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Tsilika M, Mitrou J, Antonakos N, Tseti IK, Damoraki G, Leventogiannis K, Giamarellos-Bourboulis EJ. An active new formulation of iron carried by aspartyl casein for iron-deficiency anemia: results of the ACCESS trial. Ann Hematol 2023; 102:1341-1349. [PMID: 37022473 PMCID: PMC10182142 DOI: 10.1007/s00277-023-05197-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
Oral iron supplementation is the cornerstone for the management of iron-deficiency anemia. A new oral formulation of iron conjugated with N-aspartyl-casein (Fe-ASP) (Omalin®, Uni-Pharma) is studied in the ACCESS double-blind, double-dummy randomized clinical trial; 60 patients were randomized to 12-week oral treatment twice every day either with oral ferrous sulfate (FeSO4) delivering 47 mg elementary iron or oral Fe-ASP delivering 40 mg elementary iron. Participants had hemoglobin less than 10 g/dl, decreased red blood cell (RBC) count, and ferritin lower than 30 ng/ml; patients with a medical history of malignancy were excluded. The primary endpoint was the increase of Hb in the first 4 weeks of treatment, and the study was powered for non-inferiority. A new score of global improvement was introduced where all participants were given one point for any at least 10% increase of Hb, RBC, and reticulocytes. At week 4, the mean (SE) change of Hb was 0.76 g/dl in the FeSO4 group and 0.83 g/dl in the Fe-ASP group (p: 0.876). The odds for worse allocation of the global score were 0.35 in the Fe-ASP group compared to the FeSO4 group. Patients in the Fe-ASP group experienced a significant decrease in the number of IDA-related physical signs by week 4. No differences were found between the two groups in any of the patient-reported outcomes of fatigue and of gastrointestinal adverse events either at week 4 or at week 12. ACCESS is the most recent clinical trial showing the non-inferiority of Fe-ASP to FeSO4 for the primary endpoint of the Hb change.
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Affiliation(s)
- Maria Tsilika
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Mitrou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Antonakos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Georgia Damoraki
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Leventogiannis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- 4th Department of Internal Medicine, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
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Tsilika M, Taks E, Dolianitis K, Kotsaki A, Leventogiannis K, Damoulari C, Kostoula M, Paneta M, Adamis G, Papanikolaou I, Stamatelopoulos K, Bolanou A, Katsaros K, Delavinia C, Perdios I, Pandi A, Tsiakos K, Proios N, Kalogianni E, Delis I, Skliros E, Akinosoglou K, Perdikouli A, Poulakou G, Milionis H, Athanassopoulou E, Kalpaki E, Efstratiou L, Perraki V, Papadopoulos A, Netea MG, Giamarellos-Bourboulis EJ. Corrigendum: ACTIVATE-2: A double-blind randomized trial of BCG vaccination against COVID-19 in individuals at risk. Front Immunol 2022; 13:1018384. [PMID: 36119100 PMCID: PMC9472241 DOI: 10.3389/fimmu.2022.1018384] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maria Tsilika
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Esther Taks
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
| | - Konstantinos Dolianitis
- Department of Internal Medicine, “Bodosakeio” General Hospital of Ptolemaida, Ptolemaida, Greece
| | - Antigone Kotsaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Leventogiannis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Damoulari
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Kostoula
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Paneta
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Adamis
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Kimon Stamatelopoulos
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Amalia Bolanou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Christina Delavinia
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Perdios
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Aggeliki Pandi
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Konstantinos Tsiakos
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Proios
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouela Kalogianni
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Delis
- Department of Internal Medicine, General Hospital of Karditsa, Karditsa, Greece
| | | | | | - Aggeliki Perdikouli
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Garyfallia Poulakou
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- 1Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Eva Athanassopoulou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleftheria Kalpaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Antonios Papadopoulos
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Evangelos J. Giamarellos-Bourboulis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- *Correspondence: Evangelos J. Giamarellos-Bourboulis,
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Tsilika M, Taks E, Dolianitis K, Kotsaki A, Leventogiannis K, Damoulari C, Kostoula M, Paneta M, Adamis G, Papanikolaou I, Stamatelopoulos K, Bolanou A, Katsaros K, Delavinia C, Perdios I, Pandi A, Tsiakos K, Proios N, Kalogianni E, Delis I, Skliros E, Akinosoglou K, Perdikouli A, Poulakou G, Milionis H, Athanassopoulou E, Kalpaki E, Efstratiou L, Perraki V, Papadopoulos A, Netea MG, Giamarellos-Bourboulis EJ. ACTIVATE-2: A Double-Blind Randomized Trial of BCG Vaccination Against COVID-19 in Individuals at Risk. Front Immunol 2022; 13:873067. [PMID: 35865520 PMCID: PMC9294453 DOI: 10.3389/fimmu.2022.873067] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
In a recent study of our group with the acronym ACTIVATE, Bacillus Calmete-Guérin (BCG) vaccination reduced the occurrence of new infections compared to placebo vaccination in the elderly. Most benefit was found for respiratory infections. The ACTIVATE-2 study was launched to assess the efficacy of BCG vaccination against coronavirus disease 2019 (COVID-19). In this multicenter, double-blind trial, 301 volunteers aged 50 years or older were randomized (1:1) to be vaccinated with BCG or placebo. The trial end points were the incidence of COVID-19 and the presence of anti–severe acute respiratory syndrome coronavirus 2 (anti–SARS-CoV-2) antibodies, which were both evaluated through 6 months after study intervention. Results revealed 68% relative reduction of the risk to develop COVID-19, using clinical criteria or/and laboratory diagnosis, in the group of BCG vaccine recipients compared with placebo-vaccinated controls, during a 6-month follow-up (OR 0.32, 95% CI 0.13-0.79). In total, eight patients were in need of hospitalization for COVID-19: six in the placebo group and two in the BCG group. Three months after study intervention, positive anti–SARS-CoV-2 antibodies were noted in 1.3% of volunteers in the placebo group and in 4.7% of participants in BCG-vaccinated group. The ACTIVATE II trial did not meet the primary endpoint of the reduction of the risk for COVID-19 3 months after BCG vaccination; however, the secondary endpoint of the reduction of the risk for COVID-19 6 months after BCG vaccination was met. BCG vaccination may be a promising approach against the COVID-19 pandemic.
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Affiliation(s)
- Maria Tsilika
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Esther Taks
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
| | - Konstantinos Dolianitis
- Department of Internal Medicine, “Bodosakeio” General Hospital of Ptolemaida, Ptolemaida, Greece
| | - Antigone Kotsaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Leventogiannis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Damoulari
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Kostoula
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Paneta
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Adamis
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Kimon Stamatelopoulos
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Amalia Bolanou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Christina Delavinia
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Perdios
- 1Department of Internal Medicine, “G.Gennimatas” Athens General Hospital, Athens, Greece
| | - Aggeliki Pandi
- Department of Pulmonary Medicine, Aghia Eirini General Hospital of Kerkyra, Kontokali, Greece
| | - Konstantinos Tsiakos
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Proios
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanouela Kalogianni
- Department of Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Delis
- Department of Internal Medicine, General Hospital of Karditsa, Karditsa, Greece
| | | | | | - Aggeliki Perdikouli
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Garyfallia Poulakou
- 3Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- 1Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Eva Athanassopoulou
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleftheria Kalpaki
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Antonios Papadopoulos
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Evangelos J. Giamarellos-Bourboulis
- 4Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- *Correspondence: Evangelos J. Giamarellos-Bourboulis,
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Tzikos G, Tsalkatidou D, Stavrou G, Thoma G, Chorti A, Tsilika M, Michalopoulos A, Papavramidis T, Giamarellos-Bourboulis EJ, Kotzampassi K. A Four-Probiotic Regime to Reduce Surgical Site Infections in Multi-Trauma Patients. Nutrients 2022; 14:nu14132620. [PMID: 35807801 PMCID: PMC9268677 DOI: 10.3390/nu14132620] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Investigations that focused on the protective role of probiotics against Surgical Site Infections (SSI) in multiple-trauma (MT) patients are generally few, probably due to the complexity of the concept of trauma. We aimed to assess the efficacy of a four-probiotic regime to reduce the incidence of SSI in MT patients, with a brain injury included. MT patients, being intubated and expected to require mechanical ventilation for >10 days, were randomly allocated into placebo (n = 50) or probiotic treatment (n = 53) comprising Lactobacillus acidophilus LA-5 (1.75 × 109 cfu), Lactiplantibacillus plantarum UBLP-40 (0.5 × 109 cfu), Bifidobacterium animalis subsp. lactis BB-12 (1.75 × 109 cfu), and Saccharomycesboulardii Unique-28 (1.5 × 109 cfu) in sachets. All patients received two sachets of placebo or probiotics twice/day for 15 days and were followed-up for 30 days. The operations were classified as neurosurgical, thoracostomies, laparotomies, orthopedics, and others; then, the SSI and the isolated pathogen were registered. A total of 23 (46.0%) and 13 (24.5%) infectious insults in 89 (50 placebo patients) and 88 (53 probiotics-treated) operations (p = 0.022) were recorded, the majority of them relating to osteosynthesis—17 and 8, respectively. The most commonly identified pathogens were Staphylococcus aureus and Acinetobacter baumannii. Our results support published evidence that the prophylactic administration of probiotics in MT patients exerts a positive effect on the incidence of SSI.
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Affiliation(s)
- Georgios Tzikos
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (G.T.); (D.T.); (A.C.); (A.M.); (T.P.)
| | - Despoina Tsalkatidou
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (G.T.); (D.T.); (A.C.); (A.M.); (T.P.)
| | - George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- Leeds Institute of Emergency General Surgery, Leeds Teaching Hospitals NHS Trust, Leeds LS97LS, UK
| | - Giannoula Thoma
- Intensive Care Unit, Aghios Pavlos General Hospital, 55134 Thessaloniki, Greece;
| | - Angeliki Chorti
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (G.T.); (D.T.); (A.C.); (A.M.); (T.P.)
| | - Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece; (M.T.); (E.J.G.-B.)
| | - Antonios Michalopoulos
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (G.T.); (D.T.); (A.C.); (A.M.); (T.P.)
| | - Theodosios Papavramidis
- 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (G.T.); (D.T.); (A.C.); (A.M.); (T.P.)
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 12462 Athens, Greece; (M.T.); (E.J.G.-B.)
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- Correspondence:
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Tsilika M, Thoma G, Aidoni Z, Tsaousi G, Fotiadis K, Stavrou G, Malliou P, Chorti A, Massa H, Antypa E, Vasiliadou G, Pagdatoglou K, Voudouris A, Vasiliagou S, Mitos G, Kontopoulou N, Paraforou N, Antoniadou E, Mouloudi H, Gkeka E, Grosomanidis V, Giamarellos-Bourboulis EJ, Kotzampassi K. A FOUR PROBIOTIC PREPARATION FOR VENTILATOR-ASSOCIATED PNEUMONIA IN MULTI-TRAUMA PATIENTS: RESULTS OF A RANDOMIZED CLINICAL TRIAL. Int J Antimicrob Agents 2021; 59:106471. [PMID: 34757134 DOI: 10.1016/j.ijantimicag.2021.106471] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/30/2020] [Revised: 10/17/2021] [Accepted: 10/24/2021] [Indexed: 12/31/2022]
Abstract
The role of probiotics for the prevention of ventilator-associated pneumonia remains inconclusive. Our aim was to assess the efficacy of a probiotics regimen for VAP prophylaxis in mechanically ventilated multi-trauma patients, intubated immediately after the injurious insult. In a randomized, placebo-controlled study enrolling multi-trauma patients, anticipated to require mechanical ventilation for more than 10 days were randomly assigned to receive prophylaxis either with a probiotic formula [n=59] or placebo [n=53]. The probiotic formula was a preparation of Lactobacillus acidophilus LA-5 (1.75 × 109 cfu), L. plantarum (0.5 × 109 cfu), B. lactis BB-12 (1.75 × 109 cfu) and S. boulardii (1.5 × 109 cfu) per sachet. Each patient received two sachets twice daily for 15 days; one through the nasogastric tube; and another spread on the oropharynx. The incidence of VAP was the primary endpoint. The incidence of other infections and sepsis and the duration of hospital stay were the secondary endpoints. Probiotics administration reduced notably the incidence of VAP [11.9% vs 28.3%, odds ratio 0.34, 95%CIs 0.13-0.92, p=0.034] and of sepsis [6.8% vs 24.5%, OR 0.22, 95% CIs 0.07-0.74, p=0.016]. Furthermore, probiotics prophylaxis decreases the time of stay in the intensive care unit (ICU) and of hospital stay. The prophylactic use of probiotics as a combination of enteral and topical application to oropharynx exerted a positive effect on the incidence of VAP and sepsis as well as on the ICU and total hospital stay in patients under protracted mechanical ventilation.
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Affiliation(s)
- Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Giannoula Thoma
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | - Zoi Aidoni
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | - Georgia Tsaousi
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | | | - George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Greece
| | - Petra Malliou
- Department of Surgery, Aristotle University of Thessaloniki, Greece
| | - Angeliki Chorti
- Department of Surgery, Aristotle University of Thessaloniki, Greece
| | - Helen Massa
- Intensive Care Unit, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Elli Antypa
- Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Georgia Vasiliadou
- Intensive Care Unit, George Papanikolaou General Hospital, Thessaloniki, Greece
| | | | - Antonios Voudouris
- Intensive Care Unit, Aghios Pavlos General Hospital, Thessaloniki, Greece
| | | | - Giakoumis Mitos
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
| | - Ntina Kontopoulou
- Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Niki Paraforou
- Intensive Care Unit, Trikala General Hospital, Trikala, Greece
| | - Eleni Antoniadou
- Intensive Care Unit, Georgios Gennimatas General Hospital, Thessaloniki, Greece
| | - Helen Mouloudi
- Intensive Care Unit, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Eleni Gkeka
- Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Greece
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Kyriazopoulou E, Poulakou G, Milionis H, Metallidis S, Adamis G, Tsiakos K, Fragkou A, Rapti A, Damoulari C, Fantoni M, Kalomenidis I, Chrysos G, Angheben A, Kainis I, Alexiou Z, Castelli F, Serino FS, Tsilika M, Bakakos P, Nicastri E, Tzavara V, Kostis E, Dagna L, Koufargyris P, Dimakou K, Savvanis S, Tzatzagou G, Chini M, Cavalli G, Bassetti M, Katrini K, Kotsis V, Tsoukalas G, Selmi C, Bliziotis I, Samarkos M, Doumas M, Ktena S, Masgala A, Papanikolaou I, Kosmidou M, Myrodia DM, Argyraki A, Cardellino CS, Koliakou K, Katsigianni EI, Rapti V, Giannitsioti E, Cingolani A, Micha S, Akinosoglou K, Liatsis-Douvitsas O, Symbardi S, Gatselis N, Mouktaroudi M, Ippolito G, Florou E, Kotsaki A, Netea MG, Eugen-Olsen J, Kyprianou M, Panagopoulos P, Dalekos GN, Giamarellos-Bourboulis EJ. Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial. Nat Med 2021; 27:1752-1760. [PMID: 34480127 PMCID: PMC8516650 DOI: 10.1038/s41591-021-01499-z] [Citation(s) in RCA: 297] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/10/2021] [Indexed: 12/20/2022]
Abstract
Early increase of soluble urokinase plasminogen activator receptor (suPAR) serum levels is indicative of increased risk of progression of coronavirus disease 2019 (COVID-19) to respiratory failure. The SAVE-MORE double-blind, randomized controlled trial evaluated the efficacy and safety of anakinra, an IL-1α/β inhibitor, in 594 patients with COVID-19 at risk of progressing to respiratory failure as identified by plasma suPAR ≥6 ng ml-1, 85.9% (n = 510) of whom were receiving dexamethasone. At day 28, the adjusted proportional odds of having a worse clinical status (assessed by the 11-point World Health Organization Clinical Progression Scale (WHO-CPS)) with anakinra, as compared to placebo, was 0.36 (95% confidence interval 0.26-0.50). The median WHO-CPS decrease on day 28 from baseline in the placebo and anakinra groups was 3 and 4 points, respectively (odds ratio (OR) = 0.40, P < 0.0001); the respective median decrease of Sequential Organ Failure Assessment (SOFA) score on day 7 from baseline was 0 and 1 points (OR = 0.63, P = 0.004). Twenty-eight-day mortality decreased (hazard ratio = 0.45, P = 0.045), and hospital stay was shorter.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Simeon Metallidis
- 1st Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Georgios Adamis
- 1st Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Konstantinos Tsiakos
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | | | - Aggeliki Rapti
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Christina Damoulari
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Massimo Fantoni
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - Georgios Chrysos
- 2nd Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Andrea Angheben
- Department of Infectious Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ilias Kainis
- 10th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Athens, Greece
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Petros Bakakos
- 1st Department of Chest Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vassiliki Tzavara
- 1st Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Evangelos Kostis
- Department of Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Panagiotis Koufargyris
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Katerina Dimakou
- 5th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Spyridon Savvanis
- Department of Internal Medicine, Elpis General Hospital, Athens, Greece
| | - Glykeria Tzatzagou
- 1st Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- 3rd Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genova, Italy
| | - Konstantina Katrini
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vasileios Kotsis
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - George Tsoukalas
- 4th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy & IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ioannis Bliziotis
- 1st Department of Internal Medicine, Asklepieio General Hospital of Voula, Athens, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Michael Doumas
- 2nd Department of Propedeutic Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Sofia Ktena
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Masgala
- 2nd Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Kerkyra, Corfu, Greece
| | - Maria Kosmidou
- 1st Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Dimitra-Melia Myrodia
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Chiara Simona Cardellino
- Department of Infectious Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | | | | | - Vassiliki Rapti
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Efthymia Giannitsioti
- 2nd Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Antonella Cingolani
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Styliani Micha
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | | | | | - Styliani Symbardi
- 1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Nikolaos Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Maria Mouktaroudi
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Giuseppe Ippolito
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Eleni Florou
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Antigone Kotsaki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, The Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | | | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
- Hellenic Institute for the Study of Sepsis, Athens, Greece.
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7
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Doulou S, Leventogiannis K, Tsilika M, Rodencal M, Katrini K, Antonakos N, Kyprianou M, Karofylakis E, Karageorgos A, Koufargyris P, Christopoulos G, Kassianidis G, Stamatelopoulos K, Newberry R, Giamarellos-Bourboulis EJ. A novel optical biosensor for the early diagnosis of sepsis and severe Covid-19: the PROUD study. BMC Infect Dis 2020; 20:860. [PMID: 33213370 PMCID: PMC7675385 DOI: 10.1186/s12879-020-05607-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 06/14/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background The accuracy of a new optical biosensor (OB) point-of-care device for the detection of severe infections is studied. Methods The OB emits different wavelengths and outputs information associated with heart rate, pulse oximetry, levels of nitric oxide and kidney function. At the first phase, recordings were done every two hours for three consecutive days after hospital admission in 142 patients at high-risk for sepsis by placing the OB on the forefinger. At the second phase, single recordings were done in 54 patients with symptoms of viral infection; 38 were diagnosed with COVID-19. Results At the first phase, the cutoff value of positive likelihood of 18 provided 100% specificity and 100% positive predictive value for the diagnosis of sepsis. These were 87.5 and 91.7% respectively at the second phase. OB diagnosed severe COVID-19 with 83.3% sensitivity and 87.5% negative predictive value. Conclusions The studied OB seems valuable for the discrimination of infection severity.
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Affiliation(s)
- Sarantia Doulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Konstantinos Leventogiannis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Matthew Rodencal
- Sanmina Corporation, 13000 S. Memorial Parkway, Huntsville, AL, 35803, USA
| | - Konstantina Katrini
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Nikolaos Antonakos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Miltiades Kyprianou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Emmanouil Karofylakis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Athanassios Karageorgos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Panagiotis Koufargyris
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - Gennaios Christopoulos
- 2nd Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece
| | - George Kassianidis
- Intensive Care Unit, Korgialeneion Benakeion Athens General Hospital, 115 26, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Therapeutics, National and Kapodistrian University of Athens, 115 28, Athens, Greece
| | - Robert Newberry
- Sanmina Corporation, 13000 S. Memorial Parkway, Huntsville, AL, 35803, USA
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62, Athens, Greece. .,4th Department of Internal Medicine, ATTIKON University General Hospital, 1 Rimini Str, 12462, Athens, Greece.
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8
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Azam TU, Shadid HR, Blakely P, O'Hayer P, Berlin H, Pan M, Zhao P, Zhao L, Pennathur S, Pop-Busui R, Altintas I, Tingleff J, Stauning MA, Andersen O, Adami ME, Solomonidi N, Tsilika M, Tober-Lau P, Arnaoutoglou E, Keitel V, Tacke F, Chalkias A, Loosen SH, Giamarellos-Bourboulis EJ, Eugen-Olsen J, Reiser J, Hayek SS. Soluble Urokinase Receptor (SuPAR) in COVID-19-Related AKI. J Am Soc Nephrol 2020; 31:2725-2735. [PMID: 32963090 DOI: 10.1681/asn.2020060829] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AKI commonly occurs in patients with coronavirus disease 2019 (COVID-19). Its pathogenesis is poorly understood. The urokinase receptor system is a key regulator of the intersection between inflammation, immunity, and coagulation, and soluble urokinase plasminogen activator receptor (suPAR) has been identified as an immunologic risk factor for AKI. Whether suPAR is associated with COVID-19-related AKI is unknown. METHODS In a multinational observational study of adult patients hospitalized for COVID-19, we measured suPAR levels in plasma samples from 352 adult patients that had been collected within 48 hours of admission. We examined the association between suPAR levels and incident in-hospital AKI. RESULTS Of the 352 patients (57.4% were male, 13.9% were black, and mean age was 61 years), 91 (25.9%) developed AKI during their hospitalization, of whom 25 (27.4%) required dialysis. The median suPAR level was 5.61 ng/ml. AKI incidence rose with increasing suPAR tertiles, from a 6.0% incidence in patients with suPAR <4.60 ng/ml (first tertile) to a 45.8% incidence of AKI in patients with suPAR levels >6.86 ng/ml (third tertile). None of the patients with suPAR <4.60 ng/ml required dialysis during their hospitalization. In multivariable analysis, the highest suPAR tertile was associated with a 9.15-fold increase in the odds of AKI (95% confidence interval [95% CI], 3.64 to 22.93) and a 22.86-fold increase in the odds of requiring dialysis (95% CI, 2.77 to 188.75). The association was independent of inflammatory markers and persisted across subgroups. CONCLUSIONS Admission suPAR levels in patients hospitalized for COVID-19 are predictive of in-hospital AKI and the need for dialysis. SuPAR may be a key component of the pathophysiology of AKI in COVID-19.
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Affiliation(s)
- Tariq U Azam
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Husam R Shadid
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Pennelope Blakely
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Patrick O'Hayer
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hanna Berlin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael Pan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Peiyao Zhao
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rodica Pop-Busui
- Division of Endocrinology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Izzet Altintas
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jens Tingleff
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Marius A Stauning
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Maria-Evangelia Adami
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicky Solomonidi
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pinkus Tober-Lau
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, Thessaly, Greece
| | - Verena Keitel
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Athanasios Chalkias
- Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, Thessaly, Greece
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Salim S Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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9
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Giamarellos-Bourboulis EJ, Tsilika M, Moorlag S, Antonakos N, Kotsaki A, Domínguez-Andrés J, Kyriazopoulou E, Gkavogianni T, Adami ME, Damoraki G, Koufargyris P, Karageorgos A, Bolanou A, Koenen H, van Crevel R, Droggiti DI, Renieris G, Papadopoulos A, Netea MG. Activate: Randomized Clinical Trial of BCG Vaccination against Infection in the Elderly. Cell 2020; 183:315-323.e9. [PMID: 32941801 PMCID: PMC7462457 DOI: 10.1016/j.cell.2020.08.051] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [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: 05/15/2020] [Revised: 07/10/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
BCG vaccination in children protects against heterologous infections and improves survival independently of tuberculosis prevention. The phase III ACTIVATE trial assessed whether BCG has similar effects in the elderly. In this double-blind, randomized trial, elderly patients (n = 198) received BCG or placebo vaccine at hospital discharge and were followed for 12 months for new infections. At interim analysis, BCG vaccination significantly increased the time to first infection (median 16 weeks compared to 11 weeks after placebo). The incidence of new infections was 42.3% (95% CIs 31.9%–53.4%) after placebo vaccination and 25.0% (95% CIs 16.4%–36.1%) after BCG vaccination; most of the protection was against respiratory tract infections of probable viral origin (hazard ratio 0.21, p = 0.013). No difference in the frequency of adverse effects was found. Data show that BCG vaccination is safe and can protect the elderly against infections. Larger studies are needed to assess protection against respiratory infections, including COVID-19 (ClinicalTrials.gov NCT03296423). ACTIVATE is a prospective randomized trial of BCG vaccination in the elderly BCG increased the time to first infection and decreased the incidence of new infection Strongest protection was found against viral respiratory tract infections Epigenetic reprogramming and increased cytokine production was found in monocytes
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Affiliation(s)
| | - Maria Tsilika
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Simone Moorlag
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Nikolaos Antonakos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Antigone Kotsaki
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Jorge Domínguez-Andrés
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Evdoxia Kyriazopoulou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Theologia Gkavogianni
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Maria-Evangelia Adami
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Georgia Damoraki
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Panagiotis Koufargyris
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Athanassios Karageorgos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Amalia Bolanou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Hans Koenen
- Department of Laboratory Medicine, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands
| | - Dionyssia-Irene Droggiti
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - George Renieris
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Antonios Papadopoulos
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, 124 62 Athens, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 Nijmegen, the Netherlands; Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
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10
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Tsilika M, Antonakos N, Gkavogianni T, Karageorgos A, Kyriazopoulou E, Netea MG, Giamarellos-Bourboulis EJ. Impact of comorbidities on the performance of interferon-gamma release assay in an elderly Greek population without overt immunodeficiency. Int J Antimicrob Agents 2020; 56:106073. [PMID: 32629117 DOI: 10.1016/j.ijantimicag.2020.106073] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/13/2022]
Abstract
Background The prevalence of latent tuberculosis infection (LTBI) increases with age. Interferon-gamma release assay (IGRA) is a T-cell based assay widely used for the detection of LTBI. Objectives To identify the prevalence of LTBI among an elderly Greek population using IGRA and to evaluate comorbidities associated with LTBI. Methods Individuals aged at least 65 years who were non-immunocompromised and had no history of active tuberculosis infection (TBI) underwent IGRA to identify LTBI. Participant characteristics were compared between the LTBI and non-LTBI groups. Interferon-gamma (INFγ) levels were analysed in each group. Results A total of 130 (38.7%) participants with LTBI and 206 (61.3%) participants without LTBI were included. Multivariate logistic regression analysis identified the following features that were independently associated with a positive IGRA result: female sex (odds ratio [OR]: 0.45; 95% confidence interval [CI]: 0.28-0.72; P=0.001), chronic heart failure (OR: 0.41; 95% CI: 0.22-0.77; P=0.005), history of major surgery (OR: 0.55; 95% CI: 0.33-0.92; P=0.022) and Charlson Comorbidity Index >3 (OR: 3.06; 95% CI: 1.46-6.40; P=0.003). Production of stimulated INFγ was significantly lower in the non-LTBI group. Conclusions Female sex, history of chronic heart failure and history of any surgical intervention were independently associated with a negative IGRA result, and CCI >3 was associated with a positive IGRA result. These results indicate careful interpretation of IGRA is required among elderly individuals with these characteristics.
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Affiliation(s)
- Maria Tsilika
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Nikolaos Antonakos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Athanassios Karageorgos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Infectious Diseases, Radboud University Nijmegen, The Netherlands
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11
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Tomos I, Tsilika M, Aggelou E, Karageorgas T, Tsiodras S. An 80-Year-Old Man With Hemoptysis and Unilateral Patchy Opacities. Chest 2018; 154:e135-e138. [PMID: 30409367 DOI: 10.1016/j.chest.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 10/27/2022] Open
Abstract
CASE PRESENTATION An 80-year-old man presented with a 5-day history of hemoptysis, mild shortness of breath on exertion, fatigue, and malaise. He denied chest pain or fever. He had a history of hypertension, congestive heart failure, and left nephrectomy for renal cancer 10 years earlier; he was a former cigarette smoker with a 50 pack-year history, having quit 5 years prior to presentation. The patient did not report any recent travel history or occupational or animal exposures, and he did not have gastroesophageal reflux. Medications included diltiazem hydrochloride, irbesartan, hydrochlorothiazide, and ranitidine.
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Affiliation(s)
- Ioannis Tomos
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Maria Tsilika
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Eleni Aggelou
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Theophanis Karageorgas
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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