Removal of elevated circulating angiopoietin-2 by plasma exchange – A pilot study in critically ill patients with thrombotic microangiopathy and anti-glomerular basement membrane disease

2010 ◽  
Vol 104 (11) ◽  
pp. 1038-1043 ◽  
Author(s):  
Carsten Hafer ◽  
Jan Kielstein ◽  
Marion Haubitz ◽  
Hermann Haller ◽  
Svjetlana Lovric ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Glomerular Basement Membrane ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Vascular Inflammation ◽  
Endothelial Damage ◽  
Healthy Controls ◽  
Angiopoietin 2

SummaryIn critically ill patients, the massive release of angiopoietin-2 (Ang-2) from Weibel-Palade bodies interferes with protective angiopoietin-1 (Ang-1)/Tie2 signalling in endothelial cells, thus leading to vascular inflammation and subsequent organ-dysfunction. We hypothesised that plasma exchange (PE) is efficient for lowering excess Ang-2 levels in critically ill patients with thrombocytic microangiopathy (TMA) or anti-glomerular basement membrane (anti-GBM) disease. Plasma Ang-1 and Ang-2 were measured by immuno-luminometric assays in patients with TMA (n=9) or anti-GBM disease (n=4) before and after up to four PE sessions. Twenty apparently healthy volunteers served as controls. Median (IQR) plasma levels of Ang-2 were markedly increased in patients with TMA (7.3 (2.4–21.1) ng/ml) and anti-GBM disease (5.8 (3.4–7.0) ng/ml) compared to healthy controls (1.0 (0.9–1.4) ng/ml, p <0.001). Moreover, Ang-1 plasma levels were decreased in both, TMA (1.02 (0.62–1.62) ng/ml) and anti-GBM disease patients (0.74 (0.59–3.62) ng/ml) compared to healthy controls (2.5 (1.93–3.47) ng/ ml, p <0.005). During a total of 32 treatments, PE effectively lowered elevated mean (SD) Ang-2 plasma levels by 36.7 ± 19.6 % per treatment (p <0.0001), whereas low Ang-1 plasma levels remained unchanged (0.3 ± 58.5 %; p =0.147). Ang-2 levels declined to almost normal values during ≤4 PE treatments (Friedman´s test p <0.0001). PE is an effective method to remove excess circulating Ang-2. It remains to be elucidated if the removal of Ang-2 is crucial to ameliorate endothelial damage in critically ill patients with severely altered endothelial integrity.

scholarly journals Decreased CTRP3 Plasma Concentrations Are Associated with Sepsis and Predict Mortality in Critically Ill Patients

Diagnostics ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 63 ◽  
Author(s):  
Eray Yagmur ◽  
Simone Otto ◽  
Ger H. Koek ◽  
Ralf Weiskirchen ◽  
Christian Trautwein ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Plasma Concentrations ◽  
Healthy Controls ◽  
Medical Intensive Care ◽  
Wide Group ◽  
First Time ◽  
Necrosis Factor

C1q/ tumor necrosis factor (TNF)-like protein 3 (CTRP3) represents a novel member of the adipokine family that exerts favorable metabolic actions in humans. However, the role of CTRP3 in critical illness and sepsis is currently unknown. Upon admission to the medical intensive care unit (ICU), we investigated CTRP3 plasma concentrations in 218 critically ill patients (145 with sepsis, 73 without sepsis). Results were compared with 66 healthy controls. CTRP3 plasma levels were significantly decreased in critically ill patients, when compared to healthy controls. In particular, low CTRP3 levels were highly associated with the presence of sepsis. CTRP3 levels were neither associated with obesity nor diabetes. In critically ill patients, CTRP3 plasma concentrations were inversely correlated with inflammatory cytokines and classical sepsis markers. Among a wide group of adipokines, CTRP3 only correlated with circulating resistin. Low CTRP3 plasma levels were associated with the overall mortality, and CTRP3 levels below 620.6 ng/mL indicated a particularly increased mortality risk in ICU patients. Our study demonstrates for the first time the role of circulating CTRP3 as a biomarker in critically ill patients that might facilitate diagnosis of sepsis as well as prognosis prediction. The association between low CTRP3 and increased inflammation warrants further pathophysiological investigations.

scholarly journals Elevated MR-proANP plasma concentrations are associated with sepsis and predict mortality in critically ill patients

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Eray Yagmur ◽  
Johanna Hermine Sckaer ◽  
Ger H. Koek ◽  
Ralf Weiskirchen ◽  
Christian Trautwein ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Plasma Concentrations ◽  
Retinol Binding Protein ◽  
Healthy Controls ◽  
Icu Patients ◽  
Retinol Binding Protein 4

Abstract Background and aims Mid-regional pro atrial natriuretic peptide (MR-proANP) is an established biomarker for heart failure, based on its key role in regulating homeostasis of water balance and blood pressure. The aim of the study was to determine the value of MR-proANP as a clinical biomarker in critical illness and/or sepsis. Upon admission to the medical intensive care unit (ICU), we investigated MR-proANP plasma concentrations in 217 critically ill patients (144 with sepsis, 73 without sepsis). Results were compared with 65 healthy controls. Results MR-proANP plasma levels were significantly elevated in critically ill patients, when compared to healthy controls. Notably, MR-proANP levels were significantly higher in ICU patients with sepsis. MR-proANP levels were not associated with metabolic comorbidities like diabetes or obesity. In critically ill patients, MR-proANP plasma concentrations correlated with inflammatory cytokines, markers of organ dysfunction and several adipocytokines, such as resistin, retinol-binding protein 4 (RBP4) and adiponectin. Importantly, high MR-proANP plasma levels were associated with mortality, as MR-proANP levels above 227.0 pmol/l indicated a particularly increased mortality risk in ICU patients. The association between MR-proANP and mortality was independent of single organ failure and inflammation markers. Conclusion Our study emphasizes the role of circulating MR-proANP as a biomarker in critically ill patients, in which high MR-proANP indicates organ dysfunction, sepsis and mortality risk. The association between high MR-proANP and inflammatory as well as adipose tissue-derived endocrine mediators warrants further pathophysiological investigations.

scholarly journals ABO blood types and sepsis mortality

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Theis S. Itenov ◽  
Daniel I. Sessler ◽  
Ashish K. Khanna ◽  
Sisse R. Ostrowski ◽  
Pär I. Johansson ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
The United States ◽  
Endothelial Damage ◽  
Blood Type ◽  
Type B ◽  
Blood Concentrations ◽  
Soluble Thrombomodulin ◽  
Blood Types

Abstract Background We aimed to determine if the ABO blood types carry different risks of 30-day mortality, acute kidney injury (AKI), and endothelial damage in critically ill patients with sepsis. This was a retrospective cohort study of three independent cohorts of critically ill patients from the United States and Scandinavia consisting of adults with septic shock. We compared the 30-day mortality across the blood types within each cohort and pooled the results in a meta-analysis. We also estimated the incidence of AKI and degree of endothelial damage, as measured by blood concentrations of soluble thrombomodulin and syndecan-1. Results We included 12,342 patients with severe sepsis. In a pooled analysis blood type B carried a slightly lower risk of 30-day all-cause mortality compared to non-blood type B (adjusted HR 0.88; 95%-CI 0.79–0.98; p = 0.02). There was no difference in the risk of AKI. Soluble thrombomodulin and syndecan-1 concentrations were lower in patients with blood type B and O compared to blood type A, suggesting less endothelial damage. Conclusion Septic patients with blood type B had less endothelial damage, and a small reduction in mortality. The exposure is, however, unmodifiable.

Plasma exchange in critically ill patients with sickle cell disease

2007 ◽  
Vol 37 (1) ◽  
pp. 17-22 ◽  
Author(s):  
C. Boga ◽  
I. Kozanoglu ◽  
H. Ozdogu ◽  
Emel Ozyurek
Keyword(s):  
Sickle Cell Disease ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Sickle Cell ◽  
Critically Ill Patients ◽  
Cell Disease

scholarly journals MPO-ANCA-Positive Anti-glomerular Basement Membrane Antibody Disease Successfully Treated by Plasma Exchange and Immunosuppressive Therapy

Renal Failure ◽  
2011 ◽  
Vol 33 (6) ◽  
pp. 626-631 ◽  
Author(s):  
Taichi Murakami ◽  
Kojiro Nagai ◽  
Motokazu Matsuura ◽  
Naoki Kondo ◽  
Seiji Kishi ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Glomerular Basement Membrane

Plasma exchange for treatment of thrombotic thrombocytopenic purpura in critically ill patients

1997 ◽  
Vol 23 (1) ◽  
pp. 44-50 ◽  
Author(s):  
P. Knöbl ◽  
C. Rintelen ◽  
G. Kornek ◽  
C. Wiltschke ◽  
P. Kalhs ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Thrombocytopenic Purpura

scholarly journals N-terminal pro-brain natriuretic peptide and high-sensitivity troponin T exhibit additive prognostic value for the outcome of critically ill patients

2018 ◽  
Vol 9 (5) ◽  
pp. 496-503 ◽  
Author(s):  
Max Lenz ◽  
Konstantin A Krychtiuk ◽  
Georg Goliasch ◽  
Klaus Distelmaier ◽  
Johann Wojta ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Brain Natriuretic Peptide ◽  
Critically Ill ◽  
Natriuretic Peptide ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Troponin T ◽  
High Sensitivity ◽  
The Individual

Background: Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. Methods: We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter. Results: Of the included 148 patients, 52% were male, mean age was of 64.2 ± 16.8 years and 30-day mortality was 33.2%. Non-survivors showed significantly higher NT-proBNP and TnT plasma levels as compared with survivors ( p<0.01). An elevation of both markers exhibited an additive effect on mortality, as those with both NT-proBNP and TnT levels above the median had a 30-day mortality rate of 51.0%, while those with both markers below the median had a 16.7% mortality rate (hazard ratio 3.7). These findings were independent of demographic and clinical parameters ( p<0.05). Conclusions: Our findings regarding the individual predictive properties of NT-proBNP and TnT are in line with literature. However, we were able to highlight that they exhibit additive prognostic potential which exceeds their individual value. This might be attributed to a difference in underlying pathomechanisms and an assessment of synergistic risk factors.

scholarly journals Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

2020 ◽  
Vol 60 ◽  
pp. 328-333 ◽  
Author(s):  
Fahad Faqihi ◽  
Abdulrahman Alharthy ◽  
Mohammed Alodat ◽  
Demetrios J. Kutsogiannis ◽  
Peter G. Brindley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

scholarly journals Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Mohsin Ijaz ◽  
Naeem Abbas ◽  
Dmitry Lvovsky
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Glomerular Basement Membrane ◽  
Metabolic Alkalosis ◽  
Fresh Frozen Plasma ◽  
Maintenance Hemodialysis ◽  
Positive Serology ◽  
Aged Woman ◽  
Fresh Frozen ◽  
Intravenous Steroids

Metabolic alkalosis secondary to citrate toxicity from plasma exchange is very uncommon in patients with normal renal function. In patients with advanced renal disease this can be a fatal event. We describe a case of middle-aged woman with Goodpasture’s syndrome treated with plasma exchange who developed severe metabolic alkalosis. High citrate load in plasma exchange fluid is the underlying etiology. Citrate metabolism generates bicarbonate and once its level exceeds the excretory capacity of kidneys, the severe metabolic alkalosis ensues. Our patient presented with generalized weakness, fever, and oliguria and developed rapidly progressive renal failure. Patient had positive serology for antineutrophilic cytoplasmic antibodies myeloperoxidase (ANCA-MPO) and anti-glomerular basement membrane antibodies (anti-GBM). Renal biopsy showed diffuse necrotizing and crescentic glomerulonephritis with linear glomerular basement membrane staining. Patient did not respond to intravenous steroids. Plasma exchange was started with fresh frozen plasma but patient developed severe metabolic alkalosis. This metabolic alkalosis normalized with cessation of plasma exchange and initiation of low bicarbonate hemodialysis. ANCA-MPO and anti-GBM antibodies levels normalized within 2 weeks and remained undetectable at 3 months. Patient still required maintenance hemodialysis.

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