1
|
Konsberg Y, Åneman A, Olsen F, Hessulf F, Nellgård B, Hård Af Segerstad M, Dalla K. Progressive changes in pulmonary gas exchange during invasive respiratory support for COVID-19 associated acute respiratory failure: A retrospective study of the association with 90-day mortality. Acta Anaesthesiol Scand 2024. [PMID: 38563250 DOI: 10.1111/aas.14415] [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: 09/17/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Ratio of arterial pressure of oxygen and fraction of inspired oxygen (P/F ratio) together with the fractional dead space (Vd/Vt) provides a global assessment of pulmonary gas exchange. The aim of this study was to assess the potential value of these variables to prognosticate 90-day survival in patients with COVID-19 associated ARDS admitted to the Intensive Care Unit (ICU) for invasive ventilatory support. METHODS In this single-center observational, retrospective study, P/F ratios and Vd/Vt were assessed up to 4 weeks after ICU-admission. Measurements from the first 2 weeks were used to evaluate the predictive value of P/F ratio and Vd/Vt for 90-day mortality and reported by the adjusted hazard ratio (HR) and 95% confidence intervals [95%CI] by Cox proportional hazard regression. RESULTS Almost 20,000 blood gases in 130 patients were analyzed. The overall 90-day mortality was 30% and using the data from the first ICU week, the HR was 0.85 [0.77-0.94] for every 10 mmHg increase in P/F ratio and 1.61 [1.20-2.16] for every 0.1 increase in Vd/Vt. In the second week, the HR for 90-day mortality was 0.82 [0.75-0.89] for every 10 mmHg increase in P/F ratio and 1.97 [1.42-2.73] for every 0.1 increase in Vd/Vt. CONCLUSION The progressive changes in P/F ratio and Vd/Vt in the first 2 weeks of invasive ventilatory support for COVID-19 ARDS were significant predictors for 90-day mortality.
Collapse
Affiliation(s)
- Ylva Konsberg
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Anders Åneman
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Intensive Care Unit, Liverpool Hospital, Southwestern Sydney Local Health District, Australia
- South Western Clinical School, University of New South Wales, Australia
- Ingham Institute for Applied Medical Science, Sydney, Australia
| | - Fredrik Olsen
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska, Sweden
| | - Fredrik Hessulf
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Mathias Hård Af Segerstad
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| |
Collapse
|
2
|
Sellbrant I, Nellgård B, Karlsson J, Albert J, Jakobsson JG. Anaesthesia practice, quality indices including all-cause 30-day mortality associate to wrist fracture repositioning and surgery in Sweden: A perioperative register-based study 2018-2021. Acta Anaesthesiol Scand 2024; 68:402-409. [PMID: 37952557 DOI: 10.1111/aas.14358] [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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Wrist fracture is one of most common fractures frequently requiring surgical anaesthesia. There is limited information related to the anaesthetic practice and quality including 30-day mortality associated with wrist fracture in Sweden in recent years. AIM The aim of the present register-based study was to investigate the anaesthesia techniques used and quality indices including 30-day mortality associated with wrist fracture surgery in Sweden during the period 2018-2021. MATERIALS AND METHODS All fracture repositions, and surgical interventions related to wrist fracture requiring anaesthesia in patients aged >18 years registered in the Swedish Perioperative Register (SPOR) between 2018 and 2021 were included in the analysis. Information on age, ASA class, anaesthesia technique, severe operative events, most reported side-effects during recovery room stay and all-cause 30-day mortality was collected. RESULTS The data set included 25,147 procedures split into 14,796 females and 10,252 males (missing information n = 99) with a mean age of 52.9 ± 18.7 years and a significant age difference between females and males, 60.3 ± 15.4 and 42.2 ± 17.7 years, respectively. Mean age and ASA class increased during the study period (2018-2021), from 52.8 ± 18.6 to 54.0 ± 18.4 and ASA class 3-5 from 8.1% to 9.4% (p < .001 and p < .041, respectively). General anaesthesia (GA), GA combined with regional anaesthesia (RA), RA with or without sedation and sedation only was used in 41%, 13%, 40% and 6% of procedures, respectively, with minor changes over the study period. Pain at arrival in the recovery room (RR), (3.4%), severe pain during RR stay (2.1%), hypothermia (1.4%), postoperative nausea and vomiting (PONV) (1.2%) and urinary retention (0.5%) were the most reported side-effects during the RR stay. (RA) was associated with significantly lower occurrence of pain and PONV, and shorter RR stay, compared with GA (p < .001). The all-cause 30-day mortality was low (19 of 25,147 (0.08%)) with no differences over the period studied or anaesthetic technique. CONCLUSION General anaesthesia or general anaesthesia combined with regional anaesthesia are the most used anaesthetic techniques for wrist fracture procedures in Sweden. Recovery room pain, PONV, hypothermia and urinary retention is reported in overall low frequencies, with no change over the period studied, but in lower frequencies for regional anaesthesia. All-cause 30-day mortality was low; 0.08% with no change over time or between anaesthetic techniques. Thus, the present quality review based on SPOR data supports high quality of perioperative anaesthesia care.
Collapse
Affiliation(s)
- Iren Sellbrant
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johanna Albert
- Department of Anaesthesia and Intensive Care, Department for Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia and Intensive Care, Department for Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| |
Collapse
|
3
|
Fernandes Gomes B, Farris CM, Ma Y, Concha-Marambio L, Lebovitz R, Nellgård B, Dalla K, Constantinescu J, Constantinescu R, Gobom J, Andreasson U, Zetterberg H, Blennow K. α-Synuclein seed amplification assay as a diagnostic tool for parkinsonian disorders. Parkinsonism Relat Disord 2023; 117:105807. [PMID: 37591709 DOI: 10.1016/j.parkreldis.2023.105807] [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: 05/30/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Synucleinopathies such as Parkinson's disease (PD) and multiple system atrophy (MSA) can be challenging to diagnose due to the symptom overlap with, for example, atypical parkinsonisms like progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Seed amplification assays (SAA), developed for the detection of α-synuclein (αSyn) aggregates in CSF, have been successful when used as a biomarker evaluation for synucleinopathies. In this study, we investigated the potential of this assay to not only detect αSyn seeds in CSF, but also discriminate between movement disorders. METHODS The αSyn-SAA was tested in a Scandinavian cohort composed of 129 CSF samples from patients with PD (n = 55), MSA (n = 27), CBD (n = 7), and PSP (n = 16), as well as healthy controls (HC, n = 24). RESULTS The αSyn seed amplification assay (αSyn-SAA) was able to correctly identify all PD samples as positive (sensitivity of 100%) while also discriminating the PD group from HC (70.8% specificity, p < 0.0001) and tauopathies [CBD (71% specificity) and PSP (75% specificity), p < 0.0001)]. The αSyn-SAA was also able to identify almost all MSA samples as positive for αSyn aggregation (sensitivity of 92.6%). In general, this assay is able to discriminate between the synucleinopathies and tauopathies analyzed herein (p < 0.0001) despite the overlapping symptoms in these diseases. CONCLUSION These findings suggest the αSyn-SAA is a useful diagnostic tool for differentiating between different parkinsonian disorders, although further optimization may be needed.
Collapse
Affiliation(s)
- Bárbara Fernandes Gomes
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
| | | | - Yihua Ma
- R&D Unit, Amprion Inc., San Diego, CA, 92121, USA
| | | | | | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | - Radu Constantinescu
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Gobom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Ulf Andreasson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China; Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
4
|
Weiner S, Sauer M, Brinkmalm G, Constantinescu J, Constantinescu R, Gomes BF, Becker B, Nellgård B, Dalla K, Galasko D, Zetterberg H, Blennow K, Gobom J. SCRN1: A cerebrospinal fluid biomarker correlating with tau in Alzheimer's disease. Alzheimers Dement 2023; 19:4609-4618. [PMID: 36946611 DOI: 10.1002/alz.13042] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Secernin-1 (SCRN1) is a neuronal protein that co-localizes with neurofibrillary tangles in Alzheimer's disease (AD), but not with tau inclusions in corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), or Pick's disease. METHODS We measured SCRN1 concentration in cerebrospinal fluid (CSF) using a novel mass spectrometric parallel reaction monitoring method in three clinical cohorts comprising patients with neurochemically characterized AD (n = 25) and controls (n = 28), clinically diagnosed Parkinson's disease (PD; n = 38), multiple system atrophy (MSA; n = 31), PSP (n = 20), CBD (n = 8), healthy controls (n = 37), and neuropathology-confirmed AD (n = 47). RESULTS CSF SCRN1 was significantly increased in AD (P < 0.01, fold change = 1.4) compared to controls (receiver operating characteristic area under the curve = 0.78) but not in CBD, PSP, PD, or MSA. CSF SCRN1 positively correlated with CSF total tau (R = 0.78, P = 1.1 × 10-13 ), phosphorylated tau181 (R = 0.64, P = 3.2 × 10-8 ), and Braak stage and negatively correlated with Mini-Mental State Examination score. DISCUSSION CSF SCRN1 is a candidate biomarker of AD, reflecting tau pathology. HIGHLIGHTS We developed a parallel reaction monitoring assay to measure secernin-1 (SCRN1) in cerebrospinal fluid (CSF). CSF SCRN1 was increased in Alzheimer's disease compared to healthy controls. CSF SCRN1 remained unchanged in Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, or corticobasal degeneration compared to controls. CSF SCRN1 correlated strongly with CSF phosphorylated tau and total tau. CSF SCRN1 increased across Braak stages and negatively correlated with Mini-Mental State Examination score.
Collapse
Affiliation(s)
- Sophia Weiner
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Mathias Sauer
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Gunnar Brinkmalm
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Julius Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Bárbara Fernandes Gomes
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Bruno Becker
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Johan Gobom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
5
|
Konsberg Y, Szaro P, Aneman A, Kjellberg S, Solidakis N, Svedlund S, Nellgård B, Dalla K. Radiological appearance and lung function six months after invasive ventilation in ICU for COVID-19 pneumonia: An observational follow-up study. PLoS One 2023; 18:e0289603. [PMID: 37656699 PMCID: PMC10473523 DOI: 10.1371/journal.pone.0289603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/22/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Respiratory functional sequelae in COVID-19 patients admitted to the intensive care unit for invasive ventilation are sparsely reported. The aim of this study was to investigate the radiological lung appearance, lung function and their association at 6 months after hospital discharge. It was hypothesized that the degree of pathological morphology on CT scans would correlate with lung function at the time of follow-up. METHODS AND FINDINGS In this single-centre prospective observational study, 86 from 154 patients admitted to ICU due to COVID-19 between March 2020 and May 2021 were followed up at 6 months post discharge with computed tomography (CT) of the chest and pulmonary function tests (PFTs). The PFT results were expressed as z-scores calculated as the difference between the measured and predicted values divided by the standard deviation obtained from a reference population. Correlations were evaluated by Spearman's rho including the 95% confidence interval. Pathological changes on CT were found in 78/85 participants with fibrous parenchymal bands being the most prevalent finding (91%) followed by traction bronchiectasis (64%) and ground glass opacities (41%). Sixty-five participants performed PFTs, and a restrictive pattern was the most prevalent abnormality (34%). Diffusing capacity of the lung for carbon monoxide (DLCO) was reduced in 66% of participants. The CT severity score weakly correlated with forced vital capacity (FVC) z-score (0.295, p = 0.006), DLCO z-score (-0.231, p = 0.032) and alveolar volume (VA) z-score (0.253, p = 0.019). CONCLUSIONS Most patients showed persistent radiological abnormalities on CT and reduced lung volumes, impaired diffusion capacity and patterns of restrictive lung function at 6 months post discharge from the ICU. The correlations between abnormalities on CT and lung function tests were weak. Further, studies with a long-term follow-up of lung function in this group of patients are needed.
Collapse
Affiliation(s)
- Ylva Konsberg
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Aneman
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Science, Sydney, Australia
| | - Sanna Kjellberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Göteborg, Sweden
| | - Nektarios Solidakis
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Svedlund
- Department of Clinical Physiology, Sahlgrenska Univsersity Hospital, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| |
Collapse
|
6
|
Stevens-Jones O, Malmeström C, Constantinescu C, Dalla K, Nellgård B, Zelano J, Constantinescu R, Axelsson M. Presence of neural surface and onconeural autoantibodies in cerebrospinal fluid and serum in neurological diseases presents a potential risk for misdiagnosis. Eur J Neurol 2023; 30:2602-2610. [PMID: 37312655 DOI: 10.1111/ene.15926] [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] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE Autoantibodies have been found to contribute to pathology and are used in the diagnosis of some neurological diseases. We examined the prevalence of autoantibodies in patients with various neurological diseases and whether patients who had autoantibodies differed in age, sex, or disability from those who did not. METHODS We examined the prevalence of neural surface and onconeural autoantibodies in cerebrospinal fluid (CSF) and serum from patients with multiple sclerosis (n = 64), Parkinson disease plus atypical parkinsonism (n = 150), amyotrophic lateral sclerosis (n = 43), or autoimmune encephalitis (positive control; n = 7) and a healthy control group (n = 37). A total of 12 onconeural autoantibodies and six neural surface autoantibodies were tested in all participants. RESULTS Autoantibodies were present in all cohorts. The prevalence of autoantibodies was high (>80%) in the autoimmune encephalitis cohort but low (<20%) in all other cohorts. When comparing patients within cohorts who were positive for autoantibodies to patients who were not, there was no difference in age, sex, and disability. This was apart from the multiple sclerosis and Parkinson disease plus atypical parkinsonism cohorts, where those with positivity for autoantibodies in the CSF were significantly older. CONCLUSIONS The presence of the autoantibodies examined does not appear to have a substantial clinical impact within the diseases examined in this study. The presence of autoantibodies in all cohorts presents a risk for misdiagnosis when the method is used incorrectly on patients with atypical clinical presentation.
Collapse
Affiliation(s)
- Oskar Stevens-Jones
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clas Malmeström
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clara Constantinescu
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Keti Dalla
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Nellgård
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Zelano
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center of Molecular and Translational Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Radu Constantinescu
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Axelsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
7
|
Gonzalez-Ortiz F, Dulewicz M, Ashton NJ, Kac PR, Zetterberg H, Andersson E, Yakoub Y, Hanrieder J, Turton M, Harrison P, Nellgård B, Karikari TK, Blennow K. Association of Serum Brain-Derived Tau With Clinical Outcome and Longitudinal Change in Patients With Severe Traumatic Brain Injury. JAMA Netw Open 2023; 6:e2321554. [PMID: 37399012 PMCID: PMC10318474 DOI: 10.1001/jamanetworkopen.2023.21554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/10/2023] [Indexed: 07/04/2023] Open
Abstract
Importance Blood-based measurements of total tau (T-tau) are commonly used to examine neuronal injury in patients with traumatic brain injury (TBI), but current assays do not differentiate between brain-derived tau (BD-tau) and tau produced in peripheral tissues. A novel assay for BD-tau has recently been reported that selectively quantifies nonphosphorylated tau of central nervous system origin in blood samples. Objectives To examine the association of serum BD-tau with clinical outcomes in patients with severe TBI (sTBI) and its longitudinal changes over 1 year. Design, Setting, and Participants This prospective cohort study was conducted at the neurointensive unit at the Sahlgrenska University Hospital, Gothenburg, Sweden, between September 1, 2006, and July 1, 2015. The study included 39 patients with sTBI followed up for up to 1 year. Statistical analysis was performed between October and November 2021. Exposures Serum BD-tau, T-tau, phosphorylated tau231 (p-tau231), and neurofilament light chain (NfL) measured on days 0, 7, and 365 after injury. Main Outcomes and Measures Associations of serum biomarkers with clinical outcome and longitudinal change in sTBI. Severity of sTBI was evaluated using the Glasgow Coma Scale at hospital admission, while clinical outcome was assessed with the Glasgow Outcome Scale (GOS) at 1-year follow-up. Participants were classified as having a favorable outcome (GOS score, 4-5) or unfavorable outcome (GOS score, 1-3). Results Among the 39 patients (median age at admission, 36 years [IQR, 22-54 years]; 26 men [66.7%]) in the study on day 0, the mean (SD) serum BD-tau level was higher among patients with unfavorable outcomes vs those with favorable outcomes (191.4 [190.8] pg/mL vs 75.6 [60.3] pg/mL; mean difference, 115.9 pg/mL [95% CI, 25.7-206.1 pg/mL]), while the other markers had smaller between-group mean differences (serum T-tau, 60.3 pg/mL [95% CI, -22.0 to 142.7 pg/mL]; serum p-tau231, 8.3 pg/mL [95% CI, -6.4 to 23.0 pg/mL]; serum NfL, -5.4 pg/mL [95% CI, -99.0 to 88.3 pg/mL]). Similar results were recorded on day 7. Longitudinally, baseline serum BD-tau concentrations showed slower decreases in the whole cohort (42.2% on day 7 [from 138.6 to 80.1 pg/mL] and 93.0% on day 365 [from 138.6 to 9.7 pg/mL]) compared with serum T-tau (81.5% on day 7 [from 57.3 to 10.6 pg/mL] and 99.0% on day 365 [from 57.3 to 0.6 pg/mL]) and p-tau231 (92.5% on day 7 [from 20.1 to 1.5 pg/mL] and 95.0% on day 365 [from 20.1 to 1.0 pg/mL]). These results did not change when considering clinical outcome, where T-tau decreased twice as fast as BD-tau in both groups. Similar results were obtained for p-tau231. Furthermore, the biomarker levels on day 365 were lower, compared with day 7, for BD-tau but not T-tau or p-tau231. Serum NfL had a different trajectory to the tau biomarkers, with levels increasing by 255.9% on day 7 compared with day 0 (from 86.8 to 308.9 pg/mL) but decreasing by 97.0% by day 365 vs day 7 (from 308.9 to 9.2 pg/mL). Conclusions and Relevance This study suggests that serum BD-tau, T-tau, and p-tau231 have differential associations with clinical outcome and 1-year longitudinal change in patients with sTBI. Serum BD-tau demonstrated utility as a biomarker to monitor outcomes in sTBI and can provide valuable information regarding acute neuronal damage.
Collapse
Affiliation(s)
- Fernando Gonzalez-Ortiz
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Maciej Dulewicz
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Nicholas J. Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute London, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation London, London, United Kingdom
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Przemysław R. Kac
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin–Madison, Madison
| | - Emma Andersson
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Yara Yakoub
- Douglas Mental Health University Institute, Centre for Studies on the Prevention of Alzheimer’s Disease, Montreal, Quebec, Canada
| | - Jörg Hanrieder
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | | | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care; Sahlgrenska University Hospital, Mölndal, Sweden
| | - Thomas K. Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
8
|
Olsen F, Hård af Segerstad M, Dalla K, Ricksten SE, Nellgård B. Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients. F1000Res 2023; 12:210. [PMID: 37497335 PMCID: PMC10366555 DOI: 10.12688/f1000research.130387.2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/28/2023] Open
Abstract
Background: Systemic haemodynamic effects of intrathecal anaesthesia in an aging and frail population has not been well investigated. We examined the systemic haemodynamics of fractional spinal anaesthesia following intermittent microdosing of a local anaesthetic and an opioid. Methods: We included 15 patients aged over 65 with significant comorbidities, planned for hip fracture repair. Patients received a spinal catheter and cardiac output monitoring using the LiDCOplus system. All measurements were performed prior to start of surgery. Invasive mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate and stroke volume index (SVI) were registered. Two doses of bupivacaine 2.25 mg and fentanyl 15 µg were administered with 25-minute intervals. Hypotension was defined as a fall in MAP by >30% or a MAP <65 mmHg. Results: The incidence of hypotension was 30%. Hypotensive patients (n=5) were treated with low doses of norepinephrine (0.01-0.12 µg/kg/min). MAP showed a maximum reduction of 17% at 10 minutes following the first dose. CI, systemic vascular resistance index and stroke volume index decreased by 10%, 6%, and 7%, respectively, while heart rate was unchanged over time. After the second dose, none of the systemic haemodynamic variables were affected. Conclusions: Fractional spinal anaesthesia administered prior to surgery induced a minor to moderate fall in MAP, mainly caused by a reduction in cardiac output, induced by systemic venodilation, causing a fall in venous return. Our results are contrary to the widely held belief that hypotension is mainly the result of a reduction of systemic vascular resistance.
Collapse
Affiliation(s)
- Fredrik Olsen
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Keti Dalla
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Nellgård
- Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
9
|
Frödin M, Rogmark C, Nellgård B, Gillespie BM, Wikström E, Andersson AE. Interactive Interventions Can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care-Experience From the "Safe Hands" Project. J Perianesth Nurs 2023; 38:284-290. [PMID: 36319520 DOI: 10.1016/j.jopan.2022.07.006] [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: 02/15/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. DESIGN This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. METHODS The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. FINDINGS The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. CONCLUSIONS This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.
Collapse
Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden.
| | - Cecilia Rogmark
- Department of Orthopedics Malmö, Lund University, Skane University Hospital, Lund, Skane, Sweden; The Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Västra Götalandregionen, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Griffith, Queensland, Australia; Health Service, Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| | - Annette E Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| |
Collapse
|
10
|
Falk Erhag H, Guðnadóttir G, Alfredsson J, Cederholm T, Ekerstad N, Religa D, Nellgård B, Wilhelmson K. The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature. Clin Interv Aging 2023; 18:249-261. [PMID: 36843633 PMCID: PMC9946013 DOI: 10.2147/cia.s388160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 09/13/2022] [Accepted: 12/14/2022] [Indexed: 02/19/2023] Open
Abstract
Background Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill. Purpose To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings. Design Systematic review with narrative synthesis. Methods Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Results Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review. Conclusion A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
Collapse
Affiliation(s)
- Hanna Falk Erhag
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Correspondence: Hanna Falk Erhag, Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Wallinsgatan 6, Gothenburg, SE 431 41, Sweden, Tel +46 760 476888, Fax +46 31 786 60 77, Email
| | - Gudny Guðnadóttir
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Ekerstad
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden,The Research and Development Unit, NU Hospital Group, Trollhättan, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences, and Society, Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden,Division for Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Studies, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Wilhelmson
- Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
11
|
Nilsson J, Constantinescu J, Nellgård B, Jakobsson P, Brum WS, Gobom J, Forsgren L, Dalla K, Constantinescu R, Zetterberg H, Hansson O, Blennow K, Bäckström D, Brinkmalm A. Cerebrospinal Fluid Biomarkers of Synaptic Dysfunction are Altered in Parkinson's Disease and Related Disorders. Mov Disord 2023; 38:267-277. [PMID: 36504237 DOI: 10.1002/mds.29287] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 06/09/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Synaptic dysfunction and degeneration are central contributors to the pathogenesis and progression of parkinsonian disorders. Therefore, identification and validation of biomarkers reflecting pathological synaptic alterations are greatly needed and could be used in prognostic assessment and to monitor treatment effects. OBJECTIVE To explore candidate biomarkers of synaptic dysfunction in Parkinson's disease (PD) and related disorders. METHODS Mass spectrometry was used to quantify 15 synaptic proteins in two clinical cerebrospinal fluid (CSF) cohorts, including PD (n1 = 51, n2 = 101), corticobasal degeneration (CBD) (n1 = 11, n2 = 3), progressive supranuclear palsy (PSP) (n1 = 22, n2 = 21), multiple system atrophy (MSA) (n1 = 31, n2 = 26), and healthy control (HC) (n1 = 48, n2 = 30) participants, as well as Alzheimer's disease (AD) (n2 = 23) patients in the second cohort. RESULTS Across both cohorts, lower levels of the neuronal pentraxins (NPTX; 1, 2, and receptor) were found in PD, MSA, and PSP, compared with HC. In MSA and PSP, lower neurogranin, AP2B1, and complexin-2 levels compared with HC were observed. In AD, levels of 14-3-3 zeta/delta, beta- and gamma-synuclein were higher compared with the parkinsonian disorders. Lower pentraxin levels in PD correlated with Mini-Mental State Exam scores and specific cognitive deficits (NPTX2; rho = 0.25-0.32, P < 0.05) and reduced dopaminergic pre-synaptic integrity as measured by DaTSCAN (NPTX2; rho = 0.29, P = 0.023). Additionally, lower levels were associated with the progression of postural imbalance and gait difficulty symptoms (All NPTX; β-estimate = -0.025 to -0.038, P < 0.05) and cognitive decline (NPTX2; β-estimate = 0.32, P = 0.021). CONCLUSIONS These novel findings show different alterations of synaptic proteins in parkinsonian disorders compared with AD and HC. The neuronal pentraxins may serve as prognostic CSF biomarkers for both cognitive and motor symptom progression in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Johanna Nilsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Julius Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Protik Jakobsson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Wagner S Brum
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Johan Gobom
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Radu Constantinescu
- Department of Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - David Bäckström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Ann Brinkmalm
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| |
Collapse
|
12
|
Robertson J, Nellgård B, Hultén LM, Nilsson S, Dalla K, Börjesson M, Zetterberg H, Svanvik J, Gisslén M. Sex difference in circulating soluble form of ACE2 protein in moderate and severe COVID-19 and healthy controls. Front Med (Lausanne) 2022; 9:1058120. [PMID: 36569121 PMCID: PMC9773379 DOI: 10.3389/fmed.2022.1058120] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Membrane-bound angiotensin-converting enzyme-2 (ACE2) in epithelial cells is the main receptor for SARS-CoV-2. The extracellular portion of ACE2 may be shedded to plasma in which process ADAM17 (a disintegrin and metalloproteinase 17) is important. Results on the relationship between circulating levels of the soluble form of ACE2 (sACE2) and disease severity are inconclusive. This study investigates if sACE2 concentration correlates with COVID-19 severity, and whether this is affected by sex. Materials and methods Soluble form of ACE2 was analyzed in three groups: 104 patients (23 women and 81 men) with severe COVID-19 admitted to an intensive care unit (ICU), patients with moderate COVID-19 who required hospital care (n = 19, 4 women and 15 men), and age and sex matched healthy controls (n = 20, 4 women and 16 men). Blood samples were collected at hospital admission between 18 March 2020, and 3 May 2021, and at follow-up between 27 October 2020, and 19 October 2021. Circulating sACE2 (μg/L) was measured in EDTA plasma with a sensitive enzyme-linked immunosorbent assay. Additionally, CRP, ferritin, and lymphocyte count were analyzed during hospital stay. Results In total, 23 patients (22%) died in the ICU. When comparing healthy controls [mean age 58.1 (SD 11.4) years] and patients with moderate COVID-19 [mean age 61.0 (SD 13.2) years] with patients in the ICU [mean age 63.6 (SD 11.6) years], we found that sACE2 concentration decreased (70% reduction) with disease severity in men (p = 0.002) but increased 3.7-fold with severity in women (p = 0.043), suggesting a sex-related difference in how COVID-19 severity is related to sACE2 concentration. Moreover, we identified a relationship between inflammatory biomarkers and sACE2 concentration during the intensive care treatment, such that higher CRP and higher ferritin concentration correlated with lower sACE2 concentration in men. Conclusion The decrease in sACE2 concentration, selectively in men, in severe COVID-19 is of pathophysiological interest since men are affected more severely by the disease compared to women. Additionally, the inflammatory biomarkers, CRP and ferritin, correlated inversely with sACE2 concentration, suggesting a role in severe disease. Our findings imply that sACE2 is a possible biomarker of disease severity in a sex-specific manner.
Collapse
Affiliation(s)
- Josefina Robertson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden,*Correspondence: Josefina Robertson,
| | - Bengt Nellgård
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Anaesthesiology and Intensive care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lillemor Mattsson Hultén
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Keti Dalla
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Anaesthesiology and Intensive care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden,Center for Health and Performance, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Neurodegenerative Disease, University College London (UCL) Institute of Neurology, London, United Kingdom,United Kingdom Dementia Research Institute, University College London (UCL), London, United Kingdom,Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Kowloon, Hong Kong SAR, China
| | - Joar Svanvik
- The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
13
|
Frödin M, Nellgård B, Rogmark C, Gillespie BM, Wikström E, Andersson AE. A co-created nurse-driven catheterisation protocol can reduce bladder distension in acute hip fracture patients - results from a longitudinal observational study. BMC Nurs 2022; 21:276. [PMID: 36224550 PMCID: PMC9559039 DOI: 10.1186/s12912-022-01057-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Urinary retention is common in elderly patients undergoing acute hip fracture surgery. Avoiding overfilling the urinary bladder is important to avoid detrusor muscle damage and associated motility problems. The aim of this study was to analyse associations between the co-creation of a nurse-driven urinary catheterisation protocol and the incidence of bladder distension in patients undergoing hip fracture surgery. Methods This is a single-centre implementation intervention with a retrospective longitudinal observation design, using five measures points, spanning from June 2015 to March 2020. The intervention was theory driven and the participants, together with the facilitators and researcher, co-created a nurse-driven urinary catheterisation protocol. Data were retrieved from the hip fracture register. Uni- and multivariable logistic regressions were used for analyses of changes in bladder distension and urinary volume of ≥500 ml over the years. Results A total of 3078 patients were included over a five-year period. The implementation intervention was associated with a reduction in the proportion of patients with bladder distension of 31.5% (95% confidence interval 26.0–37.0), from year 1 to year 5. The multivariable analysis indicated a 39% yearly reduction in bladder distension, OR 0.61 (95% confidence interval 0.57–0.64, p < 0001). There was a reduction in the proportion of patients with a bladder volume of ≥500 ml of 42.8% (95% confidence interval 36.2–49.4), from year 1 to year 5. The multivariable analysis found a 41% yearly reduction in patients with a bladder volume of ≥500 ml, OR 0.59 (95% confidence interval 0.55–0.64, p < 0.0001). The intervention was associated with improved documentation of both catheter indications and removal plans. Conclusion The use of predefined catheter indications and a tighter bladder scanning schedule were associated with a reduction in the incidence of both bladder distension and urine volume ≥ 500 ml in hip fracture patients. Registered nurses can play an active role in the facilitation of timely and appropriate catheter treatment in patients with hip fractures. Trial registration Clinical Trial Registry ISRCTN 17022695 registered retrospectively on 23 December 2021, in the end of the study, after data collection. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01057-z.
Collapse
Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden.
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden
| | - Cecilia Rogmark
- Skane University Hospital, Department of Orthopaedics Malmö, Lund University, Lund, Sweden.,The Swedish Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Queensland, Griffith University, Brisbane, Australia.,Gold Coast University Hospital and Health Service, Southport, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska University Hospital, Ortopedoperation 1, Göteborgsvägen 31, SE-431 80, Gothenburg, Sweden
| |
Collapse
|
14
|
Erichsen Andersson A, Gillespie BM, Karlsson M, Malchau H, Nellgård B, Wikström E, Rogmark C, Tillander J. Reduction of early surgical site and other care related infections in 3553 hip fracture patients: lessons learned from the 5-year Safe Hands project. Antimicrob Resist Infect Control 2022; 11:113. [PMID: 36064457 PMCID: PMC9444111 DOI: 10.1186/s13756-022-01153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Surgical site infection (SSI) after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project. Methods This was a single-centre observational study with a 5-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Results The incidence of early SSIs decreased from 2.5% in years 1–2 to 1.1% in years 4–5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression results suggest that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly.
Conclusions Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other hospital acquired infections after hip fracture surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements.
Trial registration: Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016—Retrospectively registered.
Collapse
|
15
|
Ali M, Sung YJ, Wang F, Fernández MV, Morris JC, Fagan AM, Blennow K, Zetterberg H, Heslegrave A, Johansson PM, Svensson J, Nellgård B, Lleó A, Alcolea D, Clarimon J, Rami L, Molinuevo JL, Suárez-Calvet M, Morenas-Rodríguez E, Kleinberger G, Haass C, Ewers M, Levin J, Farlow MR, Perrin RJ, Cruchaga C. Leveraging large multi-center cohorts of Alzheimer disease endophenotypes to understand the role of Klotho heterozygosity on disease risk. PLoS One 2022; 17:e0267298. [PMID: 35617280 PMCID: PMC9135221 DOI: 10.1371/journal.pone.0267298] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 02/23/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
Two genetic variants in strong linkage disequilibrium (rs9536314 and rs9527025) in the Klotho (KL) gene, encoding a transmembrane protein, implicated in longevity and associated with brain resilience during normal aging, were recently shown to be associated with Alzheimer disease (AD) risk in cognitively normal participants who are APOE ε4 carriers. Specifically, the participants heterozygous for this variant (KL-SVHET+) showed lower risk of developing AD. Furthermore, a neuroprotective effect of KL-VSHET+ has been suggested against amyloid burden for cognitively normal participants, potentially mediated via the regulation of redox pathways. However, inconsistent associations and a smaller sample size of existing studies pose significant hurdles in drawing definitive conclusions. Here, we performed a well-powered association analysis between KL-VSHET+ and five different AD endophenotypes; brain amyloidosis measured by positron emission tomography (PET) scans (n = 5,541) or cerebrospinal fluid Aβ42 levels (CSF; n = 5,093), as well as biomarkers associated with tau pathology: the CSF Tau (n = 5,127), phosphorylated Tau (pTau181; n = 4,778) and inflammation: CSF soluble triggering receptor expressed on myeloid cells 2 (sTREM2; n = 2,123) levels. Our results found nominally significant associations of KL-VSHET+ status with biomarkers for brain amyloidosis (e.g., CSF Aβ positivity; odds ratio [OR] = 0.67 [95% CI, 0.55-0.78], β = 0.72, p = 0.007) and tau pathology (e.g., biomarker positivity for CSF Tau; OR = 0.39 [95% CI, 0.19-0.77], β = -0.94, p = 0.007, and pTau; OR = 0.50 [95% CI, 0.27-0.96], β = -0.68, p = 0.04) in cognitively normal participants, 60-80 years old, who are APOE e4-carriers. Our work supports previous findings, suggesting that the KL-VSHET+ on an APOE ε4 genotype background may modulate Aβ and tau pathology, thereby lowering the intensity of neurodegeneration and incidence of cognitive decline in older controls susceptible to AD.
Collapse
Affiliation(s)
- Muhammad Ali
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Neurogenomics and Informatics Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Yun Ju Sung
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Neurogenomics and Informatics Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Fengxian Wang
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Neurogenomics and Informatics Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Maria V. Fernández
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Neurogenomics and Informatics Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Anne M. Fagan
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Department of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Department of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
| | - Per M. Johansson
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Svensson
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Bengt Nellgård
- Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Alberto Lleó
- Neurology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Daniel Alcolea
- Neurology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Jordi Clarimon
- Neurology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Lorena Rami
- IDIBAPS, Alzheimer´s Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic, Barcelona, Spain
| | - José Luis Molinuevo
- IDIBAPS, Alzheimer´s Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic, Barcelona, Spain
- Alzheimer´s Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari, Barcelona, Spain
- BarcelonaBeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Marc Suárez-Calvet
- BarcelonaBeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- Biomedical Center (BMC), Biochemistry, Ludwig‐Maximilians‐Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Estrella Morenas-Rodríguez
- Biomedical Center (BMC), Biochemistry, Ludwig‐Maximilians‐Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Gernot Kleinberger
- Biomedical Center (BMC), Biochemistry, Ludwig‐Maximilians‐Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Christian Haass
- Biomedical Center (BMC), Biochemistry, Ludwig‐Maximilians‐Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin R. Farlow
- Indiana Alzheimer Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Richard J. Perrin
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | | | | | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Neurogenomics and Informatics Center, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, Missouri, United States of America
| |
Collapse
|
16
|
Frödin M, Ahlstrom L, Gillespie BM, Rogmark C, Nellgård B, Wikström E, Erichsen Andersson A. Effectiveness of implementing a preventive urinary catheter care bundle in hip fracture patients. J Infect Prev 2022; 23:41-48. [PMID: 35340925 PMCID: PMC8941588 DOI: 10.1177/17571774211060417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/20/2020] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Urinary catheter (UC)–associated infections are one of the most common
preventable healthcare-associated infections (HAIs) and they frequently
occur in older, frail populations. Aim The study aim was to describe the incidence of UC-associated infection in
elderly patients undergoing hip fracture surgery after implementing a
preventive care bundle. Methods A longitudinal prospective study using a before-and-after design. The bundle
was theory driven and involved the co-creation of a standard operational
procedure, education and practical training sessions. Prospectively
collected registry data were analysed. Univariable statistics and
multivariable logistic regressions were used for analyses. Results 2,408 patients with an acute hip fracture were included into the study. There
was an overall reduction in UC catheter associated-associated urinary tract
infections, from 18.5% (n = 75/406) over time to 4.2%
(n = 27/647). When adjusting for all identified
confounders, patients in phase 4 were 74% less likely to contract an
UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p
< 0.0001). Discussion Bundled interventions can reduce UC-associated infections substantially, even
in elderly frail patients. Partnership and co-creation as implementation
strategies appear to be promising in the fight against HAI.
Collapse
Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Ahlstrom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Brigid M. Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia
- Gold Coast University Hospital and Health Service, Southport, QLD, Australia
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, Malmö, Sweden
- Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
17
|
Sellbrant I, Blomstrand J, Karlsson J, Nellgård B, Jakobsson J. Brace versus cast following surgical treatment of distal radial fracture: a prospective randomised study comparing quality of recovery. F1000Res 2022; 10:336. [PMID: 35211291 PMCID: PMC8837810 DOI: 10.12688/f1000research.52046.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Immobilisation following surgical treatment of distal radial fractures (DRF) is traditionally performed with a dorsal cast splint. There is an interest in changing the rigid cast to a removable brace. This can reduce the risk for cast-corrections, complications and improve recovery of function. The aim of the study was to compare quality of recovery (QoR) between brace and traditional cast for immobilisation during the first postoperative week. Methods: 60 patients with American Society of Anesthesiologists (ASA) physical status 1–3, scheduled for surgical treatment of DRF under a supraclavicular block (SCB) in a day-surgery setting were randomised into two groups of immobilisation post-surgery; brace (n=30)
versus traditional cast (n=30). Study objectives were: differences in self-assessed QoR using the QoR-15 questionnaire, postoperative oral oxycodone consumption, perioperative time events and unplanned healthcare contacts one week postoperatively. Results: 54 patients, 46 females/eight males were included in the analysis; 27 with brace and 27 with traditional cast. QoR-15 median scores improved significantly from baseline/preoperative to day 7 (brace p=0.001, cast p=0.001) with no differences between the two groups. The only difference found was that patients in the brace group had significantly worse pain score 24-hours post-surgery (p=0.022). No significant differences were seen in total median oxycodone consumption the
first three postoperative days. No differences were found in perioperative events or unplanned healthcare contacts. Conclusions: Brace appears to be a feasible option to traditional cast for immobilisation following surgical treatment of DRF. The early QoR was similar in both groups apart from more pain in the brace group the first 24 postoperative hours.
Collapse
Affiliation(s)
- Irén Sellbrant
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Johanna Blomstrand
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Jan Jakobsson
- Department of Anaesthesia & Intensive Care, Institute of Clinical Science, Karolinska Institute, Danderyd University Hospital, Stockholm, 182 88, Sweden
| |
Collapse
|
18
|
Kanberg N, Simrén J, Éden A, Andersson L, Nilsson S, Ashton NJ, Sundvall P, Nellgård B, Blennow K, Zetterberg H, Gisslén M. Neurochemical signs of astrocytic and neuronal injury in acute COVID‐19 normalizes during long‐term follow‐up. Alzheimers Dement 2021. [PMCID: PMC9011655 DOI: 10.1002/alz.057889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022]
Abstract
Background Neurologic manifestations are well‐recognized features of coronavirus disease 2019 (COVID‐19). However, the longitudinal association of biomarkers reflecting CNS impact and neurological symptoms is not known. We wished to determine whether plasma biomarkers of CNS injury were associated with neurologic sequelae after COVID‐19. Method Patients with confirmed acute COVID‐19 were studied prospectively. Neurological symptoms were recorded during the acute phase of the disease and at six months follow‐up, and blood samples were collected longitudinally. Healthy age‐matched individuals were included as controls. We analyzed plasma concentrations of neurofilament light‐chain (NfL), glial fibrillary acidic protein (GFAp), and growth differentiation factor 15 (GDF‐15). Result We recruited 100 patients with mild (n = 24), moderate (n = 28), and severe (n = 48) COVID‐19 who were followed for a median of (IQR) 225 (187–262) days. In the acute phase, patients with severe COVID‐19 had higher concentrations of NfL than all other groups (all p < 0.001) and higher GFAp than controls (p < 0.001). GFAp was also significantly increased in moderate disease (p < 0.05) compared with controls. NfL (r = 0.53, p < 0.001) and GFAp (r = 0.39, p < 0.001) correlated with GDF‐15 during the acute phase. After six months, NfL and GFAp concentrations had normalized, with no persisting group differences. Despite this, 50 patients reported persistent neurological symptoms, most commonly included fatigue (n = 40), “brain‐fog” (n = 29), and changes in cognition (n = 25). We found no relation between persistent neurological symptoms and CNS injury biomarkers in the acute phase. Conclusion The normalization of CNS injury biomarkers in all individuals, regardless of previous disease severity or persisting neurological symptoms, indicate that post‐acute COVID‐19 neurological sequelae are not accompanied by ongoing CNS injury. Although injury biomarkers commonly increase in severe acute COVID‐19, further investigations into the causes of post‐infectious sequelae are needed.
Collapse
Affiliation(s)
- Nelly Kanberg
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Joel Simrén
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital Mölndal Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
| | - Arvid Éden
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Lars‐Magnus Andersson
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Staffan Nilsson
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Nicholas J. Ashton
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation London United Kingdom
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Gothenburg Sweden
- King's College London London United Kingdom
| | - Pär‐Daniel Sundvall
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland Gothenburg Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Bengt Nellgård
- Institute of Clinical Sciences/Sahlgrenska Academy Gothenburg Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital Mölndal Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital Mölndal Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- UCL Institute of Neurology London United Kingdom
- UK Dementia Research Institute Fluid Biomarkers Laboratory, UK DRI at UCL London United Kingdom
| | - Magnus Gisslén
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| |
Collapse
|
19
|
Sellbrant I, Karlsson J, Jakobsson JG, Nellgård B. Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study. BMC Anesthesiol 2021; 21:273. [PMID: 34753423 PMCID: PMC8577027 DOI: 10.1186/s12871-021-01499-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/17/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control. METHODS Patients (n = 90) with ASA physical status 1-3 were prospectively randomised to receive; SCB with mepivacine 1%, 25-30 ml (n = 30), SCB with ropivacaine 0.5%, 25-30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups. RESULTS The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3-3.3) and 2.7 (IQR 1.3-4.2) (p = 0.017) and OEC 30 mg (IQR 10-80) and 85 mg (IQR 45-125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%). CONCLUSIONS The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution. TRIAL REGISTRATION NCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).
Collapse
Affiliation(s)
- Irén Sellbrant
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jon Karlsson
- Department of Orthopedic Surgery, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia & Intensive Care, Institute of Clinical Science, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
20
|
Olsen F, Lundborg F, Kristiansson J, Hård af Segerstad M, Ricksten S, Nellgård B. Validation of the Nottingham Hip Fracture Score (NHFS) for the prediction of 30-day mortality in a Swedish cohort of hip fractures. Acta Anaesthesiol Scand 2021; 65:1413-1420. [PMID: 34363201 DOI: 10.1111/aas.13966] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/22/2020] [Revised: 07/07/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hip fracture is a common osteoporotic fracture with great morbidity and mortality. The utility of ASA classification is limited, as most patients are ≥ASA 3. A reliable predictor of mortality risk could support decision-making. We aimed to evaluate Nottingham hip fracture score (NHFS) for the prediction of 30-day mortality and then to recalibrate the formula converting NHFS to risk of 30-day mortality. METHODS All patients >60 years with surgically treated hip fracture surgery during 2015-16 were assessed. Data was extracted manually from routinely collected clinical data in registry and medical records. Discriminative performance of NHFS and ASA was assessed with C-statistics. The conversion formula from NHFS to risk of 30-day mortality was recalibrated using logistic binominal regression. Observed vs expected ratios of 30-day mortality were compared with the 2012 NHFS-formula and recalibration was performed in a split dataset. RESULTS 1864 patients were included, with 213 deaths within 30 days. C-statistic were 0.64 for NHFS and 0.62 for ASA. Comparing expected values from the 2012-revision with our observed deaths gave a ratio of 1.37. Relating predicted levels of 30-day mortality based on 70% of our cohort vs. 30% test portion of our Swedish dataset gave a ratio of 0.97. DISCUSSION NHFS underestimated mortality in our cohort and showed poor discrimination. Revision of the formula based on a split dataset improved calibration. We suggest NHFS to be routinely implemented to support clinical judgements, expand preoperative assessment and escalate intraoperative monitoring.
Collapse
Affiliation(s)
- Fredrik Olsen
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Fredrika Lundborg
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Johan Kristiansson
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Mathias Hård af Segerstad
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| | - Sven‐Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Sahlgrenska University Hospital Mölndal Sweden
| |
Collapse
|
21
|
Kanberg N, Simrén J, Edén A, Andersson LM, Nilsson S, Ashton NJ, Sundvall PD, Nellgård B, Blennow K, Zetterberg H, Gisslén M. Neurochemical signs of astrocytic and neuronal injury in acute COVID-19 normalizes during long-term follow-up. EBioMedicine 2021; 70:103512. [PMID: 34333238 PMCID: PMC8320425 DOI: 10.1016/j.ebiom.2021.103512] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [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: 05/07/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023] Open
Abstract
Background Neurologic manifestations are well-recognized features of coronavirus disease 2019 (COVID-19). However, the longitudinal association of biomarkers reflecting CNS impact and neurological symptoms is not known. We sought to determine whether plasma biomarkers of CNS injury were associated with neurologic sequelae after COVID-19. Methods Patients with confirmed acute COVID-19 were studied prospectively. Neurological symptoms were recorded during the acute phase of the disease and at six months follow-up, and blood samples were collected longitudinally. Healthy age-matched individuals were included as controls. We analysed plasma concentrations of neurofilament light-chain (NfL), glial fibrillary acidic protein (GFAp), and growth differentiation factor 15 (GDF-15). Findings One hundred patients with mild (n = 24), moderate (n = 28), and severe (n = 48) COVID-19 were followed for a median (IQR) of 225 (187–262) days. In the acute phase, patients with severe COVID-19 had higher concentrations of NfL than all other groups (all p < 0·001), and higher GFAp than controls (p < 0·001). GFAp was also significantly increased in moderate disease (p < 0·05) compared with controls. NfL (r = 0·53, p < 0·001) and GFAp (r = 0·39, p < 0·001) correlated with GDF-15 during the acute phase. After six months, NfL and GFAp concentrations had normalized, with no persisting group differences. Despite this, 50 patients reported persistent neurological symptoms, most commonly fatigue (n = 40), “brain-fog” (n = 29), and changes in cognition (n = 25). We found no correlation between persistent neurological symptoms and CNS injury biomarkers in the acute phase. Interpretation The normalization of CNS injury biomarkers in all individuals, regardless of previous disease severity or persisting neurological symptoms, indicates that post COVID-19 neurological sequelae are not accompanied by ongoing CNS injury. Funding The Swedish State Support for Clinical Research, SciLifeLab Sweden, and the Knut and Alice Wallenberg Foundation have provided funding for this project.
Collapse
Affiliation(s)
- Nelly Kanberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Arvid Edén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, London, UK; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - Pär-Daniel Sundvall
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Sweden; General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive care, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
22
|
Bergström S, Remnestål J, Yousef J, Olofsson J, Markaki I, Carvalho S, Corvol JC, Kultima K, Kilander L, Löwenmark M, Ingelsson M, Blennow K, Zetterberg H, Nellgård B, Brosseron F, Heneka MT, Bosch B, Sanchez-Valle R, Månberg A, Svenningsson P, Nilsson P. Multi-cohort profiling reveals elevated CSF levels of brain-enriched proteins in Alzheimer's disease. Ann Clin Transl Neurol 2021; 8:1456-1470. [PMID: 34129723 PMCID: PMC8283172 DOI: 10.1002/acn3.51402] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/13/2021] [Revised: 03/30/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Decreased amyloid beta (Aβ) 42 together with increased tau and phospho-tau in cerebrospinal fluid (CSF) is indicative of Alzheimer's disease (AD). However, the molecular pathophysiology underlying the slowly progressive cognitive decline observed in AD is not fully understood and it is not known what other CSF biomarkers may be altered in early disease stages. METHODS We utilized an antibody-based suspension bead array to analyze levels of 216 proteins in CSF from AD patients, patients with mild cognitive impairment (MCI), and controls from two independent cohorts collected within the AETIONOMY consortium. Two additional cohorts from Sweden were used for biological verification. RESULTS Six proteins, amphiphysin (AMPH), aquaporin 4 (AQP4), cAMP-regulated phosphoprotein 21 (ARPP21), growth-associated protein 43 (GAP43), neurofilament medium polypeptide (NEFM), and synuclein beta (SNCB) were found at increased levels in CSF from AD patients compared with controls. Next, we used CSF levels of Aβ42 and tau for the stratification of the MCI patients and observed increased levels of AMPH, AQP4, ARPP21, GAP43, and SNCB in the MCI subgroups with abnormal tau levels compared with controls. Further characterization revealed strong to moderate correlations between these five proteins and tau concentrations. INTERPRETATION In conclusion, we report six extensively replicated candidate biomarkers with the potential to reflect disease development. Continued evaluation of these proteins will determine to what extent they can aid in the discrimination of MCI patients with and without an underlying AD etiology, and if they have the potential to contribute to a better understanding of the AD continuum.
Collapse
Affiliation(s)
- Sofia Bergström
- Division of Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Julia Remnestål
- Division of Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Jamil Yousef
- Division of Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Jennie Olofsson
- Division of Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ioanna Markaki
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Stephanie Carvalho
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Assistance-Publique Hôpitaux de Paris, INSERM, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, Centre d'Investigation Clinique Neurosciences, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Assistance-Publique Hôpitaux de Paris, INSERM, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, Centre d'Investigation Clinique Neurosciences, Paris, France
| | - Kim Kultima
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Malin Löwenmark
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Bengt Nellgård
- Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg
| | - Frederic Brosseron
- Universitätsklinikum Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Beatriz Bosch
- Alzheimer's and other cognitive disorders Unit. Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Raquel Sanchez-Valle
- Alzheimer's and other cognitive disorders Unit. Service of Neurology, Hospital Clínic de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Anna Månberg
- Division of Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Peter Nilsson
- Division of Affinity Proteomics, Department of Protein Science, SciLifeLab, KTH Royal Institute of Technology, Stockholm, Sweden
| |
Collapse
|
23
|
Norden N, Lundin EO, Hagberg E, Gao SA, Hård af Segerstad M, Nellgård B, Dalla K. Cardiac involvement in critically ill and mechanically ventilated patients with COVID-19 - a prospective, observational echocardiographic study. Am J Cardiovasc Dis 2021; 11:253-261. [PMID: 34084661 PMCID: PMC8166586] [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] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/20/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION In this prospective, observational study, we have evaluated right (RV) and left (LV) ventricular function with echocardiography and correlated it to the levels of biomarkers, hs-TNT, NT-pro-BNP, D-dimer and fibrinogen. In a subgroup, we have evaluated the effect of inhaled milrinone on RV afterload and function. METHODS Thirty-one ICU patients with COVID-19 in need of mechanical ventilation and norepinephrine infusion were prospectively included. Hemodynamic and respiratory variables were measured at the time of the echocardiographic examination and biomarkers were obtained on arrival at the ICU and then followed up routinely. Eight patients received inhaled aerosolized milrinone at a dose of 2.5 mg/hour. RESULTS The most common echocardiographic pattern was RV dilation with or without systolic dysfunction, which was found in 62% of patients. Pulmonary acceleration time was abnormal in 55% and indices of RV systolic function, such as fractional area of change, RV strain, were abnormal in 30% and 31% of patients respectively. A cardiac index of < 2.5 l/min*m2 was seen in 58% of the patients. Left ventricular ejection fraction and global left ventricular strain were impaired in 10% and 16% respectively. The correlation between echocardiographic variables and cardiac biomarkers was poor. RV afterload correlated well to the levels of D-dimer. Milrinone inhalation did not improve RV function or afterload. CONCLUSION RV dysfunction was the most common finding. The poor correlation to cardiac biomarkers argues against extensive myocardial involvement. The lack of improvement in RV function after milrinone inhalation suggests that the most likely cause of RV dysfunction is increased RV afterload caused by pulmonary thrombosis/embolism.
Collapse
Affiliation(s)
- Nina Norden
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Erik O Lundin
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Eva Hagberg
- Department of Clinical Physiology, Institute of Medicine, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of GothenburgSweden
| | - Sinsia A Gao
- Department of Clinical Physiology, Institute of Medicine, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Mathias Hård af Segerstad
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Bengt Nellgård
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| | - Keti Dalla
- Department of Anaesthesia and Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy at The University of GothenburgGothenburg, Sweden
| |
Collapse
|
24
|
Olsen F, Hård Af Segerstad M, Nellgård B, Houltz E, Ricksten SE. The role of bone cement for the development of intraoperative hypotension and hypoxia and its impact on mortality in hemiarthroplasty for femoral neck fractures. Acta Orthop 2020; 91:293-298. [PMID: 32237931 PMCID: PMC8023921 DOI: 10.1080/17453674.2020.1745510] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The bone cement implantation syndrome characterized by hypotension and/or hypoxia is a well-known complication in cemented arthroplasty. We studied the incidence of hypotension and/or hypoxia in patients undergoing cemented or uncemented hemiarthroplasty for femoral neck fractures and evaluated whether bone cement was an independent risk factor for postoperative mortality.Patients and methods - In this retrospective cohort study, 1,095 patients from 2 hospitals undergoing hemiarthroplasty with (n = 986) and without (n = 109) bone cementation were included. Pre-, intra-, and postoperative data were obtained from electronic medical records. Each patient was classified for grade of hypotension and hypoxia during and after prosthesis insertion according to Donaldson's criteria (Grade 1, 2, 3). After adjustments for confounders, the hazard ratio (HR) for the use of bone cement on 1-year mortality was assessed.Results - The incidence of hypoxia and/or hypotension was higher in the cemented (28%) compared with the uncemented group (17%) (p = 0.003). The incidence of severe hypotension/hypoxia (grade 2 or 3) was 6.9% in the cemented, but not observed in the uncemented group. The use of bone cement was an independent risk factor for 1-year mortality (HR 1.9, 95% CI 1.3-2.7), when adjusted for confounders.Interpretation - The use of bone cement in hemiarthroplasty for femoral neck fractures increases the incidence of intraoperative hypoxia and/or hypotension and is an independent risk factor for postoperative 1-year mortality. Efforts should be made to identify patients at risk for BCIS and alternative strategies for the management of these patients should be considered.
Collapse
Affiliation(s)
- Fredrik Olsen
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mathias Hård Af Segerstad
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Houltz
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden,Correspondence:
| |
Collapse
|
25
|
Kristiansson J, Hagberg E, Nellgård B. The influence of time-to-surgery on mortality after a hip fracture. Acta Anaesthesiol Scand 2020; 64:347-353. [PMID: 31652349 DOI: 10.1111/aas.13494] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/30/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effect of time-to-surgery on mortality in acute hip fracture (AHF) patients has been debated and studies are inconsistent regarding from what time limit mortality starts to increase. At Sahlgrenska University Hospital/Mölndal, surgery is recommended within 24 hours leaving little time for pre-operative optimization. However, internationally the definition of early surgery varies between 24 and 48 hours and over. This retrospective study was initiated to investigate the relation between time-to-surgery and 30-day mortality. METHOD Data of AHF patients from January 2007 through December 2016 were collected. The variables analysed were: age, gender, American Society of Anesthesiologists physical status classification, surgical method (prosthesis or osteosynthesis) and time-to-surgery, along with 30-day mortality. Primary outcome was 30-day mortality related to time-to-surgery divided into groups. Secondary outcome was 30-day mortality related to time-to-surgery analysed hour-by-hour. RESULTS From 10,844 eligible patients, 9,270 patients were included into the study. Mean time-to-surgery was 19.4 hours and overall 30-day mortality was 7.6%. Adjusted Cox regression analysis revealed an increased mortality rate in patients with time-to-surgery >48 hours. In the hour-by-hour analysis, significant mortality increase was observed at 39 hours of time-to-surgery. Patients with time-to-surgery >24 hours did not have increased mortality compared to patients with time-to-surgery <24 hours. CONCLUSION In AHF patients, a time-to-surgery exceeding 39-48 hours was associated with increased mortality. Patients with surgeries performed before 39-48 hours did not have increased mortality and this time may, in some patients, be used for optimization prior surgery even if time-to-surgery exceeds 24 hours.
Collapse
Affiliation(s)
- Johan Kristiansson
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
| | - Eva Hagberg
- Department of Clinical Physiology Sahlgrenska University Hospital Mölndal Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Sahlgrenska University Hospital
- Institution of Clinical Sciences Sahlgrenska Academy University of Gothenburg
| |
Collapse
|
26
|
Danielson M, Wiklund A, Granath F, Blennow K, Mkrtchian S, Nellgård B, Oras J, Jonsson Fagerlund M, Granström A, Schening A, Rasmussen LS, Erlandsson Harris H, Zetterberg H, Ricksten S, Eriksson LI. Neuroinflammatory markers associate with cognitive decline after major surgery: Findings of an explorative study. Ann Neurol 2020; 87:370-382. [DOI: 10.1002/ana.25678] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Mattias Danielson
- Department of Anesthesiology and Intensive Care MedicineInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Andreas Wiklund
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care MedicineKarolinska Institutet Stockholm Sweden
- Department of Anesthesia and Intensive CareCapio Sankt Goran Hospital Stockholm Sweden
| | - Fredrik Granath
- Clinical Epidemiology Division, Department of Medicine, SolnaKarolinska Institutet Stockholm Sweden
| | - Kaj Blennow
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry LaboratorySahlgrenska University Hospital Mölndal Sweden
| | - Souren Mkrtchian
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care MedicineKarolinska Institutet Stockholm Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care MedicineInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Jonatan Oras
- Department of Anesthesiology and Intensive Care MedicineInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Malin Jonsson Fagerlund
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care MedicineKarolinska Institutet Stockholm Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Stockholm Sweden
| | - Anna Granström
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Stockholm Sweden
| | - Anna Schening
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Stockholm Sweden
| | - Lars S. Rasmussen
- Department of Anesthesia, Centre of Head and Orthopedics, Rigshospitalet, CopenhagenUniversity of Copenhagen Copenhagen Denmark
| | - Helena Erlandsson Harris
- Rheumatology Unit, Center for Molecular Medicine, Department for Medicine SolnaKarolinska Institute Stockholm Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry LaboratorySahlgrenska University Hospital Mölndal Sweden
- Department of Neurodegenerative DiseaseUCL Institute of Neurology London United Kingdom
- UK Dementia Research Institute at UCL London United Kingdom
| | - Sven‐Erik Ricksten
- Department of Anesthesiology and Intensive Care MedicineInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Lars I. Eriksson
- Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care MedicineKarolinska Institutet Stockholm Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
27
|
Dutkiewicz R, Zetterberg H, Andreasson U, Blennow K, Nellgård B. Dementia and CSF-biomarkers for Alzheimer's disease predict mortality after acute hip fracture. Acta Anaesthesiol Scand 2020; 64:93-103. [PMID: 31508810 DOI: 10.1111/aas.13472] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/29/2019] [Accepted: 08/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mortality is high after an acute hip fracture (AHF) surgery. Are cognitive impairment and/or altered levels of Alzheimer's Disease (AD)-biomarkers in cerebrospinal fluid (CSF) predictors of mortality in AHF-patients, as retrospective studies indicate? METHODS Prospective single-center study including 373 AHF-patients, operated in spinal anesthesia. Cognitive status was evaluated by clinical dementia rating (CDR); CSF was analyzed for AD-biomarker concentrations (total tau (T-tau), phosphorylated tau (P-tau), amyloid beta ratio (Aβ42/Aβ40). CDR and biomarker levels were related to mortality up to one-year post-surgery, using univariate logistic regression analysis. RESULTS Survival analyses showed that mortality was associated to the degree of dementia. In the entire patient cohort 30-, 90-, and 365-day mortality rates were 7.2%, 15.5%, and 25.5%, respectively, but only 2.7%, 5.5%, and 12.6%, for cognitively intact vs 16.3%, 31.7%, and 42.3% for demented patients (OR = 2.2-2.8 [CI = 1.6-4.9]; P = .0001). High CSF T-tau (OR = 1.19 [CI = 1.05-1.33]; P = .004) and low Aβ42/Aβ40-ratio (OR = 0.85 [CI = 0.74-0.97]; P = .017) were associated with increased 90-day mortality. Analysis of 4 subgroups (Cognitive impairment ± and Biomarkers ±) showed significant associations of dementia and CSF biomarker concentrations to mortality after an AHF. Even cognitively intact patients presenting with abnormal AD-biomarkers showed an increased 90-day mortality which, however, was statistically insignificant. CONCLUSIONS Cognitive impairment and altered CSF biomarker concentrations indicative of AD pathology can predict increased mortality in patients with an AHF, and so probably even before clinical dementia diagnosis by early biomarker analysis; a notion that may have substantial clinical implications by improving perioperative treatment and postoperative rehabilitation.
Collapse
Affiliation(s)
- Robert Dutkiewicz
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital Mölndal Sweden
- Institute of Clinical Sciences Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- Department of Molecular Neuroscience UCL Institute of Neurology London UK
- UK Dementia Research Institute at UCL London UK
| | - Ulf Andreasson
- Department of Psychiatry and Neurochemistry Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital Mölndal Sweden
- Institute of Clinical Sciences Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| |
Collapse
|
28
|
Hård af Segerstad M, Olsen F, Houltz E, Nellgård B, Ricksten S. Inhaled prostacyclin for the prevention of increased pulmonary vascular resistance in cemented hip hemiarthroplasty-A randomised trial. Acta Anaesthesiol Scand 2019; 63:1152-1161. [PMID: 31270800 DOI: 10.1111/aas.13423] [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: 03/25/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bone cementation may cause pulmonary vasoconstriction and ventilation/perfusion abnormalities in patients undergoing cemented hip hemiarthroplasty. In this randomised trial, we tested the hypothesis that intra-operative inhalation of prostacyclin could attenuate the increase in pulmonary vascular resistance index (PVRI, primary endpoint) when compared to inhaled saline in this group of patients. METHODS Twenty-two patients with displaced femoral neck fractures were allocated to receive inhaled aerosolised prostacyclin (20 ng/kg/min) (n = 11) or inhaled saline (NaCl, 9 mg/mL) (n = 11). All patients received total intravenous anaesthesia and were catheterised with radial and pulmonary artery fast response thermodilution catheters, for measurements of arterial and pulmonary arterial pressures, cardiac output, right ventricular ejection fraction and effective pulmonary arterial elastance. Haemodynamic measurements were performed after induction of anaesthesia, during surgery before and immediately after bone cementation and prosthesis insertion, 10 and 20 min after insertion and during skin closure. RESULTS During the surgical procedure, PVRI increased both in the saline (44%, P < 0.001) and the prostacyclin (36%, P = 0.019) groups, with a less pronounced increase in the prostacyclin group (P = 0.031). Effective pulmonary arterial elastance increased both in the saline (44%, P < 0.001) and the prostacyclin groups (29%, P = 0.032), with a trend for a less pronounced increase in the prostacyclin group (P = 0.084). Right ventricular ejection fraction decreased significantly in both groups with no difference between the groups. CONCLUSION Inhalation of prostacyclin attenuates the increase in pulmonary vascular resistance in patients undergoing cemented hip hemiarthroplasty and could potentially attenuate/prevent haemodynamic instability induced by an increase in right ventricular afterload seen in this procedure.
Collapse
Affiliation(s)
- Mathias Hård af Segerstad
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Fredrik Olsen
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Erik Houltz
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Sven‐Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| |
Collapse
|
29
|
Deming Y, Filipello F, Cignarella F, Cantoni C, Hsu S, Mikesell R, Li Z, Del-Aguila JL, Dube U, Farias FG, Bradley J, Budde J, Ibanez L, Fernandez MV, Blennow K, Zetterberg H, Heslegrave A, Johansson PM, Svensson J, Nellgård B, Lleo A, Alcolea D, Clarimon J, Rami L, Molinuevo JL, Suárez-Calvet M, Morenas-Rodríguez E, Kleinberger G, Ewers M, Harari O, Haass C, Brett TJ, Benitez BA, Karch CM, Piccio L, Cruchaga C. The MS4A gene cluster is a key modulator of soluble TREM2 and Alzheimer's disease risk. Sci Transl Med 2019; 11:eaau2291. [PMID: 31413141 PMCID: PMC6697053 DOI: 10.1126/scitranslmed.aau2291] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 04/05/2019] [Indexed: 12/13/2022]
Abstract
Soluble triggering receptor expressed on myeloid cells 2 (sTREM2) in cerebrospinal fluid (CSF) has been associated with Alzheimer's disease (AD). TREM2 plays a critical role in microglial activation, survival, and phagocytosis; however, the pathophysiological role of sTREM2 in AD is not well understood. Understanding the role of sTREM2 in AD may reveal new pathological mechanisms and lead to the identification of therapeutic targets. We performed a genome-wide association study (GWAS) to identify genetic modifiers of CSF sTREM2 obtained from the Alzheimer's Disease Neuroimaging Initiative. Common variants in the membrane-spanning 4-domains subfamily A (MS4A) gene region were associated with CSF sTREM2 concentrations (rs1582763; P = 1.15 × 10-15); this was replicated in independent datasets. The variants associated with increased CSF sTREM2 concentrations were associated with reduced AD risk and delayed age at onset of disease. The single-nucleotide polymorphism rs1582763 modified expression of the MS4A4A and MS4A6A genes in multiple tissues, suggesting that one or both of these genes are important for modulating sTREM2 production. Using human macrophages as a proxy for microglia, we found that MS4A4A and TREM2 colocalized on lipid rafts at the plasma membrane, that sTREM2 increased with MS4A4A overexpression, and that silencing of MS4A4A reduced sTREM2 production. These genetic, molecular, and cellular findings suggest that MS4A4A modulates sTREM2. These findings also provide a mechanistic explanation for the original GWAS signal in the MS4A locus for AD risk and indicate that TREM2 may be involved in AD pathogenesis not only in TREM2 risk-variant carriers but also in those with sporadic disease.
Collapse
Affiliation(s)
- Yuetiva Deming
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Fabia Filipello
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Francesca Cignarella
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Claudia Cantoni
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Simon Hsu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Robert Mikesell
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zeran Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jorge L Del-Aguila
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Umber Dube
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Fabiana Geraldo Farias
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joseph Bradley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - John Budde
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura Ibanez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Department of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Department of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Per M Johansson
- Department of Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Johan Svensson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology, Sahlgrenska University Hospital, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Alberto Lleo
- Department of Neurology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Networker Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Daniel Alcolea
- Department of Neurology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Networker Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Jordi Clarimon
- Department of Neurology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Networker Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Lorena Rami
- IDIBAPS, Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic, Barcelona, Spain
| | - José Luis Molinuevo
- IDIBAPS, Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic, Barcelona, Spain
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
| | - Marc Suárez-Calvet
- Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Estrella Morenas-Rodríguez
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Gernot Kleinberger
- Biomedical Center (BMC), Biochemistry, Ludwig-Maximilians-Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- ISAR Bioscience GmbH, 2152 Planegg, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research, University Hospital, LMU, Munich, Germany
| | - Oscar Harari
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Christian Haass
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Chair of Metabolic Biochemistry, Biomedical Center (BMC), Faculty of Medicine, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Thomas J Brett
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Bruno A Benitez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Celeste M Karch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura Piccio
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
- Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
- NeuroGenomics and Informatics, Washington University School of Medicine, St. Louis, MO 63110, USA
| |
Collapse
|
30
|
Segerstad MHA, Olsen F, Patel A, Houltz E, Nellgård B, Ricksten SE. Pulmonary haemodynamics and right ventricular function in cemented vs uncemented total hip arthroplasty-A randomized trial. Acta Anaesthesiol Scand 2019; 63:298-305. [PMID: 30203412 DOI: 10.1111/aas.13262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/18/2018] [Revised: 08/10/2018] [Accepted: 08/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is a feared complication in orthopaedic surgery with a huge impact on post-operative morbidity. In this randomized trial, we evaluated the effects of bone cement on pulmonary and systemic haemodynamics in patients receiving either cemented or uncemented hip arthroplasty for isolated femoral neck fracture. METHODS Twenty-two patients were randomized to receive either cemented (n = 10) or uncemented (n = 12) total hip arthroplasty. Surgery was performed under total intravenous anaesthesia in the lateral position. All patients were catheterized with radial- and pulmonary artery catheters, for continuous measurements of mean arterial pressure (MAP), pulmonary arterial pressure (PAP), cardiac output, right ventricular (RV) end-diastolic volume (RVEDV) and RV ejection fraction (RVEF). Haemodynamic measurements and blood gas analyses were performed after induction of anaesthesia, during surgery before and immediately after bone cementation and prosthesis insertion, 10 and 20 minutes after insertion and during skin closure. RESULTS Pulmonary vascular resistance index (PVRI) increased during and after prosthesis insertion by 45% and 20% in the cemented and uncemented group, respectively (P < 0.005). Systolic and mean PAP increased by 18% and 17% in the cemented group, which was not seen in the uncemented group (P < 0.001). There was a trend for a more pronounced fall in RVEF in the cemented group, while there were no differences in cardiac output or stroke volume between groups. CONCLUSION The use of bone cement in total hip arthroplasty increases pulmonary vascular resistance and the afterload of the RV with potentially negative effects on RV performance.
Collapse
Affiliation(s)
- Mathias Hård af Segerstad
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Fredrik Olsen
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Arun Patel
- Department of Orthopedic Surgery; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Erik Houltz
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences Sahlgrenska Academy; Sahlgrenska University Hospital; University of Gothenburg; Gothenburg Sweden
| |
Collapse
|
31
|
Kristiansson J, Olsen F, Hagberg E, Dutkiewicz R, Nellgård B. Prolonged vasopressor support during hip-fracture surgery is a risk factor for enhanced mortality. Acta Anaesthesiol Scand 2019; 63:46-54. [PMID: 30079572 DOI: 10.1111/aas.13215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hip fracture is a common injury in the elderly population and is associated with high morbidity and mortality. Intraoperative hypotension is commonly noted, and is often treated with vasopressors (VP), however, to what extent is unknown. We set out to examine retrospectively how many hip fracture-patients received VP perioperatively and further to investigate if VP treatment is connected to increased mortality. METHOD Data on VP treatment were captured from medical and anaesthesia journals, and if so, data were investigated to find potential confounders. Patients were divided into (a) no VP, (b) VP by injection, (c) VP by infusion <3 hours, and (d) VP by infusion ≥3 hours to achieve stratification. RESULTS Nine hundred and ninety-seven patients were included. About 80.4% received VP treatment. The 30-day mortality rates in subgroups were 3.6%, 5.4%, 6.4% and 19.1% respectively. The 90-day mortality rates were 6.7%, 10.3%, 11.6% and 30.3% respectively. Finally, the same patient groups had 365-day mortality rates of 12.8%, 20.0%, 23.3% and 44.9% respectively. We found a significant increase in mortality (30-90-365 days) in patients receiving VP infusion ≥3 hours, after adjusting for confounding factors. There was no increased mortality in patients treated by injection and by infusion <3 hours after adjustment for confounding factors vs untreated patients. CONCLUSION Vasopressor treatment is common during hip fracture surgery. Patients treated with VP infusion ≥3 hours have increased mortality, while patients treated with injections or infusion <3 hours have not. We suggest that the prolonged use of VP treatment is linked to increased mortality.
Collapse
Affiliation(s)
- Johan Kristiansson
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital; Mölndal Sweden
| | - Fredrik Olsen
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital; Mölndal Sweden
- Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - Eva Hagberg
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital; Mölndal Sweden
| | - Robert Dutkiewicz
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital; Mölndal Sweden
- Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care; Sahlgrenska University Hospital; Mölndal Sweden
- Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| |
Collapse
|
32
|
Rackauskaite D, Svanborg E, Andersson E, Löwhagen K, Csajbok L, Nellgård B. Prospective study: Long-term outcome at 12-15 years after aneurysmal subarachnoid hemorrhage. Acta Neurol Scand 2018; 138:400-407. [PMID: 29963687 DOI: 10.1111/ane.12980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with aneurysmal subarachnoid hemorrhage (aSAH) have poor outcome. Studies on outcome beyond 1 year post-aSAH are few, and late recovery is poorly investigated, initiating this prospective outcome study on patients 12-15 years after an aSAH. We hypothesized to find; functional improvement > 1 year post-ictus; increased long-term mortality in aSAH patients vs matched controls, and finally to present; predictors of long-term favorable outcome (GOS 4-5). METHODS We prospectively investigated patients, admitted 2000-2003 to the Sahlgrenska University Hospital, 1 year post-ictus using Glasgow Outcome Scale (GOS). The patients were revalidated 12-15 years post-aSAH by structured-telephone interviews (GOS), followed by statistical analysis. RESULTS A total of 158 patients were included, (women n = 114, men n = 44), with a mean age of 55 years at aSAH. Patients treated with surgical clipping had lower mortality. At the follow-up 12-15 years post-aSAH, all 103 survivors (65.2%) were categorized as having; good recovery (39.9%), moderate disability (15.2%), or severe disability (10.1%). Within the patient cohort, 23.6% improved GOS over time. Fifty-five patients died, median at 4 years post-ictus. aSAH patients had 3.5 times increased mortality 12-15 years post-ictus vs matched controls (P < .0001). Patients with favorable outcome at 1 year (67.3%, n = 101) had similar survival probability as control patients. Prognostic indicators of long-term favorable outcome were low age and high GOS at 1-year follow-up, (AUCROC, 0.79). CONCLUSIONS Individual functional improvement was found >1 year post-ictus. Patients with favorable outcome at 1 year had similar long-term life expectancy as the general population. Indicators of long-term favorable prognosis were low age at ictus and high GOS at 1-year follow-up.
Collapse
Affiliation(s)
- D. Rackauskaite
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Svanborg
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
| | - E. Andersson
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - K. Löwhagen
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Csajbok
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
| | - B. Nellgård
- Department of Anesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital; Mölndal Sweden
- Institution of clinical sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| |
Collapse
|
33
|
Thelandersson A, Nellgård B, Ricksten SE, Cider Å. Effects of Early Bedside Cycle Exercise on Intracranial Pressure and Systemic Hemodynamics in Critically Ill Patients in a Neurointensive Care Unit. Neurocrit Care 2017; 25:434-439. [PMID: 27216931 DOI: 10.1007/s12028-016-0278-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/21/2022]
Abstract
BACKGROUND Physiotherapy is an important part of treatment after severe brain injuries and stroke, but its effect on intracranial and systemic hemodynamics is minimally investigated. Therefore, the aim of this study was to assess the effects of an early bedside cycle exercise on intracranial and systemic hemodynamics in critically ill patients when admitted to a neurointensive care unit (NICU). METHODS Twenty critically ill patients suffering from brain injuries or stroke were included in this study performed in the NICU at Sahlgrenska University Hospital. One early implemented exercise session was performed using a bedside cycle ergometer for 20 min. Intracranial and hemodynamic variables were measured two times before, three times during, and two times after the bedside cycling exercise. Analyzed variables were intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), cardiac output (CO), stroke volume (SV), and stroke volume variation (SVV). The cycling intervention was conducted within 7 ± 5 days after admission to the NICU. RESULTS Cycle exercise increased MAP (p = 0.029) and SV (p = 0.003) significantly. After exercise CO, SV, MAP, and CPP decreased significantly, while no changes in HR, SVV, SpO2, or ICP were noted when compared to values obtained during exercise. There were no differences in data obtained before versus after exercise. CONCLUSION Early implemented exercise with a bedside cycle ergometer, for patients with severe brain injuries or stroke when admitted to a NICU, is considered to be a clinically safe procedure.
Collapse
Affiliation(s)
- Anneli Thelandersson
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden. .,Department of Occupational- and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Bengt Nellgård
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive care, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Cider
- Institute of Physiology and Neuroscience, Department of Health and Rehabilitation/Physiotherapy, Gothenburg University, Gothenburg, Sweden.,Department of Occupational- and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
34
|
Andersson E, Rackauskaite D, Svanborg E, Csajbók L, Öst M, Nellgård B. A prospective outcome study observing patients with severe traumatic brain injury over 10-15 years. Acta Anaesthesiol Scand 2017; 61:502-512. [PMID: 28374472 DOI: 10.1111/aas.12880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe traumatic brain injury (sTBI) can be divided into primary and secondary injuries. Intensive care protocols focus on preventing secondary injuries. This prospective cohort study was initiated to investigate outcome, including mortality, in patients treated according to the Lund Concept after a sTBI covering 10-15 years post-trauma. METHODS Patients were included during 2000-2004 when admitted to the neurointensive care unit, Sahlgrenska University Hospital. Inclusion criteria were: Glasgow coma scale score of ≤8, need for artificial ventilation and intracranial monitoring. Glasgow Outcome Scale (GOS) was used to evaluate outcome both at 1-year and 10-15 years post-trauma. RESULTS Ninety-five patients, (27 female and 68 male), were initially included. Both improvement and deterioration were noted between 1- and 10-15 years post-injury. Mortality rate (34/95) was higher in the studied population vs. a matched Swedish population, (Standard mortality rate (SMR) 9.5; P < 0.0001). When dividing the cohort into Good (GOS 4-5) and Poor (GOS 2-3) outcome at 1-year, only patients with Poor outcome had a higher mortality rate than the matched population (SMR 7.3; P < 0.0001). Further, good outcome (high GOS) at 1-year was associated with high GOS 10-15 years post-trauma (P < 0.0001). Finally, a majority of patients demonstrated symptoms of mental fatigue. CONCLUSION This indicates that patients with severe traumatic brain injury with Good outcome at 1-year have similar survival probability as a matched Swedish population and that high Glasgow outcome scale at 1-year is related to good long-term outcome. Our results further emphasise the advantage of the Lund concept.
Collapse
Affiliation(s)
- E. Andersson
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - D. Rackauskaite
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Svanborg
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Csajbók
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - M. Öst
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - B. Nellgård
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| |
Collapse
|
35
|
Shahim P, Gren M, Liman V, Andreasson U, Norgren N, Tegner Y, Mattsson N, Andreasen N, Öst M, Zetterberg H, Nellgård B, Blennow K. Serum neurofilament light protein predicts clinical outcome in traumatic brain injury. Sci Rep 2016; 6:36791. [PMID: 27819296 PMCID: PMC5098187 DOI: 10.1038/srep36791] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [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: 07/01/2016] [Accepted: 10/17/2016] [Indexed: 12/12/2022] Open
Abstract
Axonal white matter injury is believed to be a major determinant of adverse outcomes following traumatic brain injury (TBI). We hypothesized that measurement of neurofilament light protein (NF-L), a protein found in long white-matter axons, in blood samples, may serve as a suitable biomarker for neuronal damage in TBI patients. To test our hypotheses, we designed a study in two parts: i) we developed an immunoassay based on Single molecule array technology for quantification of NF-L in blood, and ii) in a proof-of-concept study, we tested our newly developed method on serial serum samples from severe TBI (sTBI) patients (n = 72) and controls (n = 35). We also compared the diagnostic and prognostic utility of NF-L with the established blood biomarker S100B. NF-L levels were markedly increased in sTBI patients compared with controls. NF-L at admission yielded an AUC of 0.99 to detect TBI versus controls (AUC 0.96 for S100B), and increased to 1.00 at day 12 (0.65 for S100B). Importantly, initial NF-L levels predicted poor 12-month clinical outcome. In contrast, S100B was not related to outcome. Taken together, our data suggests that measurement of serum NF-L may be useful to assess the severity of neuronal injury following sTBI.
Collapse
Affiliation(s)
- Pashtun Shahim
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-43180 Mölndal, Sweden
| | - Magnus Gren
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-43180 Mölndal, Sweden
| | - Victor Liman
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-43180 Mölndal, Sweden
| | - Ulf Andreasson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-43180 Mölndal, Sweden
| | | | - Yelverton Tegner
- Division of Medical Sciences, Department of Health Sciences, Luleå University of Technology, SE 971 87 Luleå, Sweden
| | - Niklas Mattsson
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Niels Andreasen
- Department of NVS, Karolinska Institute, Center for Alzheimer Research, Stockholm, Sweden
| | - Martin Öst
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-43180 Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N1PJ, UK
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-43180 Mölndal, Sweden
| |
Collapse
|
36
|
Remnestål J, Just D, Mitsios N, Fredolini C, Mulder J, Schwenk JM, Uhlén M, Kultima K, Ingelsson M, Kilander L, Lannfelt L, Svenningsson P, Nellgård B, Zetterberg H, Blennow K, Nilsson P, Häggmark-Månberg A. CSF profiling of the human brain enriched proteome reveals associations of neuromodulin and neurogranin to Alzheimer's disease. Proteomics Clin Appl 2016; 10:1242-1253. [PMID: 27604409 PMCID: PMC5157753 DOI: 10.1002/prca.201500150] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/25/2016] [Accepted: 09/02/2016] [Indexed: 01/08/2023]
Abstract
Purpose This study is part of a larger effort aiming to expand the knowledge of brain‐enriched proteins in human cerebrospinal fluid (CSF) and to provide novel insight into the relation between such proteins and different neurodegenerative diseases. Experimental design Here 280 brain‐enriched proteins in CSF from patients with Alzheimer's disease (AD), Parkinson's disease (PD) and dementia with Lewy bodies (DLB) are profiled. In total, 441 human samples of ventricular CSF collected post mortem and lumbar CSF collected ante mortem are analyzed using 376 antibodies in a suspension bead array setup, utilizing a direct labelling approach. Results Among several proteins displaying differentiated profiles between sample groups, we focus here on two synaptic proteins, neuromodulin (GAP43) and neurogranin (NRGN). They are both found at elevated levels in CSF from AD patients in two independent cohorts, providing disease‐associated profiles in addition to verifying and strengthening previously observed patterns. Increased levels are also observed for patients for whom the AD diagnosis was not established at the time of sampling. Conclusions and clinical relevance These findings indicate that analyzing the brain‐enriched proteins in CSF is of particular interest to increase the understanding of the CSF proteome and its relation to neurodegenerative disorders. In addition, this study lends support to the notion that measurements of these synaptic proteins could potentially be of great relevance in future diagnostic tests for AD.
Collapse
Affiliation(s)
- Julia Remnestål
- Affinity Proteomics, SciLifeLab, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - David Just
- Affinity Proteomics, SciLifeLab, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Nicholas Mitsios
- SciLifeLab, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Fredolini
- Affinity Proteomics, SciLifeLab, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Jan Mulder
- SciLifeLab, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jochen M Schwenk
- Affinity Proteomics, SciLifeLab, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Mathias Uhlén
- Affinity Proteomics, SciLifeLab, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Kim Kultima
- Department of Medical Sciences, Cancer Pharmacology and Computational Medicine, Uppsala University, Uppsala, Sweden
| | - Martin Ingelsson
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Lars Lannfelt
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Per Svenningsson
- Translational Neuropharmacology, Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Peter Nilsson
- Affinity Proteomics, SciLifeLab, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Anna Häggmark-Månberg
- Affinity Proteomics, SciLifeLab, KTH-Royal Institute of Technology, Stockholm, Sweden
| |
Collapse
|
37
|
Shahim P, Gren M, Liman V, Andreasson U, Norgren N, Tegner Y, Mattsson N, Andreassen N, Öst M, Zetterberg H, Nellgård B, Blennow K. P3‐193: Serum Neurofilament Light Protein Predicts Clinical Outcome in Traumatic Brain Injury. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pashtun Shahim
- Institute of Neuroscience and Physiology / The Sahlgrenska AcademyGothenburgSweden
| | - Magnus Gren
- Institute of Neuroscience and Physiology / The Sahlgrenska AcademyGothenburgSweden
| | - Victor Liman
- Institute of Neuroscience and Physiology / The Sahlgrenska AcademyGothenburgSweden
| | - Ulf Andreasson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | | | - Yelverton Tegner
- Division of Medical Sciences / Luleå University of Technology LuleåSweden
| | | | - Niels Andreassen
- Department of NVS Karolinska Institute, Center for Alzheimer ResearchStockholmSweden
| | - Martin Öst
- Institute of Clinical Sciences / Sahlgrenska AcademyGothenburgSweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Bengt Nellgård
- Institute of Clinical Sciences / Sahlgrenska AcademyGothenburgSweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of GothenburgGothenburgSweden
| |
Collapse
|
38
|
Csajbok LZ, Nylén K, Öst M, Blennow K, Zetterberg H, Nellgård P, Nellgård B. Apolipoprotein E polymorphism in aneurysmal subarachnoid haemorrhage in West Sweden. Acta Neurol Scand 2016; 133:466-74. [PMID: 26374096 DOI: 10.1111/ane.12487] [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] [Accepted: 08/25/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Aneurysmal subarachnoid haemorrhage (aSAH) is associated with high morbidity and mortality despite novel treatments. Genetic variability may explain outcome differences. Apolipoprotein E (ApoE) is a glycoprotein with a major role in brain lipoprotein metabolism. It has three isoforms encoded by distinct alleles: APOEε2, APOEε3 and APOEε4. The APOEε4 allele is associated with Alzheimer's disease and worse outcome after traumatic brain injury and ischaemic stroke. This prospective blinded study explored the influence of the APOEε4 polymorphism on the risk of aSAH, risk of cerebral vasospasm (CVS) and 1-year neurological outcome. METHODS The APOΕε4 polymorphism was analysed in 147 patients with aSAH. Allele and genotype frequencies were compared to those found in a gender- and area-matched control group of healthy individuals (n = 211). Early CVS was identified and treated according to neurointensive care unit (NICU) guidelines. Neurological deficit(s) at admittance and at 1-year follow-up visit was recorded. Neurological outcome was assessed by the National Institute of Health Stroke Scale, Barthel Index and the Extended Glasgow Outcome Scale. RESULTS APOEε4 and non-APOEε4 allele frequencies were similar in aSAH patients and healthy individuals. The presence of APOEε4 was not associated with the development of early CVS. We could not find an influence of the APOE polymorphism on 1-year neurological outcome between groups. Subgroup analyses of patients treated with surgical clipping vs endovascular coiling did not reveal any associations. CONCLUSIONS The APOEε4 polymorphism has no major influence on risk of aSAH, the occurrence of CVS or long-term neurological outcome after aSAH.
Collapse
Affiliation(s)
- L. Z. Csajbok
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - K. Nylén
- Department of Neurology; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - M. Öst
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - K. Blennow
- Clinical Neurochemistry Laboratory; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
| | - H. Zetterberg
- Clinical Neurochemistry Laboratory; Institute of Neuroscience and Physiology; Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
- UCL Institute of Neurology; Queen Square London UK
| | - P. Nellgård
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| | - B. Nellgård
- Department of Anesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy at the University of Gothenburg; Göteborg Sweden
| |
Collapse
|
39
|
Suárez-Calvet M, Kleinberger G, Araque Caballero MÁ, Brendel M, Rominger A, Alcolea D, Fortea J, Lleó A, Blesa R, Gispert JD, Sánchez-Valle R, Antonell A, Rami L, Molinuevo JL, Brosseron F, Traschütz A, Heneka MT, Struyfs H, Engelborghs S, Sleegers K, Van Broeckhoven C, Zetterberg H, Nellgård B, Blennow K, Crispin A, Ewers M, Haass C. sTREM2 cerebrospinal fluid levels are a potential biomarker for microglia activity in early-stage Alzheimer's disease and associate with neuronal injury markers. EMBO Mol Med 2016; 8:466-76. [PMID: 26941262 PMCID: PMC5120370 DOI: 10.15252/emmm.201506123] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [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] [Indexed: 12/19/2022] Open
Abstract
TREM2 is an innate immune receptor expressed on the surface of microglia. Loss‐of‐function mutations of TREM2 are associated with increased risk of Alzheimer's disease (AD). TREM2 is a type‐1 protein with an ectodomain that is proteolytically cleaved and released into the extracellular space as a soluble variant (sTREM2), which can be measured in the cerebrospinal fluid (CSF). In this cross‐sectional multicenter study, we investigated whether CSF levels of sTREM2 are changed during the clinical course of AD, and in cognitively normal individuals with suspected non‐AD pathology (SNAP). CSF sTREM2 levels were higher in mild cognitive impairment due to AD than in all other AD groups and controls. SNAP individuals also had significantly increased CSF sTREM2 compared to controls. Moreover, increased CSF sTREM2 levels were associated with higher CSF total tau and phospho‐tau181P, which are markers of neuronal degeneration and tau pathology. Our data demonstrate that CSF sTREM2 levels are increased in the early symptomatic phase of AD, probably reflecting a corresponding change of the microglia activation status in response to neuronal degeneration.
Collapse
Affiliation(s)
- Marc Suárez-Calvet
- BioMedical Center (BMC), Biochemistry, Ludwig-Maximilians-University Munich, Munich, Germany German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
| | - Gernot Kleinberger
- BioMedical Center (BMC), Biochemistry, Ludwig-Maximilians-University Munich, Munich, Germany Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Miguel Ángel Araque Caballero
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Axel Rominger
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany Department of Nuclear Medicine, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Daniel Alcolea
- Department of Neurology, Institut d'Investigacions Biomèdiques Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona, Barcelona, Spain Center for Networked Biomedical Research for Neurodegenerative Diseases, CIBERNED, Madrid, Spain
| | - Juan Fortea
- Department of Neurology, Institut d'Investigacions Biomèdiques Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona, Barcelona, Spain Center for Networked Biomedical Research for Neurodegenerative Diseases, CIBERNED, Madrid, Spain
| | - Alberto Lleó
- Department of Neurology, Institut d'Investigacions Biomèdiques Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona, Barcelona, Spain Center for Networked Biomedical Research for Neurodegenerative Diseases, CIBERNED, Madrid, Spain
| | - Rafael Blesa
- Department of Neurology, Institut d'Investigacions Biomèdiques Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona, Barcelona, Spain Center for Networked Biomedical Research for Neurodegenerative Diseases, CIBERNED, Madrid, Spain
| | - Juan Domingo Gispert
- Clinical and Neuroimaging Departments, Barcelona Beta Brain Research Center Pasqual Maragall Foundation, Barcelona, Spain Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Antonell
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José L Molinuevo
- Clinical and Neuroimaging Departments, Barcelona Beta Brain Research Center Pasqual Maragall Foundation, Barcelona, Spain Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, ICN Hospital Clinic i Universitari, Barcelona, Spain Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Michael T Heneka
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany Neurology Department, Universitätsklinikum Bonn, Bonn, Germany
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge University of Antwerp, Antwerp, Belgium Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Laboratory of Neurochemistry and Behavior, Institute Born-Bunge University of Antwerp, Antwerp, Belgium Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Kristel Sleegers
- Neurodegenerative Brain Diseases Group, Department of Molecular Genetics, VIB, Antwerp, Belgium Laboratory of Neurogenetics, Institute Born-Bunge University of Antwerp, Antwerp, Belgium
| | - Christine Van Broeckhoven
- Neurodegenerative Brain Diseases Group, Department of Molecular Genetics, VIB, Antwerp, Belgium Laboratory of Neurogenetics, Institute Born-Bunge University of Antwerp, Antwerp, Belgium
| | - Henrik Zetterberg
- Clinical Neurochemistry Lab, Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden Reta Lila Weston Laboratories and Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Lab, Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Alexander Crispin
- Institute of Medical Informatics, Biometry, and Epidemiology, Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Haass
- BioMedical Center (BMC), Biochemistry, Ludwig-Maximilians-University Munich, Munich, Germany German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| |
Collapse
|
40
|
Thelandersson A, Nellgård B, Ricksten SE, Cider Å. Intracranial and hemodynamic effects of a bed-cycling exercise in critically ill patients with severe brain injuries and/or stroke. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
41
|
Hanson E, Olsson S, Bayazit B, Csajbok LZ, Nylén K, Nellgård B, Jern C. Association between variation in ADAMTS13 and aneurysmal subarachnoid hemorrhage. Thromb Res 2013; 131:99-101. [DOI: 10.1016/j.thromres.2012.10.006] [Citation(s) in RCA: 6] [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] [Received: 06/12/2012] [Revised: 10/01/2012] [Accepted: 10/17/2012] [Indexed: 12/21/2022]
|
42
|
Olsson S, Csajbok LZ, Jood K, Nylén K, Nellgård B, Jern C. No evidence for an association between genetic variation at the MMP2 and MMP9 loci and aneurysmal subarachnoid haemorrhage. J Neurol 2011; 259:193-5. [PMID: 21735328 DOI: 10.1007/s00415-011-6157-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 06/23/2011] [Indexed: 11/30/2022]
|
43
|
Olsson S, Csajbok LZ, Jood K, Nylén K, Nellgård B, Jern C. Association between genetic variation on chromosome 9p21 and aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2011; 82:384-8. [PMID: 20974651 DOI: 10.1136/jnnp.2009.187427] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [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: 11/04/2022]
Abstract
BACKGROUND AND AIM Genetic factors play a role in susceptibility to subarachnoid haemorrhage, but little is known about which genes are involved. Recently, genome wide association studies have identified the 9p21 region as a risk locus for intracranial aneurysms (IA). The aim of the present study was to examine the possible association between 9p21 and ruptured IA--that is, aneurysmal subarachnoid haemorrhage (aSAH)--in a Swedish population. There is one study showing an association between 9p21 and arterial stiffness, and arterial stiffness plays a role in the development of hypertension. Therefore, a second aim was to investigate whether a putative association is independent of hypertension. METHODS The study comprised 183 patients presenting with aSAH to the Neurointensive Care Unit at Sahlgrenska University Hospital and 366 healthy, age and sex matched population based controls. As the causative functional variant in the region has not yet been identified, a 44 kbp region on 9p21 was tagged using HapMap. Six single nucleotide polymorphism (SNPs) were genotyped. RESULTS Two SNPs, rs10757278 and rs1333045, showed significant associations with aSAH in univariate analyses. After adjustment for hypertension as well as for smoking, the association between aSAH and rs10757278 remained significant with an OR for aSAH of 1.42 (95% CI 1.08 to 1.87; p=0.01) for the uncommon G allele. CONCLUSIONS These data confirm earlier results showing that 9p21 is a susceptibility locus for IA, and that this association is present in a Swedish sample restricted to ruptured IA. For the first time, it has been demonstrated that this association is independent of hypertension.
Collapse
Affiliation(s)
- Sandra Olsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy at University of Gothenburg, Sweden
| | | | | | | | | | | |
Collapse
|
44
|
Ladenvall C, Csajbok L, Nylén K, Jood K, Nellgård B, Jern C. Association between factor XIII single nucleotide polymorphisms and aneurysmal subarachnoid hemorrhage. J Neurosurg 2009; 110:475-81. [DOI: 10.3171/2008.7.jns08272] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Family studies have suggested a role of genetic factors in susceptibility to aneurysmal subarachnoid hemorrhage (aSAH), but the underlying genetic risk factors remain poorly defined. There is an activation of the fibrinolytic system in aSAH, and fibrinolytic markers may be useful in predicting outcome. The authors investigate associations between putative functional variants in genes of importance for fibrinolysis and aSAH and/or outcome following aSAH.
Methods
One hundred eighty-three patients presenting with aSAH at a neurointensive care unit were consecutively recruited. Two healthy controls per case, matched for age, sex, and geographic region, were randomly recruited. Outcome was assessed after 1 year according to the extended Glasgow Outcome Scale. Single nucleotide polymorphisms (SNPs) in the tissue-type plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), and factor XIII (FXIII) genes were investigated.
Results
Participants carrying the FXIII 34Leu allele showed an increased risk of aSAH. When adjusting for smoking and hypertension, 2 haplotypes, differing on either the FXIII Val34Leu or the Pro564Leu position, showed an association to aSAH. No significant association was observed for the tPA -7351 C > T, PAI-1 -675 4G > 5G, or TAFI Ala147Thr SNPs. No specific SNP or haplotype was associated with outcome after aSAH, whereas a weak association was observed for a tPA/PAI-1 genotype combination.
Conclusions
Polymorphisms in the FXIII gene showed association to aSAH. The finding of an increased risk of bleeding in FXIII 34Leu carriers is biologically plausible.
Collapse
Affiliation(s)
- Claes Ladenvall
- 1Institute of Neuroscience and Physiology, Department of Neuroscience and Rehabilitation, the Sahlgrenska Academy at the University of Gothenburg; and
- 2Departments of Clinical Genetics and
| | - Ludvig Csajbok
- 3Anesthesia (Neurointensive Care Unit), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Nylén
- 1Institute of Neuroscience and Physiology, Department of Neuroscience and Rehabilitation, the Sahlgrenska Academy at the University of Gothenburg; and
| | - Katarina Jood
- 1Institute of Neuroscience and Physiology, Department of Neuroscience and Rehabilitation, the Sahlgrenska Academy at the University of Gothenburg; and
| | - Bengt Nellgård
- 3Anesthesia (Neurointensive Care Unit), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Jern
- 1Institute of Neuroscience and Physiology, Department of Neuroscience and Rehabilitation, the Sahlgrenska Academy at the University of Gothenburg; and
- 2Departments of Clinical Genetics and
| |
Collapse
|
45
|
Jernås M, Olsson B, Sjöholm K, Sjögren A, Rudemo M, Nellgård B, Carlsson LMS, Sjöström CD. Changes in adipose tissue gene expression and plasma levels of adipokines and acute-phase proteins in patients with critical illness. Metabolism 2009; 58:102-8. [PMID: 19059537 DOI: 10.1016/j.metabol.2008.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 08/15/2008] [Indexed: 02/03/2023]
Abstract
Insulin resistance develops rapidly during critical illness. The release of adipokines from adipose tissue is thought to play a key role in the development of insulin resistance, as are elevated levels of acute-phase proteins. The aim of this study was to identify changes in adipose tissue gene expression and plasma levels of adipokines and acute-phase proteins during critical illness. From 8 patients with subarachnoidal hemorrhage, consecutive blood samples and adipose tissue biopsies were obtained at 3 time points, twice during intensive care (1-2 days [IC1] and 7-9 days after subarachnoidal hemorrhage) and once after 8 months (recovery). The patients received a continuous insulin infusion to maintain normal glucose levels reflecting insulin resistance. The DNA microarray analysis showed increased zink-alpha2 glycoprotein (ZAG) and phospholipase A2, group IIA messenger RNA levels during intensive care compared with recovery (P < .05). Real-time polymerase chain reaction confirmed the increased expression of ZAG and phospholipase A2, group IIA. Plasma levels of ZAG, serum amyloid A, and C-reactive protein were higher at 7 to 9 days after subarachnoidal hemorrhage compared with either IC1 or recovery (P = .0001); and plasma levels of retinol-binding protein 4 and adiponectin were lower at IC1 compared with recovery (P = .05). The described changes in adipose tissue gene expression and plasma levels of adipokines and acute-phase proteins may influence the development of insulin resistance during critical illness.
Collapse
Affiliation(s)
- Margareta Jernås
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE 413 45 Gothenburg, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Ost M, Nylén K, Csajbok L, Blennow K, Rosengren L, Nellgård B. Apolipoprotein E polymorphism and gender difference in outcome after severe traumatic brain injury. Acta Anaesthesiol Scand 2008; 52:1364-9. [PMID: 19025529 DOI: 10.1111/j.1399-6576.2008.01675.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is one of the most common causes of death and dismal outcome among children and young adults. The morbidity and mortality differ but more aggressive monitoring and more designated neuro intensive care units have improved the results. Studies have demonstrated a connection between apolipoprotein E (APOE) genotype and outcome after TBI, but few are prospective and none is from northern Europe. APOE has three alleles: epsilon2, epsilon3 and epsilon4. METHODS A total of 96 patients with Glasgow coma score (GCS) < or =8 were prospectively and consecutively included. APOE genotypes were all analyzed at the same laboratory from blood samples by polymerase chain reaction-restriction fragment length polymorphism. RESULTS All patients were assessed at 1 year with Glasgow outcome scale extended (GOSE), National Institute of Health Stroke Scale (NIHSS) and the Barthel daily living index. The genotype was available in all patients. Twenty-six patients expressed APOE epsilon4 while 70 patients did not. Outcome demonstrated that patients with APOE epsilon4 had worse outcome vs. those lacking this allele. When subdividing patients into gender, males with APOE epsilon4 did worse, a difference not detected among female patients. CONCLUSIONS APOE epsilon4 correlated to worse outcome in TBI patients. We also found that males with APOE epsilon4 had poor outcome while females did not. Thus, the results indicate that genetic polymorphism may influence outcome after TBI.
Collapse
Affiliation(s)
- M Ost
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | | | | | | | | |
Collapse
|
47
|
Nylén K, Csajbok LZ, Ost M, Rashid A, Blennow K, Nellgård B, Rosengren L. Serum Glial Fibrillary Acidic Protein Is Related to Focal Brain Injury and Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke 2007; 38:1489-94. [PMID: 17395862 DOI: 10.1161/strokeaha.106.478362] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysmal subarachnoid hemorrhage (aSAH) stands out from other subtypes of stroke because of the high early mortality and the risk of complications. Serum glial fibrillary acidic protein (s-GFAP) concentrations are increased after stroke. The aim of this study was to investigate whether s-GFAP could be used as a marker of brain damage and outcome after aSAH. METHODS Serum samples were obtained on a regular basis from 116 adults during a 2-week period after aSAH and analyzed using an enzyme-linked immunosorbent assay. The World Federation of Neurological Surgeons scale was used for neurological evaluation. Outcome was assessed after 1 year and categorized according to the Extended Glasgow Outcome Scale. RESULTS Increased s-GFAP levels were seen in 81 of the 116 patients. Maximum s-GFAP correlated with World Federation of Neurological Surgeons scale on arrival and on days 10 to 15 (r=0.37, P<0.001 and r=0.47, P<0.001, respectively). Furthermore, maximum s-GFAP levels were increased in the patient group with radiological signs of focal lesions acute or at 1 year, compared with the group without focal lesions (P<0.001 in both comparisons). Patients with secondary events (re-bleeding or ischemia) reached maximum levels later in the series and both maximum and final s-GFAP levels increased compared with the levels in patients without secondary events (P<0.001 in all 3 comparisons). Finally, maximum s-GFAP correlated with outcome (r=-0.48, P<0.001) and s-GFAP was an independent predictor of dichotomized outcome. CONCLUSIONS s-GFAP provides information about brain injury severity and outcome after aSAH, which can be useful as a complement to clinical data.
Collapse
Affiliation(s)
- Karin Nylén
- Department of Neurology, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, University of Göteborg, Göteborg, Sweden.
| | | | | | | | | | | | | |
Collapse
|
48
|
Ost M, Nylén K, Csajbok L, Ohrfelt AO, Tullberg M, Wikkelsö C, Nellgård P, Rosengren L, Blennow K, Nellgård B. Initial CSF total tau correlates with 1-year outcome in patients with traumatic brain injury. Neurology 2006; 67:1600-4. [PMID: 17101890 DOI: 10.1212/01.wnl.0000242732.06714.0f] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We investigated if tau, microtubular binding protein, in serum and ventricular CSF (vCSF) in patients with severe traumatic brain injury (TBI) during the initial posttraumatic days correlated to 1-year outcome. METHODS Patients with severe TBI (n = 39, Glasgow Coma Scale score <or=8) were included. We measured serum and vCSF total tau on days 0 to 14, using ELISA. vCSF total tau correlated to 1-year Extended Glasgow Outcome Scale (GOSE), the NIH Stroke Scale (NIHSS) neurologic status, and the Bartel Daily Living Index. Patients (n = 20) with normal pressure hydrocephalus (NPH) served as reference. RESULTS Higher levels of tau were found in TBI patients vs patients with NPH. A correlation was found between initial vCSF total tau and GOSE levels (R = 0.42, p < 0.001) but not between vCSF total tau and NIHSS or Bartel scores at 1 year. A vCSF total tau level of >2,126 pg/mL on days 2 to 3 discriminated between dead and alive (sensitivity of 100% and a specificity of 81%). A vCSF total tau level of >702 pg/mL on days 2 to 3 discriminated between bad (GOSE 1 to 4) and good (GOSE 5 to 8) outcome (sensitivity of 83% and a specificity of 69%). Patients with GOSE 1 (dead) had higher vCSF total tau levels on days 2 to 3 (p < 0.001) vs both surviving patients (GOSE 2 to 8) and those with NPH. Total tau was not detected in serum throughout the study. CONCLUSION The increase in ventricular CSF (vCSF) total tau probably reflects axonal damage, known to be a central pathologic mechanism in traumatic brain injury (TBI). These results suggest that vCSF total tau may be an important early biochemical neuromarker for predicting long-term outcome in patients with a severe TBI.
Collapse
Affiliation(s)
- M Ost
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
BACKGROUND Prone position has been used for several years to treat acute lung insufficiency, but in previous studies patients with unstable intracranial pressure (ICP) are mostly excluded. The aim of this study was to investigate if prone position is a safe and useful treatment in patients with reduced intracranial compliance. METHODS A consecutive, prospective pilot study of 11 patients admitted to the neuro intensive care unit (NICU) due to traumatic brain injury or intracerebral haemorrhage. ICP, cerebral perfusion pressure (CPP), heart rate (HR), mean arterial blood pressure (MABP), arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)) and respiratory system compliance were measured before, three times during and two times after the patients were placed in the prone position. RESULTS No significant changes were demonstrated in ICP, CPP or MABP. PaO(2) and SaO(2) were significantly increased in the prone position. HR was significantly increased in the prone position and after 10 min in the supine post-prone position and the respiratory system compliance was increased after 1 h in the supine post-prone position. CONCLUSION Turning NICU patients from the supine to the prone position did not influence ICP, CPP or MABP, but significantly improved patient PaO(2), SaO(2) and respiratory system compliance.
Collapse
Affiliation(s)
- A Thelandersson
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | | |
Collapse
|
50
|
Nylén K, Csajbok LZ, Ost M, Rashid A, Karlsson JE, Blennow K, Nellgård B, Rosengren L. CSF –Neurofilament correlates with outcome after aneurysmal subarachnoid hemorrhage. Neurosci Lett 2006; 404:132-6. [PMID: 16806706 DOI: 10.1016/j.neulet.2006.05.029] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 05/11/2006] [Accepted: 05/14/2006] [Indexed: 11/24/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating event. Following the bleeding, a number of pathophysiological changes and clinical factors determine outcome. Not surprisingly, attempts to predict outcome based on a single factor have failed. The neurological status graded at admission to hospital and distributions of the blood on CT are the strongest predictors. There is evidence that cerebrospinal fluid (CSF) proteins may serve as markers of the extent of brain damage. The present study is focused on the light unit of neurofilament protein (NFL), previously not evaluated in aSAH. Lumbar puncture (LP), neurological grading according to World Federation of Neurological Surgeons (WFNS) and neurological examination according to the National Institute of Health Stroke Scale (NIHSS) were performed in 48 consecutive patients with aSAH 10-14 days after the hemorrhage. CSF-NFL concentrations were analyzed using an ELISA. Outcome was assessed after 1 year and categorised according to the extended Glasgow Outcome Scale (GOSE). A significant correlation between CSF-NFL and GOSE was detected at follow up after 1 year. CSF-NFL also correlated with WFNS and NIHSS on the day of the lumbar puncture. CSF-NFL is a biochemical marker of brain damage correlating to neurological status and long-term outcome after aneurysmal subarachnoid hemorrhage.
Collapse
Affiliation(s)
- K Nylén
- Department of Neurology, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, University of Göteborg, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|