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Kassianidis G, Siampanos A, Poulakou G, Adamis G, Rapti A, Milionis H, Dalekos GN, Petrakis V, Sympardi S, Metallidis S, Alexiou Z, Gkavogianni T, Giamarellos-Bourboulis EJ, Theoharides TC. Calprotectin and Imbalances between Acute-Phase Mediators Are Associated with Critical Illness in COVID-19. Int J Mol Sci 2022; 23:ijms23094894. [PMID: 35563282 PMCID: PMC9099708 DOI: 10.3390/ijms23094894] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/13/2022] Open
Abstract
The trajectory from moderate and severe COVID-19 into acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation (MV) is a field of active research. We determined serum levels within 24 h of presentation of 20 different sets of mediators (calprotectin, pro- and anti-inflammatory cytokines, interferons) of patients with COVID-19 at different stages of severity (asymptomatic, moderate, severe and ARDS/MV). The primary endpoint was to define associations with critical illness, and the secondary endpoint was to identify the pathways associated with mortality. Results were validated in serial measurements of mediators among participants of the SAVE-MORE trial. Levels of the proinflammatory interleukin (IL)-8, IL-18, matrix metalloproteinase-9, platelet-derived growth factor (PDGF)-B and calprotectin (S100A8/A9) were significantly higher in patients with ARDS and MV. Levels of the anti-inflammatory IL-1ra and IL-33r were also increased; IL-38 was increased only in asymptomatic patients but significantly decreased in the more severe cases. Multivariate ordinal regression showed that pathways of IL-6, IL-33 and calprotectin were associated with significant probability for worse outcome. Calprotectin was serially increased from baseline among patients who progressed to ARDS and MV. Further research is needed to decipher the significance of these findings compared to other acute-phase reactants, such as C-reactive protein (CRP) or ferritin, for the prognosis and development of effective treatments.
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Affiliation(s)
- Georgios Kassianidis
- Intensive Care Unit, Korgialeneion-Benakeion Athens General Hospital, 115 26 Athens, Greece;
| | - Athanasios Siampanos
- 4th Department of Internal Medicine, ATTIKON University General Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62 Athens, Greece; (A.S.); (T.G.)
| | - Garyphalia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - George Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital of Athens, 115 27 Athens, Greece;
| | - Aggeliki Rapti
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, 115 27 Athens, Greece;
| | - Haralampos Milionis
- 1st Department of Internal Medicine, Medical School, University of Ioannina, 455 00 Ioannina, Greece;
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National and European Expertise Center in Autoimmune Liver Diseases, General University Hospital of Larissa, 412 21 Larissa, Greece;
| | - Vasileios Petrakis
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Styliani Sympardi
- 1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, 196 00 Magoula, Greece;
| | - Symeon Metallidis
- 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece;
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, Thriasio General Hospital of Eleusis, 196 00 Magoula, Greece;
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, ATTIKON University General Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62 Athens, Greece; (A.S.); (T.G.)
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, ATTIKON University General Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62 Athens, Greece; (A.S.); (T.G.)
- Correspondence: (E.J.G.-B.); (T.C.T.); Tel.: +30-210-58-31-994 (E.J.G.-B.); Fax: +30-210-53-26446 (E.J.G.-B.)
| | - Theoharis C. Theoharides
- Laboratory of Molecular Immunopharmacology and Drug Discovery, Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA
- School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111, USA
- Department of Internal Medicine, Tufts University School of Medicine and Tufts Medical Center, Boston, MA 02111, USA
- Institute of Neuro-Immune Medicine, Nova Southeastern University, Clearwater, FL 33759, USA
- Correspondence: (E.J.G.-B.); (T.C.T.); Tel.: +30-210-58-31-994 (E.J.G.-B.); Fax: +30-210-53-26446 (E.J.G.-B.)
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Marinakis G, Kassianidis G, Kafkoula E, Stamatopoulou C, Kavallieratos F, Patrani M, Katsenos C. Community-acquired Klebsiella spp Meningitis/Invasive Infection in Filipino-descent Patients Living in Greece: A Case Series. Eur J Case Rep Intern Med 2021; 8:002576. [PMID: 34268262 PMCID: PMC8276926 DOI: 10.12890/2021_002576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/07/2022] Open
Abstract
Klebsiella spp community-acquired meningitis caused by hypervirulent strains is well described as part of a distinct syndrome consisting of liver abscess and multiple septic metastatic lesions (Klebsiella pneumoniae invasive syndrome) occurring usually in diabetic, alcoholic, elderly or cancer patients, in Taiwan and other South-East Asian countries. In Western countries, these infections are very rare in natives and usually occur in patients of Asian origin. We report three cases of Filipino-origin patients, residents of Greece, with community-acquired invasive Klebsiella meningitis, who were treated in our ICU over a 10-year period.
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Affiliation(s)
- Giorgos Marinakis
- Intensive Care Unit, Red Cross Hospital of Athens "Korgialeneio-Benakeio", Athens, Greece
| | - Georgios Kassianidis
- Emergency Department, Red Cross Hospital of Athens "Korgialeneio-Benakeio", Athens, Greece
| | - Eleni Kafkoula
- Department of Medical Biopathology, Red Cross Hospital of Athens "Korgialeneio-Benakeio", Athens, Greece
| | | | - Fotios Kavallieratos
- Intensive Care Unit, Red Cross Hospital of Athens "Korgialeneio-Benakeio", Athens, Greece
| | - Maria Patrani
- Intensive Care Unit, Red Cross Hospital of Athens "Korgialeneio-Benakeio", Athens, Greece
| | - Chrysostomos Katsenos
- Intensive Care Unit, Red Cross Hospital of Athens "Korgialeneio-Benakeio", Athens, Greece
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Routsi C, Gkoufa A, Arvaniti K, Kokkoris S, Tourtoglou A, Theodorou V, Vemvetsou A, Kassianidis G, Amerikanou A, Paramythiotou E, Potamianou E, Ntorlis K, Kanavou A, Nakos G, Hassou E, Antoniadou H, Karaiskos I, Prekates A, Armaganidis A, Pnevmatikos I, Kyprianou M, Zakynthinos S, Poulakou G, Giamarellou H. De-escalation of antimicrobial therapy in ICU settings with high prevalence of multidrug-resistant bacteria: a multicentre prospective observational cohort study in patients with sepsis or septic shock. J Antimicrob Chemother 2021; 75:3665-3674. [PMID: 32865203 DOI: 10.1093/jac/dkaa375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND De-escalation of empirical antimicrobial therapy, a key component of antibiotic stewardship, is considered difficult in ICUs with high rates of antimicrobial resistance. OBJECTIVES To assess the feasibility and the impact of antimicrobial de-escalation in ICUs with high rates of antimicrobial resistance. METHODS Multicentre, prospective, observational study in septic patients with documented infections. Patients in whom de-escalation was applied were compared with patients without de-escalation by the use of a propensity score matching by SOFA score on the day of de-escalation initiation. RESULTS A total of 262 patients (mean age 62.2 ± 15.1 years) were included. Antibiotic-resistant pathogens comprised 62.9%, classified as MDR (12.5%), extensively drug-resistant (49%) and pandrug-resistant (1.2%). In 97 (37%) patients de-escalation was judged not feasible in view of the antibiotic susceptibility results. Of the remaining 165 patients, judged as patients with de-escalation possibility, de-escalation was applied in 60 (22.9%). These were matched to an equal number of patients without de-escalation. In this subset of 120 patients, de-escalation compared with no de-escalation was associated with lower all-cause 28 day mortality (13.3% versus 36.7%, OR 0.27, 95% CI 0.11-0.66, P = 0.006); ICU and hospital mortality were also lower. De-escalation was associated with a subsequent collateral decrease in the SOFA score. Cox multivariate regression analysis revealed de-escalation as a significant factor for 28 day survival (HR 0.31, 95% CI 0.14-0.70, P = 0.005). CONCLUSIONS In ICUs with high levels of antimicrobial resistance, feasibility of antimicrobial de-escalation was limited because of the multi-resistant pathogens isolated. However, when de-escalation was feasible and applied, it was associated with lower mortality.
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Affiliation(s)
- Christina Routsi
- 1st Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, 'Evangelismos' Hospital, Athens, Greece.,Hellenic Society of Antimicrobial Chemotherapy, Greece
| | | | - Kostoula Arvaniti
- Department of Intensive Care, 'Papageorgiou' Hospital, Thessaloniki, Greece
| | - Stelios Kokkoris
- 1st Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, 'Evangelismos' Hospital, Athens, Greece
| | | | - Vassiliki Theodorou
- Department of Intensive Care, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | - Anna Vemvetsou
- Department of Intensive Care, 'Papageorgiou' Hospital, Thessaloniki, Greece
| | | | | | - Elisabeth Paramythiotou
- 2nd Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, 'Attikon' Hospital, Athens, Greece
| | - Efstathia Potamianou
- 1st Department of Respiratory Medicine, Intensive Care Unit, School of Medicine, National and Kapodistrian University of Athens, 'Sotiria' Hospital, Athens, Greece
| | - Kyriakos Ntorlis
- Department of Intensive Care, 'Konstantopouleio' Hospital, Athens, Greece
| | - Angeliki Kanavou
- Department of Intensive Care, 'Thriassio' Hospital, Elefsina, Greece
| | - Georgios Nakos
- Department of Intensive Care, 'Henry Dunant' Hospital Center, Athens, Greece
| | - Eleftheria Hassou
- Department of Intensive Care, 'Gennimatas' Hospital, Thessaloniki, Greece
| | - Helen Antoniadou
- Department of Intensive Care, 'Gennimatas' Hospital, Thessaloniki, Greece
| | - Ilias Karaiskos
- Hellenic Society of Antimicrobial Chemotherapy, Greece.,Hygeia General Hospital, Athens, Greece
| | | | - Apostolos Armaganidis
- 2nd Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, 'Attikon' Hospital, Athens, Greece
| | - Ioannis Pnevmatikos
- Department of Intensive Care, Democritus University of Thrace, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | | | - Spyros Zakynthinos
- 1st Department of Intensive Care, School of Medicine, National and Kapodistrian University of Athens, 'Evangelismos' Hospital, Athens, Greece
| | - Garyfallia Poulakou
- Hellenic Society of Antimicrobial Chemotherapy, Greece.,School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Giamarellou
- Hellenic Society of Antimicrobial Chemotherapy, Greece.,Hygeia General Hospital, Athens, Greece
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