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Wang X, Xia J, Shan Y, Yang Y, Li Y, Sun H. Predictive value of the Oxford Acute Severity of Illness Score in acute stroke patients with stroke-associated pneumonia. Front Neurol 2023; 14:1251944. [PMID: 37731859 PMCID: PMC10507346 DOI: 10.3389/fneur.2023.1251944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background Stroke-associated pneumonia (SAP) is associated with a poor prognosis and a high mortality rate in stroke patients. However, the accuracy of early prediction of SAP is insufficient, and there is a lack of effective prognostic evaluation methods. Therefore, in this study, we investigated the predictive value of the Oxford Acute Severity of Illness Score (OASIS) in SAP to provide a potential reference index for the incidence and prognosis of SAP. Methods We recruited a total of 280 patients with acute ischemic stroke who had been diagnosed and treated in the Zhumadian Central Hospital between January 2021 and January 2023. These patients were divided into an SAP group (86 cases) and a non-SAP group (194 cases) according to SAP diagnostic criteria by expert consensus on the diagnosis and treatment of SAP. We collated general and clinical data from all patients, including the survival of SAP patients during the follow-up period. Multivariate logistic regression was used to analyze the risk factors for SAP. Kaplan-Meier and multivariate COX regression analyses were used to investigate the relationship between OASIS and the prognosis of SAP, and a receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of OASIS for SAP. Results Our analyses identified body temperature, C-reactive protein, procalcitonin, OASIS, and a prolonged length of intensive care unit (ICU) stay as the main risk factors for SAP (all Ps < 0.05). Advanced age and an elevated OASIS were identified as the main risk factors for death in SAP patients (all Ps < 0.05). The risk of death in patients with OASIS of 31-42 points was significantly higher than that in patients with OASIS of 12-20 points (HR = 5.588, 95% CI = 1.531-20.401, P = 0.009). ROC curve analysis further showed that OASIS had a high predictive value for morbidity and the incidence of death in SAP patients. Conclusion OASIS can effectively predict the onset and death of SAP patients and provides a potential reference index for early diagnosis and the prediction of prognosis in patients with SAP. Our findings should be considered in clinical practice.
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Affiliation(s)
- Ximei Wang
- Department of General Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China
| | - Jianhua Xia
- Department of Neurology, Zhumadian Central Hospital, Zhumadian, China
| | - Yanhua Shan
- Department of General Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China
| | - Yang Yang
- Department of Scientific Research Management, Zhumadian Central Hospital, Zhumadian, China
| | - Yun Li
- Department of General Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China
| | - Haiyan Sun
- Department of Neurology, Jilin Province First Auto Work General Hospital, Jilin, China
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Huang L, Zhang R, Ji J, Long F, Wang Y, Lu J, Xu G, Sun Y. Hypersensitive C-reactive protein-albumin ratio is associated with stroke-associated pneumonia and early clinical outcomes in patients with acute ischemic stroke. Brain Behav 2022; 12:e2675. [PMID: 35748095 PMCID: PMC9304827 DOI: 10.1002/brb3.2675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES We aimed to explore the association between the baseline hypersensitive C-reactive protein-albumin ratio (CAR) and stroke-associated pneumonia (SAP) during hospitalization and the short-term prognosis in patients with acute ischemic stroke (AIS). METHODS We enrolled 766 patients with AIS and collected their admission baseline characteristics, including their National Institutes of Health Stroke Scale score, CAR, age, atrial fibrillation, dysphagia, sex, stroke severity (A2 DS2 ) score, and other information. The occurrence of SAP within 7 days after stroke, length of hospital stay, and physical condition at discharge were also recorded. The patients' Modified Rankin Scale (mRS) scores and mortality 3 months after AIS were further evaluated at follow-up. All patients were divided into four groups based on the quartiles of the admission CAR (Q1 <1.3, Q2 1.3-3.7, Q3 3.7-9.3, Q4 ≥9.3). RESULTS During hospitalization, 92 (11.9%) patients were diagnosed with SAP. The patients with SAP had a higher CAR than the non-SAP patients (p < .001). In the multivariate-adjusted model, the patients in the Q3 and Q4 groups had a higher SAP risk (aOR was 5.21 and 17.72, p-trend < .001) than those in the lowest quartile. The area under the curve for the CAR's ability to predict SAP was 0.810 in the receiver operating characteristic curve analysis and had a similar predictive efficacy as the A2 DS2 score (p <.05). The length of stay in the SAP group was almost the same as that in the non-SAP group, but the clinical outcomes were worse at discharge and at the 3-month follow-up in the SAP group. In addition, the patients in the higher CAR quartiles at admission were more likely to have poorer clinical outcomes. CONCLUSIONS Patients with AIS with a high CAR at admission are more likely to develop SAP during hospitalization and have poor short-term clinical outcomes. These findings might help to timely identify patients at high risk of SAP and provide a basis for further research on prophylactic antibiotic therapy.
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Affiliation(s)
- Lingling Huang
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Rong Zhang
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Jiahui Ji
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Fengdan Long
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Yadong Wang
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Juan Lu
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Ge Xu
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Yaming Sun
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
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Fang C, Mao Y, Jiang M, Yin W. Serum sTREM-1 and CXCL-16 Levels in Children with Mycoplasma pneumoniae Pneumonia and Their Diagnostic Value. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:7179796. [PMID: 34691220 PMCID: PMC8528593 DOI: 10.1155/2021/7179796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022]
Abstract
Mycoplasma pneumoniae pneumonia (MPP) is an acute respiratory tract infection caused by Mycoplasma pneumoniae. It is characterized by severe symptoms, long course of disease, many intrapulmonary complications, and poor therapeutic effect. In recent years, the incidence of Mycoplasma infection have been gradually rising trend, and the children's own immune system development is not mature, cases differences, children with mild can only show the upper respiratory tract infection, and critically ill children can lead to lung infection and even lead to multiple organ dysfunction, affect life and health of children. Soluble triggering receptors expressed on myeloid cell-1 (sTREM-1) is a subtype secreted by myeloid cell trigger receptor-1, which is released into blood in large amounts when the body is infected, and is a newly discovered inflammatory indicator in recent years. CXC chemokine 16 (CXCL-16) can recruit lymphocytes by chemotaxis through binding to its receptor CXCR6 to participate in the body's immune regulation. The purpose of this study was to investigate serum sTREM-1 and CXCL-16 levels in children with MPP and to analyze their correlation with the disease and diagnostic value. The results showed that the serum levels of sTREM-1 and CXCL-16 were increased in children with Mycoplasma. Serum levels of sTREM-1 and CXCL-16 were positively correlated with the severity of the disease. sTREM-1 combined with CXCL-16 has an important value in the diagnosis of children with MPP.
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Affiliation(s)
- Chengchao Fang
- Department of Pediatrics, The First People's Hospital of Yuhang, Yuhang District, Hangzhou, Zhejiang 311100, China
| | - Yueyan Mao
- Department of Pediatrics, The First People's Hospital of Yuhang, Yuhang District, Hangzhou, Zhejiang 311100, China
| | - Mingfen Jiang
- Department of Hemodialysis Center, The First People's Hospital of Yuhang, Yuhang District, Hangzhou, Zhejiang 311100, China
| | - Wei Yin
- Department of Pediatrics, The First People's Hospital of Yuhang, Yuhang District, Hangzhou, Zhejiang 311100, China
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Shao SL, Cong HY, Wang MY, Liu P. The diagnostic roles of neutrophil in bloodstream infections. Immunobiology 2019; 225:151858. [PMID: 31836303 DOI: 10.1016/j.imbio.2019.10.007] [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: 02/19/2019] [Revised: 04/15/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022]
Abstract
Bloodstream infections remain a leading cause of death worldwide, despite advances in critical care and understanding of the pathophysiology and treatment strategies. No specific biomarkers or therapy are available for these conditions. Neutrophils play a critical role in controlling infection and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated diagnostic biomarkers involved neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically predict the outcome of sepsis.
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Affiliation(s)
- Shu-Li Shao
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China
| | - Hai-Yan Cong
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China
| | - Ming-Yi Wang
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China.
| | - Peng Liu
- Department of Central Lab, Weihai Municipal Hospital Affiliated to Dalian Medical University, Weihai, Shandong, 264200, PR China.
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Wang Y, Zhang S, Li L, Xie J. The usefulness of serum procalcitonin, C-reactive protein, soluble triggering receptor expressed on myeloid cells 1 and Clinical Pulmonary Infection Score for evaluation of severity and prognosis of community-acquired pneumonia in elderly patients. Arch Gerontol Geriatr 2018; 80:53-57. [PMID: 30366226 DOI: 10.1016/j.archger.2018.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 01/06/2023]
Abstract
AIMS To comparatively analyze the usefulness of serum procalcitonin (PCT), C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) and Clinical Pulmonary Infection Score (CPIS) for assessing the severity and prognosis of community-acquired pneumonia (CAP) in the elderly. METHODS A total of 214 elderly patients with CAP and 106 healthy persons were enrolled in this prospective study. On the admission day, serum inflammatory markers, including CRP, PCT, sTREM-1, and CPIS were analyzed. By severity, the CAP patients were subdivided into non-severe CAP group and severe CAP group. By outcome, the patients were classified into survival group and death group. The efficiency of three inflammatory markers and CPIS on predicting prognosis of pneumonia patients was then analyzed. RESULTS The serum inflammatory markers and CPIS were significantly higher in CAP patients than in healthy controls. These biomarkers and CPIS were significantly higher in patients with severe CAP than in patients with non-severe CAP. Compared with patients who would survive, these markers and CPIS were significantly higher in patients who would die. Receiver operating characteristic curve analysis showed that the area under the curve and sensitivity were higher for serum sTREM-1 than for other indicators, while the specificity of serum PCT was the highest. CONCLUSIONS Serum CRP, PCT, and sTREM-1 and CPIS determined on the admission day are effective indicators to evaluate the severity and prognosis of CAP in the elderly. The prognostic value of PCT and sTREM-1 is better than that of CRP and CPIS.
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Affiliation(s)
- Yanhui Wang
- Department of Gerontology, Shanghai No.5 Hospital, Fudan University, Shanghai, 200240, China
| | - Shan Zhang
- Department of Gerontology, Shanghai No.5 Hospital, Fudan University, Shanghai, 200240, China
| | - Liang Li
- Department of Gerontology, Shanghai No.5 Hospital, Fudan University, Shanghai, 200240, China
| | - Juan Xie
- Department of Gerontology, Shanghai No.5 Hospital, Fudan University, Shanghai, 200240, China.
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Bustamante A, García-Berrocoso T, Penalba A, Giralt D, Simats A, Muchada M, Zapata E, Rubiera M, Montaner J. Sepsis biomarkers reprofiling to predict stroke-associated infections. J Neuroimmunol 2017; 312:19-23. [PMID: 28886956 DOI: 10.1016/j.jneuroim.2017.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/17/2017] [Accepted: 08/23/2017] [Indexed: 12/21/2022]
Abstract
We aimed to evaluate the usefulness of sepsis biomarkers to predict stroke-associated infections. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), mid-regional pro-adrenomedullin (MR-proADM), presepsin (sCD14), and soluble urokinase-type plasminogen activator receptor (suPAR), were explored in 125 blood samples collected at different time-points. At baseline, MR-proADM was an independent predictor of infection [>0.94pg/mL, OR=3.63 (1.16-11.33), p=0.026], as well as suPAR at 24h [>2185.8pg/mL, OR=5.81 (1.05-32.26), p=0.044]. Both MR-proADM and suPAR were raised in patients with infections throughout the first week after stroke. These results are especially relevant for MR-proADM given its early elevation, which would allow early preventive interventions.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Simats
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Elena Zapata
- Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio, Seville, Spain
| | - Marta Rubiera
- Stroke Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Tziolos N, Kotanidou A, Orfanos SE. Biomarkers in infection and sepsis: Can they really indicate final outcome? Int J Antimicrob Agents 2015; 46 Suppl 1:S29-32. [PMID: 26607340 DOI: 10.1016/j.ijantimicag.2015.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Infectious diseases are among the most common reasons for admission to hospital and can easily lead to sepsis. Sepsis is globally associated with increased mortality, and although biomarkers could help clinicians in the early diagnosis of sepsis and immediate onset of antibiotics, there are always questions to be answered about their usefulness in the prognosis of infectious diseases. This article reviews some of the available biomarkers used in infectious diseases and sepsis in order to evaluate their utility to predict mortality and unfavourable outcome. Several studies present the pros and cons of each compound, but it is obvious that the ideal biomarker, with high sensitivity and specificity, cost effectiveness and with definite cut-off ranges and time of blood sampling, is yet to be found.
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Affiliation(s)
- Nikolaos Tziolos
- 4th Department of Internal Medicine, University of Athens Medical School, Athens, Greece
| | - Anastasia Kotanidou
- 1st Department of Critical Care, University of Athens Medical School, Athens, Greece
| | - Stylianos E Orfanos
- 2nd Department of Critical Care, University of Athens Medical School, Athens, Greece.
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