Neutrophil CD64 as a sepsis biomarker

Neutrophilic granulocytes express their Fcgamma receptor, also known as the CD64 antigen, predominantly when they are activated. This makes neutrophil CD64 a potential biomarker for infection and sepsis. Indeed there is ample literature on the diagnostic utility of neutrophil CD64 in a variety of diseases. This review summarizes the literature on its application as a sepsis biomarker, in adults as well as in neonates and infants. The available data indicate that neutrophil CD64 seems to have high sensitivity (86%) and specificity (87%), but the methodological quality of most studies is questionable. Nevertheless, neutrophil CD64 appears to be a better diagnostic test than traditional hematological assays, C-reactive protein and probably even procalcitonin. Application of neutrophil CD64 in other conditions than sepsis is briefly presented. Finally, future clinical studies are discussed which are needed in order to confirm the diagnostic performance of this promising biomarker.     

Increased plasma zonulin in patients with sepsis

Introduction:

Zonulin is a eukaryotic protein structurally similar to Vibrio cholerae’s zonula occludens toxin. It plays an important role in the opening of small intestine tight junctions. The loss of gut wall integrity during sepsis might be pivotal and has been described in various experimental as well as human studies. Increased levels of zonulin could be demonstrated in diseases associated with increased intestinal inflammation, such as celiac disease and type 1 diabetes. We therefore investigated the role of plasma levels of zonulin in patients with sepsis as a non-invasive marker of gut wall integrity.

Materials and methods:

Plasma level of zonulin was measured in 25 patients with sepsis, severe sepsis or septic shock according to ACCP/SCCM criteria at the first day of diagnosed sepsis. 18 non-septic post-surgical ICU-patients and 20 healthy volunteers served as control. Plasma levels were determined by using commercially available ELISA kit. Data are given as median and interquartile range (IQR).

Results:

Significantly higher plasma concentration of zonulin were found in the sepsis group: 6.61 ng/mL (IQR 3.51–9.46), as compared to the to the post-surgical control group: 3.40 ng/mL (IQR 2.14–5.70) (P = 0.025), as well as to the healthy group: 3.55 ng/mL (IQR 3.14–4.14) (P = 0.008).

Conclusion:

We were able demonstrate elevated levels of plasma zonulin, a potential marker of intestinal permeability in septic patients. Increased zonulin may serve as an additional mechanism for the observed increased intestinal permeability during sepsis and SIRS.     

Increased plasma vaspin concentration in patients with sepsis: an exploratory examination

Introduction

Vaspin (visceral adipose tissue-derived serpin) was first described as an insulin-sensitizing adipose tissue hormone. Recently its anti-inflammatory function has been demonstrated. Since no appropriate data is available yet, we sought to investigate the plasma concentrations of vaspin in sepsis.

Materials and methods

57 patients in intensive care, fulfilling the ACCP/SCCM criteria for sepsis, were prospectively included in our exploratory study. The control group consisted of 48 critically ill patients, receiving intensive care after trauma or major surgery. Patients were matched by age, sex, weight and existence of diabetes before statistical analysis. Blood samples were collected on the day of diagnosis. Vaspin plasma concentrations were measured using a commercially available enzyme-linked immunosorbent assay.

Results

Vaspin concentrations were significantly higher in septic patients compared to the control group (0.3 (0.1-0.4) ng/mL vs. 0.1 (0.0-0.3) ng/mL, respectively; P < 0.001). Vaspin concentration showed weak positive correlation with concentration of C-reactive protein (CRP) (r = 0.31, P = 0.002) as well as with SAPS II (r = 0.34, P = 0.002) and maximum of SOFA (r = 0.39, P < 0.001) scoring systems, as tested for the overall study population.

Conclusion

In the sepsis group, vaspin plasma concentration was about three-fold as high as in the median surgical control group. We demonstrated a weak positive correlation between vaspin and CRP concentration, as well as with two scoring systems commonly used in intensive care settings. Although there seems to be some connection between vaspin and inflammation, its role in human sepsis needs to be evaluated further.Key words: adipocytokine, inflammation, vaspin, CRP, intensive care     

Performance of D-dimer for predicting sepsis mortality in the intensive care unit

IntroductionThe prognostic value of D-dimer (DD) in sepsis remains controversial. This study aimed to investigate the performance of DD for predicting sepsis mortality in the hospital and for identifying its potential correlates.Materials and methodsThe clinical and laboratory data of adult sepsis patients were extracted from the Medical Information Mart for Intensive Care III (MIMIC III, v1.4) database using the structured query language (SQL). The database contains critical illness admitted to the intensive care unit at Beth Israel Deaconess Medical Center between June 2001 and October 2012. The association between DD and mortality was investigated with receiver operating characteristic (ROC) curve, restricted cubic spline and logistic regression analysis. Subgroup analysis was also used for identifying DD correlates.ResultsThe study population consisted of 358 sepsis patients. Those who died during hospital stay (N = 160) had significantly higher DD values than those who survived (N = 198). The area under the ROC curve (AUC) of DD was 0.59 (P < 0.010). In subgroup analysis, white blood cell (WBC) count > 18 x10⁹/L and vasopressor therapy significantly decreased DD diagnostic performance. Categorical DD value was independently associated with hospital mortality after sequential organ failure score (SOFA) and blood lactate adjustment. Restricted cubic spline analysis revealed a U-shape relationship between DD and in-hospital mortality.DiscussionWe conclude that the accuracy of DD for predicting in-hospital sepsis mortality depends on WBC count and vasopressor therapy. Both low and extremely elevated DD values are associated with higher risk of death.     

Determination of reference interval for presepsin,an early marker for sepsis

Introduction

Presepsin, the circulating soluble form of CD14 subtype (sCD14-ST) is a new emerging early marker for sepsis. Various cutoff levels of presepsin have been proposed, to discriminate between systemic bacterial and nonbacterial infectious diseases. The aim of this work was to define the reference interval for presepsin according to the CLSI C28-A3c approved guideline.

Materials and methods

Reference individuals (N = 200; 120 females) aged 18-75 years (median 39 years), free from inflammatory diseases, were selected for the study. Presepsin concentrations were measured by a commercially available chemiluminescent enzyme immunoassay (PATHFAST^TM, Mitsubishi Chemical Europe GmbH, Düsseldorf, Germany). Reference limits were calculated using the non-parametric percentile method.

Results

Overall, the reference limits for the presepsin were 55–184 pg/mL (90% confidence intervals, CI, were 45 to 58 and 161 to 214, respectively). There were no significant differences between males and females and the presepsin concentrations were not even particularly influenced by age. The upper reference limit for the presepsin is much lower than every cut-off limit so far proposed, both for sepsis and also for systemic inflammatory response syndrome.

Conclusion

Specific decision levels are required to define the diagnostic and prognostic roles of presepsin in different settings of inflammatory and infectious diseases. Reference values can help to distinguish and quickly rule out healthy subjects or patients with other pathologies.Key words: CD14 Antigen, presepsin, reference values, male, female, Clinical and Laboratory Standard Institute     

蓝光治疗照射对新生儿ABO血溶性黄疸的疗效分析

目的:分析研究蓝光治疗照射对于新生儿ABO血溶性黄疸的治疗效果。方法:针对在某医院2012-2013年间治疗的100例患儿的临床试验进行研究分析,根据住院时间的先后顺序将这些患儿随机地分成两个小组,对照组和观察组。每一个组别中有50个患儿,其中对照组中的患儿分别给予口服苯巴比妥、皮质激素、尼可刹米、碳酸氢钠等常规基础治疗;观察组在对照组治疗的基础上利用黄疸治疗箱行间断蓝光照射进行治疗。结果:试验发现观察组临床实验效率远远高于对照组,由于两个组别之间的差异存在一定的研究意义,实验表明对于新生儿ABO血溶性黄疸患儿,蓝光间断治疗是一种比较安全并且可靠的治疗手段,具有一定的现实意义。     

光照疗法配合茵栀黄颗粒、双歧杆菌三联活菌冲剂治疗新生儿黄疸临床疗效分析

目的:进一步探寻治疗新生儿黄疸的方法。方法:选取潍坊市妇幼保健院2019年12月至2020年6月收治的新生儿病理性黄疸患儿100例,随机分为观察组与对照组各50例。其中观察组采用光照疗法配合茵栀黄颗粒、双歧杆菌三联活菌冲剂治疗;对照组只采用光照疗法。比较两组治疗前后经皮测胆红素平均水平、黄疸消失时间及两组不良反应发生率。结果:治疗后经皮测,观察组的胆红素平均水平明显低于对照组,黄疸消失时间观察组也明显短于对照组,差异有统计学意义P<0. 05;两组不良反应差异无统计学意义(P>0. 05)。结论:光照疗法配合茵栀黄颗粒、双歧杆菌三联活菌冲剂治疗新生儿黄疸临床疗效显著、安全性好,值得在新生儿黄疸患儿的治疗中推广使用。