Decreased HLA (human leucocyte antigen)-DR expression on peripheral blood monocytes predicts the development of organ failure in patients with acute pancreatitis

2003 ◽  
Vol 105 (4) ◽  
pp. 409-417 ◽  
Author(s):  
Panu MENTULA ◽  
Marja-Leena KYLÄNPÄÄ-BÄCK ◽  
Esko KEMPPAINEN ◽  
Annika TAKALA ◽  
Sten-Erik JANSSON ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Dysfunction ◽  
Immune Suppression ◽  
Human Leucocyte Antigen ◽  
Severe Disease ◽  
Positive Likelihood Ratio ◽  
Group Iii ◽  
Group I ◽  
Hla Dr ◽  
Cellular Marker

Immune suppression plays an important role in the pathogenesis of acute pancreatitis. Monocyte expression of HLA (human leucocyte antigen)-DR, a cellular marker of immune suppression, was determined in relation to the development of organ dysfunction in patients with acute pancreatitis. A total of 310 consecutive patients with acute pancreatitis, admitted to a university hospital within 72 h of pain onset, were studied; 194 (63%) had mild disease (group I), 87 (28%) had severe disease without organ dysfunction (group II), and 29 (9%) had severe disease with organ dysfunction (group III). HLA-DR expression, defined both as the proportion of monocytes that were HLA-DR-positive and as monocyte HLA-DR fluorescence intensity, was determined at admission, using whole-blood flow cytometry. Of the patients in group III, 13 (45%) developed organ dysfunction within 24 h of admission. The proportion of HLA-DR-positive monocytes and monocyte HLA-DR density were both related to the severity of pancreatitis (P<0.001 for linear trend). In predicting organ dysfunction, the sensitivity, specificity and positive-likelihood ratio for the proportion of HLA-DR-positive monocytes were 83% [95% CI (confidence interval) 64–94%], 72% (67–77%) and 3.0 respectively, and for monocyte HLA-DR density the respective values were 69% (49–85%), 84% (79–88%) and 4.3. In conclusion, monocyte HLA-DR expression predicts the development of organ dysfunction that occurs early in patients with acute pancreatitis.

scholarly journals The prognostic role of inflammatory markers in COVID 19 patients – A retrospective analysis.

2021 ◽  
Author(s):  
Shivkumar Gopalakrishnan ◽  
sangeetha kandasamy ◽  
S.Malini ◽  
S.Peer Mohamed ◽  
k.velmurugan
Keyword(s):  
Inflammatory Markers ◽  
Severe Disease ◽  
Radiation Hazard ◽  
P Value ◽  
Binary Logistic Regression Analysis ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
D Dimer

Abstract Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited specificity and radiation hazard. Laboratory biomarkers are eyed as simple, specific and point of care triage tools to optimize management decisions.This study aimed to study the role of inflammatory markers in prognosticating COVID-19 patients.Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classified into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically significant.Results. The mean age was 49.32 +/- 17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020]Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most specific combination was NLR, Lymphocyte percentage and D-dimer levels done between 7th – 10th day of symptoms.

scholarly journals Prediction of acute pancreatitis severity via the combined analysis of inflammatory biomarkers and coagulation parameters

2017 ◽  
Vol 25 (3) ◽  
pp. 237-244
Author(s):  
Snezana Tesic Rajkovic ◽  
Biljana Radovanovic Dinic ◽  
Miodrag Djordjevic ◽  
Goran Marjanovic ◽  
Sasa Grgov
Keyword(s):  
Acute Pancreatitis ◽  
Coagulation Factors ◽  
Inflammatory Biomarkers ◽  
Systemic Complications ◽  
Mathematical Formula ◽  
Coagulation Parameters ◽  
Group Iii ◽  
Group I ◽  
Combined Use ◽  
Group B

AbstractIntroduction. Timely assessment of severity of acute pancreatitis is needed to avoid severe systemic complications by making optimal therapeutic approach and correct prognosis of the disease. The aim of the study was to establish the role of several inflammatory biomarkers and coagulation parameters in prediction of AP severity, and also to propose a mathematical formula which allows their combined use for the same purpose. Material and Methods. The prospective study included 70 patients with AP. The patients were divided into groups: mild (group I), moderate (group II) and severe AP (group III). All patients were further classified into two groups: group A (mild AP) and group B (moderate and severe AP). Biochemical markers, inflammatory biomarkers and coagulation factors were tested in all patients. Results. Based on the results of Mann-Whitney,s test, it can be concluded that groups A and B are significant different from each other for CRP (p<0.05). Using the Wald’s stepwise forward method, a prediction model with CRP, PCT, D-dimer1, D-dimer3, fibrinogen1 and fibrinogen3 parameters as predictors of the severity of AP was obtained. The percentage of successful prediction of moderate or severe AP based on this model was 76.9%. The use of ROC analysis with the introduced linear combination from the logistic regression yielded equally good or even better results in the assessment of the severity of AP with the combined use of analyzed parameters. Conclusion. The combined analyses of biohumoral markers and coagulation parameters presented in the form a mathematical formula enabled a more accurate, rapid, rational and clinically available prediction of the severity of AP.

scholarly journals Appraisal of surgical treatment of 47 cases of patellofemoral instability

2002 ◽  
Vol 57 (3) ◽  
pp. 103-107 ◽  
Author(s):  
Roberto Freire da Mota e Albuquerque ◽  
Alexandre Pagotto Pacheco ◽  
Arnaldo José Hernandez ◽  
Marco Martins Amatuzzi ◽  
José Ricardo Pécora ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Advanced Disease ◽  
Severe Disease ◽  
Patellofemoral Instability ◽  
Late Diagnosis ◽  
Group Iii ◽  
Group I ◽  
Proximal Realignment ◽  
Significant Difference ◽  
Distal Realignment

INTRODUCTION: Patellofemoral instability is a common knee disease. Its etiology is complex and variable, with many components making different contributions in each individual, resulting in several distinct clinical presentations. Our goal was to analyze the results of surgical treatment in our hospital over a period of 10 years. PATIENTS AND METHODS: We analyzed 55 knees of 47 patients who underwent surgery for patellofemoral instability and were classified into 2 main groups: proximal realignment and combined proximal and distal realignment. Three other groups were analyzed according to the duration of preoperative symptoms: less than 1 year (group I); 1 to 10 years (group II); and more than 10 years (group III). RESULTS: There were 62% good results overall, with 78% good results in groups I and II. Group III had 81% bad results, showing that a late diagnosis of advanced disease results in a poor prognosis. In addition to late diagnosis, bad results were usually associated with incorrect diagnosis or choice of surgical technique. There was no significant difference between isolated proximal realignment and combined proximal and distal realignment in groups I or II, but in group III, the combined technique yielded better results. DISCUSSION: Our results indicate that patellofemoral instability should be addressed in its early stages. Patients with long-lasting symptoms or more severe disease seem to achieve better results with combined techniques. CONCLUSION: Proximal and distal realignments produce better results than isolated proximal realignment in patients with joint degeneration or with greater duration of disease. The realignment surgery does not produce good results in patients with advanced disease.

scholarly journals Polymorphonuclear leukocyte dysregulation during the systemic inflammatory response syndrome

Blood ◽  
1994 ◽  
Vol 83 (5) ◽  
pp. 1398-1407 ◽  
Author(s):  
HH Simms ◽  
R D'Amico
Keyword(s):  
Acute Pancreatitis ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Pertussis Toxin ◽  
Whole Blood ◽  
Systemic Inflammatory Response ◽  
Matrix Proteins ◽  
H2o2 Production ◽  
Group Iii ◽  
Group I

Abstract Altered polymorphonuclear leukocyte (PMN) function is thought to contribute to organ dysfunction during the systemic inflammatory response syndrome (SIRS). To test this hypothesis, we evaluated whole blood PMN function adherent to fibronectin or laminin in patients with mild or severe acute pancreatitis as a paradigm for sirs. Whole-blood PMN intracellular H2O2 production, expression of CD32w (Fc gamma R II), CD16 (Fc gamma R III), and phagocytosis were performed using dichlorofluorescein diacetate, fluorescein isothiocyanate-labeled anti- CD32w, CD16, and serum-opsonized fluorescent microspheres. Group I (n x 7) represents normal control individuals; group II (n x 11) represents patients with mild acute pancreatitis. Group III (n x 15) represents critically ill patients with severe acute pancreatitis. Adherence of PMN from groups I and II to matrix proteins resulted in a 5% to 20% increase in each PMN function assayed whereas adherence of PMN from group III to matrix proteins resulted in 50% to 75% increases in each PMN function assayed. Pertussis toxin, pentoxifylline, and dibutyryl cyclic adenosine monophosphate (cAMP) each reduced group I-II H2O2 production and phagocytosis. Pentoxifylline and dibutyryl cAMP but not pertussis toxin reduced group III H2O2 production. Both intracellular H2O2 and phagocytosis assays from group III but not groups I-II showed exaggerated upregulation when exposed to NaF (4 mmol/L). Anti- interleukin-6 reduced the increase in intracellular H2O2 production in group III patients and significantly altered the exaggerated oxidative response to NaF. Longitudinal studies of group III whole-blood PMN showed persistent upregulation of intracellular H2O2 production in those patients whose hospital courses were complicated by multiple system organ failure. These results demonstrate abnormal whole blood PMN function during the systemic inflammatory response syndrome in the presence of fibronectin, or laminin and that this is mediated in part via a pertussis toxin insensitive altered guanosine triphosphate- binding protein.

scholarly journals Ameliorative effect of certolizumab on experimentally induced acute necrotic pancreatitis in rats

2019 ◽  
Vol 65 (2) ◽  
pp. 204-210
Author(s):  
Mehmet Ali Kosekli ◽  
Özkan Herek ◽  
Özlem Ozmen ◽  
Sima Sahinduran
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Male Rats ◽  
Control Group ◽  
Group Iii ◽  
Group I ◽  
Necrotic Pancreatitis ◽  
Ameliorative Effect ◽  
Factor Α ◽  
Experimentally Induced

SUMMARY OBJECTIVE: The effects of Certolizumab, a pegylated monoclonal antibody to tumor necrosis factor α, on experimentally induced acute pancreatitis (AP) were examined. METHODS: Thirty-six Wistar Albino male rats were randomly divided into four groups. Group I was the control group and no medication administered to this group. Group II was the Certolizumab group, and 100 ml/kg serum physiologic administered into the biliopancreatic duct and a single dose of 10 μg Certolizumab was simultaneously administered intraperitoneally. Acute pancreatitis was induced with a retrograde injection of 3% Na taurocholate into the common biliopancreatic duct in the study (Group III) and treatment (Groups IV) groups. Rats were sacrificed 72 hours later. Serum amylase, lipase, lactate dehydrogenase activities, along with pancreatic histopathology, were examined. RESULTS: Certolizumab treatment significantly decreased serum amylase, lipase, and LDH levels; histopathologically edema, hemorrhage, parenchymal necrosis, fat necrosis, and infiltration scores; immunohistochemically MDA, MPO, TNF-α and Caspase-3 activity. CONCLUSION: The results support the idea that certolizumab might be beneficial for the severity of AP.

scholarly journals SOME CHARACTERISTICS OF THE COURSE OF CORONARY HEART DISEASE WITH A COMORBID PATHOLOGY

2020 ◽  
Vol 24 (1-2) ◽  
pp. 8-11
Author(s):  
Т.А. Trybrat ◽  
S.V. Shut ◽  
Z.O. Borisova ◽  
V.D. Sakevych ◽  
O.O. Goncharova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Medicine ◽  
Nyha Class ◽  
Severe Disease ◽  
Age Group ◽  
Comorbid Conditions ◽  
Group Iii ◽  
Group I ◽  
Number Of Patients

Nowadays, scientists and doctors are increasingly paying attention to the study of the cardinal problem of modern clinical medicine, comorbidity and polymorbidity, which may arise as a result of common etiology, pathogenesis, cause and effect influences (the syntopic impairments) or as an accidental combination of disease (the accompanying impairments) with age factor, anatomical closeness of the affected organs or accidental combination of diseases. The aim: to define the concomitant diseases and their course, which are most often observed in patients with CHD. The prospective study involved 100 patients with coronary heart disease: stable angina, І-ІV NYHA Class, І-II HF. Results and discussion. The incidence of combined pathology in patients with CHD increases with age: in group I, one of the comorbid conditions prevails (mainly gastrointestinal tract diseases), in group II and III, there are two or more concomitant diseases. Among the total number of patients, 95% live in the city, hence the result of the urbanization process, and only 5% live in the village. The analysis of medicines prescriptions, used in the treatment of patients with CHD revealed an increased use of larger amounts of drugs in age group III (≥60) as compared to groups I (≤40) and II (41-60). Adequate combined prescriptions of medicines to patients with comorbid conditions will allow us not only to prevent progression of each disease, but also to improve the long-term prognosis. Essential hypertension is the «leader» in the total number of comorbid diseases, which makes up 77% of patients among the total number of subjects, with the highest incidence in the II (41-60) and III (≥60) age group. Thus, the obtained results indicate differences in the course and clinical presentation of coronary heart disease, depending on the presence of comorbid pathology, which leads to a more severe disease course, a greater number of comorbidities with increasing age of patients.

Assessment of Pharmacological Prophylaxis for Acute Pancreatitis Following ERCP in Patients with Choledoholithiasis

2015 ◽  
Vol 87 (12) ◽  
Author(s):  
Ewa Łubowska-Pająk ◽  
Krzysztof Kołomecki
Keyword(s):  
Molecular Weight ◽  
Acute Pancreatitis ◽  
Low Molecular Weight Heparin ◽  
Statistical Significance ◽  
Control Group ◽  
Low Molecular Weight ◽  
Pharmacological Prophylaxis ◽  
Group Iii ◽  
Group I ◽  
Group Ii

AbstractEndoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP.The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP.Material and methods. The study enrolled three groups of 30 patients diagnosed with cholelithiasis; group I: patients who received low-molecular-weight heparin prior to ERCP, group II: patients who received somatostatin and diclofenac, group III: control group. The study assessed the incidence of acute pancreatitis, hyperamylasemia and increased CRP levels.Results. Acute pancreatitis was observed in 13.3% of group I patients, 10% of group II patients and 16.7% of group III patients (no statistical significance). Hyperamylasemia was observed in 16.7% of group I patients, 16.7% of group II patients and 43.3% of group III patients. These differences were statistically significant. No significant differences were found in the occurrence of increased CRP levels among the study groups.Conclusions. No significant reduction in the occurrence of acute pancreatitis after ERCP was observed in patients who received pharmacological prophylaxis. A significant reduction in the occurrence of hyperamylasemia was found in drug-treated patients.

Effects of Zinc Supplementation on the Immune System and on Antibody Response to Multivalent Influenza Vaccine in Hemodialysis Patients

1998 ◽  
Vol 21 (5) ◽  
pp. 274-278 ◽  
Author(s):  
S. TüRK ◽  
S. Bozfakioglu ◽  
S.T. Ecder ◽  
T. Kahraman ◽  
N. GüREL ◽  
...  
Keyword(s):  
Immune System ◽  
Antibody Response ◽  
Influenza Vaccine ◽  
Hemodialysis Patients ◽  
The Other ◽  
Group Iii ◽  
Group I ◽  
Hla Dr ◽  
Serum Zn ◽  
Antibody Levels

The depression of the immune system in chronic uremia is a well-known phenomenon but the role of serum zinc (Zn) levels on both cell-mediated and humoral immunity is still controversial. The aim of this study was to investigate the effect of Zn supplementation on the immune system and on antibody response to multivalent influenza vaccine (MIV) in hemodialysis patients (HP). Twenty-six HP and 11 healthy subjects (HS) were vaccinated with MIV. Hemodialysis patients were randomly divided into two groups. Group 1 (13 HP) was supplemented with 120 mg ZnS04 after each dialysis session. Group II (13 HP) and Grouip III (11 HS) were given placebo. In all cases, the serum Zn levels, CD3, CD4, CD8, CD19, HLA-DR+ cell percentages, CD4/CD8 ratio and CD3+HLA-DR+ cell percentages were determined before and 30 days after vaccination. Antibody levels to subgroups of MIV were also measured. All the baseline parameters studied were not statistically different between Group I and II. However, there was a significant difference between the basal parameters of Group III and the other two groups, except for CD3 and CD4 cell percentages. Serum Zn, CD19 cell percentage and antibody levels to MIV subgroups were significantly increased in Group I at the end of the first month of the study (p<0.01, p<0.05, p<0.001, p<0.001, and p<0.01, respectively), but the other parameters showed no significant changes. The only significant change observed in Groups II and III was an increase in antibody levels to MIV subgroups one month after vaccination. Antibody levels to MIV subgroups, were not statistically different between Groups I and II, but in Group III they were strikingly higher than those of HP (p<0.001). These results led us to conclude that Zn supplementation could not restore the immune parameters and enhance antibody response to MIV in HP.

scholarly journals Predicting the Severity of Acute Pancreatitis by Rapid Measurement of Trypsinogen-2 in Urine

2001 ◽  
Vol 47 (12) ◽  
pp. 2103-2107 ◽  
Author(s):  
Marko Lempinen ◽  
Marja-Leena Kylänpää-Bäck ◽  
Ulf-Håkan Stenman ◽  
Pauli Puolakkainen ◽  
Reijo Haapiainen ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Detection Limit ◽  
Severe Disease ◽  
Positive Likelihood Ratio ◽  
Test Strip ◽  
Therapeutic Interventions ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Predictive Values ◽  
Reactive Protein

Abstract Background: Early identification of patients at risk of developing a severe attack of acute pancreatitis (AP) is of great importance because rapid therapeutic interventions improve outcome. At a cutoff of 50 μg/L, trypsinogen-2 measured by a rapid urinary dipstick is a sensitive and specific diagnostic test in AP. The trypsinogen-2 concentration correlates with the severity of the disease, and a test with a higher cutoff might therefore be useful for prediction of disease severity. Methods: We increased the detection limit of the urinary trypsinogen-2 test strip (Actim Pancreatitis) from 50 μg/L to 2000 μg/L and evaluated the prognostic value of this test. The results were compared with those obtained with serum C-reactive protein and the acute physiology and chronic health evaluation II (APACHE II) score. The study population consisted of 150 consecutive patients with AP (42 with severe disease). Results: The sensitivity of the rapid urinary test strip (detection limit, 2000 μg/L) for prediction of severe AP, both on admission and at 24 h, was 62%; specificities were 87% and 85%, respectively, positive predictive values were 65% and 62%, and negative predictive values were 85% and 85%. C-Reactive protein had a sensitivity of only 38% on admission, but at 24 h, it was 83%; specificities were 90% and 70%, respectively, whereas positive predictive values were 59% and 52%, and NPVs were 79% and 91%, respectively. On admission the positive-likelihood ratio for the urinary trypsinogen-2 test strip was 4.8, and at 24 h it was 4.2; for C-reactive protein, the values were 3.7 and 2.7, respectively. Conclusions: The urinary trypsinogen-2 dipstick is a simple and rapid method for prediction of severe acute pancreatitis.

scholarly journals Polymorphonuclear leukocyte dysregulation during the systemic inflammatory response syndrome

Blood ◽  
1994 ◽  
Vol 83 (5) ◽  
pp. 1398-1407 ◽  
Author(s):  
HH Simms ◽  
R D'Amico
Keyword(s):  
Acute Pancreatitis ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Pertussis Toxin ◽  
Whole Blood ◽  
Systemic Inflammatory Response ◽  
Matrix Proteins ◽  
H2o2 Production ◽  
Group Iii ◽  
Group I

Altered polymorphonuclear leukocyte (PMN) function is thought to contribute to organ dysfunction during the systemic inflammatory response syndrome (SIRS). To test this hypothesis, we evaluated whole blood PMN function adherent to fibronectin or laminin in patients with mild or severe acute pancreatitis as a paradigm for sirs. Whole-blood PMN intracellular H2O2 production, expression of CD32w (Fc gamma R II), CD16 (Fc gamma R III), and phagocytosis were performed using dichlorofluorescein diacetate, fluorescein isothiocyanate-labeled anti- CD32w, CD16, and serum-opsonized fluorescent microspheres. Group I (n x 7) represents normal control individuals; group II (n x 11) represents patients with mild acute pancreatitis. Group III (n x 15) represents critically ill patients with severe acute pancreatitis. Adherence of PMN from groups I and II to matrix proteins resulted in a 5% to 20% increase in each PMN function assayed whereas adherence of PMN from group III to matrix proteins resulted in 50% to 75% increases in each PMN function assayed. Pertussis toxin, pentoxifylline, and dibutyryl cyclic adenosine monophosphate (cAMP) each reduced group I-II H2O2 production and phagocytosis. Pentoxifylline and dibutyryl cAMP but not pertussis toxin reduced group III H2O2 production. Both intracellular H2O2 and phagocytosis assays from group III but not groups I-II showed exaggerated upregulation when exposed to NaF (4 mmol/L). Anti- interleukin-6 reduced the increase in intracellular H2O2 production in group III patients and significantly altered the exaggerated oxidative response to NaF. Longitudinal studies of group III whole-blood PMN showed persistent upregulation of intracellular H2O2 production in those patients whose hospital courses were complicated by multiple system organ failure. These results demonstrate abnormal whole blood PMN function during the systemic inflammatory response syndrome in the presence of fibronectin, or laminin and that this is mediated in part via a pertussis toxin insensitive altered guanosine triphosphate- binding protein.

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