scholarly journals Monocyte Trajectories Endotypes Are Associated With Worsening in Septic Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Maxime Bodinier ◽  
Estelle Peronnet ◽  
Karen Brengel-Pesce ◽  
Filippo Conti ◽  
Thomas Rimmelé ◽  
...  
Keyword(s):  
Immune System ◽  
Risk Stratification ◽  
Host Response ◽  
Surface Protein ◽  
Immunomodulatory Treatment ◽  
Early Risk ◽  
Hla Dr ◽  
Surface Protein Expression ◽  
Life Threatening ◽  
Over Time

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The immune system plays a key role in sepsis onset and remains dysregulated over time in a heterogeneous manner. Here, we decipher the heterogeneity of the first week evolution of the monocyte HLA-DR (mHLA-DR) surface protein expression in septic patients, a key molecule for adaptive immunity onset. We found and verified four distinctive trajectories endotypes in a discovery (n = 276) and a verification cohort (n = 102). We highlight that 59% of septic patients exhibit low or decreasing mHLA-DR expression while in others mHLA-DR expression increased. This study depicts the first week behavior of mHLA-DR over time after sepsis onset and shows that initial and third day mHLA-DR expression measurements is sufficient for an early risk stratification of sepsis patients. These patients might benefit from immunomodulatory treatment to improve outcomes. Going further, our study introduces a way of deciphering heterogeneity of immune system after sepsis onset which is a first step to reach a more comprehensive landscape of sepsis.

scholarly journals Inflammatory Response to Different Toxins in Experimental Sepsis Models

2019 ◽  
Vol 20 (18) ◽  
pp. 4341 ◽  
Author(s):  
Kayle Dickson ◽  
Christian Lehmann
Keyword(s):  
Immune System ◽  
Host Response ◽  
Physiological Responses ◽  
Lipoteichoic Acid ◽  
Experimental Sepsis ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Preclinical Drug Development ◽  
Life Threatening ◽  
Microcirculatory Disturbances

Sepsis is defined as life-threatening organ dysfunction caused by the dysregulated host response to infection. Despite serious mortality and morbidity, no sepsis-specific drugs exist. Endotoxemia is often used to model the hyperinflammation associated with early sepsis. This model classically uses lipopolysaccharide (LPS) from Gram-negative pathogens to activate the immune system, leading to hyperinflammation, microcirculatory disturbances and death. Other toxins may also be used to activate the immune system including Gram-positive peptidoglycan (PG) and lipoteichoic acid (LTA). In addition to these standard toxins, other bacterial components can induce inflammation. These molecules activate different signaling pathways and produce different physiological responses which can be taken advantage of for sepsis modeling. Endotoxemia modeling can provide information on pathways to inflammation in sepsis and contribute to preclinical drug development.

scholarly journals Risk Stratification in Sepsis: What We Can Do in the Emergency Room?

2020 ◽  
Vol 17 (3) ◽  
pp. 37-42
Author(s):  
Sebastian Dogaru ◽  
Caius Bogdan Teusdea ◽  
Florea Purcaru
Keyword(s):  
Intensive Care ◽  
Risk Stratification ◽  
Host Response ◽  
Medical Condition ◽  
Research Direction ◽  
Medical Intervention ◽  
Life Threatening ◽  
Increased Sensitivity ◽  
Early Phases ◽  
Global Health Problem

AbstractSepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection and it is an important global health problem. After the Sepsis 3 definition, sepsis is only the tip of the iceberg. Only when is life-threatening, an infection is declared sepsis, so the rapid medical intervention is paramount. As the sepsis is a so important medical condition in daily clinical practice, many scores and biomarkers were studied in order to have a better risk stratification in early phases of an infection. By design, some scores were intended to be used in Emergency Departments (ED), Intensive Care Units (ICU), or in specific wards.Ideally, the intervention should take place as rapid and earlier as possible. A possible research direction should be based on a rapidly, low-resources, none or minimum equipment requested for measuring parameters for determining a EWS (increased sensitivity) used with a biomarker (rapidly determined) for gaining specificity in order to buy time, further used to reduce the length of stay in ICU and mortality. Verified and revised scores as NEWS2 and biomarkers such as procalcitonin and presepsin offer a research direction to be explored.

A Serological Storm

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Bertha Wong MD ◽  
Maria Bagovich MD ◽  
Ivan Blasutig PhD ◽  
Simon Carette MD MPhil
Keyword(s):  
Differential Diagnosis ◽  
Hepatitis C Virus ◽  
Immune System ◽  
Hepatitis C ◽  
Hcv Infection ◽  
Clinical Context ◽  
Autoantibody Profile ◽  
Life Threatening ◽  
Clinically Significant ◽  
Sensory Polyneuropathy

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.

scholarly journals Risk stratification in cardiogenic shock: a focus on the available evidence

2021 ◽  
Author(s):  
C. Sciaccaluga ◽  
G. E. Mandoli ◽  
N. Ghionzoli ◽  
F. Anselmi ◽  
C. Sorini Dini ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cardiogenic Shock ◽  
Clinical Syndrome ◽  
Diagnostic Assessment ◽  
Prognostic Scores ◽  
Current Evidence ◽  
Efficient Resource ◽  
Threatening Condition ◽  
Life Threatening ◽  
Future Direction

AbstractCardiogenic shock is a clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia. It represents a complex life-threatening condition, characterized by a high mortality rate, that requires urgent diagnostic assessment as well as treatment; therefore, it is of paramount important to advocate for a thorough risk stratification. In fact, the early identification of patients that could benefit the most from more aggressive and invasive approaches could facilitate a more efficient resource allocation. This review attempts to critically analyse the current evidence on prognosis in cardiogenic shock, focusing in particular on clinical, laboratoristic and echocardiographic prognostic parameters. Furthermore, it focuses also on the available prognostic scores, highlighting the strengths and the possible pitfalls. Finally, it provides insights into future direction that could be followed in order to ameliorate risk stratification in this delicate subset of patients.

Prognostic Value of Early Risk Stratification in Pediatric Pulmonary Arterial Hypertension

2021 ◽  
Author(s):  
László Ablonczy ◽  
Tamás Ferenci ◽  
Orsolya Somoskövi ◽  
Réka Osváth ◽  
György S. Reusz ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Risk Stratification ◽  
Arterial Hypertension ◽  
Prognostic Value ◽  
Early Risk ◽  
Pulmonary Arterial

scholarly journals Dynamic changes in practical inflammation and immunity markers in cancer patients receiving immune-enhancing nutritional supplementation during concurrent chemoradiotherapy

2021 ◽  
pp. 1-11
Author(s):  
Nontiya Homkham ◽  
Pooriwat Muangwong ◽  
Veeradej Pisprasert ◽  
Patrinee Traisathit ◽  
Rungarun Jiratrachu ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Immune System ◽  
Cancer Patients ◽  
Concurrent Chemoradiotherapy ◽  
Absolute Lymphocyte Count ◽  
Diet Group ◽  
Cancer Therapies ◽  
Dynamic Changes ◽  
Regular Diet ◽  
Over Time

BACKGROUND: Immune-enhancing nutrition (IMN) strengthens the systematic inflammatory response and the immune system. Neutrophil to lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) are affected during cancer therapies. OBJECTIVE: We carried out an analysis of the dynamic changes in NLR and ALC over time in cancer patients with or without IMN supplementation. METHODS: 88 cancer patients receiving concurrent chemoradiotherapy (CCRT) were randomized into regular diet group, and regular diet and IMN group.Generalized estimation equation models were used to assess associations between patient’s characteristics, IMN, and dynamic changes in NLR and ALC over time. RESULTS: NLR and ALC at preCCRT were significantly associated with dynamic changes in NLR (adjusted β= 1.08, 95% confidence interval [CI]: 0.64–1.52) and ALC (adjusted β= 0.41, 95% CI: 0.36–0.46). The magnitudes of the NLR and ALC changes through CCRT were lower in patients receiving IMN, although the differences were not statistically significant except ALC at the end of CCRT in head and neck cancer patients (P= 0.023). CONCLUSION: Dynamic negative changes in both markers were demonstrated throughout CCRT. There were non-significant trend in promising changes in both NLR and ALC values in the whole group in IMN supplementation.

scholarly journals Myeloid phenotypes in severe COVID-19 predict secondary infection and mortality: a pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Clémence Marais ◽  
Caroline Claude ◽  
Nada Semaan ◽  
Ramy Charbel ◽  
Simon Barreault ◽  
...  
Keyword(s):  
Critically Ill ◽  
Host Response ◽  
Secondary Infection ◽  
Myeloid Cells ◽  
Suppressor Cells ◽  
Human Leukocyte ◽  
Myeloid Derived Suppressor Cells ◽  
Phenotypic Characteristics ◽  
Leukocyte Antigen ◽  
Hla Dr

Abstract Background De-regulated host response to severe coronavirus disease 2019 (COVID-19), directly referring to the concept of sepsis-associated immunological dysregulation, seems to be a strong signature of severe COVID-19. Myeloid cells phenotyping is well recognized to diagnose critical illness-induced immunodepression in sepsis and has not been well characterized in COVID-19. The aim of this study is to review phenotypic characteristics of myeloid cells and evaluate their relations with the occurrence of secondary infection and mortality in patients with COVID-19 admitted in an intensive care unit. Methods Retrospective analysis of the circulating myeloid cells phenotypes of adult COVID-19 critically ill patients. Phenotyping circulating immune cells was performed by flow cytometry daily for routine analysis and twice weekly for lymphocytes and monocytes subpopulations analysis, as well as monocyte human leukocyte antigen (mHLA)-DR expression. Results Out of the 29 critically ill adult patients with severe COVID-19 analyzed, 12 (41.4%) developed secondary infection and six patients died during their stay. Monocyte HLA-DR kinetics was significantly different between patients developing secondary infection and those without, respectively, at day 5–7 and 8–10 following admission. The monocytes myeloid-derived suppressor cells to total monocytes ratio was associated with 28- and 60-day mortality. Those myeloid characteristics suggest three phenotypes: hyperactivated monocyte/macrophage is significantly associated with mortality, whereas persistent immunodepression is associated with secondary infection occurrence compared to transient immunodepression. Conclusions Myeloid phenotypes of critically ill COVID-19 patients may be associated with development of secondary infection, 28- and 60-day mortality.

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