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Groiss SJ, Balloff C, Elben S, Brandenburger T, Müttel T, Kindgen-Milles D, Vollmer C, Feldt T, Kunstein A, Ole Jensen BE, Hartung HP, Schnitzler A, Albrecht P. Prolonged Neuropsychological Deficits, Central Nervous System Involvement, and Brain Stem Affection After COVID-19-A Case Series. Front Neurol 2020; 11:574004. [PMID: 33224088 PMCID: PMC7674620 DOI: 10.3389/fneur.2020.574004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: The affection of both the peripheral (PNS) and central nervous system (CNS) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been assumed to play a direct role in the respiratory failure of patients with Corona virus disease 2019 (COVID-19) through affection of medullary cardiorespiratory centers resulting in neurological complications and sequelae. Methods: We used a multimodal electrophysiological approach combined with neuropsychological investigations to study functional alteration of both the PNS and CNS in four patients with severe COVID-19. Results: We found electrophysiological evidence for affection of both the PNS and CNS, and particularly affection of brain stem function. Furthermore, our neuropsychological investigations provide evidence of marked impairment of cognition independent of delirium, and outlasting the duration of acute infection with SARS-CoV-2. Conclusion: This case series provides first direct electrophysiological evidence for functional brain stem involvement in COVID-19 patients without evident morphological changes supporting the notion of the brain stem contributing to respiratory failure and thus promoting severe courses of the disease. Moreover, sustained neuropsychological sequelae in these patients may be of particular psychosocial and possibly also economic relevance for society.
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Polok K, Fronczek J, Artigas A, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Bollen Pinto B, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W, Joannidis M, Mesotten D, Reper P, Oeyen S, Swinnen W, Brix H, Brushoej J, Villefrance M, Nedergaard HK, Bjerregaard AT, Balleby IR, Andersen K, Hansen MA, Uhrenholt S, Bundgaard H, Fjølner J, Hussein AARM, Salah R, Ali YKNM, Wassim K, Elgazzar YA, Tharwat S, Azzam AY, habib AA, Abosheaishaa HM, Azab MA, Leaver S, Galbois A, Guidet B, Charron C, Guerot E, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, Plantefeve G, Vanderlinden T, Jurcisin I, Megarbane B, Caillard A, Valent A, Garnier M, Besset S, Oziel J, RAPHALEN JH, Dauger S, Dumas G, Goncalves B, Piton G, Barth E, Goebel U, Barth E, Kunstein A, Schuster M, Welte M, Lutz M, Meybohm P, Steiner S, Poerner T, Haake H, Schaller S, Schaller S, Schaller S, Kindgen-Milles D, Meyer C, Kurt M, Kuhn KF, Randerath W, Wollborn J, Dindane Z, et alPolok K, Fronczek J, Artigas A, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Bollen Pinto B, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W, Joannidis M, Mesotten D, Reper P, Oeyen S, Swinnen W, Brix H, Brushoej J, Villefrance M, Nedergaard HK, Bjerregaard AT, Balleby IR, Andersen K, Hansen MA, Uhrenholt S, Bundgaard H, Fjølner J, Hussein AARM, Salah R, Ali YKNM, Wassim K, Elgazzar YA, Tharwat S, Azzam AY, habib AA, Abosheaishaa HM, Azab MA, Leaver S, Galbois A, Guidet B, Charron C, Guerot E, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, Plantefeve G, Vanderlinden T, Jurcisin I, Megarbane B, Caillard A, Valent A, Garnier M, Besset S, Oziel J, RAPHALEN JH, Dauger S, Dumas G, Goncalves B, Piton G, Barth E, Goebel U, Barth E, Kunstein A, Schuster M, Welte M, Lutz M, Meybohm P, Steiner S, Poerner T, Haake H, Schaller S, Schaller S, Schaller S, Kindgen-Milles D, Meyer C, Kurt M, Kuhn KF, Randerath W, Wollborn J, Dindane Z, Kabitz HJ, Voigt I, Shala G, Faltlhauser A, Rovina N, Aidoni Z, Chrisanthopoulou E, Papadogoulas A, Gurjar M, Mahmoodpoor A, Ahmed AK, Marsh B, Elsaka A, Sviri S, Comellini V, Rabha A, Ahmed H, Namendys-Silva SA, Ghannam A, Groenendijk M, Zegers M, de Lange D, Cornet A, Evers M, Haas L, Dormans T, Dieperink W, Romundstad L, Sjøbø B, Andersen FH, Strietzel HF, Olasveengen T, Hahn M, Czuczwar M, Gawda R, Klimkiewicz J, de Lurdes Campos Santos M, Gordinho A, Santos H, Assis R, Oliveira AIP, Badawy MR, Perez-Torres D, Gomà G, Villamayor MI, Mira AP, Cubero PJ, Rivera SA, Tomasa T, Iglesias D, Vázquez EM, Aldecoa C, Ferreira AF, Zalba-Etayo B, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, Sancho S, Priego J, Abualqumboz EMY, Hilles MMY, Saleh M, Ben-HAmouda N, Roberti A, Dullenkopf A, Fleury Y, Bollen Pinto B, Schefold JC, Al-Sadawi M. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study. Crit Care 2022; 26:224. [PMID: 35869557 PMCID: PMC9305028 DOI: 10.1186/s13054-022-04082-1] [Show More Authors] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. METHODS This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. RESULTS Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). CONCLUSIONS Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .
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Loosen SH, Demir M, Kunstein A, Jördens M, Qvarskhava N, Luedde M, Luedde T, Roderburg C, Kostev K. Variables associated with increased incidence of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002243. [PMID: 34049870 PMCID: PMC8166633 DOI: 10.1136/bmjdrc-2021-002243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/17/2021] [Accepted: 03/28/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD) show a rapidly increasing incidence worldwide. Although both diseases often occur in the same patient population, their mutual influence is not fully understood. We therefore aimed at analyzing the impact of T2D on the incidence of NAFLD in a large cohort of outpatients in Germany. RESEARCH DESIGN AND METHODS 32 201 patients with T2D diagnosed between 2012 and 2018 were identified in the IQVIA Disease Analyzer database. Probability of NAFLD was analyzed using Cox regression models. RESULTS The cumulative incidence of NAFLD within the 7-year observation period was 4.3%. The probability of NAFLD was significantly higher among patients with T2D with increased body mass index but not hemoglobin A1c. Prescriptions of sodium-glucose cotransporter-2 inhibitors (HR: 0.54, 95% CI 0.45 to 0.64), glucagon-like peptide-1 receptor antagonists (HR: 0.65, 95% CI 0.52 to 0.81), and insulin (HR: 0.72, 95% CI 0.62 to 0.8) were significantly associated with lower incidence of NAFLD. CONCLUSION Our data from a large population-based cohort of patients with T2D identified sociodemographic and therapeutic parameters associated with NAFLD incidence in patients with T2D which should be taken into account for novel therapeutic concepts.
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Keitel V, Bode JG, Feldt T, Walker A, Müller L, Kunstein A, Klindt C, Killer A, Senff T, Timm J, Ostermann P, Damagnez M, Lübke N, Adams O, Schaal H, Antoch G, Neubert J, Albrecht P, Meuth S, Elben S, Mohring A, Fischer JC, Bölke E, Hoenig M, Schulz AS, Luedde T, Jensen B. Case Report: Convalescent Plasma Achieves SARS-CoV-2 Viral Clearance in a Patient With Persistently High Viral Replication Over 8 Weeks Due to Severe Combined Immunodeficiency (SCID) and Graft Failure. Front Immunol 2021; 12:645989. [PMID: 34012436 PMCID: PMC8126709 DOI: 10.3389/fimmu.2021.645989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/22/2021] [Indexed: 01/02/2023] Open
Abstract
We describe the unique disease course and cure of SARS-CoV-2 infection in a patient with SCID and graft failure. In absence of a humoral immune response, viral clearance was only achieved after transfusion of convalescent plasma. This observation underscores the necessity of the humoral immune response for SARS-CoV-2 clearance.
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Kunstein A, Drößler L, Nia AM, Lüdde T, Jensen BEO. [Oro- and nasopharyngeal swab for detection of SARS-CoV-2 - step-by-step approach]. Dtsch Med Wochenschr 2021; 146:419-424. [PMID: 33465784 DOI: 10.1055/a-1294-1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Oro- and nasopharyngeal swab specimens by quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) to detect SARS-CoV-2 is currently the main diagnostic tool during the ongoing COVID-19 pandemia. Accurate performance of the procedure to avoid false negative results, adequate personal protective equipment and material sparing algorithms are mandatory while obtaining swab specimens. In the current stey-by-step review a feasible approach will be presented.
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Loosen SH, Kunstein A, vom Dahl S, Bode JG, Luedde T, Kandler J. Digital single-operator cholangioscopy with EHL as salvage therapy of an internalized and stone-impacted biliary stent 13 years after implantation. Endosc Int Open 2022; 10:E269-E272. [PMID: 35295243 PMCID: PMC8920710 DOI: 10.1055/a-1728-9526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Baldia PH, Wernly B, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Bruno RR, Binnebößel S, Wolff G, Erkens R, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Leaver S, De Lange DW, Guidet B, Jung C, Joannidis M, Mesotten D, Reper P, Swinnen W, Serck N, DEWAELE ELISABETH, Brix H, Brushoej J, Kumar P, Nedergaard HK, Balleby IR, Bundesen C, Hansen MA, Uhrenholt S, Bundgaard H, Innes R, Gooch J, Cagova L, Potter E, Reay M, Davey M, Abusayed MA, Humphreys S, Galbois A, Charron C, Berlemont CH, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, PLANTEFEVE G, Vanderlinden T, Jurcisin I, Megarbane B, Chousterman BG, Dépret F, Garnier M, Besset S, Oziel J, Ferre A, Dauger S, Dumas G, Goncalves B, Vettoretti L, Thevenin D, Schaller S, Schaller S, Kurt M, Faltlhauser A, Schaller S, Milovanovic M, Lutz M, Shala G, Haake H, Randerath W, Kunstein A, Meybohm P, Schaller S, Steiner S, Barth E, Poerner T, Simon P, Lorenz M, Dindane Z, Kuhn KF, Welte M, Voigt I, et alBaldia PH, Wernly B, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Bruno RR, Binnebößel S, Wolff G, Erkens R, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Leaver S, De Lange DW, Guidet B, Jung C, Joannidis M, Mesotten D, Reper P, Swinnen W, Serck N, DEWAELE ELISABETH, Brix H, Brushoej J, Kumar P, Nedergaard HK, Balleby IR, Bundesen C, Hansen MA, Uhrenholt S, Bundgaard H, Innes R, Gooch J, Cagova L, Potter E, Reay M, Davey M, Abusayed MA, Humphreys S, Galbois A, Charron C, Berlemont CH, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, PLANTEFEVE G, Vanderlinden T, Jurcisin I, Megarbane B, Chousterman BG, Dépret F, Garnier M, Besset S, Oziel J, Ferre A, Dauger S, Dumas G, Goncalves B, Vettoretti L, Thevenin D, Schaller S, Schaller S, Kurt M, Faltlhauser A, Schaller S, Milovanovic M, Lutz M, Shala G, Haake H, Randerath W, Kunstein A, Meybohm P, Schaller S, Steiner S, Barth E, Poerner T, Simon P, Lorenz M, Dindane Z, Kuhn KF, Welte M, Voigt I, Kabitz HJ, Wollborn J, Goebel U, Stoll SE, Kindgen-Milles D, Dubler S, Jung C, Fuest K, Schuster M, Papadogoulas A, Mulita F, Rovina N, Aidoni Z, CHRISANTHOPOULOU EVANGELIA, KONDILI EUMORFIA, Andrianopoulos I, Groenendijk M, Evers M, Evers M, van Lelyveld-Haas L, Meynaar I, Cornet AD, Zegers M, Dieperink W, de Lange D, Dormans T, Hahn M, Sjøbøe B, Strietzel HF, Olasveengen T, Romundstad L, Kluzik A, Zatorski P, Drygalski T, Klimkiewicz J, Solek-pastuszka J, Onichimowski D, Czuczwar M, Gawda R, Stefaniak J, Stefanska-Wronka K, Zabul E, Oliveira AIP, Assis R, de Lurdes Campos Santos M, Santos H, Cardoso FS, Gordinho A, Banzo MJA, Zalba-Etayo B, CUBERO PATRICIAJIMENO, Priego J, Gomà G, Tomasa-Irriguible TM, Sancho S, Ferreira AF, Vázquez EM, Mira ÁP, Ibarz M, Iglesias D, Arias-Rivera S, Frutos-Vivar F, Lopez-Cuenca S, Aldecoa C, Perez-Torres D, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, de Gopegui PR, Ben-Hamouda N, Roberti A, Fleury Y, Abidi N, Dullenkopf A, Pugh R, Smuts S. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial. BMC Geriatr 2022; 22:1000. [PMID: 36575394 PMCID: PMC9794407 DOI: 10.1186/s12877-022-03709-w] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients. METHODS This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression. RESULTS 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis. CONCLUSION Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19. TRIAL REGISTRATION This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020.
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Mertens A, Essing T, Kunstein A, Weigel C, Bode J, Roderburg C, Luedde T, Kandler J, Loosen SH. Acute Variceal Hemorrhage in Germany-A Nationwide Study of 65,357 Hospitalized Cases: Variceal Hemorrhage in Germany. Can J Gastroenterol Hepatol 2024; 2024:5453294. [PMID: 39483247 PMCID: PMC11527532 DOI: 10.1155/2024/5453294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/07/2024] [Accepted: 10/01/2024] [Indexed: 11/03/2024] Open
Abstract
Background: Acute variceal hemorrhage (AVH) is a frequent cause of upper gastrointestinal bleeding (UGIB) in liver cirrhosis. Most cases require urgent endoscopic intervention due to potentially life-threatening courses. Different endoscopic hemostasis techniques can be used, in particular endoscopic variceal ligation (EVL) and endoscopic sclerotherapy (EST), depending on the bleeding side (esophageal, fundal, and gastric) as well as radiological interventions (e.g., embolization and transjugular intrahepatic portosystemic shunt [TIPS]). This study aimed to investigate trends in incidence, treatment modalities, and outcome parameters, such as in-hospital mortality and adverse events in Germany. Methods: We evaluated the current epidemiological trends, therapeutic strategies, and in-hospital mortality of AVH in Germany based on the standardized hospital discharge data provided by the German Federal Statistical Office from 2010 to 2019. Results: A total of 65,357 AVH cases, predominately males (68.3%), were included in the analysis. The annual incidence rate (hospitalization cases per 100,000 persons) was 8.9. The in-hospital mortality was 18.6%. The most common underlying disease was alcohol-related liver cirrhosis (60.6%). The most common clinical complication was bleeding anemia (60.1%), whereas hypovolemic shock (12.8%) was the less frequent. In esophageal variceal hemorrhage (EVH), EVL was the most frequently performed endoscopic therapy, while in gastric variceal hemorrhage (GVH), EST and fibrin glue injection were the most commonly performed therapies. EVL showed the lowest in-hospital mortality (12.3%) in EVH, while EST showed favorable results (14% in-hospital mortality) in GVH. Combination therapies overall showed a higher in-hospital mortality and were more frequent in GVH. The presence of hypovolemic shock, AKI, sepsis, artificial ventilation, ARDS, bleeding anemia, hepatic encephalopathy, and male sex was associated with a significantly worse outcome. Conclusion: Our study provides detailed insight into the incidence, patient-related risk factors, endoscopic treatment, and in-hospital mortality in a sizeable AVH collective in Germany. These data might help improve risk stratification and treatment strategies for AVH patients in the future.
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Kunstein A, Drößler L, Nia AM, Lüdde T, Jensen BEO. [Oro- and Nasopharyngeal Swab for Detection of SARS-CoV-2 - Step-by-step Approach]. Pneumologie 2021; 75:383-388. [PMID: 33940658 DOI: 10.1055/a-1334-2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Oro- and nasopharyngeal swab specimens by quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) to detect SARS-CoV-2 is currently the main diagnostic tool during the ongoing COVID-19 pandemia. Accurate performance of the procedure to avoid false negative results, adequate personal protective equipment and material sparing algorithms are mandatory while obtaining swab specimens. In the current stey-by-step review a feasible approach will be presented.
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Loosen SH, Benz F, Mohr R, Reuken PA, Wirtz TH, Junker L, Jansen C, Meyer C, Praktiknjo M, Wree A, Reißing J, Demir M, Gu W, Vucur M, Schierwagen R, Stallmach A, Kunstein A, Bode J, Trautwein C, Tacke F, Luedde T, Bruns T, Trebicka J, Roderburg C. Soluble urokinase plasminogen activator receptor levels predict survival in patients with portal hypertension undergoing TIPS. JHEP Rep 2024; 6:101054. [PMID: 38681861 PMCID: PMC11053213 DOI: 10.1016/j.jhepr.2024.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 12/10/2023] [Accepted: 01/12/2024] [Indexed: 05/01/2024] Open
Abstract
Background & Aims Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective therapy for complications of portal hypertension. However, clinical outcomes following TIPS placement vary widely between patients and identifying ideal candidates remains a challenge. Soluble urokinase plasminogen activator receptor (suPAR) is a circulating marker of immune activation that has previously been associated with liver inflammation, but its prognostic value in patients receiving TIPS is unknown. In the present study, we evaluated the potential clinical relevance of suPAR levels in patients undergoing TIPS insertion. Methods suPAR concentrations were measured by ELISA in hepatic vein (HV) and portal vein (PV) blood samples from 99 patients (training cohort) as well as peripheral venous blood samples from an additional 150 patients (validation cohort) undergoing TIPS placement. The association between suPAR levels and patient outcomes was assessed using Kaplan-Meier methods and Cox-regression analyses. Results suPAR concentrations were significantly higher in HV samples compared to PV samples and correlated with PV concentration, the presence of ascites, renal injury, and consequently with the Child-Pugh and MELD scores. Patients with lower suPAR levels had significantly better short- and long-term survival after TIPS insertion, which remained robust after adjustment for confounders in multivariate Cox-regression analyses. Sensitivity analysis showed an improvement in risk prediction in patients stratified by Child-Pugh or MELD scores. In an independent validation cohort, higher levels of suPAR predicted poor transplant-free survival after TIPS, particularly in patients with Child-Pugh A/B cirrhosis. Conclusion suPAR is largely derived from the injured liver and its levels are predictive of outcome in patients undergoing TIPS. suPAR, as a surrogate of hepatic inflammation, may be used to stratify care in patients following TIPS insertion. Impact and implications Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective therapy for complications of portal hypertension. However, clinical outcomes following TIPS placement vary widely between patients and identification of the ideal candidates remains challenging. We show that soluble urokinase plasminogen activator receptor (suPAR), a circulating marker of immune activation that can easily be measured in routine clinical practice, is a novel marker to identify patients who will benefit from TIPS and those who will not.
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