED-predicted ESR was positively correlated to the ESRw method at 1 h (r = 0.74; p < 0.001) and 24 h (r = 0.62; p < 0.001). Comparing dogs with or without inflammation (defined as plasma fibrinogen concentration >3.5 g/L [350 mg/dL]), significant differences were seen in the MIZAR parameters of base point, amplitude, integral, and half-time. Median cell-free DNA concentrations were higher in the group of dogs with inflammation (117 [range: 51-266] ng/mL vs. 82.7 [range: 19-206] ng/mL; p = 0.024). The iSED-predicted ESR is a good predictor of the ESRw and was obtained more rapidly. Rheometric parameters measured by MIZAR may be useful in detecting inflammation and monitoring secondary morphologic and functional changes in canine RBCs.
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Affiliation(s)
- Rachel C Clarkin-Breslin
- Department of Small Animal Medicine and Surgery, University of Georgia Veterinary Teaching Hospital, Athens, GA, USA
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia Veterinary Teaching Hospital, Athens, GA, USA
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Schlapbach LJ, Goertz S, Hagenbuch N, Aubert B, Papis S, Giannoni E, Posfay-Barbe KM, Stocker M, Heininger U, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Aebi C, Berger C, Agyeman PKA. Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Pediatr Crit Care Med 2024; 25:e117-e128. [PMID: 37878412 PMCID: PMC10904004 DOI: 10.1097/pcc.0000000000003388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/27/2023]
Abstract
OBJECTIVES Previous studies applying Sepsis-3 criteria to children were based on retrospective analyses of PICU cohorts. We aimed to compare organ dysfunction criteria in children with blood culture-proven sepsis, including emergency department, PICU, and ward patients, and to assess relevance of organ dysfunctions for mortality prediction. DESIGN We have carried out a nonprespecified, secondary analysis of a prospective dataset collected from September 2011 to December 2015. SETTING Emergency departments, wards, and PICUs in 10 tertiary children's hospitals in Switzerland. PATIENTS Children younger than 17 years old with blood culture-proven sepsis. We excluded preterm infants and term infants younger than 7 days old. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We compared the 2005 International Pediatric Sepsis Consensus Conference (IPSCC), Pediatric Logistic Organ Dysfunction-2 (PELOD-2), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Organ Dysfunction Information Update Mandate (PODIUM) scores, measured at blood culture sampling, to predict 30-day mortality. We analyzed 877 sepsis episodes in 807 children, with a 30-day mortality of 4.3%. Percentage with organ dysfunction ranged from 32.7% (IPSCC) to 55.3% (pSOFA). In adjusted analyses, the accuracy for identification of 30-day mortality was area under the curve (AUC) 0.87 (95% CI, 0.82-0.92) for IPSCC, 0.83 (0.76-0.89) for PELOD-2, 0.85 (0.78-0.92) for pSOFA, and 0.85 (0.78-0.91) for PODIUM. When restricting scores to neurologic, respiratory, and cardiovascular dysfunction, the adjusted AUC was 0.89 (0.84-0.94) for IPSCC, 0.85 (0.79-0.91) for PELOD-2, 0.87 (0.81-0.93) for pSOFA, and 0.88 (0.83-0.93) for PODIUM. CONCLUSIONS IPSCC, PELOD-2, pSOFA, and PODIUM performed similarly to predict 30-day mortality. Simplified scores restricted to neurologic, respiratory, and cardiovascular dysfunction yielded comparable performance.
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Affiliation(s)
- Luregn J Schlapbach
- Department of Intensive Care and Neonatology, and Children`s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Sabrina Goertz
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Niels Hagenbuch
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Blandine Aubert
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sebastien Papis
- Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, Children's Hospital of Geneva, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, Children's Hospital of Geneva, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | | | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University Children's Hospital Basel, Basel, Switzerland
| | | | | | | | | | - Christa Relly
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Martin KR, Gamell C, Tai TY, Bonelli R, Hansen J, Tatoulis J, Alhamdoosh M, Wilson N, Wicks I. Whole blood transcriptomics reveals granulocyte colony-stimulating factor as a mediator of cardiopulmonary bypass-induced systemic inflammatory response syndrome. Clin Transl Immunology 2024; 13:e1490. [PMID: 38375330 PMCID: PMC10875393 DOI: 10.1002/cti2.1490] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Objectives Systemic inflammatory response syndrome (SIRS) is a frequent complication of cardiopulmonary bypass (CPB). SIRS is associated with significant morbidity and mortality, but its pathogenesis remains incompletely understood, and as a result, biomarkers are lacking and treatment remains expectant and supportive. This study aimed to understand the pathophysiological mechanisms driving SIRS induced by CPB and identify novel therapeutic targets that might reduce systemic inflammation and improve patient outcomes. Methods Twenty-one patients undergoing cardiac surgery and CPB were recruited, and blood was sampled before, during and after surgery. SIRS was defined using the American College of Chest Physicians/Society of Critical Care Medicine criteria. We performed immune cell profiling and whole blood transcriptomics and measured individual mediators in plasma/serum to characterise SIRS induced by CPB. Results Nineteen patients fulfilled criteria for SIRS, with a mean duration of 2.7 days. Neutrophil numbers rose rapidly with CPB and remained elevated for at least 48 h afterwards. Transcriptional signatures associated with neutrophil activation and degranulation were enriched during CPB. We identified a network of cytokines governing these transcriptional changes, including granulocyte colony-stimulating factor (G-CSF), a regulator of neutrophil production and function. Conclusions We identified neutrophils and G-CSF as major regulators of CPB-induced systemic inflammation. Short-term targeting of G-CSF could provide a novel therapeutic strategy to limit neutrophil-mediated inflammation and tissue damage in SIRS induced by CPB.
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Affiliation(s)
- Katherine R Martin
- WEHIParkvilleVICAustralia
- Department of Medical BiologyUniversity of MelbourneParkvilleVICAustralia
| | | | - Tsin Yee Tai
- WEHIParkvilleVICAustralia
- CSL Innovation, Bio21 InstituteParkvilleVICAustralia
| | - Roberto Bonelli
- WEHIParkvilleVICAustralia
- Department of Medical BiologyUniversity of MelbourneParkvilleVICAustralia
- CSL Innovation, Bio21 InstituteParkvilleVICAustralia
| | | | - James Tatoulis
- Cardiothoracic SurgeryRoyal Melbourne HospitalParkvilleVICAustralia
- Department of SurgeryUniversity of MelbourneParkvilleVICAustralia
| | | | | | - Ian Wicks
- WEHIParkvilleVICAustralia
- Department of Medical BiologyUniversity of MelbourneParkvilleVICAustralia
- Department of RheumatologyRoyal Melbourne HospitalParkvilleVICAustralia
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Yao C, Kong J, Xu F, Wang S, Wu S, Sun W, Gao J. Heme-Inducing Endothelial Pyroptosis Plays a Key Role in Radiofrequency Ablation of Hepatic Hemangioma Leading to Systemic Inflammatory Response Syndrome. J Inflamm Res 2024; 17:371-385. [PMID: 38260812 PMCID: PMC10802182 DOI: 10.2147/jir.s435486] [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] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Systemic inflammatory response syndrome (SIRS) is a common complication of radiofrequency ablation (RFA) for hepatic hemangiomas. RFA can cause hemolytic reactions during hepatic hemangioma ablation. However, the mechanisms underlying RFA-induced SIRS remain unclear. Methods We established an orthotopic liver hemangioma model and performed radiofrequency ablation. The levels of interleukin (IL)-1β and IL-18 and the production of ROS were measured. The wet-to-dry lung ratio, inflammation score, and in vivo endothelial cell permeability were examined. GSDMD-/- mice were used to investigate the effect of heme-inducing SIRS. RNA sequencing (RNA-seq) was performed to identify the main pathways underlying heme-induced SIRS. Western blotting and immunoprecipitation were used to determine the changes and interactions of associated proteins. Results The levels of heme, IL-1β, and IL-18 were significantly increased after RFA. The wet-to-dry lung ratio increased in hepatic hemangiomas after RFA, indicating that SIRS occurred. Heme induced increased levels of IL-1β and IL-18, cell death, wet-to-dry lung radio, and inflammation score in vitro and in vivo, indicating that heme induced SIRS and pyroptosis. Furthermore, GSDMD participates in heme-induced SIRS in mice, and GSDMD deletion in mice reverses the effect of heme. Heme regulates NLRP3 activation through the NOX4/ROS/TXNIP-TRX pathway, and an N-acetyl-L-cysteine (NAC) or NOX4 inhibitor (GLX351322) reverses heme-induced SIRS. Conclusion Our findings suggest that heme induces endothelial cell pyroptosis and SIRS in mice and decreasing heme levels and ROS scavengers may prevent SIRS in hepatic hemangioma after RFA.
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Affiliation(s)
- Changyu Yao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Jian Kong
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Fei Xu
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Shaohong Wang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Shilun Wu
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Wenbing Sun
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
| | - Jun Gao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People’s Republic of China
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Papareddy P, Selle M, Partouche N, Legros V, Rieu B, Olinder J, Ryden C, Bartakova E, Holub M, Jung K, Pottecher J, Herwald H. Identifying biomarkers deciphering sepsis from trauma-induced sterile inflammation and trauma-induced sepsis. Front Immunol 2024; 14:1310271. [PMID: 38283341 PMCID: PMC10820703 DOI: 10.3389/fimmu.2023.1310271] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
Objective The purpose of this study was to identify a panel of biomarkers for distinguishing early stage sepsis patients from non-infected trauma patients. Background Accurate differentiation between trauma-induced sterile inflammation and real infective sepsis poses a complex life-threatening medical challenge because of their common symptoms albeit diverging clinical implications, namely different therapies. The timely and accurate identification of sepsis in trauma patients is therefore vital to ensure prompt and tailored medical interventions (provision of adequate antimicrobial agents and if possible eradication of infective foci) that can ultimately lead to improved therapeutic management and patient outcome. The adequate withholding of antimicrobials in trauma patients without sepsis is also important in aspects of both patient and environmental perspective. Methods In this proof-of-concept study, we employed advanced technologies, including Matrix-Assisted Laser Desorption/Ionization (MALDI) and multiplex antibody arrays (MAA) to identify a panel of biomarkers distinguishing actual sepsis from trauma-induced sterile inflammation. Results By comparing patient groups (controls, infected and non-infected trauma and septic shock patients under mechanical ventilation) at different time points, we uncovered distinct protein patterns associated with early trauma-induced sterile inflammation on the one hand and sepsis on the other hand. SYT13 and IL1F10 emerged as potential early sepsis biomarkers, while reduced levels of A2M were indicative of both trauma-induced inflammation and sepsis conditions. Additionally, higher levels of TREM1 were associated at a later stage in trauma patients. Furthermore, enrichment analyses revealed differences in the inflammatory response between trauma-induced inflammation and sepsis, with proteins related to complement and coagulation cascades being elevated whereas proteins relevant to focal adhesion were diminished in sepsis. Conclusions Our findings, therefore, suggest that a combination of biomarkers is needed for the development of novel diagnostic approaches deciphering trauma-induced sterile inflammation from actual infective sepsis.
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Affiliation(s)
- Praveen Papareddy
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Michael Selle
- Genomics and Bioinformatics of Infectious Diseases, Institute for Animal Genomics, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Nicolas Partouche
- Hôpitaux Universitaires de Strasbourg, Service d’Anesthésie-Réanimation & Médecine Péri-opératoire - Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Vincent Legros
- Département d’Anesthésie-Réanimation et Médecine Peri-Operatoire, Centre Hospitalier et Universitaire (CHU) de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Benjamin Rieu
- Réanimation Médico-Chirurgicale, Trauma Center, Pôle Médecine Péri-Opératoire, Centre Hospitalier et Universitaire (CHU) de Clermont-Ferrand, Clermont Ferrand, France
| | - Jon Olinder
- Division of Infection Medicine, Helsingborg Hospital and Department of Clinical Sciences Helsingborg, Lund University, Helsingborg, Sweden
| | - Cecilia Ryden
- Division of Infection Medicine, Helsingborg Hospital and Department of Clinical Sciences Helsingborg, Lund University, Helsingborg, Sweden
| | - Eva Bartakova
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czechia
| | - Michal Holub
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czechia
| | - Klaus Jung
- Genomics and Bioinformatics of Infectious Diseases, Institute for Animal Genomics, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Julien Pottecher
- Hôpitaux Universitaires de Strasbourg, Service d’Anesthésie-Réanimation & Médecine Péri-opératoire - Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Heiko Herwald
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
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Peng L, Gan Q, Xiao Y, He J, Cheng X, Wang P, Chen L, Li T, He Y, Chong W, Hai Y, You C, Fang F, Zhang Y. Postoperative systemic inflammatory response syndrome predicts increased mortality in patients after elective craniotomy. Front Surg 2024; 10:1331073. [PMID: 38239666 PMCID: PMC10794578 DOI: 10.3389/fsurg.2023.1331073] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Patients undergoing craniotomy are at high risk of perioperative morbidity and mortality due to excessive inflammatory responses. The purpose of the present study is to evaluate the prognostic utility of postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing craniotomy. Methods We performed a retrospective cohort study of patients who underwent craniotomy between January 2011 and March 2021. SIRS was diagnosed based on two or more criteria (hypo-/hyperthermia, tachypnea, leukopenia/leukocytosis, tachycardia). We used univariate and multivariate analysis for the development of SIRS with postoperative 30-day mortality. Results Of 12,887 patients who underwent craniotomy, more than half of the patients (n = 6,725; 52.2%) developed SIRS within the first 7 days after surgery, and 157 (1.22%) patients died within 30 days after surgery. In multivariable analyses, SIRS (OR, 1.57; 95% CI, 1.12-2.21) was associated with 30-day mortality. Early SIRS was not predictive of 30-day mortality, whereas delayed SIRS was predictive of 30-day mortality. Abnormal white blood cell (WBC) counts contributed the most to the SIRS score, followed by abnormal body temperature, respiratory rate, and heart rate. Conclusion Postoperative SIRS commonly occurs after craniotomy and is an independent predictor of postoperative 30-day mortality. This association was seen only in delayed SIRS but not early SIRS. Moreover, increased WBC counts contributed the most to the SIRS score.
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Affiliation(s)
- Liyuan Peng
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Qi Gan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peng Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Tiangui Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan He
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Yang Hai
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Center for Evidence Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
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11
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McConnell ZA, Patel KM, Mears SC, Stronach BM, Barnes CL, Stambough JB. Systemic Inflammatory Response Syndrome and Prosthetic Joint Infection. J Arthroplasty 2024; 39:236-241. [PMID: 37531981 DOI: 10.1016/j.arth.2023.07.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The development of systemic inflammatory response syndrome (SIRS) criteria leads to increased mortality. Little is known about development of SIRS in patients who have prosthetic joint infection (PJI). We aimed to determine the incidence, risk factors, clinical outcomes, and causative organisms in patients who develop SIRS with PJI. METHODS We retrospectively identified 655 patients (321 men, 334 women; 382 total hip, 273 total knee) who have hip or knee PJI at 1 institution between July 1, 2015 and December 31, 2020. We formed 2 groups: patients who have SIRS alert (PJI + SIRS) and patients who do not have SIRS alert (PJI). We analyzed clinical outcomes, comorbidities, and operating room culture results. RESULTS Of 655 patients, 63 developed SIRS with PJI (9.6%). Intensive care unit (ICU) admission rates (27.0 versus. 6.9%, P < .001) and length of stay (7.7 versus. 5.6 days, P = .003) were greater in PJI + SIRS. At 2 years, reoperation (36.5 versus. 22.3%, P = .01) and mortality rates (17.5 versus. 8.8%, P = .03) were greater in PJI + SIRS. Risk factors included deficiency anemia (P = .001), blood loss anemia (P = .013), uncomplicated diabetes (P = .006), diabetes with complication (P = .001), electrolyte disorder (P < .00001), neurological disorder (P = .0001), paralysis (P = .026), renal failure (P = .005), and peptic ulcer disease (P = .004). Staphylococcus aureus more commonly speciated on tissue cultures in PJI + SIRS (P = .002). CONCLUSION The incidence of SIRS is 10% among patients who have PJI. Development of PJI + SIRS is associated with increased lengths of stay, ICU admissions, and 2-year reoperation and mortality rates. Identifying certain comorbidities can stratify patients' risk of developing PJI + SIRS.
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Affiliation(s)
- Zachary A McConnell
- Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Karan M Patel
- Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Simon C Mears
- Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Benjamin M Stronach
- Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - C Lowry Barnes
- Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jeffrey B Stambough
- Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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12
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Narayanan V, Devadas K, Sreesh S, Varghese J, Solanki R, Mohapatra SD, Pal R, Madhu D, Chakravorty A. Novel predictors of response to therapy with terlipressin and albumin in hepatorenal syndrome-acute kidney injury. Ann Gastroenterol 2024; 37:81-88. [PMID: 38223250 PMCID: PMC10785019 DOI: 10.20524/aog.2023.0853] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024] Open
Abstract
Background A combination of terlipressin and albumin is the first-line pharmacologic treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI). We assessed the response rates to terlipressin-albumin therapy in patients with HRS-AKI and determined early predictors of treatment response and survival. Methods A total of 84 patients with HRS-AKI (International Club of Ascites definition 2015) treated with terlipressin-albumin were included. Predictors of HRS reversal were identified by logistic regression analysis. Survival analysis was performed using the Kaplan-Meier method, and Cox regression models were used to determine independent predictors of mortality. Results Complete response to therapy was observed in 54.8%, partial response in 14.3%, and no response in 31% of patients. The factors associated with complete treatment response were the presence of systemic inflammatory response syndrome (SIRS), baseline serum creatinine, a rise in mean arterial pressure by day 3, and a reduction in the renal resistive index (ΔRRI) by day 3 of treatment. Independent predictors of HRS reversal were the presence of SIRS at baseline (P=0.022; odds ratio [OR] 15.74, 95% confidence interval [CI] 1.47-167.82) and ΔRRI ≥5% by day 3 of treatment (P=0.048; OR 6.67, 95%CI 1.021-43.62). Mean transplant-free survival at 6 months was significantly better in treatment responders (148 vs. 90 days, P<0.001). Independent predictors of 6-month mortality were response to treatment (P=0.004) and model for end-stage liver disease-sodium >23 (P=0.018). Conclusions SIRS and ΔRRI are simple parameters to predict treatment response in HRS-AKI. Non-responders have higher mortality and should be identified early to expedite liver transplantation.
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Affiliation(s)
- Vijay Narayanan
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Krishnadas Devadas
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Srijaya Sreesh
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Jijo Varghese
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Rushil Solanki
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Shivabrata Dhal Mohapatra
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Ravindra Pal
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Devika Madhu
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
| | - Avisek Chakravorty
- Department of Medical Gastroenterology, Government Medical College, Thiruvananthapuram, Kerala, India (Vijay Narayanan, Krishnadas Devadas, Srijaya Sreesh, Jijo Varghese, Rushil Solanki, Shivabrata Dhal Mohapatra, Ravindra Pal, Devika Madhu, Avisek Chakravorty)
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Schaefer N, Lindner HA, Hahn B, Schefzik R, Velásquez SY, Schulte J, Fuderer T, Centner FS, Schoettler JJ, Himmelhan BS, Sturm T, Thiel M, Schneider-Lindner V, Coulibaly A. Pneumonia in the first week after polytrauma is associated with reduced blood levels of soluble herpes virus entry mediator. Front Immunol 2023; 14:1259423. [PMID: 38187375 PMCID: PMC10770833 DOI: 10.3389/fimmu.2023.1259423] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background Pneumonia develops frequently after major surgery and polytrauma and thus in the presence of systemic inflammatory response syndrome (SIRS) and organ dysfunction. Immune checkpoints balance self-tolerance and immune activation. Altered checkpoint blood levels were reported for sepsis. We analyzed associations of pneumonia incidence in the presence of SIRS during the first week of critical illness and trends in checkpoint blood levels. Materials and methods Patients were studied from day two to six after admission to a surgical intensive care unit (ICU). Blood was sampled and physician experts retrospectively adjudicated upon the presence of SIRS and Sepsis-1/2 every eight hours. We measured the daily levels of immune checkpoints and inflammatory markers by bead arrays for polytrauma patients developing pneumonia. Immune checkpoint time series were additionally determined for clinically highly similar polytrauma controls remaining infection-free during follow-up. We performed cluster analyses. Immune checkpoint time trends in cases and controls were compared with hierarchical linear models. For patients with surgical trauma and with and without sepsis, selected immune checkpoints were determined in study baseline samples. Results In polytrauma patients with post-injury pneumonia, eleven immune checkpoints dominated subcluster 3 that separated subclusters 1 and 2 of myeloid markers from subcluster 4 of endothelial activation, tissue inflammation, and adaptive immunity markers. Immune checkpoint blood levels were more stable in polytrauma cases than controls, where they trended towards an increase in subcluster A and a decrease in subcluster B. Herpes virus entry mediator (HVEM) levels (subcluster A) were lower in cases throughout. In unselected surgical patients, sepsis was not associated with altered HVEM levels at the study baseline. Conclusion Pneumonia development after polytrauma until ICU-day six was associated with decreased blood levels of HVEM. HVEM signaling may reduce pneumonia risk by strengthening myeloid antimicrobial defense and dampening lymphoid-mediated tissue damage. Future investigations into the role of HVEM in pneumonia and sepsis development and as a predictive biomarker should consider the etiology of critical illness and the site of infection.
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Abbasciano RG, Tomassini S, Roman MA, Rizzello A, Pathak S, Ramzi J, Lucarelli C, Layton G, Butt A, Lai F, Kumar T, Wozniak MJ, Murphy GJ. Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults. Cochrane Database Syst Rev 2023; 10:CD013584. [PMID: 37873947 PMCID: PMC10594589 DOI: 10.1002/14651858.cd013584.pub2] [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: 10/25/2023]
Abstract
BACKGROUND Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a causal role in organ injury. A wide range of organ protection interventions targeting the innate immune response have been evaluated in randomised controlled trials (RCTs) in adult cardiac surgery patients, with inconsistent results in terms of effectiveness. OBJECTIVES The aim of the review was to summarise the results of RCTs of organ protection interventions targeting the innate immune response in adult cardiac surgery. The review considered whether the interventions had a treatment effect on inflammation, important clinical outcomes, or both. SEARCH METHODS CENTRAL, MEDLINE, Embase, conference proceedings and two trial registers were searched on October 2022 together with reference checking to identify additional studies. SELECTION CRITERIA RCTs comparing organ protection interventions targeting the innate immune response versus placebo or no treatment in adult patients undergoing cardiac surgery where the treatment effect on innate immune activation and on clinical outcomes of interest were reported. DATA COLLECTION AND ANALYSIS Searches, study selection, quality assessment, and data extractions were performed independently by pairs of authors. The primary inflammation outcomes were peak IL-6 and IL-8 concentrations in blood post-surgery. The primary clinical outcome was in-hospital or 30-day mortality. Treatment effects were expressed as risk ratios (RR) and standardised mean difference (SMD) with 95% confidence intervals (CI). Meta-analyses were performed using random effects models, and heterogeneity was assessed using I2. MAIN RESULTS A total of 40,255 participants from 328 RCTs were included in the synthesis. The effects of treatments on IL-6 (SMD -0.77, 95% CI -0.97 to -0.58, I2 = 92%) and IL-8 (SMD -0.92, 95% CI -1.20 to -0.65, I2 = 91%) were unclear due to heterogeneity. Heterogeneity for inflammation outcomes persisted across multiple sensitivity and moderator analyses. The pooled treatment effect for in-hospital or 30-day mortality was RR 0.78, 95% CI 0.68 to 0.91, I2 = 0%, suggesting a significant clinical benefit. There was little or no treatment effect on mortality when analyses were restricted to studies at low risk of bias. Post hoc analyses failed to demonstrate consistent treatment effects on inflammation and clinical outcomes. Levels of certainty for pooled treatment effects on the primary outcomes were very low. AUTHORS' CONCLUSIONS A systematic review of RCTs of organ protection interventions targeting innate immune system activation did not resolve uncertainty as to the effectiveness of these treatments, or the role of innate immunity in organ injury following cardiac surgery.
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Affiliation(s)
| | | | - Marius A Roman
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Angelica Rizzello
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Suraj Pathak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Joussi Ramzi
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Carla Lucarelli
- Department of Cardiac Surgery, University of Verona, Verona, Italy
| | - Georgia Layton
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ayesha Butt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Florence Lai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Tracy Kumar
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Marcin J Wozniak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Mc Loughlin J, Hinchion J. The gut microbiome and cardiac surgery an unusual symphony. Perfusion 2023; 38:1330-1339. [PMID: 35466814 DOI: 10.1177/02676591221097219] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The relationship between the gut microbiome and various organ systems has gained interest throughout the scientific community in recent times. The understanding of these complex relationships has greatly improved with clinical benefits now being seen. Cardiopulmonary bypass (CPB) is a form of extracorporeal circulation that provides circulatory and respiratory support during cardiac surgery. This physiological support facilitates a still and bloodless field facilitating operations on the heart to be performed. Through various mechanisms CPB results in a systemic inflammatory response syndrome (SIRS). This response can vary from mild hypotension to multiple organ failure. It remains difficult to predict the degree to which a patient will experience SIRS post-operatively. The relationship between the composition of the gut microbiome and inflammatory processes associated with disease has been seen across several fields including gastroenterology, neurology, psychiatry and cardiology. To date, minimal research has been undertaken to examine the impact the gut microbiome has on outcomes following cardiac surgery. This review paper explores the pathophysiology behind the SIRS response associated with CPB for cardiac surgery and the hypothesis that a correlation exists between a patients gut microbiome composition and the degree of inflammatory response experienced following cardiac surgery.
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Affiliation(s)
- Joseph Mc Loughlin
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - J Hinchion
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
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Li M, Wei J, Zhu G, Fu S, He X, Hu X, Yu Y, Mou Y, Wang J, You X, Xiao X, Gu T, Ye Z, Zha Y. Quizartinib inhibits necroptosis by targeting receptor-interacting serine/threonine protein kinase 1. FASEB J 2023; 37:e23178. [PMID: 37698367 DOI: 10.1096/fj.202300600rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023]
Abstract
Systemic inflammatory response syndrome (SIRS), at least in part driven by necroptosis, is characterized by life-threatening multiple organ failure. Blocking the progression of SIRS and consequent multiple organ dysfunction is challenging. Receptor-interacting serine/threonine protein kinase 1 (RIPK1) is an important cell death and inflammatory mediator, making it a potential treatment target in several diseases. Here, using a drug repurposing approach, we show that inhibiting RIPK1 is also an effective treatment for SIRS. We performed cell-based high-throughput drug screening of an US Food and Drug Administration (FDA)-approved drug library that contains 1953 drugs to identify effective inhibitors of necroptotic cell death by SYTOX green staining. Dose-response validation of the top candidate, quizartinib, was conducted in two cell lines of HT-22 and MEFs. The effect of quizartinib on necroptosis-related proteins was evaluated using western blotting, immunoprecipitation, and an in vitro RIPK1 kinase assay. The in vivo effects of quizartinib were assessed in a murine tumor necrosis factor α (TNFα)-induced SIRS model. High-throughput screening identified quizartinib as the top "hit" in the compound library that rescued cells from necroptosis in vitro. Quizartinib inhibited necroptosis by directly inhibiting RIPK1 kinase activity and blocking downstream complex IIb formation. Furthermore, quizartinib protected mice against TNFα-induced SIRS. Quizartinib, as an FDA-approved drug with proven safety and efficacy, was repurposed for targeted inhibition of RIPK1. This work provides essential preclinical data for transferring quizartinib to the treatment of RIPK1-dependent necroptosis-induced inflammatory diseases, including SIRS.
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Affiliation(s)
- Min Li
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Jun Wei
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Guofeng Zhu
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Shufang Fu
- Yichang Central People's Hospital, Yichang, China
- Department of Paediatrics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Xiaoyan He
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Xinqian Hu
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Yajie Yu
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Yan Mou
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Jia Wang
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Xiaoling You
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Xin Xiao
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Tanrong Gu
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Zhi Ye
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
| | - Yunhong Zha
- Institute of Neural Regeneration and Repair, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Yichang Central People's Hospital, Yichang, China
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Ling ZY, Lv QZ, Li J, Lu RY, Chen LL, Xu WH, Wang Y, Zhuang CL. Protective Effect of a Novel RIPK1 Inhibitor, Compound 4-155, in Systemic Inflammatory Response Syndrome and Sepsis. Inflammation 2023; 46:1796-1809. [PMID: 37227549 DOI: 10.1007/s10753-023-01842-1] [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] [Received: 02/17/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
Excessive inflammatory response is a critical pathogenic factor for the tissue damage and organ failure caused by systemic inflammatory response syndrome (SIRS) and sepsis. In recent years, drugs targeting RIPK1 have proved to be an effective anti-inflammatory strategy. In this study, we identified a novel anti-inflammatory lead compound 4-155 that selectively targets RIPK1. Compound 4-155 significantly inhibited necroptosis of cells, and its activity is about 10 times higher than the widely studied Nec-1 s. The anti-necroptosis effect of 4-155 was mainly dependent on the inhibition of phosphorylation of RIPK1, RIPK3, and MLKL. In addition, we demonstrated that 4-155 specifically binds RIPK1 by drug affinity responsive target stability (DARTS), immunoprecipitation, kinase assay, and immunofluorescence microscopy. More importantly, compound 4-155 could inhibit excessive inflammation in vivo by blocking RIPK1-mediated necroptosis and not influence the activation of MAPK and NF-κB, which is more potential for the subsequent drug development. Compound 4-155 effectively protected mice from TNF-induced SIRS and sepsis. Using different doses, we found that 6 mg/kg oral administration of compound 4-155 could increase the survival rate of SIRS mice from 0 to 90%, and the anti-inflammatory effect of 4-155 in vivo was significantly stronger than Nec-1 s at the same dose. Consistently, 4-155 significantly reduced serum levels of pro-inflammatory cytokines (TNF-α and IL-6) and protected the liver and kidney from excessive inflammatory damages. Taken together, our results suggested that compound 4-155 could inhibit excessive inflammation in vivo by blocking RIPK1-mediated necroptosis, providing a new lead compound for the treatment of SIRS and sepsis.
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Affiliation(s)
- Zhong-Yi Ling
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China
| | - Quan-Zhen Lv
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China
| | - Jiao Li
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China
| | - Ren-Yi Lu
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China
| | - Lin-Lin Chen
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China
| | - Wei-Heng Xu
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China
| | - Yan Wang
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China.
| | - Chun-Lin Zhuang
- School of Pharmacy, Second Military Medical University, Shanghai, 200433, China.
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Pugliese M, Napoli E, La Maestra R, Or ME, Bilgiç B, Previti A, Biondi V, Passantino A. Cardiac Troponin I and Electrocardiographic Evaluation in Hospitalized Cats with Systemic Inflammatory Response Syndrome. Vet Sci 2023; 10:570. [PMID: 37756092 PMCID: PMC10538112 DOI: 10.3390/vetsci10090570] [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] [Received: 07/25/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Several studies conducted on humans demonstrate the increase in cardiac troponins and the onset of arrhythmias in the course of systemic inflammatory response syndrome (SIRS). The aim of the current study was to assess the blood concentration of cardiac troponin I (cTnI) and electrocardiographic findings in SIRS-affected cats. Seventeen shorthair cats hospitalized with SIRS were enrolled (Group 1). SIRS diagnosis was performed based on the detection of at least two of the four criteria such as abnormal body temperature, abnormal heart rate (i.e., tachycardia or bradycardia), abnormal respiratory rate (i.e., tachypnea or bradypnea), and alterations of white blood cell number (i.e., leukocytes or band neutrophils). Ten cats screened for elective surgery such as neutering or dental procedures were evaluated as a control population (Group 2). They were considered healthy based on history, physical examination, hematological and biochemical profile, urinalysis, coprological exam, thyroxine assay, blood pressure measurement, and echocardiography. A physical examination, complete blood cell count, biochemistry test (including an electrolyte panel), electrocardiographic examination, and cTnI assay were carried out in each cat enrolled. Traumatic events, gastrointestinal, neoplastic, respiratory, and neurological disorders were identified as causes of SIRS in Group 1. In Group 1, a significantly higher concentration of cTnI than that in Group 2 was recorded (p = 0.004). In 37.5% of cats with SIRS, ventricular premature complexes occurring in couplets with multiform configuration were detected. Similarly, to humans, data herein reported would indicate possible cardiac damage present in cats with SIRS diagnosis.
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Affiliation(s)
- Michela Pugliese
- Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy; (E.N.); (R.L.M.); (A.P.); (V.B.); (A.P.)
| | - Ettore Napoli
- Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy; (E.N.); (R.L.M.); (A.P.); (V.B.); (A.P.)
| | - Rocky La Maestra
- Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy; (E.N.); (R.L.M.); (A.P.); (V.B.); (A.P.)
| | - Mehmet Erman Or
- Faculty of Veterinary Medicine, İstanbul University-Cerrahpasa, 34098 Istanbul, Turkey; (M.E.O.); (B.B.)
| | - Bengü Bilgiç
- Faculty of Veterinary Medicine, İstanbul University-Cerrahpasa, 34098 Istanbul, Turkey; (M.E.O.); (B.B.)
| | - Annalisa Previti
- Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy; (E.N.); (R.L.M.); (A.P.); (V.B.); (A.P.)
| | - Vito Biondi
- Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy; (E.N.); (R.L.M.); (A.P.); (V.B.); (A.P.)
| | - Annamaria Passantino
- Department of Veterinary Sciences, University of Messina, Via Umberto Palatucci, 98168 Messina, Italy; (E.N.); (R.L.M.); (A.P.); (V.B.); (A.P.)
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Wu BL, Hu Y, Luo XJ, Lei XL, Gan YQ, Zhu ZG, Yao HY, Zhang Y. Multiple organ dysfunction after mitral valve replacement in a patient with systemic lupus erythematosus complicated by Libman-Sacks endocarditis: a case report and literature review. J Int Med Res 2023; 51:3000605231198731. [PMID: 37702581 PMCID: PMC10501069 DOI: 10.1177/03000605231198731] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
This case report describes a 47-year-old woman with systemic lupus erythematosus (SLE) complicated by Libman-Sacks endocarditis (LSE) who developed multiple organ dysfunction after mitral valve replacement surgery. The patient presented with a 5-day history of cough, sputum, and fever. Transthoracic echocardiography showed significant vegetations on the mitral valve. Biopsy was performed, and the pathological diagnosis was SLE complicated by LSE. After the mitral valve replacement surgery, the patient developed clinical manifestations of hepatic and renal dysfunction, cardiopulmonary failure, oliguria, and shock. The clinical symptoms significantly improved after administration of mechanical ventilation, continuous renal replacement therapy, plasma exchange, anti-inflammatory and anti-infection treatments, immunomodulatory and immunosuppressive therapies, and low-molecular-weight heparin anticoagulation. Multiple organ dysfunction after mitral valve replacement in patients with SLE complicated by LSE has rarely been reported. This report discusses the clinical manifestations, pathogenesis, and treatment of this severe complication. We hope the sharing of our experience in this case will provide a clinical basis for the treatment of severe multiple organ dysfunction after mitral valve replacement in patients with SLE complicated by LSE.
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Affiliation(s)
- Bo Lan Wu
- Department of Gastroenterology, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
- The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Yang Hu
- Department of Gastroenterology, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
- The Affiliated Nanhua Hospital, Hengyang Medical College, University of South China, Hengyang, Hunan, China
| | - Xiang Jun Luo
- Department of Rheumatology and Immunology, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
| | - Xiang Li Lei
- Department of Rheumatology and Immunology, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
| | - Yan Qing Gan
- Department of Intensive Care Unit, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
| | - Zi Gui Zhu
- Department of Intensive Care Unit, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
| | - Hong Yi Yao
- Department of Intensive Care Unit, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
| | - Yi Zhang
- Department of Cardiothoracic Surgery, The Affiliated Nanhua Hospital, Hengyang, Hunan, China
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20
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Phillips AE, Wilson AS, Greer PJ, Hinton A, Culp S, Paragomi P, Pothoulakis I, Singh V, Lee PJ, Lahooti I, Whitcomb DC, Papachristou GI. Relationship of circulating levels of long-chain fatty acids to persistent organ failure in acute pancreatitis. Am J Physiol Gastrointest Liver Physiol 2023; 325:G279-G285. [PMID: 37461868 PMCID: PMC10511174 DOI: 10.1152/ajpgi.00074.2023] [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] [Received: 04/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023]
Abstract
During acute pancreatitis (AP), free fatty acids (FFAs) are liberated from circulating triglycerides (TG) and injured adipocytes by pancreatic lipase. Circulating FFAs have been suspected as a source of systemic lipotoxicity in AP. However, assessment of FFAs is difficult and time-consuming, and little is known about relative levels of FFAs between patients with different severities of AP and controls. This study's aims were to assess early circulating levels of FFAs, (both saturated and unsaturated) in patients with AP vs. controls, and associations between FFA levels and AP severity. Serum samples from patients with AP were collected at enrollment (day 1 of hospital stay); serum samples were also collected from controls. FFAs including palmitic, palmitoleic, stearic, oleic, and linoleic acid were extracted and quantitated using gas chromatography separation. Severity of AP was determined by Revised Atlanta Classification. Differences in FFA levels and percentages of total FFAs were assessed between patients with AP and controls and patients with AP of different severity grades. A total of 93 patients with AP (48 female, 52%) and 29 controls (20 female, 69%) were enrolled. Of the patients with AP, 74 had mild/moderate and 19 had severe AP. Serum levels of all FFAs except stearic acid were significantly higher in patients with AP compared with controls. A strong and independent association between elevated palmitoleic acid levels and severe AP was found. Serum unsaturated FFA levels, specifically palmitoleic acid, appear to correlate with severe AP. These findings have potential clinical implications for targeted AP therapies.NEW & NOTEWORTHY Drivers of the inflammatory response in acute pancreatitis remain incompletely understood. Unsaturated fatty acids, specifically palmitoleic, appear to have an association with more severe acute pancreatitis. This finding presents a new clinical understanding of fatty acid toxicity and highlights a potential future target for treatment in severe acute pancreatitis.
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Affiliation(s)
- Anna Evans Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Annette S Wilson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Phil J Greer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Stacey Culp
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Pedram Paragomi
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Ioannis Pothoulakis
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Vijay Singh
- Division of Gastroenterology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona, United States
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ila Lahooti
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University, Columbus, Ohio, United States
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Fischer CP, Kastoft E, Olesen BRS, Myrup B. Delayed Treatment of Bloodstream Infection at Admission is Associated With Initial Low Early Warning Score and Increased Mortality. Crit Care Explor 2023; 5:e0959. [PMID: 37644974 PMCID: PMC10461960 DOI: 10.1097/cce.0000000000000959] [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: 08/31/2023] Open
Abstract
OBJECTIVES To identify factors associated with antibiotic treatment delay in patients admitted with bloodstream infections (BSIs). DESIGN Retrospective cohort study. SETTING North Zealand Hospital, Denmark. PATIENTS Adult patients with positive blood cultures obtained within the first 48 hours of admission between January 1, 2015, and December 31, 2015 (n = 926). MEASUREMENTS AND MAIN RESULTS First recorded Early Warning Score (EWS), patient characteristics, time to antibiotic treatment, and survival at day 60 after admission were obtained from electronic health records and medicine module. Presence of contaminants and the match between the antibiotic treatment and susceptibility of the cultured microorganism were included in the analysis. Data were stratified according to EWS quartiles. Overall, time from admission to prescription of antibiotic treatment was 3.7 (3.4-4.0) hours, whereas time from admission to antibiotic treatment was 5.7 (5.4-6.1) hours. A gap between prescription and administration of antibiotic treatment was present across all EWS quartiles. Importantly, 23.4% of patients admitted with BSI presented with an initial EWS 0-1. Within this group of patients, time to antibiotic treatment was markedly higher among nonsurvivors at day 60 compared with survivors. Furthermore, time to antibiotic treatment later than 6 hours was associated with increased mortality at day 60. Among patients with an initial EWS of 0-1, 51.3% of survivors received antibiotic treatment within 6 hours, whereas only 19.0% of nonsurvivors received antibiotic treatment within 6 hours. CONCLUSIONS Among patients with initial low EWS, delay in antibiotic treatment of BSIs was associated with increased mortality at day 60. Lag from prescription to administration may contribute to delayed antibiotic treatment. A more frequent reevaluation of patients with infections with a low initial EWS and reduction of time from prescription to administration may reduce the time to antibiotic treatment, thus potentially improving survival.
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Affiliation(s)
| | - Emili Kastoft
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, North Zealand, Denmark
- Department of Forensic Medicine, University of Copenhagen, København, Denmark
| | | | - Bjarne Myrup
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, North Zealand, Denmark
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Marcinek M, Tkocz M, Marczewski K, Partyka R, Kukulski L, Młynarek-Śnieżek K, Sędziak-Marcinek B, Rajwa P, Berezowski A, Kokocińska D. Evaluation of Parameters Affecting the Occurrence of Systemic Inflammatory Response Syndrome in Patients Operated on Due to Kidney Tumors. Biomedicines 2023; 11:2195. [PMID: 37626692 PMCID: PMC10452910 DOI: 10.3390/biomedicines11082195] [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] [Received: 06/04/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
The application and prognostic nature of systemic inflammatory reaction syndrome (SIRS) is still being researched, as using SIRS parameters to predict patient status is cheap, efficient, fast, and easy. The study aimed to determine SIRS markers and postoperative complications occurrence in patients undergoing kidney tumor surgery, and to verify if SIRS occurrence depends on age, sex, BMI (body mass index), comorbidities, patients' general condition before the surgery, type of surgery, intraoperative blood loss, or intraoperative ischemia time. Body temperature, heart rate, respiratory rate, and leukocyte count were measured in patients (n = 285) operated on due to a kidney tumor on the first (T0) and third (T3) postoperative day. Univariable and multivariable logistic regression were used to analyze the factors affecting postoperative SIRS and complications occurrence. T0: SIRS developed in patients with higher BMI, >2 ASA points, and more substantial intraoperative blood loss. T3: SIRS developed in obese or overweight patients, with >2 ASA points, significantly higher relative HR change, lower relative body temperature change, respiratory rate, and leukocyte count. BMI values, preoperative general health status, and the amount of intraoperative blood loss in patients undergoing surgery due to a kidney tumor can contribute to SIRS occurrence. Patient's sex, age, tumor size, type of surgery, operated side, and time of intraoperative ischemia do not affect SIRS occurrence.
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Affiliation(s)
- Mateusz Marcinek
- Department of Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Plac Medyków 1, 41-200 Sosnowiec, Poland
| | - Michał Tkocz
- Department of Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Plac Medyków 1, 41-200 Sosnowiec, Poland
| | - Kamil Marczewski
- Department of Urology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Plac Medyków 1, 41-200 Sosnowiec, Poland
| | - Robert Partyka
- Department of Emergency Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Francuska 20, 40-027 Katowice, Poland
| | - Leszek Kukulski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Curie-Skłodowskiej 9, 41-800 Zabrze, Poland
| | - Krystyna Młynarek-Śnieżek
- Department of Urology, Voivodeship Specialised Hospital No. 3, Energetyków 46, 44-200 Rybnik, Poland
| | - Bogumiła Sędziak-Marcinek
- Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland
| | - Paweł Rajwa
- Department of Urology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 3 Maja 13/15, 41-800 Zabrze, Poland
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Adam Berezowski
- Beskidzkie Centrum Medyczne, Młodzieżowa 21, 43-309 Bielsko-Biała, Poland
| | - Danuta Kokocińska
- Department of Emergency Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Francuska 20, 40-027 Katowice, Poland
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Schertz AR, Eisner AE, Smith SA, Lenoir KM, Thomas KW. Clinical Phenotypes of Sepsis in a Cohort of Hospitalized Patients According to Infection Site. Crit Care Explor 2023; 5:e0955. [PMID: 37614801 PMCID: PMC10443761 DOI: 10.1097/cce.0000000000000955] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES Clinical sepsis phenotypes may be defined by a wide range of characteristics such as site of infection, organ dysfunction patterns, laboratory values, and demographics. There is a paucity of literature regarding the impact of site of infection on the timing and pattern of clinical sepsis markers. This study hypothesizes that important phenotypic variation in clinical markers and outcomes of sepsis exists when stratified by infection site. DESIGN Retrospective cohort study. SETTING Five hospitals within the Wake Forest Health System from June 2019 to December 2019. PATIENTS Six thousand seven hundred fifty-three hospitalized adults with a discharge International Classification of Diseases, 10th Revision code for acute infection who met systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA), or Sequential Organ Failure Assessment (SOFA) criteria during the index hospitalization. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome of interest was a composite of 30-day mortality or shock. Infection site was determined by a two-reviewer process. Significant demographic, vital sign, and laboratory result differences were seen across all infection sites. For the composite outcome of shock or 30-day mortality, unknown or unspecified infections had the highest proportion (21.34%) and CNS infections had the lowest proportion (8.11%). Respiratory, vascular, and unknown or unspecified infection sites showed a significantly increased adjusted and unadjusted odds of the composite outcome as compared with the other infection sites except CNS. Hospital time prior to SIRS positivity was shortest in unknown or unspecified infections at a median of 0.88 hours (interquartile range [IQR], 0.22-5.05 hr), and hospital time prior to qSOFA and SOFA positivity was shortest in respiratory infections at a median of 54.83 hours (IQR, 9.55-104.67 hr) and 1.88 hours (IQR, 0.47-17.40 hr), respectively. CONCLUSIONS Phenotypic variation in illness severity and mortality exists when stratified by infection site. There is a significantly higher adjusted and unadjusted odds of the composite outcome of 30-day mortality or shock in respiratory, vascular, and unknown or unspecified infections as compared with other sites.
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Affiliation(s)
- Adam R Schertz
- Department of Internal Medicine, Section of Pulmonology, Critical Care, Allergy & Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ashley E Eisner
- Department of Internal Medicine, Section of Pulmonology, Critical Care, Allergy & Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Sydney A Smith
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kristin M Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Karl W Thomas
- Department of Internal Medicine, Section of Pulmonology, Critical Care, Allergy & Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC
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24
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Teo KHB, Lim SH, Hao Y, Lo YKD, Lin Z, Kaushik M, Tan CS, Thajudeen MZ, Wee CPJ. Neutrophil gelatinase-associated lipocalin: a biochemical marker for acute kidney injury and long-term outcomes in patients presenting to the emergency department. Singapore Med J 2023; 64:479-486. [PMID: 35707865 PMCID: PMC10476918 DOI: 10.11622/smedj.2022070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022]
Abstract
Introduction Creatinine has limitations in identifying and predicting acute kidney injury (AKI). Our study examined the utility of neutrophil gelatinase-associated lipocalin (NGAL) in predicting AKI in patients presenting to the emergency department (ED), and in predicting the need for renal replacement therapy (RRT), occurrence of major adverse cardiac events (MACE) and all-cause mortality at three months post visit. Methods This is a single-centre prospective cohort study conducted at Singapore General Hospital (SGH). Patients presenting to SGH ED from July 2011 to August 2012 were recruited. They were aged ≥21 years, with an estimated glomerular filtration rate <60 mL/min/1.73 m2, and had congestive cardiac failure, systemic inflammatory response syndrome or required hospital admission. AKI was diagnosed by researchers blinded to experimental measurements. Serum NGAL was measured as a point-of-care test. Results A total of 784 patients were enrolled, of whom 107 (13.6%) had AKI. Mean serum NGAL levels were raised (P < 0.001) in patients with AKI (670.0 ± 431.9 ng/dL) compared with patients without AKI (490.3 ± 391.6 ng/dL). The sensitivity and specificity of NGAL levels >490 ng/dL for AKI were 59% (95% confidence interval [CI] 49%-68%) and 65% (95% CI 61%-68%), respectively. Need for RRT increased 21% per 100 ng/dL increase in NGAL (P < 0.001), whereas odds of death in three months increased 10% per 100 ng/dL increase in NGAL (P = 0.028). No clear relationship was observed between NGAL levels and MACE. Conclusion Serum NGAL identifies AKI and predicts three-month mortality.
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Affiliation(s)
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Ying Hao
- SingHealth Health Services Research Centre, Singapore
| | | | - Ziwei Lin
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
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25
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Schefzik R, Hahn B, Schneider-Lindner V. Dissecting contributions of individual systemic inflammatory response syndrome criteria from a prospective algorithm to the prediction and diagnosis of sepsis in a polytrauma cohort. Front Med (Lausanne) 2023; 10:1227031. [PMID: 37583420 PMCID: PMC10424878 DOI: 10.3389/fmed.2023.1227031] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Background Sepsis is the leading cause of death in intensive care units (ICUs), and its timely detection and treatment improve clinical outcome and survival. Systemic inflammatory response syndrome (SIRS) refers to the concurrent fulfillment of at least two out of the following four clinical criteria: tachycardia, tachypnea, abnormal body temperature, and abnormal leukocyte count. While SIRS was controversially abandoned from the current sepsis definition, a dynamic SIRS representation still has potential for sepsis prediction and diagnosis. Objective We retrospectively elucidate the individual contributions of the SIRS criteria in a polytrauma cohort from the post-surgical ICU of University Medical Center Mannheim (Germany). Methods We used a dynamic and prospective SIRS algorithm tailored to the ICU setting by accounting for catecholamine therapy and mechanical ventilation. Two clinically relevant tasks are considered: (i) sepsis prediction using the first 24 h after admission to our ICU, and (ii) sepsis diagnosis using the last 24 h before sepsis onset and a time point of comparable ICU treatment duration for controls, respectively. We determine the importance of individual SIRS criteria by systematically varying criteria weights when summarizing the SIRS algorithm output with SIRS descriptors and assessing the classification performance of the resulting logistic regression models using a specifically developed ranking score. Results Our models perform better for the diagnosis than the prediction task (maximum AUROC 0.816 vs. 0.693). Risk models containing only the SIRS level average mostly show reasonable performance across criteria weights, with prediction and diagnosis AUROCs ranging from 0.455 (weight on leukocyte criterion only) to 0.693 and 0.619 to 0.800, respectively. For sepsis prediction, temperature and tachypnea are the most important SIRS criteria, whereas the leukocytes criterion is least important and potentially even counterproductive. For sepsis diagnosis, all SIRS criteria are relevant, with the temperature criterion being most influential. Conclusion SIRS is relevant for sepsis prediction and diagnosis in polytrauma, and no criterion should a priori be omitted. Hence, the original expert-defined SIRS criteria are valid, capturing important sepsis risk determinants. Our prospective SIRS algorithm provides dynamic determination of SIRS criteria and descriptors, allowing their integration in sepsis risk models also in other settings.
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Affiliation(s)
- Roman Schefzik
- Department of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Mishra A, Mittal J, Tripathi S, Paul S. Factors predicting infective complications following percutaneous nephrolithotomy and retrograde intrarenal surgery according to systemic inflammatory response syndrome and quick sequential organ failure assessment: A prospective study. Urol Ann 2023; 15:295-303. [PMID: 37664105 PMCID: PMC10471817 DOI: 10.4103/ua.ua_150_22] [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] [Received: 12/04/2022] [Revised: 12/25/2022] [Accepted: 05/29/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Materials and Methods Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA. Results The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures. Conclusion Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients.
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Affiliation(s)
- Amit Mishra
- Department of Urology, AIIMS, Raebareli, Uttar Pradesh, India
| | - Jayesh Mittal
- Department of Urology, Kota Heart Institute, Kota, Rajasthan, India
| | - Sujata Tripathi
- Department of Pathology, Narayan Medical College and Hospital, Sasaram, Bihar, India
| | - Sourabh Paul
- Department of Community Medicine, AIIMS, Raebareli, Uttar Pradesh, India
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Yao Y, Kang H, Cheng Y, Su X, Wang B. Inflammatory Progression in Patients Undergoing Extracorporeal Membrane Oxygenation. Curr Mol Med 2023:CMM-EPUB-132560. [PMID: 37340745 DOI: 10.2174/1566524023666230619102723] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is identified as a novel therapeutic strategy that offers short-term support to the metabolism of the heart and lungs in humans. Recently, the clinical centers, which provide ECMO has increased rapidly worldwide. The indications for the use of ECMO in daily clinical practice were broadened dynamically. However, even with the widespread adoption of ECMO, it still remains significant morbidity and mortality, and the underlying mechanisms are still not elucidated. Notably, one of the vital complications during ECMO was proposed as the inflammatory progression within the extracorporeal circulation. Via the development of inflammatory response, patients with ECMO may further suffer from systemic inflammatory response syndrome (SIRS), posing serious risks to human health. Recently, growing evidence confirmed that through exposure of blood into the ECMO circuit could lead to the stimulation of the immune system which also facilitated the inflammatory response and systemic impaired. In the current review, the pathological development of inflammatory progression in patients with ECMO is well-listed. Furthermore, the relationship between immune-related activation and the development of inflammation is also summarized, which may further help us to decide the therapeutic strategies in daily clinical practice.
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Affiliation(s)
- Yan'er Yao
- Department of Cardiology, the Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, Fujian, China
| | - Huiyuan Kang
- Department of Cardiology, the Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, Fujian, China
| | - Ye Cheng
- Department of Cardiology, the Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, Fujian, China
| | - Xin Su
- Department of Cardiology, the Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, Fujian, China
| | - Bin Wang
- Department of Cardiology, the Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, Fujian, China
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Wang M, Yang Z, He N, Wang D, Lan H. Predictive model of systemic inflammatory response syndrome after percutaneous nephrolithotomy for kidney calculi based on logistic regression. Am J Transl Res 2023; 15:4138-4146. [PMID: 37434839 PMCID: PMC10331654] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To establish a predictive model of systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) for kidney calculi based on logistic regression. METHODS The data of 148 patients with unilateral kidney calculi treated in Xi'an International Medical Center Hospital from October 2019 to September 2022 were analyzed retrospectively. According to development of SIRS after PCNL, the patients were divided into one group with SIRS after operation (occurrence group, n = 19) and another group without SIRS after operation (non-occurrence group, n = 129). The clinical data of patients were collected, and risk factors for SIRS after PCNL in patients with unilateral kidney calculi were analyzed by logistic regression. RESULTS Gender, body mass index (BMI), hypertension, diabetes mellitus (DM), calculi size ≥ 30 mm, renal insufficiency, and hydronephrosis were risk factors for postoperative SIRS (P < 0.05). According to multivariate logistic regression analysis, BMI, DM, hypertension, calculi size ≥ 30 mm, and hydronephrosis were independent risk factors for SIRS (P < 0.05). Based on the regression coefficient, a predictive model was established. The occurrence group had a higher risk score than the non-occurrence group (P < 0.05). According to receiver operating characteristic (ROC) curve-based analysis, the area under the curve of risk score for predicting SIRS in patients was 0.898. CONCLUSION Patients with BMI ≥ 25 kg/m2, DM, hypertension, calculi ≥ 30 mm, and/or hydronephrosis are more likely to suffer SIRS after PCNL. The risk score has high clinical value in the prediction of SIRS.
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Affiliation(s)
- Min Wang
- Department of Urinary Surgery, Xi’an International Medical Center HospitalXi’an 710100, Shaanxi, China
| | - Zengyue Yang
- Department of Urinary Surgery, Xi’an International Medical Center HospitalXi’an 710100, Shaanxi, China
| | - Ning He
- Department of Urinary Surgery, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
| | - Dong Wang
- Department of Urinary Surgery, Xi’an International Medical Center HospitalXi’an 710100, Shaanxi, China
| | - Haihe Lan
- Department of Urinary Surgery, Hanzhong Central HospitalHanzhong 723000, Shaanxi, China
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Burovenko IY, Sonin DL, Borshcheva OV, Istomina MS, Zaitseva EA, Protsak ES, Borshchev VY, Borshchev YY, Galagudza MM. Influence of Interleukin-2 and Brain-Derived Neurotrophic Factor (BDNF) on the Size of Myocardial Infarction in Rats with Systemic Inflammatory Response. Bull Exp Biol Med 2023; 175:219-224. [PMID: 37464198 DOI: 10.1007/s10517-023-05838-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Indexed: 07/20/2023]
Abstract
We studied the influence of recombinant IL-2 and brain-derived neurotrophic factor (BDNF) on the size of the myocardial necrosis zone of rats with systemic inflammatory response syndrome (SIRS). A significant increase in the necrosis zone and the levels of proinflammatory cytokines was revealed in animals with SIRS in comparison with the control. The administration of IL-2 to animals with SIRS significantly reduced the size of the necrosis zone, which was paralleled by a pronounced increase in IL-2 and BDNF in comparison with the corresponding parameters in rats with SIRS that did not receive IL-2. Administration of BDNF to animals with SIRS was followed by normalization of TNFα and IL-1α levels, but did not lead to a decrease in the size of the necrosis zone.
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Affiliation(s)
- I Yu Burovenko
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - D L Sonin
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - O V Borshcheva
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - M S Istomina
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - E A Zaitseva
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - E S Protsak
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - V Yu Borshchev
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - Yu Yu Borshchev
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - M M Galagudza
- Institute of Experimental Medicine, V. A. Almazov National Medical Research Center, Ministry of Health of the Russian Federation, St. Petersburg, Russia.
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Ferrante MS, Pisano C, Van Rothem J, Ruvolo G, Abouliatim I. Cerebrovascular events after cardiovascular surgery: diagnosis, management and prevention strategies. Kardiochir Torakochirurgia Pol 2023; 20:118-122. [PMID: 37564967 PMCID: PMC10410632 DOI: 10.5114/kitp.2023.130020] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/06/2023] [Indexed: 08/12/2023]
Abstract
Introduction Cerebrovascular events after cardiac surgery are among the most serious complications, related to a greater risk of patient mortality. This problem can occur following the formation of gas emboli during open heart surgery. Aim To address all the mechanisms that can lead to embolic events after cardiovascular surgery, how to manage them and how to possibly prevent them. Material and methods A search of the PubMed database was conducted. We reviewed the clinical literature and examined all aspects to identify the root causes that can lead to the formation of emboli. Results Among the studies reviewed, it was found that the main causes include manipulation of the aorta, inadequate deaeration after cardiac surgery, and blood-component contact of extracorporeal circulation. It has been reported that gas emboli can lead to deleterious damage such as damage to the cerebral vascular endothelium, disruption of the blood-brain barrier, complement activation, leukocyte aggregation, increased platelet adhesion, and fibrin deposition in the microvascular system. Conclusions Stroke after cardiovascular surgery is one of the most important complications, with a great impact on operative mortality and patient survival. Efforts have been made over time to understand all the pathophysiological mechanisms related to this complication, with the aim of reducing its incidence. One of the goals should be to improve both the surgical technique and the perfusion modality and minimize the formation of air bubbles or to facilitate their elimination during the cardiopulmonary bypass procedure.
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Affiliation(s)
| | - Calogera Pisano
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | | | - Giovanni Ruvolo
- Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
| | - Issam Abouliatim
- Cardiovascular and Thoracic Surgery Department, Clinique Pasteur, Toulouse, France
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Weidinger A, Meszaros AT, Dumitrescu S, Kozlov AV. Effect of mitoTEMPO on Redox Reactions in Different Body Compartments upon Endotoxemia in Rats. Biomolecules 2023; 13:biom13050794. [PMID: 37238664 DOI: 10.3390/biom13050794] [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] [Received: 02/22/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Mitochondrial ROS (mitoROS) control many reactions in cells. Biological effects of mitoROS in vivo can be investigated by modulation via mitochondria-targeted antioxidants (mtAOX, mitoTEMPO). The aim of this study was to determine how mitoROS influence redox reactions in different body compartments in a rat model of endotoxemia. We induced inflammatory response by lipopolysaccharide (LPS) injection and analyzed effects of mitoTEMPO in blood, abdominal cavity, bronchoalveolar space, and liver tissue. MitoTEMPO decreased the liver damage marker aspartate aminotransferase; however, it neither influenced the release of cytokines (e.g., tumor necrosis factor, IL-4) nor decreased ROS generation by immune cells in the compartments examined. In contrast, ex vivo mitoTEMPO treatment substantially reduced ROS generation. Examination of liver tissue revealed several redox paramagnetic centers sensitive to in vivo LPS and mitoTEMPO treatment and high levels of nitric oxide (NO) in response to LPS. NO levels in blood were lower than in liver, and were decreased by in vivo mitoTEMPO treatment. Our data suggest that (i) inflammatory mediators are not likely to directly contribute to ROS-mediated liver damage and (ii) mitoTEMPO is more likely to affect the redox status of liver cells reflected in a redox change of paramagnetic molecules. Further studies are necessary to understand these mechanisms.
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Affiliation(s)
- Adelheid Weidinger
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria
| | - Andras T Meszaros
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Sergiu Dumitrescu
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria
| | - Andrey V Kozlov
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria
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Chand S, Kumar N, Mawari G, Sarkar S, Daga MK, Raghu RV, Aarthi J, Fatima A. Systemic inflammatory response syndrome criteria (SIRS) and sepsis 3 criteria for assessing outcomes in sepsis: A prospective observational study. Lung India 2023; 40:200-204. [PMID: 37148015 PMCID: PMC10298813 DOI: 10.4103/lungindia.lungindia_400_22] [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] [Received: 08/09/2022] [Revised: 01/07/2023] [Accepted: 02/16/2023] [Indexed: 05/07/2023] Open
Abstract
Background Sepsis is a major cause of death in hospitalised patients worldwide. Most studies for assessing outcomes in sepsis are from the western literature. Sparse data from Indian settings are available comparing the systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) (sepsis 3 criteria) for assessing outcomes in sepsis. In this study, we aimed to compare the SIRS criteria and sepsis 3 criteria to assess disease outcome at day 28 (recovery/mortality) in a North Indian tertiary care teaching hospital. Methods A prospective observational study was performed in the Department of Medicine from 2019 to early 2020. Patients admitted to the medical emergency with clinical suspicion of sepsis were included. Systemic inflammatory response syndrome, qSOFA and SOFA scores were calculated at the time of presentation to the hospital. Patients were followed through the course of their hospital stay. Results Out of 149 patients, 139 were included in the analysis. Patients who died had significantly higher mean SOFA, qSOFA scores and mean change in SOFA score than patients who survived (P value <0.01). There was no statistical difference between recovery and deaths at similar SIRS scores. A 40.30% fatality rate was recorded. Systemic inflammatory response syndrome had low Area Under Curve (AUC) (0.47) with low sensitivity (76.8) and specificity (21.7). SOFA had the maximum AUC (0.68) compared to qSOFA (0.63) and SIRS (0.47). SOFA also had the maximum sensitivity (98.1) while the qSOFA score had the maximum specificity (84.3). Conclusion SOFA and qSOFA scores had superior predictive ability as compared to the SIRS score in assessing mortality in sepsis patients.
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Affiliation(s)
- Siddharth Chand
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Naresh Kumar
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Govind Mawari
- Centre for Occupational and Environment Health (COEH), Maulana Azad Medical College, New Delhi, India
| | - Sayan Sarkar
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Mradul Kumar Daga
- Internal Medicine and Infectious Disease, Institute of Liver and Biliary Sciences, New Delhi, India
| | - RV Raghu
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - J. Aarthi
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Arisha Fatima
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
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Zhang JZ, Liu Z, Liu J, Ren JX, Sun TS. [Retracted] Mitochondrial DNA induces inflammation and increases TLR9/NF‑κB expression in lung tissue. Int J Mol Med 2023; 51:28. [PMID: 36799160 PMCID: PMC9943536 DOI: 10.3892/ijmm.2023.5231] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/30/2014] [Indexed: 02/16/2023] Open
Abstract
Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that several of the western blotting images shown in Fig. 4 on p. 822 were strikingly similar to data which had appeared in Fig. 5A of the following paper: Fan J, Frey RS and Malik AB: TLR4 signaling induces TLR2 expression in endothelial cells via neutrophil NADPH oxidase. J Clin Invest 112: 1235‑1243, 2003. Owing to the fact that the contentious data in the above article had already been published elsewhere prior to its submission to International Journal of Molecular Medicine, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [International Journal of Molecular Medicine 33: 817‑824, 2014; DOI: 10.3892/ijmm.2014.1650].
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Affiliation(s)
- Jian-Zheng Zhang
- Department of Orthopedics, Beijing Army General Hospital, Dongcheng, Beijing 100700, P.R. China
| | - Zhi Liu
- Department of Orthopedics, Beijing Army General Hospital, Dongcheng, Beijing 100700, P.R. China
| | - Jia Liu
- Department of Orthopedics, Beijing Army General Hospital, Dongcheng, Beijing 100700, P.R. China
| | - Ji-Xin Ren
- Department of Orthopedics, Beijing Army General Hospital, Dongcheng, Beijing 100700, P.R. China
| | - Tian-Sheng Sun
- Department of Orthopedics, Beijing Army General Hospital, Dongcheng, Beijing 100700, P.R. China
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LaJoie J, Lentz B. Acute Myocarditis After Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Nurse Pract 2023; 19:104458. [PMID: 36267333 PMCID: PMC9561454 DOI: 10.1016/j.nurpra.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This case report describes a young adult patient with post-severe acute respiratory syndrome coronavirus 2 acute viral myocarditis who initially presented to a local urgent care center. The patient decompensated and was transferred to our tertiary, intensive care setting.
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Chiu CY, Cheng CK. Synergic Effect of Intravitreal Bevacizumab and Systemic Corticosteroid in Treating Systemic Inflammatory Response Syndrome (SIRS) Associated Purtscher-like Retinopathy. Ocul Immunol Inflamm 2023; 31:421-425. [PMID: 35404748 DOI: 10.1080/09273948.2022.2026412] [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: 10/18/2022]
Abstract
PURPOSE To demonstrate the treatment effect of combined intravitreal bevacizumab (IVB) and systemic steroid for systemic inflammatory response syndrome (SIRS)-related Purtscher-like retinopathy (PuR). METHODS Retrospective case report. RESULTS A 19-year-old patient experienced bilateral blurred vision after urinary tract infection-induced SIRS. Typical bilateral PuR was found in fundus examination and fluorescein angiography. Optical coherence tomography (OCT) revealed severe cystoid macular edema (CME) and OCT angiography revealed marked vascular defects in both superficial and deep plexuses. Intravitreal injection of bevacizumab 1.25 mg was first performed in the right eye along with systemic corticosteroid therapy. One week later, marked improvement in visual acuity and CME was noted in the right eye, but not in the non-IVB-treated left eye. IVB was then performed in the left eye and achieved much improvement 8 days later. CONCLUSION This report clearly demonstrated the synergic effect of IVB and systemic steroids for CME on SIRS-related PuR.
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Affiliation(s)
- Chiung-Yi Chiu
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Zhou H, Xie T, Gao Y, Yao X, Xu Y. The Relationship between Preoperative Urine Culture and Post-Percutaneous Nephrostolithotomy Systemic Inflammatory Response Syndrome: A Single-Center Retrospective Study. J Pers Med 2023; 13:jpm13020187. [PMID: 36836421 PMCID: PMC9963246 DOI: 10.3390/jpm13020187] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To predict the occurrence of systemic inflammatory response syndrome (SIRS) after percutaneous nephrostrolithotomy(PCNL), preoperative urine culture is a popular method, but the debate about its predictive value is ongoing. In order to better evaluate the value of urine culture before percutaneous nephrolithotomy, we conducted a single-center retrospective study. METHODS A total of 273 patients who received PCNL in Shanghai Tenth People's Hospital from January 2018 to December 2020 were retrospectively evaluated. Urine culture results, bacterial profiles, and other clinical information were collected. The primary outcome observed was the occurrence of SIRS after PCNL. Univariate and multivariate logistic regression analysis was performed to determine the predictive factors of SIRS after PCNL. A nomogram was constructed using the predictive factors, and the receiver operating characteristic (ROC) curves and calibration plot were drawn. RESULTS Our results showed that there was a significant correlation between positive preoperative urine cultures and the occurrence of postoperative systemic inflammatory response syndrome. Meanwhile, diabetes, staghorn calculi, and operation time were also risk factors for postoperative systemic inflammatory response syndrome. Our results suggest that among the positive bacteria in urine culture before percutaneous nephrolithotomy, Enterococcus faecalis has become the dominant strain. CONCLUSION Urine culture is still an important method of preoperative evaluation. A comprehensive evaluation of multiple risk factors should be undertaken and heeded to before percutaneous nephrostrolithotomy. In addition, the impact of changes in bacterial drug resistance is also worthy of attention.
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Affiliation(s)
| | | | | | | | - Yunfei Xu
- Correspondence: ; Tel./Fax: +86-138-1799-0948
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Corda F, Ballocco I, Corda A, Mollica A, Cilano A, Polinas M, Pinna Parpaglia ML. Coagulation Abnormalities in Dogs with Parvoviral Enteritis. Vet Sci 2023; 10:vetsci10010041. [PMID: 36669042 PMCID: PMC9861196 DOI: 10.3390/vetsci10010041] [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] [Received: 11/30/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
Hemostatic alterations have been documented in dogs with canine parvoviral enteritis. This study's aims were to measure the standard coagulation parameters, and to assess the relationship between them and the clinical variables in dogs with canine parvoviral enteritis. Nine client-owned dogs with a canine parvoviral infection were included in a prospective, observational clinical study. Clinical score and coagulation status were assessed at admission. All nine dogs showed alterations of three or more standard coagulation variables. A correlation analysis evidenced a significantly high positive correlation between the activated partial thromboplastin time and clinical score. The present study concurs that dogs with canine parvoviral enteritis have coagulation disorders that are detectable by measuring the standard coagulation parameters.
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Liu L, Wang A, Wang D, Guo J, Zhang X, Zhao X, Wang W. Systemic Inflammatory Response Syndrome on Admission and Clinical Outcomes After Intracerebral Hemorrhage. J Inflamm Res 2023; 16:917-926. [PMID: 36891171 PMCID: PMC9987451 DOI: 10.2147/jir.s394635] [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] [Received: 10/24/2022] [Accepted: 02/18/2023] [Indexed: 03/05/2023] Open
Abstract
Background Since studies on systemic inflammatory response syndrome (SIRS) in patients with acute intracerebral hemorrhage (ICH) are insufficient. This study investigated the associations between SIRS on admission and clinical outcomes after acute ICH. Patients and Methods The study included 1159 patients with acute spontaneous ICH from January 2014 to September 2016. In accordance with standard criteria, SIRS was defined as two or more of the following: (1) body temperature >38°C or <36°C, (2) respiratory rate >20 per minute, (3) heart rate >90 per minute, and (4) white blood cell count >12,000/μL or <4000/μL. The clinical outcomes of interest were death and major disability (defined as a modified Rankin Scale of 6 and 3-5), combined and separate at 1 month, 3 months and 1 year follow-up. Results SIRS was observed in 13.5% (157/1159) of patients and independently increased the risk of death at 1 month, 3 months, or 1 year: hazard ratio (HR) 2.532 (95% confidence interval [CI] 1.487-4.311), HR 2.436 (95% CI 1.499-3.958), HR 2.030 (95% CI 1.343-3.068), respectively (P<0.05 for all). The relationship between SIRS and ICH mortality was more pronounced in older patients or patients with larger hematoma volumes. Patients with in-hospital infections were at greater risk of major disability. The risk was enhanced when SIRS was incorporated. Conclusion The presence of SIRS at the time of admission was associated with mortality in patients with acute ICH, particularly in older patients and those with large hematomas. SIRS may exacerbate the disability caused by in-hospital infections in patients with ICH.
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Affiliation(s)
- Lijun Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Dandan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Jiahuan Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xiaoli Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Wenjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China
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Martí‐Chillón G, Muntión S, Preciado S, Osugui L, Navarro‐Bailón A, González‐Robledo J, Sagredo V, Blanco JF, Sánchez‐Guijo F. Therapeutic potential of mesenchymal stromal/stem cells in critical-care patients with systemic inflammatory response syndrome. Clin Transl Med 2023; 13:e1163. [PMID: 36588089 PMCID: PMC9806020 DOI: 10.1002/ctm2.1163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite notable advances in the support and treatment of patients admitted to the intensive care unit (ICU), the management of those who develop a systemic inflammatory response syndrome (SIRS) still constitutes an unmet medical need. MAIN BODY Both the initial injury (trauma, pancreatitis, infections) and the derived uncontrolled response promote a hyperinflammatory status that leads to systemic hypotension, tissue hypoperfusion and multiple organ failure. Mesenchymal stromal/stem cells (MSCs) are emerging as a potential therapy for severe ICU patients due to their potent immunomodulatory, anti-inflammatory, regenerative and systemic homeostasis-regulating properties. MSCs have demonstrated clinical benefits in several inflammatory-based diseases, but their role in SIRS needs to be further explored. CONCLUSION In the current review, after briefly overviewing SIRS physiopathology, we explore the potential mechanisms why MSC therapy could aid in the recovery of this condition and the pre-clinical and early clinical evidence generated to date.
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Affiliation(s)
| | - Sandra Muntión
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Silvia Preciado
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Lika Osugui
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Almudena Navarro‐Bailón
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
| | - Javier González‐Robledo
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Department of MedicineUniversity of SalamancaSalamancaSpain
| | | | - Juan F. Blanco
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
- Department of SurgeryUniversity of SalamancaSalamancaSpain
| | - Fermín Sánchez‐Guijo
- IBSAL‐University Hospital of SalamancaSalamancaSpain
- Department of MedicineUniversity of SalamancaSalamancaSpain
- RICORS TERAVISCIIIMadridSpain
- Regenerative Medicine and Cellular Therapy Network Center of Castilla y LeónSalamancaSpain
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Groff E, Orzechowski M, Schuetz C, Steger F. Ethical Aspects of Personalized Research and Management of Systemic Inflammatory Response Syndrome (SIRS) in Children. Int J Environ Res Public Health 2022; 20:470. [PMID: 36612792 PMCID: PMC9819223 DOI: 10.3390/ijerph20010470] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Systemic inflammatory response syndrome (SIRS) is a life-threatening condition with nonspecific symptoms. Because of that, defining a targeted therapy against SIRS in children and adults remains a challenge. The identification of diagnostic patterns from individualized immuneprofiling can lead to development of a personalized therapy. The aim of this study was to identify and analyze ethical issues associated with personalized research and therapy for SIRS in pediatric populations. We conducted an ethical analysis based on a principled approach according to Beauchamp and Childress' four bioethical principles. Relevant information for the research objectives was extracted from a systematic literature review conducted in the scientific databases PubMed, Embase and Web of Science. We searched for pertinent themes dealing with at least one of the four bioethical principles: "autonomy", "non-maleficence", "beneficence" and "justice". 48 publications that met the research objectives were included in the thorough analysis, structured and discussed in a narrative synthesis. From the analysis of the results, it has emerged that traditional paradigms of patient's autonomy and physician paternalism need to be reexamined in pediatric research. Standard information procedures and models of informed consent should be reconsidered as they do not accommodate the complexities of pediatric omics research.
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Affiliation(s)
- Elisa Groff
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
| | - Catharina Schuetz
- Paediatric Immunology, Medical Faculty “Carl Gustav Carus”, Technic University Dresden, 01307 Dresden, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
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Ono Y, Saito M, Sakamoto K, Maejima Y, Misaka S, Shimomura K, Nakanishi N, Inoue S, Kotani J. C188-9, a specific inhibitor of STAT3 signaling, prevents thermal burn-induced skeletal muscle wasting in mice. Front Pharmacol 2022; 13:1031906. [PMID: 36588738 PMCID: PMC9800842 DOI: 10.3389/fphar.2022.1031906] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Burn injury is the leading cause of death and disability worldwide and places a tremendous economic burden on society. Systemic inflammatory responses induced by thermal burn injury can cause muscle wasting, a severe involuntary loss of skeletal muscle that adversely affects the survival and functional outcomes of these patients. Currently, no pharmacological interventions are available for the treatment of thermal burn-induced skeletal muscle wasting. Elevated levels of inflammatory cytokines, such as interleukin-6 (IL-6), are important hallmarks of severe burn injury. The levels of signal transducer and activator of transcription 3 (STAT3)-a downstream component of IL-6 inflammatory signaling-are elevated with muscle wasting in various pro-catabolic conditions, and STAT3 has been implicated in the regulation of skeletal muscle atrophy. Here, we tested the effects of the STAT3-specific signaling inhibitor C188-9 on thermal burn injury-induced skeletal muscle wasting in vivo and on C2C12 myotube atrophy in vitro after the administration of plasma from burn model mice. In mice, thermal burn injury severity dependently increased IL-6 in the plasma and tibialis anterior muscles and activated the STAT3 (increased ratio of phospho-STAT3/STAT3) and ubiquitin-proteasome proteolytic pathways (increased Atrogin-1/MAFbx and MuRF1). These effects resulted in skeletal muscle atrophy and reduced grip strength. In murine C2C12 myotubes, plasma from burn mice activated the same inflammatory and proteolytic pathways, leading to myotube atrophy. In mice with burn injury, the intraperitoneal injection of C188-9 (50 mg/kg) reduced activation of the STAT3 and ubiquitin-proteasome proteolytic pathways, reversed skeletal muscle atrophy, and increased grip strength. Similarly, pretreatment of murine C2C12 myotubes with C188-9 (10 µM) reduced activation of the same inflammatory and proteolytic pathways, and ameliorated myotube atrophy induced by plasma taken from burn model mice. Collectively, these results indicate that pharmacological inhibition of STAT3 signaling may be a novel therapeutic strategy for thermal burn-induced skeletal muscle wasting.
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Affiliation(s)
- Yuko Ono
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan,Department of Bioregulation and Pharmacological Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan,*Correspondence: Yuko Ono,
| | - Masafumi Saito
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kazuho Sakamoto
- Department of Bio-Informational Pharmacology, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yuko Maejima
- Department of Bioregulation and Pharmacological Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shingen Misaka
- Department of Bioregulation and Pharmacological Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenju Shimomura
- Department of Bioregulation and Pharmacological Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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42
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He Y, Xia D, Tong Y, Shang H, Liu X, Peng E, Huang Q, Tang K, Chen Z. Predictive value of CD3 + cells and interleukin 2 receptor in systemic inflammatory response syndrome after percutaneous nephrolithotomy. Front Immunol 2022; 13:1017219. [PMID: 36505430 PMCID: PMC9730695 DOI: 10.3389/fimmu.2022.1017219] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of the current study was to evaluate the risk factors that influence the development of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL), including cytokines and lymphocyte subsets. Methods A total of 154 patients who underwent PCNL at our hospital between October 2019 and January 2022 were retrospectively reviewed. The development of post-PCNL SIRS was the primary endpoint of the study. Univariable analysis and multivariable logistic regression analysis were performed to identify independent risk factors of post-PCNL SIRS. A nomogram was constructed using the independent risk factors, and receiver operating characteristic (ROC) curves were drawn. Results There were 50 patients (32.5%) who developed SIRS after PCNL. In multivariate analysis, positive urine culture (odds ratio [OR], 3.556; p = 0.048), long operation time (OR, 1.011; p = 0.027), high IL-2R (OR, 1.002; p = 0.018), low percentage of CD3+ cells (OR 0.931; p = 0.006), and high white blood cell (WBC) count (OR, 1.282; p = 0.044) were independent risk factors for post-PCNL SIRS. These five significant variables were used to generate a nomogram that exhibited favorable fitting. The discrimination area under the ROC curves was 0.795. Conclusions Patients with long operation times, positive urine cultures, high interleukin 2 receptor, high white blood cell counts, and low percentages of CD3+ cells may be at a higher risk of developing SIRS after PCNL. In these patients, cautious and comprehensive preoperative evaluations and appropriate treatment strategies should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | - Kun Tang
- *Correspondence: Zhiqiang Chen, ; Kun Tang,
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Greer PJ, Lee PJ, Paragomi P, Stello K, Phillips A, Hart P, Speake C, Lacy-Hulbert A, Whitcomb DC, Papachristou GI. Severe acute pancreatitis exhibits distinct cytokine signatures and trajectories in humans: a prospective observational study. Am J Physiol Gastrointest Liver Physiol 2022; 323:G428-G438. [PMID: 36098405 PMCID: PMC9621712 DOI: 10.1152/ajpgi.00100.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 04/13/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023]
Abstract
Severe acute pancreatitis (SAP) is associated with substantial morbidity and mortality. Several cytokines have been identified to have pathophysiological significance in SAP, but studies characterizing their early trajectories are lacking. Here we characterize the early trajectories of seven key cytokines associated with SAP and compare them with non-SAP subjects. Five proinflammatory cytokines (angiopoietin-2, interleukin-6, interleukin-8, monocyte chemoattractant protein-1, resistin) and two anti-inflammatory cytokines (hepatocyte growth factor, and soluble tumor necrosis factor-α receptor-1A) were measured in a prospective cohort of acute pancreatitis subjects (2012-2016) at the time of enrollment and then every 24 h for 5 days or until discharge. The cytokines' levels and trajectories were calibrated based on date of pain onset and were compared between healthy controls and three severity categories (mild, moderate, and severe). The cohort (n = 170) consisted of 27 healthy controls, 65 mild, 38 moderate, and 40 SAP. From day 1 of symptom onset, SAP subjects exhibited significantly higher levels of both pro- and anti-inflammatory cytokines compared with non-SAP and healthy subjects. But in SAP subjects, all proinflammatory cytokines' levels trended downward after day 2 (except for a flat slope for angiopoeitin-2) whereas for non-SAP subjects, the trajectory was upward: this trajectory difference between SAP versus non-SAP subjects resulted in narrowing of the differences initially seen on day 1 for proinflammatory cytokines. For anti-inflammatory cytokines, the trajectories were uniformly upward for both SAP and non-SAP subjects. Proinflammatory cytokine response is an early and time-sensitive event in SAP that should be accounted for when designing future biomarker studies and/or therapeutic trials.NEW & NOTEWORTHY In this study, we showed that the proinflammatory cytokine response in SAP is an early event, with subsequent downregulation of proinflammatory cytokines beginning at day 1 of symptom onset. Our findings underscore the importance of enrolling subjects very early in the disease course when conducting studies to investigate early immune events of SAP; this current study also serves as an important reference for the design of future biomarker studies and therapeutic trials in SAP.
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Affiliation(s)
- Phil J Greer
- Ariel Precision Medicine, Pittsburgh, Pennsylvania
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Pedram Paragomi
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kim Stello
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anna Phillips
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Phil Hart
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Adam Lacy-Hulbert
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - David C Whitcomb
- Ariel Precision Medicine, Pittsburgh, Pennsylvania
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Physiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Goossens E, Li J, Callens C, Van Rysselberghe N, Kettunen H, Vuorenmaa J, Garcia Gonzalez N, Libert C, Ducatelle R, Van Immerseel F. Acute Endotoxemia-Induced Respiratory and Intestinal Dysbiosis. Int J Mol Sci 2022; 23:11602. [PMID: 36232913 DOI: 10.3390/ijms231911602] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022] Open
Abstract
Systemic inflammatory response syndrome (SIRS) is a severe condition characterized by systemic inflammation, which may lead to multiple organ failure, shock and death. SIRS is common in burn patients, pancreatitis and sepsis. SIRS is often accompanied by intestinal dysbiosis. However, the mechanism, role and details of microbiome alterations during the early phase of acute SIRS are not completely understood. The current study aimed to characterize the dynamic alterations of both the intestinal and respiratory microbiome at two timepoints during the early phase of acute SIRS (4 and 8 h after LPS) and link these to the host response in a mouse model of a LPS-induced lethal SIRS. Acute SIRS had no effect on the microbiome in the large intestine but induced a rapid dysbiosis in the small intestine, which resembled the microbiome alterations commonly observed in SIRS patients. Later in the disease progression, a dysbiosis of the respiratory microbiome was observed, which was associated with the MMP9 expression in the lungs. Although similar bacteria were increased in both the lung and the small intestine, no evidence for a gut-lung translocation was observed. Gut dysbiosis is commonly observed in diseases involving inflammation in the gut. However, whether the inflammatory response associated with SIRS and sepsis can directly cause gut dysbiosis was still unclear. In the current study we provide evidence that a LPS-induced SIRS can directly cause dysbiosis of the small intestinal and respiratory microbiome.
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Zonneveld LEEC, van Wijk RJ, Olgers TJ, Bouma HR, Ter Maaten JC. Prognostic value of serial score measurements of the national early warning score, the quick sequential organ failure assessment and the systemic inflammatory response syndrome to predict clinical outcome in early sepsis. Eur J Emerg Med 2022; 29:348-56. [PMID: 36062434 DOI: 10.1097/MEJ.0000000000000924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND IMPORTANCE Sepsis is a common and potentially lethal syndrome, and early recognition is critical to prevent deterioration. Yet, currently available scores to facilitate recognition of sepsis lack prognostic accuracy. OBJECTIVE To identify the optimal time-point to determine NEWS, qSOFA and SIRS for the prediction of clinical deterioration in early sepsis and to determine whether the change in these scores over time improves their prognostic accuracy. DESIGN Post hoc analysis of prospectively collected data. SETTINGS AND PARTICIPANTS This study was performed in the emergency department (ED) of a tertiary-care teaching hospital. Adult medical patients with (potential) sepsis were included. OUTCOME MEASURES AND ANALYSIS The primary outcome was clinical deterioration within 72 h after admission, defined as organ failure development, the composite outcome of ICU-admission and death. Secondary outcomes were the composite of ICU-admission/death and a rise in SOFA at least 2. Scores were calculated at the ED with 30-min intervals. ROC analyses were constructed to compare the prognostic accuracy of the scores. RESULTS In total, 1750 patients were included, of which 360 (20.6%) deteriorated and 79 (4.5%) went to the ICU or died within 72 h. The NEWS at triage (AUC, 0.62; 95% CI, 0.59-0.65) had a higher accuracy than qSOFA (AUC, 0.60; 95% CI, 0.56-0.63) and SIRS (AUC, 0.59; 95% CI, 0.56-0.63) for predicting deterioration. The AUC of the NEWS at 1 h (0.65; 95% CI, 0.63-0.69) and 150 min after triage (0.64; 95% CI, 0.61-0.68) was higher than the AUC of the NEWS at triage. The qSOFA had the highest AUC at 90 min after triage (0.62; 95% CI, 0.58-0.65), whereas the SIRS had the highest AUC at 60 min after triage (0.60; 95% CI, 0.56-0.63); both are not significantly different from triage. The NEWS had a better accuracy to predict ICU-admission/death <72 h compared with qSOFA (AUC difference, 0.092) and SIRS (AUC difference, 0.137). No differences were found for the prediction of a rise in SOFA at least 2 within 72 h between the scores. Patients with the largest improvement in any of the scores were more prone to deteriorate. CONCLUSION NEWS had a higher prognostic accuracy to predict deterioration compared with SIRS and qSOFA; the highest accuracy was reached at 1 h after triage.
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Alosaimi MM, Sebzali F, Iqbal A, Rabbat CG, Clase CM. Pyoderma Gangrenosum After Insertion of a Hemodialysis Catheter: Koebner Phenomenon, Systemic Inflammatory Response Syndrome, and a Delay in Diagnosis. Can J Kidney Health Dis 2022; 9:20543581221120618. [PMID: 36160315 PMCID: PMC9493685 DOI: 10.1177/20543581221120618] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 12/03/2022] Open
Abstract
Rationale: Pyoderma gangrenosum is a rare neutrophilic dermatosis. Misdiagnosis of
pyoderma gangrenosum as an infection is not uncommon. Pyoderma gangrenosum
can be associated with Koebner phenomenon and rarely results in systemic
inflammatory response syndrome and shock. Presenting concerns of the patient: A 61-year-old woman had recently started maintenance hemodialysis, using a
tunneled catheter. She was admitted with fever and signs of inflammation at
the catheter exit site and along the tunnel. Diagnoses: The initial diagnosis was catheter-related tunnel infection. The exit site
broke down into a 5 cm × 5 cm lesion typical of pyoderma, and a new similar
lesion developed at a subcutaneous injection site in her abdomen. Clinical
diagnosis of pyoderma gangrenosum was made. She remained febrile despite
broad antibiotic coverage and catheter removal and developed systemic
inflammatory response syndrome (SIRS) that necessitated transfer to
intensive care unit. Interventions: She responded well to fluids and intravenous steroids. Viral and bacterial
cultures were negative throughout; echocardiography and computed tomography
were unrevealing. Insertion of a new hemodialysis catheter was deferred as
long as clinically possible, was undertaken while the patient was taking
steroids, and was uncomplicated. Outcomes: She remained hemodynamically stable and was discharged after rehabilitation.
Her wounds slowly granulated and healed. Steroids were tapered. Teaching points: To our knowledge, this is the first case report of a patient with pyoderma
gangrenosum developing at the site of tunneled hemodialysis catheter. Our
patient developed SIRS with no evidence of infection. We summarize 11
previous case reports of pyoderma leading to SIRS and responsive to
steroids.
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Affiliation(s)
- Majed M Alosaimi
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Fatemah Sebzali
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Ali Iqbal
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Christian G Rabbat
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Yang Z, Simovic MO, Liu B, Burgess MB, Cap AP, DalleLucca JJ, Li Y. Indices of complement activation and coagulation changes in trauma patients. Trauma Surg Acute Care Open 2022; 7:e000927. [PMID: 36117727 PMCID: PMC9476135 DOI: 10.1136/tsaco-2022-000927] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Early complementopathy and coagulopathy are shown often after trauma. However, the prevalence of any interplay between complement cascade (ComC) and coagulation cascade (CoaC) after trauma remains unclear. This study intended to explore whether complement-coagulation crosstalk exists, which may provide a reliable guide to clinical implications in trauma patients. Methods This single-center cohort study of trauma patients enrolled 100 patients along with 20 healthy volunteers. Blood samples from patients were collected at admission, 45, 90, 135 minutes, and 18 hours after admission. Demographic characteristics were recorded, blood levels of ComC and CoaC factors, and inflammatory cytokines were measured by ELISA, clot-based assays, or luminex multiplex assay, and partial thromboplastin (PT) and partial thromboplastin time (PTT) were assessed using a Behring blood coagulation system. Results Compared with the healthy controls, plasma levels of complement factors (C5b-9 and Bb) and 11 tested inflammatory cytokines increased in moderately and severely injured patients as early as 45 minutes after admission and sustained higher levels up to 18 hours after admission. C5b-9 correlated positively to patients’ hospital stay. In parallel, the consumption of coagulation factors I, II, X, and XIII was shown throughout the first 18 hours after admission in moderately and severely injured patients, whereas PT, PTT, D-dimer, factor VII, and factor VIII values significantly increased from the admission to 135 minutes in moderately and severely injured patients. Along with an inverse correlation between plasma Bb, factors I and II, a positive correlation between C5b-9, Bb, D-dimer, PT, and PTT was evident. Conclusions This study demonstrates trauma-induced early activation of plasma cascades including ComC, CoaC, and fibrinolytic cascade, and their correlation between plasma cascades in severe trauma patients. Our study suggests that the simultaneous modulation of plasma cascades might benefit clinical outcomes for trauma patients. Level of evidence Prospective study, level III.
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Affiliation(s)
- Zhangsheng Yang
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Milomir O Simovic
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Bin Liu
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Matthew B Burgess
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | | | - Yansong Li
- Department of Organ Function Support, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.,Trauma Research, UTHSCSA, San Antonio, Texas, USA.,Geneva Foundation, Tacoma, Washington, USA
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Scott JP, Tanem JM, Tomita-Mitchell A, Hoffman GM, Niebler RA, Liang HL, Simpson PM, Stamm KD, North PE, Mitchell ME. Elevated nuclear and mitochondrial cell-free deoxyribonucleic acid measurements are associated with death after infant cardiac surgery. J Thorac Cardiovasc Surg 2022; 164:367-375. [PMID: 35144816 DOI: 10.1016/j.jtcvs.2021.10.066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Mortality rates following pediatric cardiac surgery with cardiopulmonary bypass have declined over decades, but have plateaued in recent years. This is in part attributable to persistent issues with postoperative global inflammation and myocardial dysfunction, commonly manifested by systemic inflammatory response syndrome and low cardiac output syndrome, respectively. Quantified cell-free DNA (cfDNA), of nuclear or mitochondrial origin, has emerged as a biomarker for both inflammation and myocardial injury. Recent data suggest that nuclear cfDNA (ncfDNA) may quantify inflammation, whereas mitochondrial cfDNA (mcfDNA) may correlate with the degree of myocardial injury. We hypothesize that threshold levels of ncfDNA and mcfDNA can be established that are sensitive and specific for postoperative mortality mediated through independent pathways, and that association will be enhanced with combined analysis. METHODS Prospective observational study of infants younger than age 1 year undergoing planned surgery with cardiopulmonary bypass. The study received institutional review board approval. Samples were drawn before skin incision, immediately after completion of cardiopulmonary bypass, and subsequently at predetermined intervals postoperatively. Association of early postoperative ncfDNA and mcfDNA levels with mortality were assessed by logistic regression with cut-points chosen by receiving operating characteristic curve exploration. RESULTS Data were available in 59 patients. Median age and weight were 122 days (interquartile range, 63-154 days) and 4.9 kg (interquartile range, 3.9-6.2 kg). Median STAT category was 3 (interquartile range, 1-4). The primary outcome of death was met in 3 out of 59 (5%). Combined analysis of ncfDNA and mcfDNA levels at 12 hours after the initiation of cardiopulmonary bypass with death at a threshold of 50 ng/mL ncfDNA and 17 copies/μL mcfDNA yielded 100% sensitivity and negative predictive value. The specificity (91%) and positive predictive value (38%) increased through combined analysis compared with univariate analysis. Combined analysis exhibited high specificity (93%) and negative predictive value (78%) for prolonged (>30 postoperative days) hospitalization. CONCLUSIONS Combined analysis of early postoperative ncfDNA and mcfDNA can stratify risk of mortality and prolonged hospitalization following infant cardiac surgery. Evaluation of both ncfDNA and mcfDNA to identify states of generalized inflammation and myocardial injury may allow for targeted interventions and improved outcomes.
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Affiliation(s)
- John P Scott
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis; Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis.
| | - Justinn M Tanem
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis; Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Aoy Tomita-Mitchell
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - George M Hoffman
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis; Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Robert A Niebler
- Division of Pediatric Critical Medicine, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Huan Ling Liang
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Pippa M Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Karl D Stamm
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Paula E North
- Division of Pediatric Pathology, Department of Pathology, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Herma Heart Institute, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wis
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Flinspach AN, Konczalla J, Seifert V, Zacharowski K, Herrmann E, Balaban Ü, Adam EH. Detecting Sepsis in Patients with Severe Subarachnoid Hemorrhage during Critical Care. J Clin Med 2022; 11. [PMID: 35887994 DOI: 10.3390/jcm11144229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction: Sepsis and septic shock continue to have a very high mortality rate. Therefore, the last consensus-based sepsis guideline introduced the sepsis related organ failure assessment (SOFA) score to ensure a rapid diagnosis and treatment of sepsis. In neurosurgical patients, especially those patients with subarachnoid hemorrhage (SAH), there are considerable difficulties in interpreting the SOFA score. Therefore, our study was designed to evaluate the applicability of the SOFA for critical care patients with subarachnoid hemorrhage. Methods: Our retrospective monocentric study was registered (NCT05246969) and approved by the local ethics committee (# 211/18). Patients admitted to the Department of Neurosurgery at the Frankfurt University Hospital were enrolled during the study period. Results: We included 57 patients with 85 sepsis episodes of which 141 patients had SOFA score-positive results and 243 SIRS positive detections. We failed to detect a correlation between the clinical diagnosis of sepsis and positive SOFA or SIRS scores. Moreover, a significant proportion of sepsis that was incorrectly detected via the SOFA score could be attributed to cerebral vasospasms (p < 0.01) or a decrease in Glasgow Coma Scale (p < 0.01). Similarly, a positive SIRS score was often not attributed to a septic episode (49.0%). Discussion: Regardless of the fact that SAH is a rare disease, the relevance of sepsis detection should be given special attention in light of the long duration of therapy and sepsis prevalence. Among the six modules represented by the SOFA score, two highly modules were practically eliminated. However, to enable early diagnosis of sepsis, the investigator’s clinical views and synopsis of various scores and laboratory parameters should be highlighted. Conclusions: In special patient populations, such as in critically ill SAH patients, the SOFA score can be limited regarding its applicability. In particular, it is very important to differentiate between CVS and sepsis.
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Dankert A, Kraxner J, Breitfeld P, Bopp C, Issleib M, Doehn C, Bathe J, Krause L, Zöllner C, Petzoldt M. Is Prehospital Assessment of qSOFA Parameters Associated with Earlier Targeted Sepsis Therapy? A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11123501. [PMID: 35743570 PMCID: PMC9224632 DOI: 10.3390/jcm11123501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND This study aimed to determine whether prehospital qSOFA (quick sequential organ failure assessment) assessment was associated with a shortened 'time to antibiotics' and 'time to intravenous fluid resuscitation' compared with standard assessment. METHODS This retrospective study included patients who were referred to our Emergency Department between 2014 and 2018 by emergency medical services, in whom sepsis was diagnosed during hospitalization. Two multivariable regression models were fitted, with and without qSOFA parameters, for 'time to antibiotics' (primary endpoint) and 'time to intravenous fluid resuscitation'. RESULTS In total, 702 patients were included. Multiple linear regression analysis showed that antibiotics and intravenous fluids were initiated earlier if infections were suspected and emergency medical services involved emergency physicians. A heart rate above 90/min was associated with a shortened time to antibiotics. If qSOFA parameters were added to the models, a respiratory rate ≥ 22/min and altered mentation were independent predictors for earlier antibiotics. A systolic blood pressure ≤ 100 mmHg and altered mentation were independent predictors for earlier fluids. When qSOFA parameters were added, the explained variability of the model increased by 24% and 38%, respectively (adjusted R² 0.106 versus 0.131 for antibiotics and 0.117 versus 0.162 for fluids). CONCLUSION Prehospital assessment of qSOFA parameters was associated with a shortened time to a targeted sepsis therapy.
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Affiliation(s)
- André Dankert
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
- Correspondence:
| | - Jochen Kraxner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Philipp Breitfeld
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Clemens Bopp
- Department of Anesthesiology and Intensive Care Medicine, German Military Hospital Hamburg, Lesserstrasse 180, 22049 Hamburg, Germany;
| | - Malte Issleib
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Christoph Doehn
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Janina Bathe
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany;
| | - Christian Zöllner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
| | - Martin Petzoldt
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany; (J.K.); (P.B.); (M.I.); (C.D.); (J.B.); (C.Z.); (M.P.)
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