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Mohr NL, Krannich A, Jung H, Hulde N, von Dossow V. Intraoperative Blood Pressure Management and Its Effects on Postoperative Delirium After Cardiac Surgery: A Single-Center Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:1127-1134. [PMID: 38369449 DOI: 10.1053/j.jvca.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES There is accumulating evidence that blood pressure management might be associated with end-organ dysfunction after cardiac surgery. This study aimed to investigate the impact of intraoperative hypotension (IOH) on adverse neurologic outcomes and mortality. DESIGN A single-center retrospective cohort study. SETTING The Heart and Diabetes Centre Bad Oeynhausen NRW, Ruhr-University Bochum. PARTICIPANTS This retrospective cohort study included 31,315 adult patients who underwent elective cardiac surgery at the authors' institution between January 2009 and December 2018. INTERVENTIONS All cardiac surgery procedures except assist device implantation, organ transplantation, and emergency surgery. MEASUREMENTS AND MAIN RESULTS Adverse neurologic outcomes were defined as postoperative delirium and stroke. IOH was defined as mean arterial pressure below 60 mmHg for >2 minutes. The frequency of IOH episodes and the cumulative IOH duration were recorded. The association between IOH and adverse neurologic outcomes was examined with unadjusted statistical analysis and multiple logistic regression analysis. Eight hundred forty-nine (2.9%) patients developed postoperative stroke, and 2,401 (7.7%) patients developed postoperative delirium. The frequency of IOH episodes was independently associated with postoperative delirium in the multiple logistic regression analysis (odds ratio 1.02, 95% CI 1.003-1.03, p < 0.001), whereas there was no association between it and stroke. CONCLUSION This large retrospective monocentric cohort study revealed that increased episodes of IOH were associated with the risk of developing postoperative delirium after cardiac surgery. This might have important clinical implications with respect to careful and precise hemodynamic monitoring and proactive treatment, especially in patients with increased risk for postoperative delirium.
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Affiliation(s)
- Niklas L Mohr
- Institute of Anesthesiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | | | - Hilke Jung
- Institute of Congenital heart diseases, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Nikolai Hulde
- Institute of Anesthesiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Vera von Dossow
- Institute of Anesthesiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany.
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Bünger V, Hunsicker O, Krannich A, Balzer F, Spies CD, Kuebler WM, Weber-Carstens S, Menk M, Graw JA. Haptoglobin depletion during the first seven days of veno-venous ECMO therapy is associated with increased mortality and adverse outcomes in patients with ARDS. Shock 2024:00024382-990000000-00399. [PMID: 38661177 DOI: 10.1097/shk.0000000000002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Hemolysis is a frequent complication in patients with sepsis, ARDS, or extracorporeal membrane oxygenation (ECMO). Haptoglobin (Hp) can scavenge released cell-free hemoglobin (CFH). Hemolysis and low plasma concentrations of Hp may be independently associated with mortality in critically ill patients. METHODS Retrospective analysis of 435 patients with ARDS and veno-venous ECMO therapy, admitted to a tertiary ARDS referral center (01/2007-12/2018). Hp-depletion was defined as decrease in plasma Hp concentration < 0.39 g/l within the first week after ECMO initiation. Patients with Hp depletion were compared to patients without Hp depletion. The primary endpoint was 28-day mortality. Secondary endpoints included organ dysfunction-free, renal replacement therapy (RRT)-free, vasopressor-free, and ECMO-free composites. RESULTS Patients with Hp-depletion (n = 269) had a significantly higher mortality 28 days after ECMO initiation compared to patients without Hp-depletion (43.5%, [95% CI: 37.52-49.66] vs. 25.3%, [19.03-32.74], p < 0.001). Furthermore, patients with Hp depletion had fewer organ dysfunction-free days (subdistribution hazard ratio, [SHR] 0.35, [95% CI 0.25-0.50], p < 0.001), lower chances for successful weaning from renal replacement therapy (SHR 0.50, [0.32-0.79], p < 0.001), vasopressor therapy (SHR 0.39, [0.28-0.54], p < 0.001), and ECMO therapy (SHR 0.41, [0.30-0.57], p < 0.001) within 28 days after ECMO initiation. Patients with initial Hp <0.66 g/l had higher risks for Hp-depletion than patients with initial Hp ≥ 0.66 g/l. CONCLUSION Patients with Hp-depletion within the first week of ECMO therapy might benefit from close monitoring of hemolysis with early detection and elimination of the underlying cause. They might be potential candidates for future Hp supplementation therapy to prevent overload of the CFH-scavenger system.
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Affiliation(s)
| | | | | | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Wolfgang M Kuebler
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Lechner K, Bock M, von Schacky C, Scherr J, Lorenz E, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F. Trans-fatty acid blood levels of industrial but not natural origin are associated with cardiovascular risk factors in patients with HFpEF: a secondary analysis of the Aldo-DHF trial. Clin Res Cardiol 2023; 112:1541-1554. [PMID: 36640187 PMCID: PMC10584704 DOI: 10.1007/s00392-022-02143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NT-proBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown. METHODS This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were: 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E/e' 7.1 ± 1.5; NT-proBNP 158 ng/L (IQR 82-298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman's correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF and neurohumoral activation at baseline and after 12 months. RESULTS Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body mass index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function. CONCLUSIONS In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF. Higher blood levels of industrially processed TFA, but not of the naturally occurring TFA C16:1n-7t, are associated with a higher risk cardiometabolic phenotype and prognostic of lower aerobic capacity in patients with HFpEF.
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Affiliation(s)
- Katharina Lechner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Bock
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | | | - Johannes Scherr
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Elke Lorenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Göttingen, Göttingen, Germany
| | - André Duvinage
- DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Frank Edelmann
- Department of Cardiology, Campus Virchow Klinikum (CVK), Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.
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Bock M, von Schacky C, Scherr J, Lorenz E, Lechner B, Krannich A, Wachter R, Duvinage A, Edelmann F, Lechner K. De Novo Lipogenesis-Related Monounsaturated Fatty Acids in the Blood Are Associated with Cardiovascular Risk Factors in HFpEF Patients. J Clin Med 2023; 12:4938. [PMID: 37568339 PMCID: PMC10419368 DOI: 10.3390/jcm12154938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
De novo lipogenesis (DNL)-related monounsaturated fatty acids (MUFAs) in the blood are associated with incident heart failure (HF). This observation's biological plausibility may be due to the potential of these MUFAs to induce proinflammatory pathways, endoplasmic reticulum stress, and insulin resistance, which are pathophysiologically relevant in HF. The associations of circulating MUFAs with cardiometabolic phenotypes in patients with heart failure with a preserved ejection fraction (HFpEF) are unknown. In this secondary analysis of the Aldosterone in Diastolic Heart Failure trial, circulating MUFAs were analysed in 404 patients using the HS-Omega-3-Index® methodology. Patients were 67 ± 8 years old, 53% female, NYHA II/III (87/13%). The ejection fraction was ≥50%, E/e' 7.1 ± 1.5, and the median NT-proBNP 158 ng/L (IQR 82-298). Associations of MUFAs with metabolic, functional, and echocardiographic patient characteristics at baseline/12 months follow-up (12 mFU) were analysed using Spearman's correlation coefficients and linear regression analyses, using sex/age as covariates. Circulating levels of C16:1n7 and C18:1n9 were positively associated with BMI/truncal adiposity and associated traits (dysglycemia, atherogenic dyslipidemia, and biomarkers suggestive of non-alcoholic-fatty liver disease). They were furthermore inversely associated with functional capacity at baseline/12 mFU. In contrast, higher levels of C20:1n9 and C24:1n9 were associated with lower cardiometabolic risk and higher exercise capacity at baseline/12 mFU. In patients with HFpEF, circulating levels of individual MUFAs were differentially associated with cardiovascular risk factors. Our findings speak against categorizing FA based on physicochemical properties. Circulating MUFAs may warrant further investigation as prognostic markers in HFpEF.
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Affiliation(s)
- Matthias Bock
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany
| | | | - Johannes Scherr
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Elke Lorenz
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, 80336 Munich, Germany
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, 37099 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - André Duvinage
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, 80992 Munich, Germany
| | - Frank Edelmann
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Katharina Lechner
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Munich, Germany
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, 80992 Munich, Germany
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Bünger V, Hunsicker O, Krannich A, Balzer F, Spies CD, Kuebler WM, Weber-Carstens S, Menk M, Graw JA. Potential of cell-free hemoglobin and haptoglobin as prognostic markers in patients with ARDS and treatment with veno-venous ECMO. J Intensive Care 2023; 11:15. [PMID: 37081577 PMCID: PMC10116665 DOI: 10.1186/s40560-023-00664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Hemolysis is associated with increased mortality in patients with sepsis, ARDS, or therapy with extracorporeal membrane oxygenation (ECMO). To quantify a critical threshold of hemolysis in patients with ARDS and treatment with veno-venous ECMO, we aimed to identify cutoff values for cell-free hemoglobin (CFH) and haptoglobin (Hp) plasma concentrations associated with a significant increase in ICU mortality. METHODS Patients with ARDS admitted to a tertiary ARDS referral center between 01/2007 and 12/2018 and treatment with veno-venous ECMO were included. Cutoff values for mean CFH (mCFH) and mean Hp (mHp) plasma concentrations dividing the cohort into groups with significantly different ICU mortalities were calculated and patient characteristics were compared. A multiple logistic regression model with stepwise backward variable selection was included. In addition, cutoff values for vulnerable relative timespans for the respective CFH and Hp concentrations were calculated. RESULTS A quantitative cutoff value of 11 mg/dl for mCFH separated the cohort (n = 442) regarding ICU mortality (mCFH ≤ 11 mg/dl: 38%, [95%-CI: 32.22-43.93] (n = 277) vs. mCFH > 11 mg/dl: 70%, [61.99-76.47] (n = 165), p < 0.001). Analogously, a mHp cutoff value ≤ 0.39 g/l was associated with a significant increase in ICU mortality (mHp ≤ 0.39 g/l: 68.7%, [60.91-75.61] (n = 163) vs. mHp > 0.39 g/l: 38.7%, [33.01-44.72] (n = 279), p < 0.001). The independent association of ICU mortality with CFH and Hp cutoff values was confirmed by logistic regression adjusting for confounders (CFH Grouping: OR 3.77, [2.51-5.72], p < 0.001; Hp Grouping: OR 0.29, [0.19-0.43], p < 0.001). A significant increase in ICU mortality was observed when CFH plasma concentration exceeded the limit of 11 mg/dl on 13.3% of therapy days (≤ 13.3% of days with CFH > 11 mg/dl: 33%; [26.81-40.54] (n = 192) vs. > 13.3% of days with CFH > 11 mg/dl: 62%; [56.05-68.36] (n = 250), p < 0.001). Analogously, a mortality increase was detected when Hp plasma concentration remained ≤ 0.39 g/l for > 18.2% of therapy days (≤ 18.2% days with Hp ≤ 0.39 g/l: 27%; [19.80-35.14] (n = 138) vs. > 18.2% days with Hp ≤ 0.39 g/l: 60%; [54.43-65.70] (n = 304), p < 0.001). CONCLUSIONS Moderate hemolysis with mCFH-levels as low as 11 mg/dl impacts mortality in patients with ARDS and therapy with veno-venous ECMO. Furthermore, a cumulative dose effect should be considered indicated by the relative therapy days with CFH-concentrations > 11 mg/dl. In addition, also Hp plasma concentrations need consideration when the injurious effect of elevated CFH is evaluated.
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Affiliation(s)
- Victoria Bünger
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Oliver Hunsicker
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Krannich
- Clinical Trial Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department Analytics, TCC GmbH, Hamburg, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia D Spies
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang M Kuebler
- Institute of Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mario Menk
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Jan A Graw
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Ulm, Ulm University, Ulm, Germany
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Bock M, Von Schacky C, Scherr J, Lorenz E, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F, Lechner K. Trans fatty acid blood levels and HFpEF phenotype: from the Aldo-DHF RCT. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prognosis in HFpEF is determined by risk factor control and treatment of comorbidities. Industrially processed TFA (IP-TFA) from partially hydrogenated oils have been linked to altered lipoprotein metabolism, endothelial dysfunction, increased biomarkers of inflammation and increased NTproBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown.
Purpose
To evaluate associations of blood TFA with cardiovascular risk factors, aerobic capacity and cardiac function in patients with HFpEF.
Methods
This is a secondary analysis from the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n=404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67±8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥50%, E/e' 7.1±1.5; median NT-proBNP 158 ng/L (IQR 82–298). Multiple linear regression analyses, using sex and age as covariates, were used to describe associations of TFA with metabolic phenotype, functional capacity, echocardiographic markers for left ventricular diastolic function (LVDF), and neurohumoral activation at baseline and after 12-months-follow-up (12mFU). To account for randomization group, all analyses were repeated as sensitivity analysis with group as covariate. A significance level of α=5% was used for all tests. As all tests were hypothesis generating without confirmatory interpretation, no correction was applied to counteract the problem of multiple comparisons.
Results
Higher blood levels of the naturally occurring TFA C16:1n-7t were broadly associated with a more favorable lipid profile, lower body weight/central adiposity, lower white blood cell count and lower biochemical markers of non-alcoholic fatty liver disease at baseline/12mFU. Conversely, blood levels of the IP-TFA C18:1n9t were directly associated with lipid risk markers [triglycerides (β=19.7, p<0,001), non-HDL-C (β=7.9, p=0,001), and LDL-C (β=5.4, p=0,011)]. The two IP-TFA C18:2n6 isomers C18:2n6tt and C18:2n6ct were positively associated with HbA1c [(β=14.6, p=0,003) and (β=4.2, p=0,014) respectively]. The IP-TFA C18:2n6tt/-ct isomers were associated with lower submaximal aerobic capacity (distance covered in the 6MWT) at baseline/12mFU. No significant association was found between TFA blood levels and left ventricular filling pressures, left ventricular relaxation or neurohumoral activation. Significant effects of group allocation (spironolactone +/−) were found for the 12mFU outcomes systolic/diastolic blood pressure (all p<0.001), heart rate, E/e$'$ and HbA1c.
Conclusions
In HFpEF patients, higher blood levels of industrially processed TFA, but not of the TFA C16:1n-7t in full fat dairy and meat, were associated with a higher risk phenotype and lower aerobic capacity. Our findings support efforts to remove IP-TFA from the food supply for improving risk factor control in HFpEF patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Foundation of Heart Research
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Affiliation(s)
- M Bock
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
| | - C Von Schacky
- University Hospital of Munich, Omegametrix, Martinsried, Germany , Munich , Germany
| | - J Scherr
- University Hospital Balgrist , Zurich , Switzerland
| | - E Lorenz
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
| | - B Lechner
- Ludwig Maximilians University , Munich , Germany
| | - B Haller
- Technical University of Munich, Institute of AI and Informatics in Medicine , Munich , Germany
| | - A Krannich
- Charité - University Medicine Berlin , Berlin , Germany
| | - M Halle
- Technical University of Munich, Department of Prevention, Rehabilitation and Sports Medicine , Munich , Germany
| | - R Wachter
- Leipzig University Hospital, Clinic and Policlinic for Cardiology , Leipzig , Germany
| | - A Duvinage
- Technical University of Munich, Department of Prevention, Rehabilitation and Sports Medicine , Munich , Germany
| | - F Edelmann
- Charité - University Medicine Berlin, Department of Cardiology , Berlin , Germany
| | - K Lechner
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
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Lechner K, von Schacky C, Scherr J, Lorenz E, Bock M, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F. Saturated Fatty Acid Blood Levels and Cardiometabolic Phenotype in Patients with HFpEF: A Secondary Analysis of the Aldo-DHF Trial. Biomedicines 2022; 10:biomedicines10092296. [PMID: 36140396 PMCID: PMC9496272 DOI: 10.3390/biomedicines10092296] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Circulating long-chain (LCSFAs) and very long-chain saturated fatty acids (VLSFAs) have been differentially linked to risk of incident heart failure (HF). In patients with heart failure with preserved ejection fraction (HFpEF), associations of blood SFA levels with patient characteristics are unknown. Methods: From the Aldo-DHF-RCT, whole blood SFAs were analyzed at baseline in n = 404 using the HS-Omega-3-Index® methodology. Patient characteristics were 67 ± 8 years, 53% female, NYHA II/III (87%/13%), ejection fraction ≥50%, E/e’ 7.1 ± 1.5; and median NT-proBNP 158 ng/L (IQR 82–298). Spearman´s correlation coefficients and linear regression analyses, using sex and age as covariates, were used to describe associations of blood SFAs with metabolic phenotype, functional capacity, cardiac function, and neurohumoral activation at baseline and after 12-month follow-up (12 mFU). Results: In line with prior data supporting a potential role of de novo lipogenesis-related LCSFAs in the development of HF, we showed that baseline blood levels of C14:0 and C16:0 were associated with cardiovascular risk factors and/or lower exercise capacity in patients with HFpEF at baseline/12 mFU. Contrarily, the three major circulating VLSFAs, lignoceric acid (C24:0), behenic acid (C22:0), and arachidic acid (C20:0), as well as the LCSFA C18:0, were broadly associated with a lower risk phenotype, particularly a lower risk lipid profile. No associations were found between cardiac function and blood SFAs. Conclusions: Blood SFAs were differentially linked to biomarkers and anthropometric markers indicative of a higher-/lower-risk cardiometabolic phenotype in HFpEF patients. Blood SFA warrant further investigation as prognostic markers in HFpEF. One Sentence Summary: In patients with HFpEF, individual circulating blood SFAs were differentially associated with cardiometabolic phenotype and aerobic capacity.
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Affiliation(s)
- Katharina Lechner
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
- Kardiologie, Deutsches Herzzentrum München, 80636 Munich, Germany
| | | | - Johannes Scherr
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Elke Lorenz
- Kardiologie, Deutsches Herzzentrum München, 80636 Munich, Germany
| | - Matthias Bock
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
- Kardiologie, Deutsches Herzzentrum München, 80636 Munich, Germany
| | - Benjamin Lechner
- Department of Internal Medicine IV, Ludwig-Maximilians University, 80336 Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | | | - Martin Halle
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, 37077 Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, 37075 Göttingen, Germany
| | - André Duvinage
- Rehabilitation and Sports Medicine, Department of Prevention, School of Medicine, Technical University of Munich, 80992 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, 80336 Munich, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité, Universitätsmedizin Berlin, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Correspondence: ; Tel.: +49-(0)30-450-553731; Fax: +49-(0)30-450-7-553731
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8
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Piatek K, Feuerstein A, Zach V, Rozados da Conceicao C, Beblo A, Belyavskiy E, Pieske‐Kraigher E, Krannich A, Schwedhelm E, Hinz S, Pieske B, Edelmann F. Nitric oxide metabolites: associations with cardiovascular biomarkers and clinical parameters in patients with HFpEF. ESC Heart Fail 2022; 9:3961-3972. [PMID: 35979962 PMCID: PMC9773705 DOI: 10.1002/ehf2.14116] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is one of the most rapidly growing cardiovascular health burden worldwide, but there is still a lack of understanding about the HFpEF pathophysiology. The nitric oxide (NO) signalling pathway has been identified as a potential key element. The aim of our study was to investigate markers of NO metabolism [l-arginine (l-Arg), homoarginine (hArg), and asymmetric and symmetric dimethylarginine (ADMA and SDMA)], additional biomarkers [N-terminal pro-B-type natriuretic peptide (NT-proBNP), endothelin-1 (ET-1), mid-regional pro-adrenomedullin (MR-proADM), copeptin, and high-sensitivity C-reactive protein (hsCRP)], and the endothelial function in an integrated approach focusing on associations with clinical characteristics in patients with HFpEF. METHODS AND RESULTS Seventy-three patients, prospectively enrolled in the 'German HFpEF Registry', were analysed. Inclusion criteria were left ventricular ejection fraction (LVEF) ≥ 50%; New York Heart Association functional class ≥ II; elevated levels of NT-proBNP > 125 pg/mL; and at least one additional criterion for structural heart disease or diastolic dysfunction. All patients underwent transthoracic echocardiography, cardiopulmonary exercise testing, and pulse amplitude tonometry (EndoPAT™). Patients were categorized in two groups based on their retrospectively calculated HFA-PEFF score. Serum concentrations of l-Arg, hArg, ADMA, SDMA, NT-proBNP, ET-1, MR-proADM, copeptin, and hsCRP were determined. Patients had a median age of 74 years, 47% were female, and median LVEF was 57%. Fifty-two patients (71%) had an HFA-PEFF score ≥ 5 (definitive HFpEF), and 21 patients (29%) a score of 3 to 4 (risk for HFpEF). Overall biomarker concentrations were 126 ± 32 μmol/L for l-Arg, 1.67 ± 0.55 μmol/L for hArg, 0.74 (0.60;0.85) μmol/L for SDMA, and 0.61 ± 0.10 μmol/L for ADMA. The median reactive hyperaemia index (RHI) was 1.55 (1.38;1.87). SDMA correlated with NT-proBNP (r = 0.291; P = 0.013), ET-1 (r = 0.233; P = 0.047), and copeptin (r = 0.381; P = 0.001). ADMA correlated with ET-1 (r = 0.250; P = 0.033) and hsCRP (r = 0.303; P = 0.009). SDMA was associated with the left atrial volume index (β = 0.332; P = 0.004), also after adjustment for age, sex, and comorbidities. Biomarkers were non-associated with the RHI. A principal component analysis revealed two contrary clusters of biomarkers. CONCLUSIONS Our findings suggest an impaired NO metabolism as one possible key pathogenic determinant in at least a subgroup of patients with HFpEF. We argue for further evaluation of NO-based therapies. Upcoming studies should clarify whether subgroups of HFpEF patients can take more benefit from therapies that are targeting NO metabolism and pathway.
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Affiliation(s)
- Karsten Piatek
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany
| | - Anna Feuerstein
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany,DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Veronika Zach
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany
| | - Cristina Rozados da Conceicao
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany
| | - Amelie Beblo
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany
| | - Evgeny Belyavskiy
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany
| | - Elisabeth Pieske‐Kraigher
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany
| | - Alexander Krannich
- Experimental and Clinical Research Center (ECRC)Charité – Universitätsmedizin BerlinBerlinGermany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and ToxicologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/LübeckHamburgGermany
| | - Sarah Hinz
- Institute of Clinical Pharmacology and ToxicologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Burkert Pieske
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany,DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany,Department of CardiologyDeutsches Herzzentrum Berlin (DHZB)BerlinGermany
| | - Frank Edelmann
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumAugustenburger Platz 1Berlin13353Germany,DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
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9
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Graw JA, Hildebrandt P, Krannich A, Balzer F, Spies C, Francis RC, Kuebler WM, Weber-Carstens S, Menk M, Hunsicker O. The role of cell-free hemoglobin and haptoglobin in acute kidney injury in critically ill adults with ARDS and therapy with VV ECMO. Crit Care 2022; 26:50. [PMID: 35193645 PMCID: PMC8864920 DOI: 10.1186/s13054-022-03894-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background Increased plasma concentrations of circulating cell-free hemoglobin (CFH) are supposed to contribute to the multifactorial etiology of acute kidney injury (AKI) in critically ill patients while the CFH-scavenger haptoglobin might play a protective role. We evaluated the association of CFH and haptoglobin with AKI in patients with an acute respiratory distress syndrome (ARDS) requiring therapy with VV ECMO. Methods Patients with CFH and haptoglobin measurements before initiation of ECMO therapy were identified from a cohort of 1044 ARDS patients and grouped into three CFH concentration groups using a risk stratification. The primary objective was to assess the association of CFH and haptoglobin with KDIGO stage 3 AKI. Further objectives included the identification of a target haptoglobin concentration to protect from CFH-associated AKI. Measurements and main results Two hundred seventy-three patients fulfilled the inclusion criteria. Of those, 154 patients (56.4%) had AKI at ECMO initiation. The incidence of AKI increased stepwise with increasing concentrations of CFH reaching a plateau at 15 mg/dl. Compared to patients with low [< 5 mg/dl] CFH concentrations, patients with moderate [5–14 mg/dl] and high [≥ 15 mg/dl] CFH concentrations had a three- and five-fold increased risk for AKI (adjusted odds ratio [OR] moderate vs. low, 2.69 [95% CI, 1.25–5.95], P = 0.012; and OR high vs. low, 5.47 [2.00–15.9], P = 0.001). Among patients with increased CFH concentrations, haptoglobin plasma levels were lower in patients with AKI compared to patients without AKI. A haptoglobin concentration greater than 2.7 g/l in the moderate and 2.4 g/l in the high CFH group was identified as clinical cutoff value to protect from CFH-associated AKI (sensitivity 89.5% [95% CI, 83–96] and 90.2% [80–97], respectively). Conclusions In critically ill patients with ARDS requiring therapy with VV ECMO, an increased plasma concentration of CFH was identified as independent risk factor for AKI. Among patients with increased CFH concentrations, higher plasma haptoglobin concentrations might protect from CFH-associated AKI and should be subject of future research. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03894-5.
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10
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Elsanhoury A, Kühl U, Stautner B, Klein O, Krannich A, Morris D, Willner M, Jankowska E, Klingel K, Van Linthout S, Tschöpe C. The Spontaneous Course of Human Herpesvirus 6 DNA-Associated Myocarditis and the Effect of Immunosuppressive Intervention. Viruses 2022; 14:v14020299. [PMID: 35215893 PMCID: PMC8879301 DOI: 10.3390/v14020299] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: This study investigated the spontaneous clinical course of patients with endomyocardial biopsy (EMB)-proven lymphocytic myocarditis and cardiac human herpesvirus 6 (HHV6) DNA presence, and the effectiveness of steroid-based intervention in HHV6-positive patients. Results: 756 heart failure (HF) patients underwent an EMB procedure to determine the underlying cause of unexplained HF. Low levels of HHV6 DNA, detectable by nested PCR only, were found in 10.4% of the cases (n = 79) of which 62% (n = 49) showed myocardial inflammation. The spontaneous course of patients with EMB-proven HHV6 DNA-associated lymphocytic myocarditis (n = 26) showed significant improvements in the left ventricular ejection fraction (LVEF) and clinical symptoms, respectively, in 15/26 (60%) patients, 3–12 months after disease onset. EMB mRNA expression of components of the NLRP3 inflammasome pathway and protein analysis of cardiac remodeling markers, analyzed by real-time PCR and MALDI mass spectrometry, respectively, did not differ between HHV6-positive and -negative patients. In another cohort of patients with ongoing symptoms related to lymphocytic myocarditis associated with cardiac levels of HHV6-DNA copy numbers <500 copies/µg cardiac DNA, quantified by real-time PCR, the efficacy and safety of steroid-based immunosuppression for six months was investigated. Steroid-based immunosuppression improved the LVEF (≥5%) in 8/10 patients and reduced cardiac inflammation in 7/10 patients, without an increase in cardiac HHV6 DNA levels in follow-up EMBs. Conclusion: Low HHV6 DNA levels are frequently detected in the myocardium, independent of inflammation. In patients with lymphocytic myocarditis with low levels of HHV6 DNA, the spontaneous clinical improvement is nearby 60%. In selected symptomatic patients with cardiac HHV6 DNA copy numbers less than 500 copies/µg cardiac DNA and without signs of an active systemic HHV6 infection, steroid-based therapy was found to be effective and safe. This finding needs to be further confirmed in large, randomized trials.
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Affiliation(s)
- Ahmed Elsanhoury
- Berlin Institute of Health at Charite (BIH)-Universitätmedizin Berlin-BIH Center for Regenerative Therapies (BCRT), 13353 Berlin, Germany; (A.E.); (U.K.); (B.S.); (O.K.); (S.V.L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 13353 Berlin, Germany
| | - Uwe Kühl
- Berlin Institute of Health at Charite (BIH)-Universitätmedizin Berlin-BIH Center for Regenerative Therapies (BCRT), 13353 Berlin, Germany; (A.E.); (U.K.); (B.S.); (O.K.); (S.V.L.)
- Department Internal Medicine and Cardiology, Charité—University Medicine Berlin, Campus Virchow Klinikum, 13353 Berlin, Germany; (D.M.); (M.W.)
| | - Bruno Stautner
- Berlin Institute of Health at Charite (BIH)-Universitätmedizin Berlin-BIH Center for Regenerative Therapies (BCRT), 13353 Berlin, Germany; (A.E.); (U.K.); (B.S.); (O.K.); (S.V.L.)
- Institute of Heart Diseases, University Hospital Wroclaw, 50-556 Wroclaw, Poland;
| | - Oliver Klein
- Berlin Institute of Health at Charite (BIH)-Universitätmedizin Berlin-BIH Center for Regenerative Therapies (BCRT), 13353 Berlin, Germany; (A.E.); (U.K.); (B.S.); (O.K.); (S.V.L.)
| | - Alexander Krannich
- Experimental and Clinical Research Center (ECRC), Charité—Universitätsmedizin Berlin, 13125 Berlin, Germany;
| | - Daniel Morris
- Department Internal Medicine and Cardiology, Charité—University Medicine Berlin, Campus Virchow Klinikum, 13353 Berlin, Germany; (D.M.); (M.W.)
| | - Monika Willner
- Department Internal Medicine and Cardiology, Charité—University Medicine Berlin, Campus Virchow Klinikum, 13353 Berlin, Germany; (D.M.); (M.W.)
| | - Ewa Jankowska
- Institute of Heart Diseases, University Hospital Wroclaw, 50-556 Wroclaw, Poland;
- Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Sophie Van Linthout
- Berlin Institute of Health at Charite (BIH)-Universitätmedizin Berlin-BIH Center for Regenerative Therapies (BCRT), 13353 Berlin, Germany; (A.E.); (U.K.); (B.S.); (O.K.); (S.V.L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 13353 Berlin, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health at Charite (BIH)-Universitätmedizin Berlin-BIH Center for Regenerative Therapies (BCRT), 13353 Berlin, Germany; (A.E.); (U.K.); (B.S.); (O.K.); (S.V.L.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 13353 Berlin, Germany
- Department Internal Medicine and Cardiology, Charité—University Medicine Berlin, Campus Virchow Klinikum, 13353 Berlin, Germany; (D.M.); (M.W.)
- Correspondence: ; Tel.: +49-(30)-450-553711
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11
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Graw JA, Bünger V, Materne LA, Krannich A, Balzer F, Francis RCE, Pruß A, Spies CD, Kuebler WM, Weber-Carstens S, Menk M, Hunsicker O. Age of Red Cells for Transfusion and Outcomes in Patients with ARDS. J Clin Med 2022; 11:jcm11010245. [PMID: 35011986 PMCID: PMC8745782 DOI: 10.3390/jcm11010245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Packed red blood cells (PRBCs), stored for prolonged intervals, might contribute to adverse clinical outcomes in critically ill patients. In this study, short-term outcome after transfusion of PRBCs of two storage duration periods was analyzed in patients with Acute Respiratory Distress Syndrome (ARDS). Patients who received transfusions of PRBCs were identified from a cohort of 1044 ARDS patients. Patients were grouped according to the mean storage age of all transfused units. Patients transfused with PRBCs of a mean storage age ≤ 28 days were compared to patients transfused with PRBCs of a mean storage age > 28 days. The primary endpoint was 28-day mortality. Secondary endpoints included failure-free days composites. Two hundred and eighty-three patients were eligible for analysis. Patients in the short-term storage group had similar baseline characteristics and received a similar amount of PRBC units compared with patients in the long-term storage group (five units (IQR, 3-10) vs. four units (2-8), p = 0.14). The mean storage age in the short-term storage group was 20 (±5.4) days compared with 32 (±3.1) days in the long-term storage group (mean difference 12 days (95%-CI, 11-13)). There was no difference in 28-day mortality between the short-term storage group compared with the long-term storage group (hazard ratio, 1.36 (95%-CI, 0.84-2.21), p = 0.21). While there were no differences in ventilator-free, sedation-free, and vasopressor-free days composites, patients in the long-term storage group compared with patients in the short-term storage group had a 75% lower chance for successful weaning from renal replacement therapy (RRT) within 28 days after ARDS onset (subdistribution hazard ratio, 0.24 (95%-CI, 0.1-0.55), p < 0.001). Further analysis indicated that even a single PRBC unit stored for more than 28 days decreased the chance for successful weaning from RRT. Prolonged storage of PRBCs was not associated with a higher mortality in adults with ARDS. However, transfusion of long-term stored PRBCs was associated with prolonged dependence of RRT in critically ill patients with an ARDS.
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Affiliation(s)
- Jan A. Graw
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany
- Correspondence:
| | - Victoria Bünger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
| | - Lorenz A. Materne
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
| | - Alexander Krannich
- Experimental and Clinical Research Center (ECRC), Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Felix Balzer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, 10115 Berlin, Germany;
| | - Roland C. E. Francis
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Axel Pruß
- Institute of Transfusion Medicine, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Wolfgang M. Kuebler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Mario Menk
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Oliver Hunsicker
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (V.B.); (L.A.M.); (R.C.E.F.); (C.D.S.); (S.W.-C.); (M.M.); (O.H.)
- ARDS/ECMO Centrum Charité, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
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12
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Hadzibegovic S, Lena A, Churchill TW, Ho JE, Potthoff S, Denecke C, Rösnick L, Heim KM, Kleinschmidt M, Sander LE, Witzenrath M, Suttorp N, Krannich A, Porthun J, Friede T, Butler J, Wilkenshoff U, Pieske B, Landmesser U, Anker SD, Lewis GD, Tschöpe C, Anker MS. Heart failure with preserved ejection fraction according to the HFA-PEFF score in COVID-19 patients: clinical correlates and echocardiographic findings. Eur J Heart Fail 2021; 23:1891-1902. [PMID: 33932255 PMCID: PMC8239668 DOI: 10.1002/ejhf.2210] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
Aims Viral‐induced cardiac inflammation can induce heart failure with preserved ejection fraction (HFpEF)‐like syndromes. COVID‐19 can lead to myocardial damage and vascular injury. We hypothesised that COVID‐19 patients frequently develop a HFpEF‐like syndrome, and designed this study to explore this. Methods and results Cardiac function was assessed in 64 consecutive, hospitalized, and clinically stable COVID‐19 patients from April–November 2020 with left ventricular ejection fraction (LVEF) ≥50% (age 56 ± 19 years, females: 31%, severe COVID‐19 disease: 69%). To investigate likelihood of HFpEF presence, we used the HFA‐PEFF score. A low (0–1 points), intermediate (2–4 points), and high (5–6 points) HFA‐PEFF score was observed in 42%, 33%, and 25% of patients, respectively. In comparison, 64 subjects of similar age, sex, and comorbidity status without COVID‐19 showed these scores in 30%, 66%, and 4%, respectively (between groups: P = 0.0002). High HFA‐PEFF scores were more frequent in COVID‐19 patients than controls (25% vs. 4%, P = 0.001). In COVID‐19 patients, the HFA‐PEFF score significantly correlated with age, estimated glomerular filtration rate, high‐sensitivity troponin T (hsTnT), haemoglobin, QTc interval, LVEF, mitral E/A ratio, and H2FPEF score (all P < 0.05). In multivariate, ordinal regression analyses, higher age and hsTnT were significant predictors of increased HFA‐PEFF scores. Patients with myocardial injury (hsTnT ≥14 ng/L: 31%) vs. patients without myocardial injury, showed higher HFA‐PEFF scores [median 5 (interquartile range 3–6) vs. 1 (0–3), P < 0.001] and more often showed left ventricular diastolic dysfunction (75% vs. 27%, P < 0.001). Conclusion Hospitalized COVID‐19 patients frequently show high likelihood of presence of HFpEF that is associated with cardiac structural and functional alterations, and myocardial injury. Detailed cardiac assessments including echocardiographic determination of left ventricular diastolic function and biomarkers should become routine in the care of hospitalized COVID‐19 patients.
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Affiliation(s)
- Sara Hadzibegovic
- Department of Cardiology (CBF), Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Alessia Lena
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, USA.,Echocardiography Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E Ho
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sophia Potthoff
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corinna Denecke
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas Rösnick
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katrin Moira Heim
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Malte Kleinschmidt
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leif Erik Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Krannich
- Clinical Study Center (CSC), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Porthun
- Norwegian University of Science and Technology, Gjøvik, Norway
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Javed Butler
- Mississippi State University Jackson Design Center Library, Starkville, MS, USA
| | - Ursula Wilkenshoff
- Department of Cardiology (CBF), Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology (CBF), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan D Anker
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus S Anker
- Department of Cardiology (CBF), Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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13
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Gül-Klein S, Kästner A, Haber PK, Krenzien F, Wabitsch S, Krannich A, Andreou A, Eurich D, Tacke F, Horst D, Pratschke J, Schmelzle M. Recurrence of Hepatocellular Carcinoma After Liver Transplantation is Associated with Episodes of Acute Rejections. J Hepatocell Carcinoma 2021; 8:133-143. [PMID: 33777855 PMCID: PMC7987264 DOI: 10.2147/jhc.s292010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose The impact of acute rejection (AR) after liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient outcome is uncertain. This aim of this study is to investigate whether AR is associated with HCC relapse and overall survival. Patients and Methods Patients undergoing LT for HCC between 2001 and 2015 were retrospectively analyzed with regard to histopathological proven AR within the median time until recurrence. Cox’s regression analysis was conducted revealing risk factors for HCC recurrence. Results HCC recurred in 47 of 252 analyzed patients with a median time to recurrence of 20 months. Patients with AR (28.6%) had a significantly higher frequency of recurrence compared to patients without AR (13.0%, p=0.002). Multiple Cox regression analyses identified AR within 20 months to be an independent risk factor for HCC recurrence both as dichotomized (HR=2.91, 95%CI: 1.30–6.53; p=0.009) and as a continuous variable (HR=1.81, 95%CI: 1.28–2.54; p=0.001). HCC recurrence and AR were associated with higher grades of liver fibrosis one year after LT, when compared to patients without AR (p=0.019). Conclusion Our results demonstrate an association of AR with HCC recurrence after LT with implications for intervals of monitoring in tumor surveillance. Graft fibrosis and immune mechanisms are potentially related and causal interactions are worth further investigation.
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Affiliation(s)
- Safak Gül-Klein
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anika Kästner
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Konstantin Haber
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Wabitsch
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Krannich
- Clinical Study Center, Clinical Trial Office, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Andreou
- Division of Acute Care Surgery, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Dennis Eurich
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology/Gastroenterology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David Horst
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
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14
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Hommes F, van Loon W, Thielecke M, Abramovich I, Lieber S, Hammerich R, Gehrke-Beck S, Linzbach E, Schuster A, von dem Busche K, Theuring S, Gertler M, Equihua Martinez G, Richter J, Bergmann C, Bölke A, Böhringer F, Mall MA, Rosen A, Krannich A, Keller J, Bethke N, Kurzmann M, Kurth T, Kirchberger V, Seybold J, Mockenhaupt FP. SARS-CoV-2 Infection, Risk Perception, Behaviour and Preventive Measures at Schools in Berlin, Germany, during the Early Post-Lockdown Phase: A Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:ijerph18052739. [PMID: 33800392 PMCID: PMC7967466 DOI: 10.3390/ijerph18052739] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/20/2021] [Accepted: 03/04/2021] [Indexed: 12/24/2022]
Abstract
Briefly before the first peak of the COVID-19 pandemic in Berlin, Germany, schools closed in mid-March 2020. Following re-opening, schools resumed operation at a reduced level for nine weeks. During this phase, we aimed at assessing, among students and teachers, infection status, symptoms, individual behaviour, and institutional infection prevention measures. Twenty-four primary and secondary school classes, randomly selected across Berlin, were examined. Oro-nasopharyngeal swabs and capillary blood samples were collected to determine SARS-CoV-2 infection (PCR) and specific IgG (ELISA), respectively. Medical history, household characteristics, leisure activities, fear of infection, risk perception, hand hygiene, facemask wearing, and institutional preventive measures were assessed. Descriptive analysis was performed. Among 535 participants (385 students, 150 staff), one teenager was found to be infected with SARS-CoV-2 (0.2%), and seven individuals exhibited specific IgG (1.3%). Compared to pre-pandemic times, screen time (e.g., TV, gaming, social media) increased, and the majority of primary school students reported reduced physical activity (42.2%). Fear of infection and risk perception were relatively low, acceptance of adapted health behaviors was high. In this post-lockdown period of low SARS-CoV-2 incidence in Berlin, individual and school-level infection prevention measures were largely adhered to. Nevertheless, vigilance and continued preventive measures are essential to cope with future pandemic activity.
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Affiliation(s)
- Franziska Hommes
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
- Correspondence:
| | - Welmoed van Loon
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Marlene Thielecke
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Igor Abramovich
- Clinic for Anesthesiology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.A.); (S.L.)
| | - Sascha Lieber
- Clinic for Anesthesiology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (I.A.); (S.L.)
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Ralf Hammerich
- Clinical Quality and Risk Management, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Sabine Gehrke-Beck
- Institute of General Practice, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (S.G.-B.); (A.S.)
| | - Elisabeth Linzbach
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Angela Schuster
- Institute of General Practice, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (S.G.-B.); (A.S.)
| | - Katja von dem Busche
- Department of Pediatric Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Maximilian Gertler
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Gabriela Equihua Martinez
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Clara Bergmann
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Alisa Bölke
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
| | - Falko Böhringer
- Labor Berlin—Charité Vivantes Services GmbH, 13353 Berlin, Germany;
| | - Marcus A. Mall
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.A.M.); (A.R.)
| | - Alexander Rosen
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.A.M.); (A.R.)
| | - Alexander Krannich
- Clinical Study Center, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Jan Keller
- Department of Education and Psychology, Freie Universität Berlin, 14195 Berlin, Germany;
| | - Norma Bethke
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Marco Kurzmann
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Tobias Kurth
- Institute of Public Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Valerie Kirchberger
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Joachim Seybold
- Medical Directorate, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (N.B.); (M.K.); (V.K.); (J.S.)
| | - Frank P. Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (W.v.L.); (M.T.); (E.L.); (S.T.); (M.G.); (G.E.M.); (J.R.); (C.B.); (A.B.); (F.P.M.)
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15
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Hunsicker O, Materne L, Bünger V, Krannich A, Balzer F, Spies C, Francis RC, Weber-Carstens S, Menk M, Graw JA. Lower versus higher hemoglobin threshold for transfusion in ARDS patients with and without ECMO. Crit Care 2020; 24:697. [PMID: 33327953 PMCID: PMC7740070 DOI: 10.1186/s13054-020-03405-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/24/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Efficacy and safety of different hemoglobin thresholds for transfusion of red blood cells (RBCs) in adults with an acute respiratory distress syndrome (ARDS) are unknown. We therefore assessed the effect of two transfusion thresholds on short-term outcome in patients with ARDS. METHODS Patients who received transfusions of RBCs were identified from a cohort of 1044 ARDS patients. After propensity score matching, patients transfused at a hemoglobin concentration of 8 g/dl or less (lower-threshold) were compared to patients transfused at a hemoglobin concentration of 10 g/dl or less (higher-threshold). The primary endpoint was 28-day mortality. Secondary endpoints included ECMO-free, ventilator-free, sedation-free, and organ dysfunction-free composites. MEASUREMENTS AND MAIN RESULTS One hundred ninety-two patients were eligible for analysis of the matched cohort. Patients in the lower-threshold group had similar baseline characteristics and hemoglobin levels at ARDS onset but received fewer RBC units and had lower hemoglobin levels compared with the higher-threshold group during the course on the ICU (9.1 [IQR, 8.7-9.7] vs. 10.4 [10-11] g/dl, P < 0.001). There was no difference in 28-day mortality between the lower-threshold group compared with the higher-threshold group (hazard ratio, 0.94 [95%-CI, 0.59-1.48], P = 0.78). Within 28 days, 36.5% (95%-CI, 27.0-46.9) of the patients in the lower-threshold group compared with 39.5% (29.9-50.1) of the patients in the higher-threshold group had died. While there were no differences in ECMO-free, sedation-free, and organ dysfunction-free composites, the chance for successful weaning from mechanical ventilation within 28 days after ARDS onset was lower in the lower-threshold group (subdistribution hazard ratio, 0.36 [95%-CI, 0.15-0.86], P = 0.02). CONCLUSIONS Transfusion at a hemoglobin concentration of 8 g/dl, as compared with a hemoglobin concentration of 10 g/dl, was not associated with an increase in 28-day mortality in adults with ARDS. However, a transfusion at a hemoglobin concentration of 8 g/dl was associated with a lower chance for successful weaning from the ventilator during the first 28 days after ARDS onset. TRIAL REGISTRATION ClinicalTrials.gov NCT03871166.
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Affiliation(s)
- O Hunsicker
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Materne
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - V Bünger
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Krannich
- Clinical Trial Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Balzer
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Spies
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R C Francis
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Menk
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.,ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J A Graw
- Department of Anesthesiology and Operative Intensive Care Medicine CCM / CVK Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. .,ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
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16
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Kurth F, Roennefarth M, Thibeault C, Corman VM, Müller-Redetzky H, Mittermaier M, Ruwwe-Glösenkamp C, Heim KM, Krannich A, Zvorc S, Schmidt S, Kretzler L, Dang-Heine C, Rose M, Hummel M, Hocke A, Hübner RH, Opitz B, Mall MA, Röhmel J, Landmesser U, Pieske B, Knauss S, Endres M, Spranger J, Mockenhaupt FP, Tacke F, Treskatsch S, Angermair S, Siegmund B, Spies C, Weber-Carstens S, Eckardt KU, Schürmann D, Uhrig A, Stegemann MS, Zoller T, Drosten C, Suttorp N, Witzenrath M, Hippenstiel S, von Kalle C, Sander LE. Studying the pathophysiology of coronavirus disease 2019: a protocol for the Berlin prospective COVID-19 patient cohort (Pa-COVID-19). Infection 2020; 48:619-626. [PMID: 32535877 PMCID: PMC7293426 DOI: 10.1007/s15010-020-01464-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/22/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global health emergency. Pa-COVID-19 aims to provide comprehensive data on clinical course, pathophysiology, immunology and outcome of COVID-19, to identify prognostic biomarkers, clinical scores, and therapeutic targets for improved clinical management and preventive interventions. METHODS Pa-COVID-19 is a prospective observational cohort study of patients with confirmed SARS-CoV-2 infection treated at Charité - Universitätsmedizin Berlin. We collect data on epidemiology, demography, medical history, symptoms, clinical course, and pathogen testing and treatment. Systematic, serial blood sampling will allow deep molecular and immunological phenotyping, transcriptomic profiling, and comprehensive biobanking. Longitudinal data and sample collection during hospitalization will be supplemented by long-term follow-up. RESULTS Outcome measures include the WHO clinical ordinal scale on day 15 and clinical, functional, and health-related quality-of-life assessments at discharge and during follow-up. We developed a scalable dataset to (i) suit national standards of care, (ii) facilitate comprehensive data collection in medical care facilities with varying resources, and (iii) allow for rapid implementation of interventional trials based on the standardized study design and data collection. We propose this scalable protocol as blueprint for harmonized data collection and deep phenotyping in COVID-19 in Germany. CONCLUSION We established a basic platform for harmonized, scalable data collection, pathophysiological analysis, and deep phenotyping of COVID-19, which enables rapid generation of evidence for improved medical care and identification of candidate therapeutic and preventive strategies. The electronic database accredited for interventional trials allows fast trial implementation for candidate therapeutic agents. TRIAL REGISTRATION Registered at the German registry for clinical studies (DRKS00021688).
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Affiliation(s)
- Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | - Maria Roennefarth
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Charlotte Thibeault
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Holger Müller-Redetzky
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Mirja Mittermaier
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Katrin M Heim
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Alexander Krannich
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Saskia Zvorc
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Sein Schmidt
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Lucie Kretzler
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Chantip Dang-Heine
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Hummel
- Central Biobank Charité (ZeBanC), Institute of Pathology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Hocke
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Ralf H Hübner
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Bastian Opitz
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Marcus A Mall
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jobst Röhmel
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Burkert Pieske
- Medical Department, Division of Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany
| | - Samuel Knauss
- Department of Neurology with Experimental Neurology and Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology and Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anaesthesiology and Intensive Care Medicine, Charite Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefan Angermair
- Division of Gastroenterology, Infectious Diseases, Rheumatology, Medical Department, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Britta Siegmund
- Division of Gastroenterology, Infectious Diseases, Rheumatology, Medical Department, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Internal Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dirk Schürmann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Alexander Uhrig
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Miriam S Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Stefan Hippenstiel
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Christof von Kalle
- Clinical Study Center (CSC), Berlin Institute of Health, and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Leif Erik Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.
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17
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Müller I, Vogl T, Kühl U, Krannich A, Banks A, Trippel T, Noutsias M, Maisel AS, van Linthout S, Tschöpe C. Serum alarmin S100A8/S100A9 levels and its potential role as biomarker in myocarditis. ESC Heart Fail 2020; 7:1442-1451. [PMID: 32462801 PMCID: PMC7373886 DOI: 10.1002/ehf2.12760] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/20/2020] [Accepted: 04/27/2020] [Indexed: 12/30/2022] Open
Abstract
Aims The alarmin S100A8/S100A9 (S100A8/A9) is released by activated monocytes/macrophages and neutrophils in the setting lymphocytic myocarditis (MC). We recently demonstrated its therapeutic potential in experimental acute MC. Now, we investigated the diagnostic relevance of S100A8/A9 serum levels in patients with suspected acute and chronic MC and in patients with heart failure without cardiac inflammation. Methods and Results Serum S100A8/A9 levels were analysed in patients with a recent onset of MC [≤ 30 days, n = 32; ejection fraction (EF): 45.4 ± 12.9%], dilated cardiomyopathy patients with inflammation (n = 112; EF: 29.0 ± 11.4%), or without inflammation (n = 58; EF: 26.6 ± 9.3%), and controls (n = 25; EF: 68.5 ± 4.6%), by using specific ELISAs. Blood samples were collected at Time Point 1 (T1), where also endomyocardial biopsies (EMBs) were withdrawn. Patients with a recent onset of MC showed a 4.6‐fold increase in serum S100A8/A9 levels vs. controls (MC: 1948 ± 1670 ng/mL vs. controls: 426 ± 307 ng/mL; P < 0.0001). Serum S100A8/A9 correlated with the disease activity, represented by EMB‐derived counts of inflammatory cells (CD3: r = 0.486, P = 0.0047, lymphocyte function‐associated antigen‐1: r = 0.558, P = 0.0009, macrophage‐1 antigen: r = 0.434, P = 0.013), the EMB mRNA levels of S100A8, S100A9 (r = 0.541, P = 0.002), and left ventricular ejection fraction (LVEF: r = 0.498, P = 0.0043). EMB immunofluorescence co‐stainings display macrophages/monocytes and neutrophils as the main source of S100A8 and S100A9 in recent onset MC. The diagnostic value of serum alarmin levels (cut‐off 583 ng/mL) was characterized by a specificity of 92%, a sensitivity of 90.6%, positive predictive value of 93.5%, negative predictive value of 88.5%, and an accuracy of 0.949 (95% confidence interval [0.89–1]). In a subgroup of MC patients, S100A8/A9 serum levels and EMBs at T1 (n = 12) and a follow‐up visit (T2, n = 12, mean follow‐up 8.5 months) were available. A fall of serum S100A8/A9 (T1: 2208 ± 1843 ng/mL vs. T2: 888.8 ± 513.7 ng/mL; P = 0.00052) was associated with a reduced cardiac inflammation (CD3 T1: 70.02 ± 107.4 cells per square millimetre vs. T2: 59.18 ± 182.5 cells per square millimetre; P = 0.0342, lymphocyte function‐associated antigen‐1 T1: 133.5 ± 187.1 cells per square millimetre vs. T2: 74.12 ± 190.5 cells per square millimetre; P = 0.0186, and macrophage‐1 antigen T1: 132.6 ± 129.5 cells per square millimetre vs. T2: 54.41 ± 65.16 cells per square millimetre; P = 0.0015). Serum S100A8/A9 levels were only slightly increased in patients within the chronic phase of MC and in heart failure patients without inflammation vs. controls. Conclusions Serum S100A8/A9 might serve as an additional tool in the diagnostic workup of suspected acute MC patients.
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Affiliation(s)
- Irene Müller
- Berlin Institute of Health (BIH) & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Thomas Vogl
- Department of Immunology, University of Münster, Münster, Germany
| | - Uwe Kühl
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Alexander Krannich
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tobias Trippel
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alan S Maisel
- FACC, University of California San Diego, San Diego, CA, USA
| | - Sophie van Linthout
- Berlin Institute of Health (BIH) & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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18
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Bartolomaeus H, Balogh A, Yakoub M, Homann S, Markó L, Höges S, Tsvetkov D, Krannich A, Wundersitz S, Avery EG, Haase N, Kräker K, Hering L, Maase M, Kusche-Vihrog K, Grandoch M, Fielitz J, Kempa S, Gollasch M, Zhumadilov Z, Kozhakhmetov S, Kushugulova A, Eckardt KU, Dechend R, Rump LC, Forslund SK, Müller DN, Stegbauer J, Wilck N. Short-Chain Fatty Acid Propionate Protects From Hypertensive Cardiovascular Damage. Circulation 2019; 139:1407-1421. [PMID: 30586752 PMCID: PMC6416008 DOI: 10.1161/circulationaha.118.036652] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Arterial hypertension and its organ sequelae show characteristics of T cell–mediated inflammatory diseases. Experimental anti-inflammatory therapies have been shown to ameliorate hypertensive end-organ damage. Recently, the CANTOS study (Canakinumab Antiinflammatory Thrombosis Outcome Study) targeting interleukin-1β demonstrated that anti-inflammatory therapy reduces cardiovascular risk. The gut microbiome plays a pivotal role in immune homeostasis and cardiovascular health. Short-chain fatty acids (SCFAs) are produced from dietary fiber by gut bacteria and affect host immune homeostasis. Here, we investigated effects of the SCFA propionate in 2 different mouse models of hypertensive cardiovascular damage. Methods: To investigate the effect of SCFAs on hypertensive cardiac damage and atherosclerosis, wild-type NMRI or apolipoprotein E knockout–deficient mice received propionate (200 mmol/L) or control in the drinking water. To induce hypertension, wild-type NMRI mice were infused with angiotensin II (1.44 mg·kg–1·d–1 subcutaneous) for 14 days. To accelerate the development of atherosclerosis, apolipoprotein E knockout mice were infused with angiotensin II (0.72 mg·kg–1·d–1 subcutaneous) for 28 days. Cardiac damage and atherosclerosis were assessed using histology, echocardiography, in vivo electrophysiology, immunofluorescence, and flow cytometry. Blood pressure was measured by radiotelemetry. Regulatory T cell depletion using PC61 antibody was used to examine the mode of action of propionate. Results: Propionate significantly attenuated cardiac hypertrophy, fibrosis, vascular dysfunction, and hypertension in both models. Susceptibility to cardiac ventricular arrhythmias was significantly reduced in propionate-treated angiotensin II–infused wild-type NMRI mice. Aortic atherosclerotic lesion area was significantly decreased in propionate-treated apolipoprotein E knockout–deficient mice. Systemic inflammation was mitigated by propionate treatment, quantified as a reduction in splenic effector memory T cell frequencies and splenic T helper 17 cells in both models, and a decrease in local cardiac immune cell infiltration in wild-type NMRI mice. Cardioprotective effects of propionate were abrogated in regulatory T cell–depleted angiotensin II–infused mice, suggesting the effect is regulatory T cell–dependent. Conclusions: Our data emphasize an immune-modulatory role of SCFAs and their importance for cardiovascular health. The data suggest that lifestyle modifications leading to augmented SCFA production could be a beneficial nonpharmacological preventive strategy for patients with hypertensive cardiovascular disease.
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Affiliation(s)
- Hendrik Bartolomaeus
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.)
| | - András Balogh
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.)
| | - Mina Yakoub
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Germany (M.Y., S. Höges, L.H., L.C.R., J.S.)
| | - Susanne Homann
- Institute of Pharmacology and Clinical Pharmacology, University Hospital, Universitätsrat, Düsseldorf, Germany (S. Homann, M.G.)
| | - Lajos Markó
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.)
| | - Sascha Höges
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Germany (M.Y., S. Höges, L.H., L.C.R., J.S.)
| | - Dmitry Tsvetkov
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics and Interfaculty Center of Pharmacogenomics and Drug Research, Tübingen, Germany (D.T.)
| | - Alexander Krannich
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.)
| | - Sebastian Wundersitz
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.)
| | - Ellen G Avery
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.)
| | - Nadine Haase
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.)
| | - Kristin Kräker
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.)
| | - Lydia Hering
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Germany (M.Y., S. Höges, L.H., L.C.R., J.S.)
| | - Martina Maase
- Institute of Physiology II, University of Münster, Germany (M.M., K.K.-V.)
| | | | - Maria Grandoch
- Institute of Pharmacology and Clinical Pharmacology, University Hospital, Universitätsrat, Düsseldorf, Germany (S. Homann, M.G.)
| | - Jens Fielitz
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Greifswald (J.F.)
| | - Stefan Kempa
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,Integrative Proteomics and Metabolomics Platform, Berlin Institute for Medical Systems Biology, Germany (S. Kempa)
| | - Maik Gollasch
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin, Germany (M.G., K.-U.E., N.W.)
| | - Zhaxybay Zhumadilov
- National Laboratory Astana Nazarbayev University, Kazakhstan (Z.Z., S. Kozhakhmetov, A. Kushugalova)
| | - Samat Kozhakhmetov
- National Laboratory Astana Nazarbayev University, Kazakhstan (Z.Z., S. Kozhakhmetov, A. Kushugalova)
| | - Almagul Kushugulova
- National Laboratory Astana Nazarbayev University, Kazakhstan (Z.Z., S. Kozhakhmetov, A. Kushugalova)
| | - Kai-Uwe Eckardt
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin, Germany (M.G., K.-U.E., N.W.)
| | - Ralf Dechend
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.).,Department of Cardiology and Nephrology, HELIOS-Klinikum, Berlin, Germany (R.D.)
| | - Lars Christian Rump
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Germany (M.Y., S. Höges, L.H., L.C.R., J.S.)
| | - Sofia K Forslund
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.).,European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Germany (S.K.F.)
| | - Dominik N Müller
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.)
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Germany (M.Y., S. Höges, L.H., L.C.R., J.S.)
| | - Nicola Wilck
- Experimental and Clinical Research Center, a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., N.H., K.K., J.F., M.G., R.D., S.K.F., D.N.M., N.W.).,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany (H.B., A.B., L.M., D.T., S.W., E.G.A., J.B., R.D., S.K.F., D.N.M., N.W.).,Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (H.B., A.B., L.M., A. Krannich, E.G.A., N.H., K.K., S. Kempa, R.D., S.K.F., D.N.M., N.W.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (H.B., A.B., L.M., S.W., E.G.A., N.H., K.K., J.F., R.D., D.N.M., N.W.).,Berlin Institute of Health, Germany (H.B., A.B., L.M., E.G.A., N.H., K.K., R.D., S.K.F., D.N.M., N.W.).,Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin Charité - Universitätsmedizin Berlin, Germany (M.G., K.-U.E., N.W.)
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Hunsicker O, Gericke S, Graw JA, Krannich A, Boemke W, Meyer O, Braicu I, Spies C, Sehouli J, Pruß A, Feldheiser A. Transfusion of red blood cells does not impact progression-free and overall survival after surgery for ovarian cancer. Transfusion 2019; 59:3589-3600. [PMID: 31633819 DOI: 10.1111/trf.15552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Allogeneic red blood cells (RBCs) have the potential to impact the immunosurveillance of the recipient and may therefore increase the risk of recurrence after cancer surgery. In this article the relationship between perioperative RBC transfusion and the risk of recurrence after ovarian cancer surgery is examined. STUDY DESIGN AND METHODS This is a retrospective cohort analysis of a prospective database of patients who underwent surgery due to primary ovarian cancer between 2006 and 2014 and who had no residual disease after surgery. Patients who did and did not receive perioperative RBC transfusion were compared. The primary endpoint was progression-free survival (PFS). Propensity score matching (PSM) and Cox proportional hazards regression (CPH) was used to control for between-group differences of prognostic determinants. RESULTS A total of 529 patients with a median follow-up of 51.4 months (95% CI, 46.1-56.5) were eligible for analysis. Of those, 408 patients (77.1%) received allogeneic, leukoreduced RBCs with a median of 4 units (IQR, 2-6) per patient. There was a strong selection bias of prognostic determinants between patients with and without transfusion. In unadjusted analysis, transfusion of RBCs was associated with an increased risk of cancer recurrence (hazard ratio [HR] of PFS 2.71 [95% CI, 1.94-3.77], p < 0.001). After bias reduction, transfusion of RBCs was no longer associated with an increased risk of cancer recurrence, neither in PSM-adjusted (HR 1.03 [95% CI, 0.59-1.80], p = 0.91), nor in multivariable CPH-adjusted analysis (HR 1.26 [95% CI, 0.85-1.86], p = 0.23). CONCLUSION Perioperative transfusion of RBCs did not increase the risk of recurrence after ovarian cancer surgery.
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Affiliation(s)
- Oliver Hunsicker
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sara Gericke
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan Adriaan Graw
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Krannich
- Clinical Trial Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Willehad Boemke
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Meyer
- Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ioana Braicu
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, European Competence Center for Ovarian Cancer, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Axel Pruß
- Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aarne Feldheiser
- Department of Anesthesiology and Operative Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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20
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Nee J, Jörres A, Krannich A, Leithner C, Schroeder T, Munk AL, Enghard P, Moore C, Steppan S, Storm C. Elimination of glutamate using CRRT for 72 h in patients with post-cardiac arrest syndrome: A randomized clinical pilot trial. Resuscitation 2019; 144:54-59. [PMID: 31557520 DOI: 10.1016/j.resuscitation.2019.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Abstract
AIM Glutamine and glutamate are major mediators of secondary brain cell death during post-cardiac arrest syndrome. As there is an equilibrium between brain tissue and plasma concentrations of glutamine and glutamate, their elimination from systemic circulation by extracorporeal blood purification may ultimately lead to reduced secondary cell death in the brain. We hypothesized that systemic glutamine and glutamate can be significantly reduced by continuous venovenous hemodiafiltration (CVVHDF). METHODS This was a prospective, randomized clinical trial in post cardiac-arrest survivors evaluating standard of care or additional CVVHDF over 72 h immediately after admission. Glutamine and glutamate plasma concentrations were analyzed at eight time points in both groups. Primary endpoint was reduction of glutamine and glutamate plasma concentrations. The trial has been registered at clinical trial.gov (NCT02963298). RESULTS In total, 41 patients were randomized over a period of 12 months (control n = 21, CVVHDF n = 20). The primary aim reduction of glutamine and glutamate plasma concentrations by CVVHDF, was not achieved; both groups-maintained concentrations within a normal range over the study period (glutamate: 4.7-11.1 mg/dL; glutamine: 0.2-3.7 mg/dL). However, post-filter concentrations of glutamine and glutamate in CRRT patients were significantly decreased as compared to pre-filter concentrations (glutamate: pre-filter median 8.85 mg/dL IQR 7.1-9.6; post-filter 0.95 mg/dL IQR 0.5-2; p < 0.001; glutamine: pre-filter 0.7 mg/dL IQR 0.6-1; post-filter 0.2 mg/dL IQR 0-0.2; p < 0.001). CONCLUSION In this trial, CVVHDF was not able to statistically significantly lower systemic plasma glutamine and glutamate levels. Post-cardiac arrest patients had plasma glutamine and glutamate levels within the normal range.
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Affiliation(s)
- Jens Nee
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Achim Jörres
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Medicine I - Nephrology, Transplantation & Medical Intensive Care, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany
| | - Alexander Krannich
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christoph Leithner
- Department of Neurology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tim Schroeder
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anna Lena Munk
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Philip Enghard
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christoph Moore
- EMEA Medical Office, Fresenius Medical Care Deutschland GmbH, Else-Kröner-Str. 1, 61352 Bad Homburg v.d.H., Germany
| | - Sonja Steppan
- EMEA Medical Office, Fresenius Medical Care Deutschland GmbH, Else-Kröner-Str. 1, 61352 Bad Homburg v.d.H., Germany
| | - Christian Storm
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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21
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Behrens A, Kreuzmayr A, Manner H, Koop H, Lorenz A, Schaefer C, Plauth M, Jetschmann JU, von Tirpitz C, Ewald M, Sackmann M, Renner W, Krüger M, Schwab D, Hoffmann W, Engelke O, Pech O, Kullmann F, Pampuch S, Lenfers B, Weickert U, Schilling D, Boehm S, Beckebaum S, Cicinnati V, Erckenbrecht JF, Dumoulin FL, Benz C, Rabenstein T, Haltern G, Balsliemke M, de Mas C, Kleber G, Pehl C, Vogt C, Kiesslich R, Fischbach W, Koop I, Kuehne J, Breidert M, Sass NL, May A, Friedrich C, Veitt R, Porschen R, Ellrichmann M, Arlt A, Schmitt W, Dollhopf M, Schmidbaur W, Dignass A, Schmitz V, Labenz J, Kaiser G, Krannich A, Barteska N, Ell C. Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): results from the prospective multicentre electronic registry of sedation-associated complications. Gut 2019; 68:445-452. [PMID: 29298872 DOI: 10.1136/gutjnl-2015-311037] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Sedation has been established for GI endoscopic procedures in most countries, but it is also associated with an added risk of complications. Reported complication rates are variable due to different study methodologies and often limited sample size. DESIGNS Acute sedation-associated complications were prospectively recorded in an electronic endoscopy documentation in 39 study centres between December 2011 and August 2014 (median inclusion period 24 months). The sedation regimen was decided by each study centre. RESULTS A total of 368 206 endoscopies was recorded; 11% without sedation. Propofol was the dominant drug used (62% only, 22.5% in combination with midazolam). Of the sedated patients, 38 (0.01%) suffered a major complication, and overall mortality was 0.005% (n=15); minor complications occurred in 0.3%. Multivariate analysis showed the following independent risk factors for all complications: American Society of Anesthesiologists class >2 (OR 2.29) and type and duration of endoscopy. Of the sedation regimens, propofol monosedation had the lowest rate (OR 0.75) compared with midazolam (reference) and combinations (OR 1.0-1.5). Compared with primary care hospitals, tertiary referral centres had higher complication rates (OR 1.61). Notably, compared with sedation by a two-person endoscopy team (endoscopist/assistant; 53.5% of all procedures), adding another person for sedation (nurse, physician) was associated with higher complication rates (ORs 1.40-4.46), probably due to higher complexity of procedures not evident in the multivariate analysis. CONCLUSIONS This large multicentre registry study confirmed that severe acute sedation-related complications are rare during GI endoscopy with a very low mortality. The data are useful for planning risk factor-adapted sedation management to further prevent sedation-associated complications in selected patients. TRIAL REGISTRATION NUMBER DRKS00007768; Pre-results.
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Affiliation(s)
- Angelika Behrens
- Department of Internal Medicine and Gastroenterology, Evangelische Elisabeth Klinik, Teaching Hospital, Charité University Medicine, Berlin, Germany
| | - Anton Kreuzmayr
- Klinik für Innere Medizin und Gastroenterologie, Klinikum Traunstein, Essen, Germany
| | - Hendrik Manner
- Klinik für Innere Medizin und Gastroenterologie, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Herbert Koop
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Albrecht Lorenz
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Claus Schaefer
- Medizinische Klinik II, Klinikum Neumarkt, Neumarkt, Germany
| | - Mathais Plauth
- Klinik für Innere Medizin, Gastroenterologie, Klinikum Dessau, Dessau, Germany
| | - Jens-Uwe Jetschmann
- Klinik für Innere Medizin, Gastroenterologie, Klinikum Dessau, Dessau, Germany
| | | | - Marcus Ewald
- Medizinische Klinik - Schwerpunkt Gastroenterologie, Onkologie, Klinikum Kulmbach, Kulmbach, Germany
| | | | - Wanja Renner
- Medizinische Klinik II, Klinikum Bamberg, Bamberg, Germany
| | - Martin Krüger
- Klinik für Innere Medizin und Gastroenterologie, Ev. Krankehaus Bielefeld, Bielefeld, Germany
| | - Dieter Schwab
- Medizinische Klinik II, Krankenhaus Martha-Maria Nürnberg, Nuremberg, Germany
| | | | - Olaf Engelke
- Medizinische Klinik II, St. Anna Hospital, Herne, Germany
| | - Oliver Pech
- Klinik für Innere Medizin und interventionelle Gastroenterologie, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | | | - Sonja Pampuch
- Medizinische Klinik I, Klinikum Weiden, Weiden, Germany
| | - Berthold Lenfers
- Klinik für Gastroeterologie, St. Marien Hospital Klinikum Lünen, Luenen, Germany
| | - Uwe Weickert
- Medizinische Klinik II, SLK Kliniken Heilbronn, Heilbronn, Germany
| | - Dieter Schilling
- Medizinische Klinik II, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Stephan Boehm
- Medizinische Klinik für Innere Medizin, Gastroenterologie und Hepatologie, Katholische Kliniken Ruhrhalbinsel, Essen, Germany
| | - Susanne Beckebaum
- Medizinische Klinik für Innere Medizin, Gastroenterologie und Hepatologie, Katholische Kliniken Ruhrhalbinsel, Essen, Germany
| | - Vito Cicinnati
- Medizinische Klinik für Innere Medizin, Gastroenterologie und Hepatologie, Katholische Kliniken Ruhrhalbinsel, Essen, Germany
| | - Joachim F Erckenbrecht
- Klinik für Innere Medizin mit Gastroenterologie und Onkologie, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Franz Ludwig Dumoulin
- Allgemeine Innere Medizin, Gastroenterologie und Diabetologie, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
| | - Claus Benz
- Innere Medizin, Evangelisches Krankenhaus Köln-Weyertal, Cologne, Germany
| | - Thomas Rabenstein
- Klinik für Innere Medizin, Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany
| | - Georg Haltern
- Gastroenterologie, Kreiskrankenhaus Dormagen, Dormagen, Germany
| | | | - Christian de Mas
- Klinik für Innere Medizin - Gastroenterologie, Marienhaus St.Elisabeth Neuwied, Neuwied, Germany
| | | | - Christian Pehl
- Innere Medizin, Krankenhaus Vilsbiburg, Vilsbiburg, Germany
| | - Christoph Vogt
- Innere Medizin, St. Josef Krankenhaus Moers, Moers, Germany
| | - Ralf Kiesslich
- Innere Medizin, St. Marienkrankenhaus, Frankfurt, Germany
| | | | - Irmtraut Koop
- Allgemeine Innere Medizin und Gastroenterologie, Ev. Amalie Sieveking-Krankenhaus, Hamburg, Germany
| | - Jens Kuehne
- Klinik für Innere Medizin, Pius-Hospital, Oldenburg, Germany
| | - Matthias Breidert
- Gastroenterologie und Infektiologie, Klinik Koesching, Koesching, Germany
| | | | - Andrea May
- Medizinische Klinik II, Sana Klinikum Offenbach, Offenbach, Germany
| | | | - Ronni Veitt
- Klinik für Innere Medizin I - Gastroenterologie, internistische Onkologie, Elisabeth Klinikum Schmalkalden, Schmalkalden, Germany
| | - Rainer Porschen
- Klinik für Innere Medizin, Klinikum Bremen-Ost, Bremen, Germany
| | - Mark Ellrichmann
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Alexander Arlt
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Wolfgang Schmitt
- Klinik für Gastroenterologie und Hepatologie, Klinikum Neuperlach, Munich, Germany
| | - Markus Dollhopf
- Klinik für Gastroenterologie und Hepatologie, Klinikum Neuperlach, Munich, Germany
| | - Werner Schmidbaur
- Klinik für Gastroenterologie und Hepatologie, Stiftungsklinik Weissenhorn, Weissenhorn, Germany
| | - Axel Dignass
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - Volker Schmitz
- Innere Medizin, Krankenhaus St. Marienwörth, Bad Kreuznach, Germany
| | - J Labenz
- Innere Medizin, Ev.-Jung-Stilling-KKH, Siegen, Germany
| | - Gernot Kaiser
- FB Wirtschafts- und Sozialwissenschaften, Hochschule Nordhausen, Nordhausen, Germany
| | - Alexander Krannich
- Koordinierungszentrum Klinische Studien, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nico Barteska
- Klinik für Gastroenterologie, Vivantes Klinikum im Friedrichshain, Teaching hospital, Charité University Medicine, Berlin, Germany
| | - Christian Ell
- Medizinische Klinik II, Sana Klinikum Offenbach, Offenbach, Germany
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Storm C, Krannich A, Schachtner T, Engels M, Schindler R, Kahl A, Otto N. Impact of acute kidney injury on neurological outcome and long-term survival after cardiac arrest – A 10 year observational follow up. J Crit Care 2018; 47:254-259. [DOI: 10.1016/j.jcrc.2018.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023]
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Hunsicker O, Hessler K, Krannich A, Boemke W, Braicu I, Sehouli J, Meyer O, Pruß A, Spies C, Feldheiser A. Duration of storage influences the hemoglobin rising effect of red blood cells in patients undergoing major abdominal surgery. Transfusion 2018; 58:1870-1880. [DOI: 10.1111/trf.14627] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Oliver Hunsicker
- Department of Anesthesiology and Operative Intensive Care Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Katarina Hessler
- Department of Anesthesiology and Operative Intensive Care Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Alexander Krannich
- Experimental and Clinical Research Center; Charité-Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
- Max Delbrueck Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
| | - Willehad Boemke
- Department of Anesthesiology and Operative Intensive Care Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Ioana Braicu
- Department of Gynecology; European Competence Center for Ovarian Cancer, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum; Berlin Germany
| | - Jalid Sehouli
- Department of Gynecology; European Competence Center for Ovarian Cancer, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum; Berlin Germany
| | - Oliver Meyer
- Institute of Transfusion Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Axel Pruß
- Institute of Transfusion Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Aarne Feldheiser
- Department of Anesthesiology and Operative Intensive Care Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
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Friedrich CC, Lin Y, Krannich A, Wu Y, Vacanti JP, Neville CM. Cover Image, Volume 51, Issue 1. Cell Prolif 2018. [DOI: 10.1111/cpr.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Wilck N, Matus MG, Kearney SM, Olesen SW, Forslund K, Bartolomaeus H, Haase S, Mähler A, Balogh A, Markó L, Vvedenskaya O, Kleiner FH, Tsvetkov D, Klug L, Costea PI, Sunagawa S, Maier L, Rakova N, Schatz V, Neubert P, Frätzer C, Krannich A, Gollasch M, Grohme DA, Côrte-Real BF, Gerlach RG, Basic M, Typas A, Wu C, Titze JM, Jantsch J, Boschmann M, Dechend R, Kleinewietfeld M, Kempa S, Bork P, Linker RA, Alm EJ, Müller DN. Salt-responsive gut commensal modulates T H17 axis and disease. Nature 2017; 551:585-589. [PMID: 29143823 PMCID: PMC6070150 DOI: 10.1038/nature24628] [Citation(s) in RCA: 751] [Impact Index Per Article: 107.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/10/2017] [Indexed: 12/12/2022]
Abstract
A Western lifestyle with high salt consumption can lead to hypertension and cardiovascular disease. High salt may additionally drive autoimmunity by inducing T helper 17 (TH17) cells, which can also contribute to hypertension. Induction of TH17 cells depends on gut microbiota; however, the effect of salt on the gut microbiome is unknown. Here we show that high salt intake affects the gut microbiome in mice, particularly by depleting Lactobacillus murinus. Consequently, treatment of mice with L. murinus prevented salt-induced aggravation of actively induced experimental autoimmune encephalomyelitis and salt-sensitive hypertension by modulating TH17 cells. In line with these findings, a moderate high-salt challenge in a pilot study in humans reduced intestinal survival of Lactobacillus spp., increased TH17 cells and increased blood pressure. Our results connect high salt intake to the gut-immune axis and highlight the gut microbiome as a potential therapeutic target to counteract salt-sensitive conditions.
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Affiliation(s)
- Nicola Wilck
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Mariana G Matus
- Center for Microbiome Informatics and Therapeutics, and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Sean M Kearney
- Center for Microbiome Informatics and Therapeutics, and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Scott W Olesen
- Center for Microbiome Informatics and Therapeutics, and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Kristoffer Forslund
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, 69117 Heidelberg, Germany
| | - Hendrik Bartolomaeus
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Stefanie Haase
- Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Anja Mähler
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - András Balogh
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Lajos Markó
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Olga Vvedenskaya
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- Integrative Proteomics and Metabolomics Platform, Berlin Institute for Medical Systems Biology BIMSB, 13125 Berlin, Germany
- Berlin School of Integrative Oncology, Charité University Medicine Berlin, Berlin, Germany
| | - Friedrich H Kleiner
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
| | - Dmitry Tsvetkov
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Lars Klug
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Paul I Costea
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, 69117 Heidelberg, Germany
| | - Shinichi Sunagawa
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, 69117 Heidelberg, Germany
- Institute of Microbiology, ETH Zurich, 8092 Zurich, Switzerland
| | - Lisa Maier
- European Molecular Biology Laboratory, Genome Biology Unit, 69117 Heidelberg, Germany
| | - Natalia Rakova
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Valentin Schatz
- Institute of Clinical Microbiology and Hygiene, University Hospital of Regensburg, University of Regensburg, 93053 Regensburg, Germany
| | - Patrick Neubert
- Institute of Clinical Microbiology and Hygiene, University Hospital of Regensburg, University of Regensburg, 93053 Regensburg, Germany
| | | | | | - Maik Gollasch
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Diana A Grohme
- Translational Immunology, Department of Clinical Pathobiochemistry, Medical Faculty Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Beatriz F Côrte-Real
- VIB Laboratory of Translational Immunomodulation, VIB Center for Inflammation Research (IRC), Hasselt University, Campus Diepenbeek, 3590 Diepenbeek, Belgium
| | - Roman G Gerlach
- Project Group 5, Robert Koch Institute, 38855 Wernigerode, Germany
| | - Marijana Basic
- Hannover Medical School, Institute for Laboratory Animal Science and Central Animal Facility, 30625 Hannover, Germany
| | - Athanasios Typas
- European Molecular Biology Laboratory, Genome Biology Unit, 69117 Heidelberg, Germany
| | - Chuan Wu
- Experimental Immunology Branch, National Cancer Institute, US National Institutes of Health, Bethesda, Maryland, USA
| | - Jens M Titze
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, University Hospital of Regensburg, University of Regensburg, 93053 Regensburg, Germany
| | - Michael Boschmann
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Ralf Dechend
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus Kleinewietfeld
- Translational Immunology, Department of Clinical Pathobiochemistry, Medical Faculty Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
- VIB Laboratory of Translational Immunomodulation, VIB Center for Inflammation Research (IRC), Hasselt University, Campus Diepenbeek, 3590 Diepenbeek, Belgium
- Center for Regenerative Therapies Dresden (CRTD), 01307 Dresden, Germany
| | - Stefan Kempa
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Integrative Proteomics and Metabolomics Platform, Berlin Institute for Medical Systems Biology BIMSB, 13125 Berlin, Germany
| | - Peer Bork
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, 69117 Heidelberg, Germany
- Molecular Medicine Partnership Unit, University of Heidelberg and European Molecular Biology Laboratory, 69120 Heidelberg, Germany
- Department of Bioinformatics, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Ralf A Linker
- Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Eric J Alm
- Center for Microbiome Informatics and Therapeutics, and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Dominik N Müller
- Experimental and Clinical Research Center, a joint cooperation of Max-Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Friedrich CC, Lin Y, Krannich A, Wu Y, Vacanti JP, Neville CM. Enhancing engineered vascular networks in vitro and in vivo: The effects of IGF1 on vascular development and durability. Cell Prolif 2017; 51. [PMID: 29110360 DOI: 10.1111/cpr.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/21/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Creation of functional, durable vasculature remains an important goal within the field of regenerative medicine. Engineered biological vasculature has the potential to restore or improve human tissue function. We hypothesized that the pleotropic effects of insulin-like growth factor 1 (IGF1) would enhance the engineering of capillary-like vasculature. MATERIALS AND METHODS The impact of IGF1 upon vasculogenesis was examined in in vitro cultures for a period of up to 40 days and as subcutaneous implants within immunodeficient mice. Co-cultures of human umbilical vein endothelial cells and human bone marrow-derived mesenchymal stem cells in collagen-fibronectin hydrogels were supplemented with either recombinant IGF1 protein or genetically engineered cells to provide sustained IGF1. Morphometric analysis was performed on the vascular networks that formed in four concentrations of IGF1. RESULTS IGF1 supplementation significantly enhanced de novo vasculogenesis both in vitro and in vivo. Effects were long-term as they lasted the duration of the study period, and included network density, vessel length, and diameter. Bifurcation density was not affected. However, the highest concentrations of IGF1 tested were either ineffective or even deleterious. Sustained IGF1 delivery was required in vivo as the inclusion of recombinant IGF1 protein had minimal impact. CONCLUSION IGF1 supplementation can be used to produce neovasculature with significantly enhanced network density and durability. Its use is a promising methodology for engineering de novo vasculature to support regeneration of functional tissue.
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Affiliation(s)
- Claudia C Friedrich
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Anesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Yunfeng Lin
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University, Chengdu, China
| | - Alexander Krannich
- Department of Biostatistics, Clinical Research Unit, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Yinan Wu
- Department of Biostatistics, Clinical Research Unit, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joseph P Vacanti
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Craig M Neville
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Beyhoff N, Brix S, Betz IR, Klopfleisch R, Foryst-Ludwig A, Krannich A, Stawowy P, Knebel F, Grune J, Kintscher U. Application of Speckle-Tracking Echocardiography in an Experimental Model of Isolated Subendocardial Damage. J Am Soc Echocardiogr 2017; 30:1239-1250.e2. [PMID: 29066223 DOI: 10.1016/j.echo.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The subendocardium is highly vulnerable to damage and is thus affected even in subclinical disease stages. Therefore, methods reflecting subendocardial status are of great clinical relevance for the early detection of cardiac damage and the prevention of functional impairment. The aim of this study was to investigate the potential ability of myocardial strain parameters to evaluate changes within the subendocardium. METHODS Male 129/Sv mice were injected with isoproterenol (ISO; n = 32) to induce isolated subendocardial fibrotic lesions or saline as appropriate control (n = 15). Transthoracic echocardiography was performed using a 30-MHz linear-frequency transducer coupled to a high-resolution imaging system, and acquired images were analyzed for conventional and strain parameters. The degree of collagen content within the different cardiac layers was quantified by histologic analysis and serum levels of tissue inhibitor of metalloproteinase-1, a biomarker for fibrosis, were assessed. RESULTS ISO treatment induced a marked increase in subendocardial collagen content in response to cell loss (control vs ISO, 0.6 ± 0.3% vs 5.8 ± 0.9%; P < .001) and resulted in a moderate increase in left ventricular wall thickness with preserved systolic function. Global longitudinal peak strain (LS) and longitudinal strain rate were significantly decreased in ISO-treated animals (LS, -15.49% vs -11.49% [P = .001]; longitudinal strain rate, -4.81 vs -3.88 sec-1 [P < .05]), whereas radial and circumferential strain values remained unchanged. Global LS was associated with subendocardial collagen content (r = 0.46, P = .01) and tissue inhibitor of metalloproteinase-1 serum level (r = 0.52, P < .05). Further statistical analyses identified global LS as a superior predictor for the presence of subendocardial fibrosis (sensitivity, 84%; specificity, 80%; cutoff value, -14.4%). CONCLUSION Assessment of LS may provide a noninvasive method for the detection of subendocardial damage and may consequently improve early diagnosis of cardiac diseases.
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Affiliation(s)
- Niklas Beyhoff
- Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Sarah Brix
- Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Iris R Betz
- Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Robert Klopfleisch
- Department of Veterinary Pathology, College of Veterinary Medicine, Freie Universitaet Berlin, Berlin, Germany
| | - Anna Foryst-Ludwig
- Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Alexander Krannich
- Berlin Institute of Health, Clinical Research Unit - Biostatistics Unit, Berlin, Germany
| | - Philipp Stawowy
- Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Campus Mitte, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Jana Grune
- Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany
| | - Ulrich Kintscher
- Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Centre for Cardiovascular Research), Partner site Berlin, Berlin, Germany.
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28
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Beyhoff N, Grune J, Brix S, Klopfleisch R, Foryst-Ludwig A, Krannich A, Stawowy P, Knebel F, Kintscher U. P6129Changes in Global Longitudinal Strain during early cardiac disease development - insights from the lab. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brandl A, Weiss S, von Winterfeld M, Krannich A, Feist M, Pratschke J, Raue W, Rau B. Predictive value of peritoneal cancer index for survival in patients with mucinous peritoneal malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience. Int J Hyperthermia 2017; 34:512-517. [PMID: 28679331 DOI: 10.1080/02656736.2017.1351627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study investigated the correlation between the peritoneal carcinomatosis index (PCI) and patient outcome depending on the tumour type. BACKGROUND Peritoneal surface malignancy (PSM) treatment depends on tumour type. Mucinous PSM (m-PSM) is associated with a better prognosis than non-mucinous PSM (nm-PSM). The PCI's predictive ability has not yet been evaluated. METHODS We analysed 123 patients with PSM treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) between 2008 and 2015. The m-PSM group (n = 75) included patients with appendiceal cancer (n = 15), colorectal cancer (n = 21), or low-grade appendiceal mucinous neoplasm (n = 39); the nm-PSM group (n = 48) included patients with gastric (n = 18) or colorectal (n = 30) cancer. The PCI's predictive ability was evaluated by multiple Cox-proportional hazard regression analysis and Kaplan-Meier curves. RESULTS The 5-year survival and PCI were higher in m-PSM patients (67.0%; 20.5 ± 12.1) than in nm-PSM patients (32.6%; p = 0.013; 8.9 ± 6.0; p < 0.001). Colorectal nm-PSM patients with PCI ≥16 had a worse 2-year survival (25.0%) vs. patients with PCI <16 (79.1%; log rank = 0.009), but no significant effect was observed in patients with m-PSM (66.7% vs. 68.1%; p = 0.935). Underlying disease (HR 5.666-16.240), BMI (HR 1.109), and PCI (HR 1.068) significantly influenced overall survival in all patients. CONCLUSIONS PCI is prognostic in nm-PSM, but not in m-PSM. CRS and HIPEC may benefit not only patients with low PCI, but also those with high PCI and m-PSM.
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Affiliation(s)
- Andreas Brandl
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Sascha Weiss
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Moritz von Winterfeld
- b Institute of Pathology, Campus Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Alexander Krannich
- c Biostatistics Unit , Berlin Institute of Health and Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Mathilde Feist
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Johann Pratschke
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Wieland Raue
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
| | - Beate Rau
- a Department of General, Visceral, and Transplantation Surgery and Department of General, Visceral, Vascular, and Thoracic Surgery, Campus Virchow and Mitte, Charité , Universitätsmedizin Berlin , Berlin , Germany
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Albers AE, Grabow R, Qian X, Jumah MD, Hofmann VM, Krannich A, Pecher G. Efficacy and toxicity of docetaxel combination chemotherapy for advanced squamous cell cancer of the head and neck. Mol Clin Oncol 2017; 7:151-157. [PMID: 28685095 DOI: 10.3892/mco.2017.1281] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/31/2017] [Indexed: 01/08/2023] Open
Abstract
The aim of the present study was to evaluate the clinical effectiveness and toxicity of docetaxel with 5-fluorouracil and cisplatin as combination treatment in patients with curable or metastatic/recurrent head and neck cancer by a retrospective cohort study of patients treated at a single institution between 2007 and 2012. Patients with locally advanced, metastatic and/or recurrent squamous cell carcinoma of the head and neck (SCCHN), who were treated with a combination therapy including docetaxel, were considered as eligible. Survival data, clinical side effects, quality of life (QoL) and toxicity profile were retrieved from patient charts, analyzed and scored according to the National Cancer Institute Common Toxicity Criteria, version 4, and the Response Evaluation Criteria In Solid Tumors, version 1.1. An overall response rate of 86% and a 3-year survival of 65.1% were observed. The median progression-free survival was 32 months. The cumulative incidence after 3 years was 16.9% for local recurrence and 10.4% for distant metastasis. Leukopenia (58%) and anemia (51%) were the most common hematological toxicities, followed by hepatotoxicity (53%) and nausea (27%). A total of 31% of the patients experienced a compromise in their QoL following therapy completion. In conclusion, docetaxel in combination with cisplatin and 5-fluorouracil was found to effectively prolong survival in patients with locally advanced and/or recurrent metastatic SCCHN. The overall survival, progression-free survival and response rates were in accordance with those reported by previous clinical trials. Therefore, this therapy protocol is recommended for patients with SCCHN in the curative as well as the palliative settings.
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Affiliation(s)
- Andreas E Albers
- Department of Otorhinolaryngology-Head and Neck Surgery, Charité-Universitätsmedizin Berlin, CBF, D-12203 Berlin, Germany
| | - Regina Grabow
- Medical Clinic of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, CCM, D-10117 Berlin, Germany
| | - Xu Qian
- Department of Otorhinolaryngology-Head and Neck Surgery, Charité-Universitätsmedizin Berlin, CBF, D-12203 Berlin, Germany
| | - Masen D Jumah
- Clinic of Otorhinolaryngology-Head and Neck Surgery, Villingen-Schwenningen Hospital, D-78052 Villingen Schwenningen, Germany
| | - Veit M Hofmann
- Department of Otorhinolaryngology-Head and Neck Surgery, Charité-Universitätsmedizin Berlin, CBF, D-12203 Berlin, Germany
| | - Alexander Krannich
- Coordination Center for Clinical Trials, Charité-Universitätsmedizin Berlin, CVK, D-13353 Berlin, Germany
| | - Gabriele Pecher
- Medical Clinic of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, CCM, D-10117 Berlin, Germany
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Storm C, Nee J, Sunde K, Holzer M, Hubner P, Taccone FS, Friberg H, Lopez-de-Sa E, Cariou A, Schefold JC, Ristagno G, Noc M, Donker DW, Andres J, Krawczyk P, Skrifvars MB, Penketh J, Krannich A, Fries M. A survey on general and temperature management of post cardiac arrest patients in large teaching and university hospitals in 14 European countries-The SPAME trial results. Resuscitation 2017; 116:84-90. [PMID: 28377294 DOI: 10.1016/j.resuscitation.2017.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/22/2017] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION International guidelines recommend a bundle of care, including targeted temperature management (TTM), in post cardiac arrest survivors. Aside from a few small surveys in different European countries, adherence to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recommendations are unknown. METHODS This international European telephone survey was conducted to provide an overview of current clinical practice of post cardiac arrest management with a main focus on TTM. We targeted large teaching and university hospitals within Europe as leading facilities and key opinion leaders in the field of post cardiac arrest care. Selected national principal investigators conducted the survey, which was based on a predefined questionnaire, between December 2014 and March 2015, before the publication of the ERC Guidelines 2015. RESULTS The return rate was 94% from 268 participating intensive care units (ICU). The majority had a predefined standard operating procedure (SOP) protocol for post cardiac arrest patients. Altogether, 68% of the ICUs provided TTM at a target temperature of 32-34°C for 24h, and 33% had changed the target temperature to 36°C. The minority provided a written SOP for neurological prognostication, which was generally initiated 72h after return of spontaneous circulation (ROSC). Electroencephalography and somatosensory evoked potentials were used by most ICUs for early prognostication. Treating more than fifty patients a year was significantly associated with providing written SOPs for TTM and prognostication (p<0.01), as well as the use of a computer feedback device (p=0.03) for TTM. CONCLUSION This international European telephone survey revealed a high rate of implementation of TTM in post cardiac arrest patients in university and teaching hospitals. Most participants also provided a SOP, but only a minority had a SOP for neurological prognostication.
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Affiliation(s)
| | - J Nee
- Charité-Universitätsmedizin Berlin, Germany.
| | - Kjetil Sunde
- Dept. of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| | - Fabio Silvio Taccone
- Dept. of Intensive Care, Erasme Hospital-Université Libre de Bruxelles (ULB) Brussels, Belgium.
| | - Hans Friberg
- Dept. of Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
| | | | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital (Assistance Publique Hôpitaux de Paris)-INSERM U970 (Team 4) and Paris Descartes University, France.
| | - Joerg C Schefold
- Dept. of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Giuseppe Ristagno
- Dept. of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan Italy and Italian Resuscitation Council, Bologna, Italy.
| | - Marko Noc
- Centre of Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia.
| | - Dirk W Donker
- Dept. of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Janusz Andres
- Dept. of Anaesthesiology and Intensive Care, Jagiellonian University Medical College Cracow, Poland.
| | - Pawel Krawczyk
- Dept. of Anaesthesiology and Intensive Care, Jagiellonian University Medical College Cracow, Poland.
| | - Markus B Skrifvars
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University and Helsinki University Hospital, Finland.
| | - James Penketh
- Dept. of Anaesthesia and Intensive Care Medicine, Royal United Hospital Bath, UK.
| | | | - Michael Fries
- Dept. of Anaesthesiology and Intensive Care Medicine, St. Vincenz-Hospital, Limburg, Germany, Germany.
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Hunsicker O, Heinig S, Dathe JJ, Krannich A, Spies C, Feldheiser A. Comparison of bedside assessed arm and leg fluid filtration determined by venous congestion plethysmography in perioperative cancer patients: An observational study investigating agreement. Medicine (Baltimore) 2017; 96:e6066. [PMID: 28248863 PMCID: PMC5340436 DOI: 10.1097/md.0000000000006066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In recent years, pathophysiology and clinical impact of microvascular fluid filtration has regained interest. As the latest data in surgical patients have been published almost 20 years ago, there is need for further research to better understand fluid filtration during the perioperative period. Venous congestion plethysmography (VCP) provides a rapid and noninvasive method, which has been shown suitable for the assessment of fluid filtration in limbs. Fluid filtration assessed by VCP can be obtained from forearm and calf measurement sites, while in many clinical situations a reduced access to the patient often restricts the measurements to patient's forearm. We aimed to investigate if fluid filtration obtained from forearm and calf measurement site is interchangeable in nonsedated perioperative patients.Fluid filtration by VCP was obtained simultaneously from forearm and calf in patients with ovarian cancer at 4 time points during the perioperative course and assessed by the difference of volume changes of the limb between third and sixth minutes (VC6-3min) during venous congestion. VC6-3min obtained from forearm and calf measurement sites was compared with respect to agreement and evaluated regarding the association with the presence of leg edema.A total of 74 paired measurements were analyzed in 29 patients. Forearm VC6-3min was significantly higher than calf VC6-3min (median [25th; 75th quartile], 0.6 (0.4; 0.9) vs 0.4 [0.3; 0.6] %, P = 0.008). Bland-Altman and Polar analysis revealed a poor agreement between forearm and calf VC6-3min at predefined time points and changes of VC6-3min during the perioperative course (bias +0.23%, limits of agreement [LOA] -1.1% to 1.6%; angular bias -2.5°, radial LOA -82° to +77°). Forearm VC6-3min was significantly increased in patients with presence of leg edema (0.7 (0.5; 1.0) vs 0.5 (0.4; 0.6) %, P < 0.001) while calf VC6-3min did not differ in patients with and without edema.This study indicates that forearm and calf measurement sites are not interchangeable when bedside assessing fluid filtration by VCP in nonsedated perioperative patients. Considering that only forearm fluid filtration was related to the presence of edema, forearm measurement site should be chosen as a primary site for assessing fluid filtration.
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Affiliation(s)
- Oliver Hunsicker
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum
| | - Sandra Heinig
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum
| | - Jana-Jennifer Dathe
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum
| | - Alexander Krannich
- Department of Biostatistics, Coordination Center for Clinical Trials, Charité—University Medicine Berlin
- Berlin Institute of Health, Clinical Research Unit—Biostatistics Unit, Berlin, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum
| | - Aarne Feldheiser
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum
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Kork F, Balzer F, Krannich A, Bernardi MH, Eltzschig HK, Jankowski J, Spies C. Back-calculating baseline creatinine overestimates prevalence of acute kidney injury with poor sensitivity. Acta Physiol (Oxf) 2017; 219:613-624. [PMID: 27461744 DOI: 10.1111/apha.12763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/10/2016] [Accepted: 07/23/2016] [Indexed: 01/24/2023]
Abstract
AIM Acute kidney injury (AKI) is diagnosed by a 50% increase in creatinine. For patients without a baseline creatinine measurement, guidelines suggest estimating baseline creatinine by back-calculation. The aim of this study was to evaluate different glomerular filtration rate (GFR) equations and different GFR assumptions for back-calculating baseline creatinine as well as the effect on the diagnosis of AKI. METHODS The Modification of Diet in Renal Disease, the Chronic Kidney Disease Epidemiology (CKD-EPI) and the Mayo quadratic (MQ) equation were evaluated to estimate baseline creatinine, each under the assumption of either a fixed GFR of 75 mL min-1 1.73 m-2 or an age-adjusted GFR. Estimated baseline creatinine, diagnoses and severity stages of AKI based on estimated baseline creatinine were compared to measured baseline creatinine and corresponding diagnoses and severity stages of AKI. RESULTS The data of 34 690 surgical patients were analysed. Estimating baseline creatinine overestimated baseline creatinine. Diagnosing AKI based on estimated baseline creatinine had only substantial agreement with AKI diagnoses based on measured baseline creatinine [Cohen's κ ranging from 0.66 (95% CI 0.65-0.68) to 0.77 (95% CI 0.76-0.79)] and overestimated AKI prevalence with fair sensitivity [ranging from 74.3% (95% CI 72.3-76.2) to 90.1% (95% CI 88.6-92.1)]. Staging AKI severity based on estimated baseline creatinine had moderate agreement with AKI severity based on measured baseline creatinine [Cohen's κ ranging from 0.43 (95% CI 0.42-0.44) to 0.53 (95% CI 0.51-0.55)]. CONCLUSION Diagnosing AKI and staging AKI severity on the basis of estimated baseline creatinine in surgical patients is not feasible. Patients at risk for post-operative AKI should have a pre-operative creatinine measurement to adequately assess post-operative AKI.
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Affiliation(s)
- F. Kork
- Department of Anesthesiology and Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
- Institute for Molecular Cardiovascular Research; University Hospital RWTH Aachen; Aachen Germany
- Department of Anesthesiology; Uniklinik RWTH Aachen; Aachen Germany
| | - F. Balzer
- Department of Anesthesiology and Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Krannich
- Berlin Institute of Health; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. H. Bernardi
- Department of Anesthesiology and Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care; Medical University of Vienna; Vienna Austria
| | - H. K. Eltzschig
- Department of Anesthesiology; Organ Protection Program; University of Colorado School of Medicine; Aurora CO USA
| | - J. Jankowski
- Institute for Molecular Cardiovascular Research; University Hospital RWTH Aachen; Aachen Germany
- School for Cardiovascular Diseases (CARIM); University of Maastricht; Maastricht the Netherlands
| | - C. Spies
- Department of Anesthesiology and Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
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Schwarz C, Brandt C, Antweiler E, Krannich A, Staab D, Schmitt-Grohé S, Fischer R, Hartl D, Thronicke A, Tintelnot K. Prospective multicenter German study on pulmonary colonization with Scedosporium /Lomentospora species in cystic fibrosis: Epidemiology and new association factors. PLoS One 2017; 12:e0171485. [PMID: 28178337 PMCID: PMC5298894 DOI: 10.1371/journal.pone.0171485] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 01/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background An increasing rate of respiratory colonization and infection in cystic fibrosis (CF) is caused by fungi of the Scedosporium apiospermum species complex or Lomentospora prolificans (Sac-Lp). These fungi rank second among the filamentous fungi colonizing the CF airways, after Aspergillus fumigatus. However, the epidemiology, clinical relevance and risk of pulmonary colonization with Sac-Lp are rarely understood in CF. The objective of the present prospective multicenter study was to study pathogen distribution and determine association factors of pulmonary Sac-Lp colonization in patients with CF. Material and methods Clinical, microbiological and laboratory data of 161 patients aged 6–59 years with CF in Germany were analyzed for Sac-Lp distribution and association factors. The free statistical software R was utilized to investigate adjusted logistic regression models for association factors. Results Of the 161 patients included in the study, 74 (56%) were male. The median age of the study cohort was 23 years (interquartile range 13–32 years). 58 patients of the total cohort (36%) were < 18 years old. Adjusted multivariate regression analysis revealed that Sac-Lp colonization was associated with younger age (OR 0.8684, 95%CI: 0.7955–0.9480, p<0.005) and less colonization with H. influenzae (OR 0.0118, 95%CI: 0.0009–0.1585, p<0.001). In addition, Sac-Lp-colonized patients had more often allergic bronchopulmonary aspergillosis (ABPA) (OR 14.6663, 95%CI: 2.1873–98.3403, p<0.01) and have been colonized more often with the mucoid phenotype of Pseudomonas aeruginosa (OR 9.8941, 95%CI: 1.0518–93.0705, p<0.05). Conclusion Newly found association of ABPA and Pseudomonas revealed new probable risk factors for Sac-Lp colonization. Allergy might play a role in inducing immunologic host reactions which lead to a less effective response to species of Sac-Lp.
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Affiliation(s)
- Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité –Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Claudia Brandt
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Antweiler
- Reference Laboratory for Cryptococcosis, Scedosporiosis and Imported Systemic Mycoses, FG 16, Robert Koch Institute, Berlin, Germany
| | - Alexander Krannich
- Biostatistics Unit, Berlin Institute of Health, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité –Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Dominik Hartl
- Universitätsklinikum für Kinder- und Jugendmedizin Tübingen, Department of General Pediatrics, Pediatric Hematology and Oncology, Tübingen, Germany
| | - Anja Thronicke
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Tintelnot
- Reference Laboratory for Cryptococcosis, Scedosporiosis and Imported Systemic Mycoses, FG 16, Robert Koch Institute, Berlin, Germany
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Wylon K, Drozdenko G, Krannich A, Heine G, Dölle S, Worm M. Pharmacokinetic Evaluation of a Single Intramuscular High Dose versus an Oral Long-Term Supplementation of Cholecalciferol. PLoS One 2017; 12:e0169620. [PMID: 28114352 PMCID: PMC5256876 DOI: 10.1371/journal.pone.0169620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Vitamin D deficiency is frequent during the winter and occurs throughout the year in the elderly or patients suffering from autoimmune diseases. The objective of this study was to evaluate the pharmacokinetic properties of oral supplementation versus a single intramuscular injection of cholecalciferol in healthy individuals. Research design and methods Up to 8,000 I.U. oral cholecalciferol was administered daily for 84 days in a 4 week dose-escalation setting to vitamin D deficient individuals. In another cohort, a single intramuscular injection of 100,000 I.U. cholecalciferol was given. In both cohorts, individuals without vitamin D intake served as the comparison group. 25-hydroxyvitamin D (25(OH)D) concentrations were measured in all individuals at defined time points throughout the studies. Results The mean 25(OH)D serum concentration increased significantly after oral cholecalciferol intake compared to the control group (day 28: 83.4 nmol/l and 42.5 nmol/l; day 56: 127.4 nmol/l and 37.3 nmol/l; day 84: 159.7 nmol/l and 30.0 nmol/l). In individuals receiving 100,000 I.U. cholecalciferol intramuscular, the mean 25(OH)D serum concentration peaked after 4 weeks measuring 70.9 nmol/l compared to 32.7 nmol/l in the placebo group (p = 0.002). The increase of 25(OH)D serum concentrations after 28 days was comparable between both routes of administration (p = 0.264). Conclusions Oral and intramuscular cholecalciferol supplementation effectively increased serum 25(OH)D concentrations.
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Affiliation(s)
- Katharina Wylon
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gennadiy Drozdenko
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Krannich
- Koordinierungszentrum für Klinische Studien, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Guido Heine
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Dölle
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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Thronicke A, Heger N, Antweiler E, Krannich A, Roehmel J, Brandt C, Staab D, Tintelnot K, Schwarz C. Allergic bronchopulmonary aspergillosis is associated with pet ownership in cystic fibrosis. Pediatr Allergy Immunol 2016; 27:597-603. [PMID: 27145047 DOI: 10.1111/pai.12590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Late diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is associated with significant lung function decline and morbidity in cystic fibrosis (CF). The association of ABPA and domestic pet ownership in patients with CF has not been elucidated yet. Our objective was to determine the association of ABPA with pet ownership in patients with CF. METHODS Clinical and microbiological data from certified local patient registry were analyzed for 109 patients with CF aged 1-64 years: 55 pet owner and 54 non-pet owners. The primary outcome of the retrospective observational study was the occurrence of ABPA in pet owners and non-pet owners with CF. The free statistical software R was utilized to investigate logistic regression models for association factors. RESULTS Of the 109 patients included in the study, 61 (56%) were female. The mean age of the total group was 25.4 ± 13.2 years. Adjusted analysis revealed that ABPA (OR 5.0227, 95% CI: 1.182-21.340, p = 0.029) was associated with pet ownership in patients with CF. Furthermore, ABPA in pet owners with CF was associated with an increased number of exacerbations (OR 6.446, 95% CI: 1.057-39.328, p = 0.043). Other outcomes did not significantly differ. CONCLUSION Owning a pet was associated with ABPA in patients with CF. Future prospective multicenter longitudinal studies are needed to investigate chronological causality between pet ownership, ABPA development, and pulmonary exacerbations and to determine whether these estimates are generalizable for ABPA susceptible patients beyond CF (asthma, bronchiectasis).
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Affiliation(s)
- Anja Thronicke
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Heger
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Antweiler
- Reference Laboratory for Cryptococcosis, Scedosporiosis and Imported Systemic Mycoses, FG16, Robert Koch Institute, Berlin, Germany
| | - Alexander Krannich
- Biostatistics Unit, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jobst Roehmel
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Brandt
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Tintelnot
- Reference Laboratory for Cryptococcosis, Scedosporiosis and Imported Systemic Mycoses, FG16, Robert Koch Institute, Berlin, Germany
| | - Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center Berlin/Charité - Universitätsmedizin Berlin, Berlin, Germany
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Singer E, Schrezenmeier EV, Elger A, Seelow ER, Krannich A, Luft FC, Schmidt-Ott KM. Urinary NGAL-Positive Acute Kidney Injury and Poor Long-term Outcomes in Hospitalized Patients. Kidney Int Rep 2016; 1:114-124. [PMID: 29142920 PMCID: PMC5678650 DOI: 10.1016/j.ekir.2016.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 12/24/2022] Open
Abstract
Introduction Neutrophil gelatinase−associated lipocalin (NGAL) is a widely studied biomarker of renal tubular injury. Urinary NGAL (uNGAL) during acute kidney injury (AKI) predicts short-term adverse outcomes. However, the long-term predictive value is unknown. Methods We performed a prospective observational study of 145 patients with hospital-acquired AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria and analyzed the long-term predictive value of uNGAL at the time of AKI. We defined a composite outcome of all-cause mortality and the development of end-stage renal disease (ESRD). Results In all, 61 AKI patients died and 22 developed ESRD within 6 months. The uNGAL levels were significantly higher in patients with poor long-term outcomes. uNGAL levels ≥362 μg/l (highest quartile) and uNGAL levels between 95 and 362 μg/l (third quartile) were associated with hazard ratios of 3.7 (95% confidence interval, 2.1–6.5) and 1.9 (1.1–3.5), respectively, compared with uNGAL levels <95 μg/l (lower quartiles). After 6 months, 67% and 43% of patients within the highest and third uNGAL quartile, respectively, had either progressed to ESRD or died, compared to only 21% of patients with uNGAL in the lower 2 quartiles (P < 0.001). In multivariable Cox regression analyses accounting for conventional predictors, uNGAL was the strongest independent predictor of adverse long-term outcomes. The association of uNGAL levels and poor long-term outcomes remained significant in the subgroup of 107 AKI survivors discharged without requiring dialysis (P = 0.002). Discussion These data indicate that elevated uNGAL levels at AKI diagnosis predict poor long-term outcomes.
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Affiliation(s)
- Eugenia Singer
- Department of Nephrology, Charité─Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Eva V Schrezenmeier
- Department of Nephrology, Charité─Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Antje Elger
- Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Evelyn R Seelow
- Department of Nephrology, Charité─Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Krannich
- Department of Biostatistics, Clinical Research Unit, Berlin Institute of Health, Charité─University Medicine Berlin, Berlin, Germany
| | - Friedrich C Luft
- Experimental and Clinical Research Center (ECRC), a collaboration between the Charité Medical Faculty and the Max-Delbrück Center, Berlin, Germany
| | - Kai M Schmidt-Ott
- Department of Nephrology, Charité─Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine, Berlin, Germany
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Tafelski S, Kerper LF, Salz AL, Spies C, Reuter E, Nachtigall I, Schäfer M, Krannich A, Krampe H. Prospective clinical observational study evaluating gender-associated differences of preoperative pain intensity. Medicine (Baltimore) 2016; 95:e4077. [PMID: 27399095 PMCID: PMC5058824 DOI: 10.1097/md.0000000000004077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Previous studies reported conflicting results concerning different pain perceptions of men and women. Recent research found higher pain levels in men after major surgery, contrasted by women after minor procedures. This trial investigates differences in self-reported preoperative pain intensity between genders before surgery.Patients were enrolled in 2011 and 2012 presenting for preoperative evaluation at the anesthesiological assessment clinic at Charité University hospital. Out of 5102 patients completing a computer-assisted self-assessment, 3042 surgical patients with any preoperative pain were included into this prospective observational clinical study. Preoperative pain intensity (0-100 VAS, visual analog scale) was evaluated integrating psychological cofactors into analysis.Women reported higher preoperative pain intensity than men with median VAS scores of 30 (25th-75th percentiles: 10-52) versus 21 (10-46) (P < 0.001). Adjusted multiple regression analysis showed that female gender remained statistically significantly associated with higher pain intensity (P < 0.001). Gender differences were consistent across several subgroups especially with varying patterns in elderly. Women scheduled for minor and moderate surgical procedures showed largest differences in overall pain compared to men.This large clinical study observed significantly higher preoperative pain intensity in female surgical patients. This gender difference was larger in the elderly potentially contradicting the current hypothesis of a primary sex-hormone derived effect. The observed variability in specific patient subgroups may help to explain heterogeneous findings of previous studies.
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Affiliation(s)
- Sascha Tafelski
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Léonie F Kerper
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Hospital Wolfenbuettel gGmbH, Wolfenbuettel
| | - Anna-Lena Salz
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Eva Reuter
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Irit Nachtigall
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospital Waldfriede, Berlin
| | - Michael Schäfer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Alexander Krannich
- Department of Biostatistics, Clinical Research Unit, Berlin Institute of Health, Charité- Universitaetsmedizin Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
- Correspondence: Henning Krampe, Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin Charitéplatz 1, 10117 Berlin, Germany (e-mail: )
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Brandt C, Thronicke A, Roehmel JF, Krannich A, Staab D, Schwarz C. Impact of Long-Term Tiotropium Bromide Therapy on Annual Lung Function Decline in Adult Patients with Cystic Fibrosis. PLoS One 2016; 11:e0158193. [PMID: 27351829 PMCID: PMC4924629 DOI: 10.1371/journal.pone.0158193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
Background Chronic lung disease is the leading cause of death in patients with Cystic Fibrosis (CF) and is often treated with bronchodilators. It is not known whether long-term tiotropium bromide treatment may have a positive impact on lung function. Methods This retrospective cohort study estimated annual lung function decline utilizing longitudinal data for forced expiratory volume in 1 s (FEV1). Results A total of 160 adult patients with CF were analyzed. The subjects treated for 24 months with tiotropium bromide had a significantly slower decline of mean annual change of FEV1 (treated: -0.3±4.0%; control: -2.3±5.0%; p = 0.0130). In patients with FEV1 ≥70% predicted, long-term tiotropium bromide treatment was associated with greater improvements in annual lung function decline (FEV1 ≥70% predicted: treated: +0.5±4.7%; control: -4.0±6.3%; p = 0.0132; FEV1 50–69% predicted: treated: -0.5±4.4%; control: -0.8±3.8%; p = 0.7142; FEV1 ≤49% predicted: treated: -0.6±3.4%; control: -2.4±4.8%; p = 0.0898). Conclusion This study suggests that long-term tiotropium bromide treatment may be associated with reduced annual decline of FEV1 in patients with CF, particularly in adults with a mild degree of severity.
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Affiliation(s)
- Claudia Brandt
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anja Thronicke
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jobst F. Roehmel
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Alexander Krannich
- Biostatistics Unit, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- * E-mail:
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Abstract
BACKGROUND Recurrent anteroinferior shoulder dislocations are often associated with bony glenoid and humeral defects. The influence of those bony lesions on the postoperative outcomes after arthroscopic shoulder stabilization procedures has been the subject of many studies. Little is known about the influence of those lesions on preoperative function. PURPOSE To evaluate the influence of glenoid and humeral bony defects on preoperative shoulder function in recurrent anteroinferior shoulder instability. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Included in the study were 90 patients (70 men, 20 women; mean age, 27.1 years; 24 patients with prior failed stabilization) with posttraumatic recurrent anteroinferior shoulder instability who underwent preoperative computed tomography (CT) of both shoulders. The glenoid index was used to measure glenoid defect on a 3-dimensional CT. Humeral head defect was measured on a 2-dimensional CT with evaluation of the Hill-Sachs quotient, product, sum, and difference. Preoperative evaluation also included the Rowe score, Constant score, Walch-Duplay score, Melbourne Instability Shoulder Score (MISS), Western Ontario Shoulder Instability Index (WOSI), and Subjective Shoulder Value (SSV). RESULTS There was a weak but significant correlation of the Hill-Sachs quotient and the glenoid index with the Rowe score (P = .03, r = -0.22 and P = .03, r = 0.23, respectively). Furthermore, the Hill-Sachs product significantly correlated with the WOSI (P = .02); in particular, the physical symptoms subscore showed a significant correlation (P = .04). The glenoid index showed a significant correlation with the SSV (P < .01). No significant correlation was found between the Walch-Duplay score, Constant score, or MISS and bony defects. CONCLUSION The results of this study show that objective and subjective scoring systems correlate significantly with the clinical condition of patients with recurrent shoulder instability and associated bony defects. It is recommended that clinicians use the Rowe score, WOSI, and SSV for the clinical evaluation of patients with recurrent anteroinferior shoulder instability and associated bony defects. These evaluation systems may provide an early clinical indication of bony defects. Furthermore, very poor results on these evaluations could underline the necessity of a CT scan for the diagnosis of bony defects in recurrent shoulder instability and might be helpful for decision making concerning the indication of a CT.
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Affiliation(s)
- Julia Wolke
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Diem Anh Herrmann
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Alexander Krannich
- Coordination Center for Clinical Trials, Department of Biostatistics, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Berlin, Germany
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Storm C, Wutzler A, Trenkmann L, Krannich A, von Rheinbarben S, Luckenbach F, Nee J, Otto N, Schroeder T, Leithner C. Good neurological outcome despite very low regional cerebral oxygen saturation during resuscitation--a prospective preclinical trial in 29 patients. Scand J Trauma Resusc Emerg Med 2016; 24:43. [PMID: 27048406 PMCID: PMC4822235 DOI: 10.1186/s13049-016-0234-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/31/2016] [Indexed: 11/12/2022] Open
Abstract
Background Noninvasive regional cerebral oxygen saturation (rSO2) measurement using near-infrared spectroscopy (NIRS) might inform on extent and duration of cerebral hypoxia during cardiopulmonary resuscitation (CPR). This information may be used to guide resuscitation efforts and may carry relevant early prognostic information. Methods We prospectively investigated non-traumatic out-of-hospital cardiac arrest (OHCA) patients on scene. NIRS was started either during CPR or shortly after (<2 min) return of spontaneous circulation (ROSC) by emergency medical service (EMS). Outcome was determined at intensive care unit (ICU) discharge and 6 months after cardiac arrest. Results A total of 29 OHCA patients were included. In 23 patients NIRS was started during CPR and in 6 patients immediately after ROSC. 18 (62.1 %) patients did not reach ROSC. Initial rSO2 during CPR was very low (<50 % in all 23 patients, < 30 % in 19 of 23 patients) with no significant difference between patients achieving ROSC and those who did not. Of five patients with ROSC, in whom NIRS was recorded during CPR, two reached a good six-months outcome (initial rSO2 22 %) and three died during the ICU stay (initial rSO2 15, 16 and 46 %). In six patients with NIRS started immediately after ROSC (<2 min), rSO2 was substantially higher (54–85 %) than in patients during CPR (p = 0.006). Discussion and conclusion Initial frontal brain rSO2 determined by NIRS during CPR was generally very low and recovered rapidly after ROSC. Very low initial rSO2 during CPR was compatible with good neurological outcome in our limited cohort of patients. Further studies are needed to assess in larger cohorts and more detail the implications of very low initial rSO2 during CPR on scene.
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Affiliation(s)
- Christian Storm
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
| | - Alexander Wutzler
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Lars Trenkmann
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Alexander Krannich
- Department of Biostatistics, Berlin Institute of Health, Clinical Research Unit, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Sabrina von Rheinbarben
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Fridolin Luckenbach
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Jens Nee
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Natalie Otto
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Tim Schroeder
- Department of Internal Medicine, Nephrology and Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Christoph Leithner
- Department of Neurology, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
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Hunsicker O, Krannich A, Spies C, Feldheiser A. Association of Sodium Homeostasis with Blood Transfusions During Liver Transplantation. Anesth Analg 2016; 122:916-917. [DOI: 10.1213/ane.0000000000001057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Brandl A, Stolzlechner P, Eschertzhuber S, Aigner F, Weiss S, Vogel W, Krannich A, Neururer S, Pratschke J, Graziadei I, Öllinger R. Inferior graft survival of hepatitis B core positive grafts is not influenced by post-transplant hepatitis B infection in liver recipients--5-year single-center experience. Transpl Int 2016; 29:471-82. [PMID: 26716608 DOI: 10.1111/tri.12741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/11/2015] [Accepted: 12/23/2015] [Indexed: 12/21/2022]
Abstract
Nonoptimal liver grafts, and among them organs from anti-HBc+ donors, are increasingly used for liver transplantation. In this retrospective study including 1065 adult liver transplantations performed between 1977 and 2012, we analyzed long-term patient and graft survival and occurrence of HBV infection. A total of 52 (5.1%) patients received an anti-HBc+ graft. The 10-year graft and patient survival of these recipients were 50.9% and 59.0% compared to 72.0% and 76.5% (P = 0.001; P = 0.004) of patients receiving anti-HBc- grafts, respectively. Cox regression model showed that high urgency allocation (P = 0.003), recipient age (P = 0.027), anti-HCV+ recipients (P = 0.005), and anti-HBc+ organs (P = 0.048) are associated with decreased graft survival. Thirteen of 52 (25.0%) patients receiving anti-HBc+ grafts developed post-transplant HBV infection within a mean of 2.8 years. In this study, antiviral prophylaxis did not have significant impact on HBV infection, but long-term survival (P = 0.008). Development of post-transplant HBV infection did not affect adjusted 10-year graft survival (100% vs. 100%; P = 1). Anti-HBc+ liver grafts can be transplanted with reasonable but inferior long-term patient and graft survival. The inferior graft survival is not, however, related with post-transplant HBV infection as long as early diagnosis and treatment take place.
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Affiliation(s)
- Andreas Brandl
- Department of Visceral-, Transplant-, and Thoracic Surgery, Medical University, Innsbruck, Austria.,Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Berlin, Germany
| | - Philipp Stolzlechner
- Department of Visceral-, Transplant-, and Thoracic Surgery, Medical University, Innsbruck, Austria
| | - Stephan Eschertzhuber
- Department of Anaesthesia and Intensive Care Medicine, Medical University, Innsbruck, Austria
| | - Felix Aigner
- Department of Visceral-, Transplant-, and Thoracic Surgery, Medical University, Innsbruck, Austria.,Department of Anaesthesia and Intensive Care Medicine, Medical University, Innsbruck, Austria
| | - Sascha Weiss
- Department of Visceral-, Transplant-, and Thoracic Surgery, Medical University, Innsbruck, Austria.,Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Berlin, Germany
| | - Wolfgang Vogel
- Department of Internal Medicine II, Gastroenterology & Hepatology, Medical University, Innsbruck, Austria
| | - Alexander Krannich
- Department of Biostatistics, Coordination Center for Clinical Trials, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sabrina Neururer
- Department of Medical Statistics, Medical University, Innsbruck, Austria
| | - Johann Pratschke
- Department of Visceral-, Transplant-, and Thoracic Surgery, Medical University, Innsbruck, Austria.,Department of General, Visceral and Transplant Surgery, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Ivo Graziadei
- Department of Internal Medicine II, Gastroenterology & Hepatology, Medical University, Innsbruck, Austria.,Department of Internal Medicine, District Hospital Hall, Innsbruck, Austria
| | - Robert Öllinger
- Department of Visceral-, Transplant-, and Thoracic Surgery, Medical University, Innsbruck, Austria.,Department of General, Visceral and Transplant Surgery, Charité Campus Virchow-Klinikum, Berlin, Germany
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Tafelski S, Yi H, Ismaeel F, Krannich A, Spies C, Nachtigall I. Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. J Infect Public Health 2016; 9:577-85. [PMID: 26754202 DOI: 10.1016/j.jiph.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/24/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022] Open
Abstract
Worldwide incidence of obesity is increasing and impaired outcome in postoperative patients has been described. Antibiotic prescribing is complicated by different pharmacology in this population. This study evaluates mortality and morbidity of obese postoperative patients and explores possible relation to antibiotic therapy. Therefore, data obtained in a prospective study in 2009-2010 were analysed. Postoperative patients on 5 ICUs were included with >48h of ICU treatment and documented body-mass-index (BMI). Altogether 451 non-obese patients (BMI<30kg/m(2)) were compared with 130 obese patients including propensity score matching. There was significant heterogeneity of baseline characteristics. ICU-mortality was 7.5% in non-obese and 7.7% in obese patients (p>0.999), but 65.4% of obese patients required mechanical ventilation compared with only 53.2% of non-obese patients (p=0.016). These findings were validated in multivariate regression analyses (adjusted OR for ICU-mortality for obese patients 0.53, 95%-CI 0.188-1.321, p=0.197; adjusted OR for mechanical ventilation 1.841, 95%-CI 1.113-3.076, p=0.018). Results were confirmed by propensity score matching. Therapeutic drug monitoring for vancomycin (TDM) showed that underdosing and overdosing occurred more often in obese patients and sufficient TDM levels were less often achieved. In conclusion, obesity is associated with increased morbidity but ICU mortality is equal compared with a non-obese population. Pharmacological differences might explain observed differences in antibiotic therapy and in obese patients TDM might be especially of importance.
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Affiliation(s)
- Sascha Tafelski
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hailong Yi
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Fakher Ismaeel
- Department of Gynaecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Alexander Krannich
- Department of Biostatistics, Clinical Research Unit, Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Irit Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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45
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Hunsicker O, Fotopoulou C, Pietzner K, Koch M, Krannich A, Sehouli J, Spies C, Feldheiser A. Hemodynamic Consequences of Malignant Ascites in Epithelial Ovarian Cancer Surgery*: A Prospective Substudy of a Randomized Controlled Trial. Medicine (Baltimore) 2015; 94:e2108. [PMID: 26656336 PMCID: PMC5008481 DOI: 10.1097/md.0000000000002108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Malignant ascites (MA) is most commonly observed in patients scheduled for epithelial ovarian cancer (EOC) surgery and is supposed as a major risk factor promoting perioperative hemodynamic deterioration. We aimed to assess the hemodynamic consequences of MA on systemic circulation in patients undergoing cytoreductive EOC surgery.This study is a predefined post-hoc analysis of a randomized controlled pilot trial comparing intravenous solutions within a goal-directed algorithm to optimize hemodynamic therapy in patients undergoing cytoreductive EOC surgery. Ascites was used to stratify the EOC patients prior to randomization in the main study. We analyzed 2 groups according to the amount of ascites (NLAS: none or low ascites [<500 mL] vs HAS: high ascites group [>500 mL]). Differences in hemodynamic variables with respect to time were analyzed using nonparametric analysis for longitudinal data and multivariate generalized estimating equation adjusting the analysis for the randomized study groups of the main study.A total of 31 patients in the NLAS and 16 patients in the HAS group were analyzed. Although cardiac output was not different between groups suggesting a similar circulatory blood flow, the HAS group revealed higher heart rates and lower stroke volumes during surgery. There were no differences in pressure-based hemodynamic variables. In the HAS group, fluid demands, reflected by the time to reindication of a fluid challenge after preload optimization, increased steadily, whereas stroke volume could not be maintained at baseline resulting in hemodynamic instability after 1.5 h of surgery. In contrast, in the NLAS group fluid demands were stable and stroke volume could be maintained during surgery. Clinically relevant associations of the type of fluid replacement with hemodynamic consequences were particularly observed in the HAS group, in which transfusion of fresh frozen plasma (FFP) was associated to an improved circulatory flow and reduced vasopressor and fluid demands, whereas the administration of artificial infusion solutions was related to opposite effects.Malignant ascites >500 mL implies increased fluid demands and substantial alterations in circulatory blood flow during cancer surgery. Fresh frozen plasma transfusion promotes recovering hemodynamic stability in patients with malignant ascites >500 mL, in whom artificial infusion solutions could not prevent from hemodynamic deterioration.
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Affiliation(s)
- Oliver Hunsicker
- From the Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Augustenburger Platz 1, Berlin, Germany (OH, MK, CS, AF); West London Gynaecology Cancer Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, United Kingdom (CF); Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité- University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, Germany (CF, KP, JS); Department of Biostatistics, Coordination Center for Clinical Trials, Charité- University Medicine Berlin, Germany (AK); and Berlin Institute of Health, Clinical Research Unit, Biostatistics Unit, Berlin, Germany (AK)
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Maier A, Deigendesch N, Müller K, Weishaupt JH, Krannich A, Röhle R, Meissner F, Molawi K, Münch C, Holm T, Meyer R, Meyer T, Zychlinsky A. Interleukin-1 Antagonist Anakinra in Amyotrophic Lateral Sclerosis--A Pilot Study. PLoS One 2015; 10:e0139684. [PMID: 26444282 PMCID: PMC4596620 DOI: 10.1371/journal.pone.0139684] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
Preclinical studies show that blocking Interleukin–1 (IL–1) retards the progression of Amyotrophic Lateral Sclerosis (ALS). We assessed the safety of Anakinra (ANA), an IL–1 receptor antagonist, in ALS patients. In a single arm pilot study we treated 17 ALS patients with ANA (100 mg) daily for one year. We selected patients with dominant or exclusive lower motor neuron degeneration (LMND) presentation, as peripheral nerves may be more accessible to the drug. Our primary endpoint was safety and tolerability. Secondary endpoints included measuring disease progression with the revised ALS functional rating scale (ALSFRSr). We also quantified serum inflammatory markers. For comparison, we generated a historical cohort of 47 patients that fit the criteria for enrolment, disease characteristics and rate of progression of the study group. Only mild adverse events occurred in ALS patients treated with ANA. Notably, we observed lower levels of cytokines and the inflammatory marker fibrinogen during the first 24 weeks of treatment. Despite of this, we could not detect a significant reduction in disease progression during the same period in patients treated with ANA compared to controls as measured by the ALSFRSr. In the second part of the treatment period we observed an increase in serum inflammatory markers. Sixteen out of the 17 patients (94%) developed antibodies against ANA. This study showed that blocking IL–1 is safe in patients with ALS. Further trials should test whether targeting IL–1 more efficiently can help treating this devastating disease.
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Affiliation(s)
- André Maier
- Department of Neurology, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | | - Alexander Krannich
- Department of Biostatistics, Coordination Center for Clinical Trials, Charité-University Hospital, Berlin, Germany
| | - Robert Röhle
- Department of Biostatistics, Coordination Center for Clinical Trials, Charité-University Hospital, Berlin, Germany
| | - Felix Meissner
- Max-Planck Institute for Infection Biology, Berlin, Germany
| | - Kaaweh Molawi
- Max-Planck Institute for Infection Biology, Berlin, Germany
| | - Christoph Münch
- Department of Neurology, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Teresa Holm
- Department of Neurology, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Robert Meyer
- Department of Neurology, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Thomas Meyer
- Department of Neurology, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Arturo Zychlinsky
- Max-Planck Institute for Infection Biology, Berlin, Germany
- * E-mail:
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Langelotz C, Mueller-Rau C, Terziyski S, Rau B, Krannich A, Gastmeier P, Geffers C. Gender-Specific Differences in Surgical Site Infections: An Analysis of 438,050 Surgical Procedures from the German National Nosocomial Infections Surveillance System. Viszeralmedizin 2015; 30:114-7. [PMID: 26288585 PMCID: PMC4513817 DOI: 10.1159/000362100] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Surgical site infections (SSI) are among the most frequent healthcare-associated infections. They impose a substantial burden with increased morbidity and exceeding healthcare costs. Risk factors such as age, diabetes, and smoking status are commonly accounted for in the literature, but few studies address gender differences. Methods Data from the German Nosocomial Infections Surveillance System (Krankenhaus-Infektions-Surveillance-System (KISS)) from 2005 to 2010 were analysed for cardiac, vascular, visceral, and orthopaedic surgery, with a total of 438,050 surgical procedures and 8,639 SSI. Rates of SSI and isolated pathogens were analysed for gender. Results Women had a lower rate of SSI (SSI/100 procedures) in abdominal surgery than men (2.92 vs. 4.37; p < 0.001). No gender-specific differences were found in orthopaedic and vascular surgery, while women had a higher risk for SSI in cardiac surgery (5.50 vs. 3.02; p < 0.001). Isolated pathogens showed differences for sensitive Staphylococcus aureus and Pseudomonas aeruginosa, which were more frequent in women (both p = 0.007), while coagulase-negative staphylococci occurred more often in men (18.8 vs. 14.0%; p < 0.001). Conclusion Gender differences in SSI exist and are procedure-specific. The underlying mechanisms need to be further elucidated so that targeted measures for the prevention of SSI can be developed.
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Affiliation(s)
- Corinna Langelotz
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Carolin Mueller-Rau
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Stoil Terziyski
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Beate Rau
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Alexander Krannich
- Abteilung Biostatistik, Koordinierungszentrum für Klinische Studien, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Petra Gastmeier
- Nationales Referenzzentrum für die Surveillance von nosokomialen Infektionen, Berlin, Germany ; Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Christine Geffers
- Nationales Referenzzentrum für die Surveillance von nosokomialen Infektionen, Berlin, Germany ; Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Lerchl K, Rakova N, Dahlmann A, Rauh M, Goller U, Basner M, Dinges DF, Beck L, Agureev A, Larina I, Baranov V, Morukov B, Eckardt KU, Vassilieva G, Wabel P, Vienken J, Kirsch K, Johannes B, Krannich A, Luft FC, Titze J. Agreement between 24-hour salt ingestion and sodium excretion in a controlled environment. Hypertension 2015; 66:850-7. [PMID: 26259596 DOI: 10.1161/hypertensionaha.115.05851] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/19/2015] [Indexed: 11/16/2022]
Abstract
Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed 2 independent ultralong-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 g/d and collected all urine. The subjects' daily menus consisted of 27 279 individual servings, of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady-state sodium balance in both studies. Even at fixed salt intake, 24-hour urine collection for sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-g difference in salt intake. Because of the biological variability in UNaV, only every other daily urine sample correctly classified a 3-g difference in salt intake (49%). By increasing the observations to 3 consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6 to 12 g salt per day were not suitable to detect a 3-g difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials.
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Affiliation(s)
- Kathrin Lerchl
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Natalia Rakova
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Anke Dahlmann
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Manfred Rauh
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Ulrike Goller
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Mathias Basner
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - David F Dinges
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Luis Beck
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Alexander Agureev
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Irina Larina
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Victor Baranov
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Boris Morukov
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Kai-Uwe Eckardt
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Galina Vassilieva
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Peter Wabel
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Jörg Vienken
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Karl Kirsch
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Bernd Johannes
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Alexander Krannich
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.)
| | - Friedrich C Luft
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.).
| | - Jens Titze
- From the Interdisciplinary Center for Clinical Research (K.L., N.R., U.G., J.T.), Department of Nephrology and Hypertension (A.D., K.-U.E., J.T.), and Department of Pediatrics (M.R.), Friedrich-Alexander-University, Erlangen-Nürnberg, Germany; Experimental and Clinical Research Center, an institutional cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany (N.R., F.C.L.); Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.B., D.F.D.); Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany (L.B., B.J.); State Scientific Center of Russian Federation, Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia (A.A., I.L., V.B., B.M., G.V.); Fresenius Medical Care-D GmbH, Bad Homburg, Germany (P.W., J.V.); Center for Space Medicine, Institute of Physiology, Charité - University Clinic Berlin, Berlin, Germany (K.K.); Department of Biostatistics, Coordination Center for Clinical Trials, Charité University Medicine Berlin, Berlin, Germany (A.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L., J.T.).
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Hansen P, Hecht J, Ibrahim DM, Krannich A, Truss M, Robinson PN. Saturation analysis of ChIP-seq data for reproducible identification of binding peaks. Genome Res 2015; 25:1391-400. [PMID: 26163319 PMCID: PMC4561497 DOI: 10.1101/gr.189894.115] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022]
Abstract
Chromatin immunoprecipitation coupled with next-generation sequencing (ChIP-seq) is a powerful technology to identify the genome-wide locations of transcription factors and other DNA binding proteins. Computational ChIP-seq peak calling infers the location of protein–DNA interactions based on various measures of enrichment of sequence reads. In this work, we introduce an algorithm, Q, that uses an assessment of the quadratic enrichment of reads to center candidate peaks followed by statistical analysis of saturation of candidate peaks by 5′ ends of reads. We show that our method not only is substantially faster than several competing methods but also demonstrates statistically significant advantages with respect to reproducibility of results and in its ability to identify peaks with reproducible binding site motifs. We show that Q has superior performance in the delineation of double RNAPII and H3K4me3 peaks surrounding transcription start sites related to a better ability to resolve individual peaks. The method is implemented in C+l+ and is freely available under an open source license.
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Affiliation(s)
- Peter Hansen
- Institute for Medical and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Berlin Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Jochen Hecht
- Institute for Medical and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Berlin Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Daniel M Ibrahim
- Institute for Medical and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany
| | - Alexander Krannich
- Department of Biostatistics, Clinical Research Unit, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Matthias Truss
- Labor für Pädiatrische Molekularbiologie, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - Peter N Robinson
- Institute for Medical and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Berlin Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Max Planck Institute for Molecular Genetics, 14195 Berlin, Germany; Institute for Bioinformatics, Department of Mathematics and Computer Science, Freie Universität Berlin, 14195 Berlin, Germany
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50
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Balzer F, Weiß B, Kumpf O, Treskatsch S, Spies C, Wernecke KD, Krannich A, Kastrup M. Early deep sedation is associated with decreased in-hospital and two-year follow-up survival. Crit Care 2015; 19:197. [PMID: 25928417 PMCID: PMC4435917 DOI: 10.1186/s13054-015-0929-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/15/2015] [Indexed: 12/11/2022]
Abstract
Introduction There is increasing evidence that deep sedation is detrimental to critically ill patients. The aim of this study was to examine effects of deep sedation during the early period after ICU admission on short- and long-term survival. Methods In this observational, matched-pair analysis, patients receiving mechanical ventilation that were admitted to ICUs of a tertiary university hospital in six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. The Richmond Agitation-Sedation Score (RASS) was used to assess sedation depth (light sedation: −2 to 0; deep: −3 or below). Multivariate Cox regression was conducted to investigate the impact of early deep sedation within the first 48 hours of admission on in-hospital and two-year follow-up survival. Results In total, 1,884 patients met inclusion criteria out of which 27.2% (n = 513) were deeply sedated. Deeply sedated patients had longer ventilation times, increased length of stay and higher rates of mortality. Early deep sedation was associated with a hazard ratio of 1.661 (95% CI: 1.074 to 2.567; P = 0.022) for in-hospital survival and 1.866 (95% CI: 1.351 to 2.576; P <0.001) for two-year follow-up survival. Conclusions Early deep sedation during the first 48 hours of intensive care treatment was associated with decreased in-hospital and two-year follow-up survival. Since early deep sedation is a modifiable risk factor, this data shows an urgent need for prospective clinical trials focusing on light sedation in the early phase of ICU treatment. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0929-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix Balzer
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Björn Weiß
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Oliver Kumpf
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Sascha Treskatsch
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Klaus-Dieter Wernecke
- Charité - Universitätsmedizin Berlin and SOSTANA GmbH, Wildensteiner Straße 27, Berlin, 10318, Germany.
| | - Alexander Krannich
- Coordination Centre for Clinical Trials, Department of Biostatistics, Charité -Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
| | - Marc Kastrup
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany.
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