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Amino acids predict prognosis in patients with acute dyspnea. BMC Emerg Med 2021; 21:127. [PMID: 34717541 PMCID: PMC8557597 DOI: 10.1186/s12873-021-00519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background To identify amino acids that can predict risk of 90-day mortality in patients with acute dyspnea. Method Plasma levels of nine amino acids were analyzed 663 adult patients admitted to the Emergency Department (ED) with acute dyspnea. Cox proportional hazards models were used to examine the relation between amino acid levels and the risk of 90-day mortality. Result Eighty patients (12.1%) died within 90 days of admission. An “Amino Acid Mortality Risk Score” (AMRS), summing absolute plasma levels of glycine, phenylalanine and valine, demonstrated that among the patients belonging to quartile 1 (Q1) of the AMRS, only 4 patients died, compared to 44 patients in quartile 4. Using Q1 of the AMRS as reference, each increment of 1 SD in the AMRS was associated with a hazard ratio (HR) of 2.15 for 90-day mortality, and the HR was > 9 times higher in Q4. Conclusion Glycine, phenylalanine and valine are associated with a risk of 90-day mortality in patients admitted to the ED for acute dyspnea, suggesting that these amino acids may be useful in risk assessments.
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Wollmer M, Wändell P, Rosenqvist M, Larsson A, Melander O, Wessman T, Ärnlöv J, Ruge T. Plasma calprotectin in the emergency department: a potential clinical biomarker for patients with infectious diseases. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:593-597. [PMID: 34553669 DOI: 10.1080/00365513.2021.1980223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increased levels of plasma calprotectin are reported in patients with infectious diseases. However, the clinical usefulness of calprotectin as a biomarker to identify patients with infectious diseases in the emergency department (ED) setting has not been investigated. To study the ability of calprotectin to discriminate patients with acute infectious diseases and dyspnea from patients with other causes of acute dyspnea in the ED setting. Patients aged ≥18 years seeking ED during daytime on weekdays between March 2013 and July 2018, with acute dyspnea, were included. Participants (n = 1287) were triaged according to Medical Emergency Triage and Treatment System-Adult score (METTS-A) or Rapid Emergency Triage and Treatment System (RETTS), and blood samples were collected. The association between calprotectin and other markers of infectious diseases, i.e. biomarkers (CRP, leucocytes) and body temperature, was studied. The predictive value of calprotectin for the outcome of acute infection was evaluated with receiver operating characteristic (ROC) analysis. Univariate cross-sectional regression showed significant associations between calprotectin and leucocytes, CRP and body temperature. Patients with severe infections including pneumonia (n = 119) had significantly higher concentrations of calprotectin compared to patients with heart failure (n = 162) or chronic obstructive pulmonary disease (n = 183). When tested for the outcome of acute infection (n = 109), the area under the ROC curve (AUROC) was for CRP 0.83 and for calprotectin 0.78. Plasma calprotectin identifies infectious diseases in ED patients with acute dyspnea, and the clinical usefulness of Calprotectin in the ED has to be further studied.
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Affiliation(s)
- Martin Wollmer
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Mari Rosenqvist
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.,Infectious Disease Unit, Skåne University Hospital, Malmö, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Olle Melander
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Torgny Wessman
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Toralph Ruge
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Wändell P, Carlsson AC, Larsson A, Melander O, Wessman T, Ärnlöv J, Ruge T. The association between BMI and 90-day mortality in patients with and without diabetes seeking care at the emergency department. Ups J Med Sci 2021; 126:7590. [PMID: 34650780 PMCID: PMC8494247 DOI: 10.48101/ujms.v126.7590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of body mass index (BMI) on mortality varies with age and disease states. The aim of this research study was to analyse the associations between BMI categories and short- and long-term mortality in patients with or without diabetes seeking care at the emergency department (ED) with acute dyspnoea. POPULATION AND METHODS Patients aged ≥18 years at ED during daytime on weekdays from March 2013 to July 2018 were included. Participants were triaged according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A), and blood samples were collected. Totally, 1,710 patients were enrolled, with missing values in 113, leaving 1,597 patients, 291 with diabetes and 1,306 without diabetes. The association between BMI and short-term (90-day) and long-term (mean follow-up time 2.1 years) mortality was estimated by Cox regression with normal BMI (18.5-24.9) as referent category, with adjustment for age, sex, METTS-A scoring, glomerular filtration rate, smoking habits and cardiovascular comorbidity in a fully adjusted model. The Bonferroni correction was also used. RESULTS Regarding long-term mortality, patients with diabetes and BMI category ≥30 kg/m2 had a fully adjusted Hazard Ratio (HR) of 0.40 (95% confidence interval [CI]: 0.23-0.69), significant after the Bonferroni correction. Amongst patients without diabetes, those with underweight had an increased risk but only of borderline significance, whilst risks in those with overweight or obesity did not differ from reference.Regarding short-term mortality, risks did not differ from reference amongst patients with or without diabetes. CONCLUSIONS We found divergent long-term mortality risks in patients with and without diabetes, with lower risk in obese patients (BMI ≥ 30 kg/m2) with diabetes, but no increased risk for patients without diabetes and overweight (BMI: 25-29.9 kg/m2) and obesity.
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Affiliation(s)
- Per Wändell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Axel C. Carlsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Olle Melander
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University & Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Torgny Wessman
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University & Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Toralph Ruge
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University & Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Wändell P, Carlsson AC, Larsson A, Melander O, Wessman T, Ärnlöv J, Ruge T. TNFR1 is associated with short-term mortality in patients with diabetes and acute dyspnea seeking care at the emergency department. Acta Diabetol 2020; 57:1145-1150. [PMID: 32281000 PMCID: PMC7496043 DOI: 10.1007/s00592-020-01527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Circulating levels of TNF alpha receptor 1 (TNFR1) and 2 (TNFR2) are associated with increased long-term mortality and impaired kidney function. AIM To study association between circulating levels of TNFR1 and TNFR2 and short-term mortality in patients with diabetes and dyspnea. POPULATION AND METHODS Patients aged ≥ 18 years seeking at emergency department (ED) during daytime on weekdays between December 2013 and July 2018, with diabetes and acute dyspnea, identified at the triage process, were included. Participants (n = 291) were triaged according to Medical Emergency Triage and Treatment System-Adult score, and blood samples were collected. Association between TNFR1 and TNFR2, respectively, and 90-day mortality were estimated by Cox regression models adjusted for age, sex, BMI, creatinine and CRP. RESULTS Univariate models showed significant associations between TNFR1 and TNFR2, respectively, and CRP, age and creatinine. TNFR1 and TNFR2 tended to be elevated in patients with the highest triage level, compared to patients with lower triage levels (ns). In longitudinal analyses, TNFR1 but not TNFR2 was associated with increased short-term mortality, HR adjusted for age, BMI and creatinine 1.43 (95% CI 1.07-1.91), but not in the model also adjusted for CRP, HR 1.29 (95% CI 0.94-1.77). In secondary analysis for quartile 4 versus quartiles 1-3 of TNFR1, corresponding HRs were 2.46 (95% CI 1.27-5.15) and 2.21 (95% CI 1.07-2.56). CONCLUSIONS We found a trend for the association between circulating TNFR1 levels and short-term mortality in patients with diabetes and acute dyspnea at the ED, possibly suggesting an inflammatory pathway for the association.
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Affiliation(s)
- P Wändell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - A C Carlsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden
| | - A Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - O Melander
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - T Wessman
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - J Ärnlöv
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - T Ruge
- Department of Emergency and Internal Medicine, Skånes University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Red Blood Cell Distribution Width, Neutrophil-to-Lymphocyte Ratio, and In-Hospital Mortality in Dyspneic Patients Admitted to the Emergency Department. DISEASE MARKERS 2020; 2020:8839506. [PMID: 32655721 PMCID: PMC7321522 DOI: 10.1155/2020/8839506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
Red blood cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) have shown a prognostic value in various clinical settings. We aimed to investigate the association between RDW, NLR, and in-hospital mortality in patients with dyspnea. In this retrospective study with the Medical Information Mart for Intensive Care III database (version 1.4), adult patients who came to the emergency department with dyspnea were included. Patients' comorbidities, hematological parameters within the first 48 hours after admission to the emergency department, and in-hospital mortality were extracted. The relationships between RDW, NLR, and in-hospital mortality were analyzed with the receiver operating characteristic (ROC) curve analysis and multivariate logistic regression model. We found that hospital survivors had significantly lower NLR than those who died. However, RDW was not significantly increased in patients who died during the hospitalization. The area under the ROC curve of NLR for predicting in-hospital mortality was 0.62. On multivariate analysis, NLR was not independently associated with in-hospital mortality. On further analysis, lymphocyte percentage was independently associated with in-hospital mortality, with an odds ratio of 0.56. Therefore, we concluded that RDW and NLR are not reliable parameters to predict in-hospital mortality in critically ill patients admitted to the emergency department with dyspnea.
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Endostatin predicts mortality in patients with acute dyspnea - A cohort study of patients seeking care in emergency departments. Clin Biochem 2019; 75:35-39. [PMID: 31672650 DOI: 10.1016/j.clinbiochem.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/02/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increased levels of circulating endostatin predicts cardiovascular morbidity and impaired kidney function in the general population. The utility of endostatin as a risk marker for mortality in the emergency department (ED) has not been reported. AIM Our main aim was to study the association between plasma endostatin and 90-day mortality in an unselected cohort of patients admitted to the ED for acute dyspnea. Design Circulating endostatin was analyzed in plasma from 1710 adults and related to 90-day mortality in Cox proportional hazard models adjusted for age, sex, body mass index, oxygen saturation, respiratory rate, body temperature, C-reactive protein, lactate, creatinine and medical priority according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A). The predictive value of endostatin for mortality was evaluated with receiver operating characteristic (ROC) analysis and compared with the clinical triage scoring system and age. RESULTS Each one standard deviation increment of endostatin was associated with a HR of 2.12 (95% CI 1.31-3.44 p < 0.01) for 90-day mortality after full adjustment. Levels of endostatin were significantly increased in the group of patients with highest METTS-A (p < 0.001). When tested for the outcome 90-day mortality, the area under the ROC curve (AUC) was 0.616 for METTS-A, 0.701 for endostatin, 0.708 for METTS -A and age and 0.738 for METTS-A, age and levels of endostatin. CONCLUSIONS In an unselected cohort of patients admitted to the ED with acute dyspnea, endostatin had a string association to 90-day mortality and improved prediction of 90-day mortality in the ED beyond the clinical triage scoring system and age with 3%.
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He Q, Shi X, Zhou B, Teng J, Zhang C, Liu S, Lian J, Luo B, Zhao G, Lu H, Xu Y, Lian Y, Jia Y, Zhang Y. Interleukin 8 (CXCL8)-CXC chemokine receptor 2 (CXCR2) axis contributes to MiR-4437-associated recruitment of granulocytes and natural killer cells in ischemic stroke. Mol Immunol 2018; 101:440-449. [PMID: 30096583 DOI: 10.1016/j.molimm.2018.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
Granulocytes and natural killer (NK) cells have been linked to brain injury in ischemic stroke. However, their recruitment from peripheral leucocytes in stroke patients is not well understood. Here, the expression of the interleukin 8 (CXCL8) in plasma, and CXC chemokine receptor 2 (CXCR2) in peripheral leucocytes of patients with ischemic stroke were evaluated. Based on the results, CXCR2 expression positively correlated with granulocytes and NK cells, which were in turn attracted by CXCL8. The results also indicated that CXCR2 was a direct target of microRNA (miR)-4437, a negative regulator of CXCR2, which was downregulated in peripheral leucocytes from patients with ischemic stroke. Furthermore, serum CXCL8 levels were associated with the infarct volume and functional outcomes in patients with ischemic stroke. The results of the receiver operating characteristic curve analysis with an optimal cut-off value of 34 pg/mL indicated serum CXCL8 levels could be a prognostic indicator for ischemic stroke. In conclusion, these data highlighted the involvement of the CXCL8-CXCR2 chemotactic axis in the recruitment of granulocytes and NK cells in ischemic stroke. Furthermore, miR-4437 was suggested as a novel target for treating ischemic stroke, while the serum CXCL8 level could be a prognostic factor for ischemic stroke.
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Affiliation(s)
- Qianyi He
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Xiaojuan Shi
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Bin Zhou
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Junfang Teng
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Chaoqi Zhang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Shasha Liu
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Jingyao Lian
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310003, Zhejiang, China
| | - Guoqiang Zhao
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Hong Lu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Yajun Lian
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Yanjie Jia
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Yi Zhang
- Biotherapy Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou 450052, Henan, China; Key Laboratory for Tumor Immunology and Immunotherapy of Henan Province, Zhengzhou 450052, Henan, China.
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Gourhant V, Vuillot O, Claret PG, Lefebvre S, Schaub R, Flacher A, Dumont R, Sebbane M. Arterial pH selectively predicts critical care needs in emergency department obese patients with acute dyspnea: A prospective comparative study. Am J Emerg Med 2018; 37:67-72. [PMID: 29861375 DOI: 10.1016/j.ajem.2018.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Obese patients with acute dyspnea may be prone to misorientation from the emergency department (ED), due to impaired gas exchange evaluation and altered basal respiratory profiles. This study aims to evaluate the prognostic value of arterial blood pH in obese ED patients with acute dyspnea in comparison to non-obese counterparts. METHODS Single-center observational study of a cohort of 400 consecutive ED patients with acute dyspnea. The primary endpoint was a composite of Intensive Care Unit admission (with critical care needs) or in ED mortality. Predictors of the primary endpoint were assessed using multivariable logistic regression and ROC curve analysis, in obese (BMI ≥ 30 kg·m-2) and non-obese patients. RESULTS 252 patients who had arterial blood gas testing were analyzed including 76 (30%) obese comparable to non-obese in terms of clinical history. 51 patients were admitted to ICU and 2 deceased before admission (20 obese (26%) vs 33 non-obese (19%); p = 0.17). Factors associated with ICU admission were arterial blood pH (pH < 7.36 vs pH ≥ 7.36) and gender. In multivariate models adjusted for risk factors, pH remained the sole independent predictor in obese patients, with no predictive value in non-obese patients (ROC AUC: 0.74, 95% CI [0.60; 0.87], optimal threshold for pH: 7.36, odds ratio: 10.5 [95% CI 3.18; 34.68]). CONCLUSION Arterial blood pH may selectively predict critical care needs in ED obese patients with acute dyspnea, in comparison to non-obese. A falsely reassuring pH < 7.36 should be regarded as a marker of severity when assessing acute dyspnea in obese ED patients.
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Affiliation(s)
- Vincent Gourhant
- Département des urgences, CHU Montpellier - Univ Montpellier, Montpellier, France
| | - Olivier Vuillot
- Département des urgences, CHU Montpellier - Univ Montpellier, Montpellier, France
| | | | - Sophie Lefebvre
- Département des urgences, CHU Montpellier - Univ Montpellier, Montpellier, France
| | - Roxane Schaub
- Département d'information médicale, CHU Montpellier - Univ Montpellier, Montpellier, France
| | - Alexandre Flacher
- Département des urgences, CHU Montpellier - Univ Montpellier, Montpellier, France
| | - Richard Dumont
- Département des urgences, CHU Montpellier - Univ Montpellier, Montpellier, France
| | - Mustapha Sebbane
- Département des urgences, CHU Montpellier - Univ Montpellier, Montpellier, France.
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Vascular Endothelial Growth Factor D, Pulmonary Congestion, and Incidence of Heart Failure. J Am Coll Cardiol 2018; 71:580-582. [DOI: 10.1016/j.jacc.2017.11.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 01/16/2023]
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Dencker M, Gårdinger Y, Björgell O, Hlebowicz J. Effect of food intake on 92 biomarkers for cardiovascular disease. PLoS One 2017; 12:e0178656. [PMID: 28586402 PMCID: PMC5460853 DOI: 10.1371/journal.pone.0178656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/16/2017] [Indexed: 01/09/2023] Open
Abstract
Objective The present study evaluates the effect of food intake on 92 biomarkers for cardiovascular disease (CVD). Methods Twenty two healthy subjects (11 male and 11 female aged 25.9±4.2 years) were investigated. A total of 92 biomarkers were measured before a standardized meal as well as 30 and 120 minutes afterwards with the Proseek Multiplex CVD III kit. Results The levels for eight biomarkers decreased significantly (P<0.05) 30 minutes after food intake. The levels for seven biomarkers remained significantly decreased 120 minutes after food intake. Nine biomarker decreased significantly at 120 minutes after food intake. The changes were between 4–30%, most commonly around 5%. Only six biomarkers showed a difference of 10% or more due to food intake. The biggest differences were observed for Insulin-like growth factor-binding protein 1 (30%); Azurocidin, Cystatin-B, and Myeloperoxidase (13%); Monocyte chemotactic protein 1 (11%); and Myeloblastin (10%), all 120 minutes after food intake. Conclusions This study shows that food intake affects several different CVD biomarkers, but the effect is predominantly modest. Timing of blood sampling in relation to food intake, therefore, appears not to be a major concern. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible.
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Affiliation(s)
- Magnus Dencker
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
- * E-mail:
| | - Ylva Gårdinger
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ola Björgell
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Joanna Hlebowicz
- Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
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Jónsdóttir B, Jaworowski Å, San Miguel C, Melander O. IL-8 predicts early mortality in patients with acute hypercapnic respiratory failure treated with noninvasive positive pressure ventilation. BMC Pulm Med 2017; 17:35. [PMID: 28178959 PMCID: PMC5299680 DOI: 10.1186/s12890-017-0377-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background Patients with Acute Hypercapnic Respiratory Failure (AHRF) who are unresponsive to appropriate medical treatment, are often treated with Noninvasive Positive Pressure Ventilation (NPPV). Clinical predictors of the outcome of this treatment are scarce. Therefore, we evaluated the role of the biomarkers IL-8 and GDF-15 in predicting 28-day mortality in patients with AHRF who receive treatment with NPPV. Methods The study population were 46 patients treated with NPPV for AHRF. Clinical and background data was registered and blood samples taken for analysis of inflammatory biomarkers. IL-8 and GDF-15 were selected for analysis, and related to risk of 28-day mortality (primary endpoint) using Cox proportional hazard models adjusted for gender, age and various clinical parameters. Results Of the 46 patients, there were 3 subgroup in regards to primary diagnosis: Acute Exacerbation of COPD (AECOPD, n = 34), Acute Heart Failure (AHF, n = 8) and Acute Exacerbation in Obesity Hypoventilation Syndrome (AEOHS, n = 4). There was significant difference in the basic characteristic of the subgroups, but not in the clinical parameters that were used in treatment decisions. 13 patients died within 28 days of admission (28%). The Hazard Ratio for 28-days mortality per 1-SD increment of IL-8 was 3.88 (95% CI 1.86–8.06, p < 0.001). When IL-8 values were divided into tertiles, the highest tertile had a significant association with 28 days mortality, HR 10.02 (95% CI 1.24–80.77, p for trend 0.03), compared with the lowest tertile. This correlation was maintained when the largest subgroup with AECOPD was analyzed. GDF-15 was correlated in the same way, but when put into the same model as IL-8, the significance disappeared. Conclusion IL-8 is a target to explore further as a predictor of 28 days mortality, in patients with AHRF treated with NPPV.
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Affiliation(s)
- Brynja Jónsdóttir
- The Department of Clinical Sciences Malmo, Faculty of Medicine, Lund University, Lund, Sweden. .,Department of Lung- and Allergy Medicine, Skåne University Hospital, Malmö, Sweden. .,Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Åsa Jaworowski
- Department of Lung- and Allergy Medicine, Skåne University Hospital, Malmö, Sweden
| | - Carmen San Miguel
- Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- The Department of Clinical Sciences Malmo, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
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Lund N, Gränsbo K, Wernersson C, Melander O. Cardiometabolic biomarkers are predictors of readmission and death in patients hospitalized for acute dyspnea. Am J Emerg Med 2016; 35:610-614. [PMID: 28062207 PMCID: PMC5754318 DOI: 10.1016/j.ajem.2016.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022] Open
Abstract
Background Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates. Purpose To investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea. Methods 65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death. Measurements and results Cardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor receptor superfamily member 6 (FAS) and C-C motif chemokine 3 (CCL3) were independently and significantly related to the endpoint and combined into a biomarker risk score (BRS). Each SD increment of the BRS conferred a hazard ratio (HR) of 2.13 (1.39–3.27) P = 0.001. The top vs bottom tertile of the BRS conferred a HR of 4.75 (1.93–11.68) P = 0.001. Dyspnea severity was also associated with worse outcome, HR = 3.43 (1.28–9.20) P = 0.014. However, when mutually adjusted the BRS remained significant (P = 0.004) whereas dyspnea severity was not. The BRS was related to the endpoint among patients with mild to moderate dyspnea (P = 0.016) but not among those with severe dyspnea. Conclusion A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea.
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Affiliation(s)
- Nathalie Lund
- Skåne University Hospital Malmö, Clinical Research Centre, Malmoe, Sweden.
| | - Klas Gränsbo
- Skåne University Hospital Malmö, Clinical Research Centre CRC, Malmoe, Sweden
| | - Camilla Wernersson
- Skåne University Hospital Malmö, Clinical Research Centre CRC, Malmoe, Sweden
| | - Olle Melander
- Skåne University Hospital Malmö, Clinical Research Centre CRC, Malmoe, Sweden
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