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Kyriazopoulou E, Hasin-Brumshtein Y, Midic U, Poulakou G, Milionis H, Metallidis S, Astriti M, Fragkou A, Rapti A, Taddei E, Kalomenidis I, Chrysos G, Angheben A, Kainis I, Alexiou Z, Castelli F, Serino FS, Bakakos P, Nicastri E, Tzavara V, Ioannou S, Dagna L, Dimakou K, Tzatzagou G, Chini M, Bassetti M, Kotsis V, Tsoukalas DG, Selmi C, Konstantinou A, Samarkos M, Doumas M, Masgala A, Pagkratis K, Argyraki A, Akinosoglou K, Symbardi S, Netea MG, Panagopoulos P, Dalekos GN, Liesenfeld O, Sweeney TE, Khatri P, Giamarellos-Bourboulis EJ. Transitions of blood immune endotypes and improved outcome by anakinra in COVID-19 pneumonia: an analysis of the SAVE-MORE randomized controlled trial. Crit Care 2024; 28:73. [PMID: 38475786 PMCID: PMC10935809 DOI: 10.1186/s13054-024-04852-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Endotype classification may guide immunomodulatory management of patients with bacterial and viral sepsis. We aimed to identify immune endotypes and transitions associated with response to anakinra (human interleukin 1 receptor antagonist) in participants in the SAVE-MORE trial. METHODS Adult patients hospitalized with radiological findings of PCR-confirmed severe pneumonia caused by SARS-CoV-2 and plasma-soluble urokinase plasminogen activator receptor levels of ≥ 6 ng/ml in the SAVE-MORE trial (NCT04680949) were characterized at baseline and days 4 and 7 of treatment using a previously defined 33-messenger RNA classifier to assign an immunological endotype in blood. Endpoints were changes in endotypes and progression to severe respiratory failure (SRF) associated with anakinra treatment. RESULTS At baseline, 23.2% of 393 patients were designated as inflammopathic, 41.1% as adaptive, and 35.7% as coagulopathic. Only 23.9% were designated as the same endotype at days 4 and 7 compared to baseline, while all other patients transitioned between endotypes. Anakinra-treated patients were more likely to remain in the adaptive endotype during 7-day treatment (24.4% vs. 9.9%; p < 0.001). Anakinra also protected patients with coagulopathic endotype at day 7 against SRF compared to placebo (27.8% vs. 55.9%; p = 0.013). CONCLUSION We identify an association between endotypes defined using blood transcriptome and anakinra therapy for COVID-19 pneumonia, with anakinra-treated patients shifting toward endotypes associated with a better outcome, mainly the adaptive endotype. Trial registration ClinicalTrials.gov, NCT04680949, December 23, 2020.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Simeon Metallidis
- 1st Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Myrto Astriti
- 1st Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | - Aggeliki Rapti
- 2nd Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Eleonora Taddei
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Gemelli IRCCS, Rome, 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
| | | | - Petros Bakakos
- 1st Department of Chest Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vasiliki Tzavara
- 1st Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Sofia Ioannou
- Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Katerina Dimakou
- 5th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, 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
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genova, Italy
| | - Vasileios Kotsis
- 3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dionysios G Tsoukalas
- 4th Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alexandra Konstantinou
- 1st Department of Internal Medicine, Asklepieio General Hospital of Voula, Voula, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doumas
- 2nd Department of Propedeutic Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Masgala
- 2nd Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | | | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | | | - Styliani Symbardi
- 1st Department of Internal Medicine, Thriasio General Hospital of Eleusis, 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
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | | | | | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, School of Medicine, Stanford University, Stanford, CA, USA
- Center for Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - 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 Hospital, 1 Rimini Street, 124 62, Athens, Greece.
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Vaiopoulos AG, Samarkos M, Kanakis MA, Vaiopoulos G, Kaklamanis PG, Zouboulis CC. Late-onset Adamantiades-Behçet's disease-systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024; 38:e238-e241. [PMID: 37793879 DOI: 10.1111/jdv.19550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/29/2023] [Indexed: 10/06/2023]
Affiliation(s)
- A G Vaiopoulos
- Second Department of Dermatology and Venereology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Chaidari, Athens, Greece
| | - M Samarkos
- First Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Heart Surgery Centre, Athens, Greece
| | - G Vaiopoulos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Kyriazopoulou E, Dalekos GN, Metallidis S, Poulakou G, Papanikolaou IC, Tzavara V, Argyraki K, Alexiou Z, Panagopoulos P, Samarkos M, Chrysos G, Tseliou A, Milionis H, Sympardi S, Vasishta A, Giamarellos-Bourboulis EJ. HEPARIN-BINDING PROTEIN LEVELS PREDICT UNFAVORABLE OUTCOME IN COVID-19 PNEUMONIA: A POST HOC ANALYSIS OF THE SAVE TRIAL. Shock 2024; 61:395-399. [PMID: 38517242 DOI: 10.1097/shk.0000000000002315] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT We aimed to evaluate heparin-binding protein (HBP) as a marker of prognosis of unfavorable outcome in COVID-19 pneumonia. This was a post hoc analysis of the SAVE clinical trial investigating anakinra treatment, guided by suPAR (soluble urokinase plasminogen activator receptor) levels ≥6 ng/mL, for the prevention of severe respiratory failure in hospitalized patients with COVID-19 pneumonia. Baseline HBP plasma levels were measured in 534 patients by fluorescence dry quantitative immunoassay using the Jet-iStar 800 analyzer. Concentrations higher than 35 ng/mL predicted 30-day mortality with a moderate specificity of 53.3% and negative predictive value 78.1%; sensitivity was low (29.0%). After multivariate Cox analysis, HBP higher than 35 ng/mL was an independent predictor of 30-day unfavorable outcome (adjusted hazard ratio, 1.77; 95% CI, 1.06-2.94; P = 0.028) and these patients were also at greater risk of death after 90 days (hazard ratio, 1.85; 95% CI, 1.25-2.74; P = 0.002). The cutoff was not predictive of development of severe respiratory failure, septic shock or acute kidney injury. Among patients with baseline HBP levels higher than 35 ng/mL, anakinra treatment was associated with decreased mortality (7.2%) versus comparators (18.1%; P < 0.001). Results confirm that HBP may be an early biomarker of poor outcome among preselected patients at risk from COVID-19 pneumonia.ClinicalTrials.gov registration NCT04357366.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Symeon Metallidis
- First Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Garyphalia Poulakou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ilias C Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Corfu "Agia Eirini," Athens, Greece
| | - Vasiliki Tzavara
- First Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Katerina Argyraki
- Department of Internal Medicine, Sotiria Athens Hospital of Chest Diseases, Athens, Greece
| | - Zoi Alexiou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Democritus University of Thrace, Alexandropoilis, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Aikaterini Tseliou
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Styliani Sympardi
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
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Anastasopoulou A, Diamantopoulos PT, Kouzis P, Saridaki M, Sideris K, Samarkos M, Gogas H. COVID-19 in Patients with Melanoma: A Single-Institution Study. Cancers (Basel) 2023; 16:96. [PMID: 38201522 PMCID: PMC10778439 DOI: 10.3390/cancers16010096] [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: 12/06/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
We conducted a single-center, non-interventional retrospective study of melanoma patients with COVID-19 (1 March 2020 until 17 March 2023). The cohort was further divided into three groups according to the periods of SARS-CoV-2 variant dominance in Greece. We recorded demographics, comorbidities, vaccination data, cancer diagnosis/stage, types of systemic melanoma treatments, date of COVID-19 diagnosis and survival. We identified 121 patients. The vast majority (87.6%) had advanced disease (stages III or IV). A total of 80.1% of the patients were receiving immune checkpoint inhibitor-based therapies, 92.5% had asymptomatic/mild COVID-19 and 7.4% had moderate/severe/critical disease, while 83.5% contracted COVID-19 during the third period of the pandemic. Sixteen patients (13.2%) were hospitalized for COVID-19 with a median length of stay of 12 days (range: 1-55 days). Advanced age, heart failure, number of comorbidities (≤1 vs. >1), vaccination status and the time period of the infection correlated with more severe COVID-19, whereas only heart failure and time period were independently correlated with severity. The 30-day mortality rate after COVID-19 was 4.2%. With a median follow-up of 340 days post-COVID-19, 17.4% of patients were deceased. In this cohort of melanoma patients with COVID-19, the 30-day mortality rate was low. There was no association between melanoma stage, treatment receipt and type of treatment with COVID-19 severity.
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Affiliation(s)
- Amalia Anastasopoulou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.D.); (P.K.); (M.S.); (K.S.); (M.S.); (H.G.)
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Kostourou S, Samiotis I, Dedeilias P, Charitos C, Papastamopoulos V, Mantas D, Psichogiou M, Samarkos M. Effect of an E-Prescription Intervention on the Adherence to Surgical Chemoprophylaxis Duration in Cardiac Surgery: A Single Centre Experience. Antibiotics (Basel) 2023; 12:1182. [PMID: 37508278 PMCID: PMC10376074 DOI: 10.3390/antibiotics12071182] [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: 06/14/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
In our hospital, adherence to the guidelines for peri-operative antimicrobial prophylaxis (PAP) is suboptimal, with overly long courses being common. This practice does not offer any incremental benefit, and it only adds to the burden of antimicrobial consumption, promotes the emergence of antimicrobial resistance, and it is associated with adverse events. Our objective was to study the effect of an electronic reminder on the adherence to each element of PAP after cardiac surgery. We conducted a single center, before and after intervention, prospective cohort study from 1 June 2014 to 30 September 2017. The intervention consisted of a reminder of the hospital guidelines when ordering PAP through the hospital information system. The primary outcome was adherence to the suggested duration of PAP, while secondary outcomes included adherence to the other elements of PAP and incidence of surgical site infections (SSI). We have studied 1080 operations (400 pre-intervention and 680 post-intervention). Adherence to the appropriate duration of PAP increased significantly after the intervention [PRE 4.0% (16/399) vs. POST 15.4% (105/680), chi-square p < 0.001]; however, it remained inappropriately low. Factors associated with inappropriate duration of PAP were pre-operative hospitalization for <3 days, and duration of operation >4 h, while there were significant differences between the chief surgeons. Unexpectedly, the rate of SSIs increased significantly during the study (PRE 2.8% (11/400) vs. POST 5.9% (40/680), chi-square p < 0.019). The implemented intervention achieved a relative increase in adherence to the guideline-recommended PAP duration; however, adherence was still unacceptably low and further efforts to improve adherence are needed.
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Affiliation(s)
- Sofia Kostourou
- Infection Prevention Unit, Evaggelismos Hospital, 10676 Athens, Greece
| | - Ilias Samiotis
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | - Panagiotis Dedeilias
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | - Christos Charitos
- Department of Cardiac Thoracic and Vascular Surgery, Evaggelismos Hospital, 10676 Athens, Greece
| | | | - Dimitrios Mantas
- 2nd Propaedeutic Department of Surgery, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Anastasopoulou A, Samarkos M, Diamantopoulos P, Vourlakou C, Ziogas DC, Avramopoulos P, Kouzis P, Haanen J, Gogas H. CMV infections in patients treated with immune checkpoint inhibitors for solid malignancies. Open Forum Infect Dis 2023; 10:ofad164. [PMID: 37065986 PMCID: PMC10099470 DOI: 10.1093/ofid/ofad164] [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: 09/06/2022] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Cytomegalovirus (CMV) infection/disease has been repeatedly reported in patients treated with immune-checkpoint inhibitors (ICIs) and most commonly involves patients with relapsed/refractory (R/R) immune-related adverse events (irAEs). In the current study we present a melanoma patient that developed CMV gastritis during treatment with pembrolizumab in the absence of irAEs and without previous or current immunosuppression. Moreover, we review the literature regarding CMV infection/disease in patients treated with ICIs for solid malignancies. We present the currently available data on the pathogenesis, clinical characteristics, endoscopic findings, and histologic features and highlight the potential differences among cases complicating R/R irAEs versus those occurring in immunosuppression-naïve patients. Finally, we discuss the currently available data regarding potential useful diagnostic tools as well as the management of these patients.
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Affiliation(s)
- Amalia Anastasopoulou
- Correspondence: Helen Gogas, MD, PhD, First Department of Internal Medicine, Laikon General Hospital, 17 Ag. Thoma Str, Athens 11527, Greece (); Amalia Anastasopoulou, MD, PhD, First Department of Internal Medicine, Laikon General Hospital, 17 Ag. Thoma Str, Athens 11527, Greece ()
| | - Michael Samarkos
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Diamantopoulos
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitrios C Ziogas
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Avramopoulos
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kouzis
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - John Haanen
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Helen Gogas
- Correspondence: Helen Gogas, MD, PhD, First Department of Internal Medicine, Laikon General Hospital, 17 Ag. Thoma Str, Athens 11527, Greece (); Amalia Anastasopoulou, MD, PhD, First Department of Internal Medicine, Laikon General Hospital, 17 Ag. Thoma Str, Athens 11527, Greece ()
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Akinosoglou K, Kotsaki A, Gounaridi IM, Christaki E, Metallidis S, Adamis G, Fragkou A, Fantoni M, Rapti A, Kalomenidis I, Chrysos G, Boni G, Kainis I, Alexiou Z, Castelli F, Serino FS, Bakakos P, Nicastri E, Tzavara V, Safarika A, Ioannou S, Dagna L, Dimakou K, Tzatzagou G, Chini M, Bassetti M, Kotsis V, Angheben A, Tsoukalas G, Selmi C, Spiropoulou OM, Samarkos M, Doumas M, Damoraki G, Masgala A, Papanikolaou I, Argyraki A, Negri M, Leventogiannis K, Sympardi S, Gatselis NK, Petrakis V, Netea MG, Panagopoulos P, Sakka V, Milionis H, Dalekos GN, Giamarellos-Bourboulis EJ. Efficacy and safety of early soluble urokinase plasminogen receptor plasma-guided anakinra treatment of COVID-19 pneumonia: A subgroup analysis of the SAVE-MORE randomised trial. EClinicalMedicine 2023; 56:101785. [PMID: 36590789 PMCID: PMC9791950 DOI: 10.1016/j.eclinm.2022.101785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The SAVE-MORE trial demonstrated that anakinra treatment in COVID-19 pneumonia with plasma soluble urokinase plasminogen activator (suPAR) levels of 6 ng/mL or more was associated with 0.36 odds for a worse outcome compared to placebo when expressed by the WHO-Clinical Progression Scale (CPS) at day 28. Herein, we report the results of subgroup analyses and long-term outcomes. METHODS This prospective, double-blind, randomised clinical trial, recruited patients with a confirmed SARS-CoV-2 infection, in need of hospitalisation, lower respiratory tract infection and plasma suPAR ≥6 ng/mL from 37 academic and community hospitals in Greece and Italy. Patients were 1:2 randomised to subcutaneous treatment with placebo or anakinra (100 mg) once daily for 10 days. Pre-defined subgroups of Charlson's comorbidity index (CCI), sex, age, level of suPAR, and time from symptom onset were analysed for the primary endpoint (overall comparison of distribution of frequencies of the scores from the WHO-CPS between treatments on day 28), by multivariable ordinal regression analysis in the intention to treat (ITT) population. This trial is registered with the EU Clinical Trials Register (2020-005828-11) and ClinicalTrials.gov (NCT04680949). FINDINGS Patients were enrolled between 23 December 2020 and 31 March 2021; 189 patients in the placebo arm and 405 patients in the anakinra arm were the ITT population. Multivariable analysis showed that anakinra treatment was accompanied by significantly lower odds for worse outcome compared to placebo at day 28 for all studied subgroups (CCI ≥ 2, OR: 0.34, 95% confidence intervals [CI] 0.22-0.50; CCI < 2, OR: 0.38, 95% CI 0.21-0.68; suPAR > 9 ng/mL, OR: 0.35, 95% CI 0.19-0.66; suPAR 6-9 ng/mL, OR: 0.35, 95% CI 0.24-0.52; patients ≥65 years, OR: 0.41, 95% CI 0.25-0.66; and patients <65 years, OR: 0.29, 95% CI 0.19-0.45). The benefit was uniform, irrespective of the time from start of symptoms until the start of the study drug. At days 60 and 90, anakinra treatment had odds of 0.40 (95% CI 0.28-0.57) and 0.46 (95% CI 0.32-0.67) respectively, for a worse outcome compared to placebo. The costs of general ward stay, ICU stay, and drugs were lower with anakinra treatment. INTERPRETATION Anakinra represents an important therapeutic tool in the management of COVID-19 that may be administered in all subgroups of patients; benefits are maintained until day 90. FUNDING Hellenic Institute for the Study of Sepsis; Swedish Orphan Biovitrum AB.
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Affiliation(s)
| | - Antigone Kotsaki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Ioanna-Maria Gounaridi
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Christaki
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Adamis
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | - Massimo Fantoni
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Aggeliki Rapti
- Second Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Ioannis Kalomenidis
- First Department of Critical Care and Pulmonary Medicine, Medical School, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Chrysos
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Gloria Boni
- Hospital Pharmacy, IRCCS Hospital Sacro Cuore, Negrar di Valpolicella, Verona, Italy
- IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ilias Kainis
- Tenth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Athens, Greece
| | - Zoi Alexiou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Italy
| | | | - Petros Bakakos
- First Department of Chest Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Rome, Italy
| | - Vassiliki Tzavara
- First Department of Internal Medicine, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Asimina Safarika
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Sofia Ioannou
- Department of Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS Ospedale San Raffaele & Vita-Salute San Raffaele University, Milan, Italy
| | - Katerina Dimakou
- Fifth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Glykeria Tzatzagou
- First Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genoa, Italy
| | - Vasileios Kotsis
- Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andrea Angheben
- Department of Infectious – Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar di Valpolicella, Verona, Italy
| | - George Tsoukalas
- Fourth Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Olga-Maria Spiropoulou
- First Department of Internal Medicine, Asklipieio General Hospital of Voula, Athens, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doumas
- Second Department of Propedeutic Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Damoraki
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Masgala
- Second Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Ilias Papanikolaou
- Department of Pulmonary Medicine, General Hospital of Kerkyra, Kerkyra, Greece
| | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Marcantonio Negri
- Dipartimento Scienze Mediche e Chirurgiche - Fondazione Policlinico Gemelli IRCCS, Roma, Italy
| | - Konstantinos Leventogiannis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Styliani Sympardi
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Nikolaos K. Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Vasileios Petrakis
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Mihai G. Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen 6500, Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Periklis Panagopoulos
- Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Vissaria Sakka
- Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa 41110, Greece
| | - Evangelos J. Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Institute for the Study of Sepsis, Athens, Greece
- Corresponding author. 4th Department of Internal Medicine, ATTIKON University Hospital, 1 Rimini Street, Athens 12462, Greece.
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8
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Samaras C, Kyriazopoulou E, Poulakou G, Reiner E, Kosmidou M, Karanika I, Petrakis V, Adamis G, Gatselis NK, Fragkou A, Rapti A, Taddei E, Kalomenidis I, Chrysos G, Bertoli G, Kainis I, Alexiou Z, Castelli F, Saverio Serino F, Bakakos P, Nicastri E, Tzavara V, Kostis E, Dagna L, Koukidou S, Tzatzagou G, Chini M, Bassetti M, Trakatelli C, Tsoukalas G, Selmi C, Samarkos M, Pyrpasopoulou A, Masgala A, Antonakis E, Argyraki A, Akinosoglou K, Sympardi S, Panagopoulos P, Milionis H, Metallidis S, Syrigos KN, Angel A, Dalekos GN, Netea MG, Giamarellos-Bourboulis EJ. Interferon gamma-induced protein 10 (IP-10) for the early prognosis of the risk for severe respiratory failure and death in COVID-19 pneumonia. Cytokine 2023; 162:156111. [PMID: 36529030 PMCID: PMC9747699 DOI: 10.1016/j.cyto.2022.156111] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Elevated concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict progression to severe respiratory failure (SRF) or death among patients with COVID-19 pneumonia and guide early anakinra treatment. As suPAR testing may not be routinely available in every health-care setting, alternative biomarkers are needed. We investigated the performance of C-reactive protein (CRP), interferon gamma-induced protein-10 (IP-10) and TNF-related apoptosis-inducing ligand (TRAIL) for predicting SRF or death in COVID-19. METHODS Two cohorts were studied; one discovery cohort with 534 patients from the SAVE-MORE clinical trial; and one validation cohort with 364 patients from the SAVE trial including also 145 comparators. CRP, IP-10 and TRAIL were measured by the MeMed Key® platform in order to select the biomarker with the best prognostic performance for the early prediction of progression into SRF or death. RESULTS IP-10 had the best prognostic performance: baseline concentrations 2000 pg/ml or higher predicted equally well to suPAR (sensitivity 85.0 %; negative predictive value 96.6 %). Odds ratio for poor outcome among anakinra-treated participants of the SAVE-MORE trial was 0.35 compared to placebo when IP-10 was 2,000 pg/ml or more. IP-10 could divide different strata of severity for SRF/death by day 14 in the validation cohort. Anakinra treatment decreased this risk irrespective the IP-10 concentrations. CONCLUSIONS IP-10 concentrations of 2,000 pg/ml or higher are a valid alternative to suPAR for the early prediction of progression into SRF or death the first 14 days from hospital admission for COVID-19 and they may guide anakinra treatment. TRIAL REGISTRATION CLINICALTRIALS gov, NCT04680949 and NCT04357366.
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Affiliation(s)
- Charilaos Samaras
- 1(st) Department of Internal Medicine, Asklepieio General Hospital of Voula, Greece
| | - Evdoxia Kyriazopoulou
- 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Garyfallia Poulakou
- 3(rd) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Maria Kosmidou
- 1st Department of Internal Medicine, University of Ioannina, Medical School, Ioannina, Greece
| | - Ioanna Karanika
- 1st Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Vasileios Petrakis
- 2(nd) Department of Internal Medicine, Democritus University of Thrace, Medical School, 681 00, Alexandroupolis, Greece
| | - George Adamis
- 1(st) Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, 41110 Larissa, Greece
| | | | - Aggeliki Rapti
- 2(nd) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Eleonora Taddei
- Dipartimento Scienze di Laboratorio e Infettivologiche - Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Roma, Italy
| | - Ioannis Kalomenidis
- 1(st) Department of Critical Care and Pulmonary Medicine, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - George Chrysos
- 2(nd) Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Giulia Bertoli
- Department of Infectious - Tropical Diseases and Microbiology, IRCSS Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ilias Kainis
- 10(th) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases of Athens, Greece
| | - Zoi Alexiou
- 2(nd) Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Francesco Castelli
- Spedali Civili, Brescia ASST Spedali Civili Hospital, University of Brescia, Italy
| | | | - Petros Bakakos
- 1(st) Department of Chest Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emanuele Nicastri
- Department of Internal Medicine, Spallanzani Institute of Rome, Italy
| | - Vassiliki Tzavara
- 1(st) 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
| | - Sofia Koukidou
- 5(th) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Glykeria Tzatzagou
- 1(st) Department of Internal Medicine, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Chini
- 3rd Dpt of Internal Medicine and Infectious Diseases Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece
| | - Matteo Bassetti
- Infectious Diseases Clinic, Ospedale Policlinico San Martino IRCCS and Department of Health Sciences, University of Genova, Genova, Italy
| | - Christina Trakatelli
- 3(rd) Department of Internal Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - George Tsoukalas
- 4(th) Department of Pulmonary Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele and IRCCS Humanitas Research Hospital, via Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Michael Samarkos
- 1(st) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Athina Pyrpasopoulou
- 2(nd) Department of Propedeutic Medicine, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Aikaterini Masgala
- 2(nd) Department of Internal Medicine, Konstantopouleio General Hospital, Athens, Greece
| | | | - Aikaterini Argyraki
- Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Greece
| | | | - Styliani Sympardi
- 1(st) Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece
| | - Periklis Panagopoulos
- 2(nd) Department of Internal Medicine, Democritus University of Thrace, Medical School, 681 00, Alexandroupolis, 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
| | - Konstantinos N Syrigos
- 3(rd) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, Full Member of the European Reference Network on Hepatological Disases (ERN RARE-LIVER), General University Hospital of Larissa, 41110 Larissa, 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, Germany
| | - Evangelos J Giamarellos-Bourboulis
- 4(th) 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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9
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Kaye KS, Marchaim D, Thamlikitkul V, Carmeli Y, Chiu CH, Daikos G, Dhar S, Durante-Mangoni E, Gikas A, Kotanidou A, Paul M, Roilides E, Rybak M, Samarkos M, Sims M, Tancheva D, Tsiodras S, Kett D, Patel G, Calfee D, Leibovici L, Power L, Munoz-Price S, Stevenson K, Susick L, Latack K, Daniel J, Chiou C, Divine GW, Ghazyaran V, Pogue JM. Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms. NEJM Evid 2023; 2:10.1056/evidoa2200131. [PMID: 37538951 PMCID: PMC10398788 DOI: 10.1056/evidoa2200131] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Pneumonia and bloodstream infections (BSI) due to extensively drug-resistant (XDR) Acinetobacter baumannii, XDR Pseudomonas aeruginosa, and carbapenem-resistant Enterobacterales (CRE) are associated with high mortality rates, and therapeutic options remain limited. This trial assessed whether combination therapy with colistin and meropenem was superior to colistin monotherapy for the treatment of these infections. METHODS The OVERCOME (Colistin Monotherapy versus Combination Therapy) trial was an international, randomized, double-blind, placebo-controlled trial. We randomly assigned participants to receive colistin (5 mg/kg once followed by 1.67 mg/kg every 8 hours) in combination with either meropenem (1000 mg every 8 hours) or matching placebo for the treatment of pneumonia and/or BSI caused by XDR A. baumannii, XDR P. aeruginosa, or CRE. The primary outcome was 28-day mortality, and secondary outcomes included clinical failure and microbiologic cure. RESULTS Between 2012 and 2020, a total of 464 participants were randomly assigned to treatment, and 423 eligible patients comprised the modified intention-to-treat population. A. baumannii was the predominant trial pathogen (78%) and pneumonia the most common index infection (70%). Most patients were in the intensive care unit at the time of enrollment (69%). There was no difference in mortality (43 vs. 37%; P=0.17), clinical failure (65 vs. 58%; difference, 6.8 percentage points; 95% confidence interval [CI], -3.1 to 16.6), microbiologic cure (65 vs. 60%; difference, 4.8 percentage points; 95% CI, -5.6 to 15.2), or adverse events (acute kidney injury, 52 vs. 49% [P=0.55]; hypersensitivity reaction, 1 vs. 3% [P=0.22]; and neurotoxicity, 5 vs. 2% [P=0.29]) between patients receiving monotherapy and combination therapy, respectively. CONCLUSIONS Combination therapy with colistin and meropenem was not superior to colistin monotherapy for the treatment of pneumonia or BSI caused by these pathogens. (Funded by the National Institute of Allergy and Infectious Diseases, Division of Microbiology and Infectious Diseases protocol 10-0065; ClinicalTrials.gov number, NCT01597973.).
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Affiliation(s)
- Keith S Kaye
- Division of Allergy, Immunology, and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Dror Marchaim
- Division of Infectious Diseases, Assaf Harofeh Medical Center, Be'er Ya'akov, Israel
| | - Visanu Thamlikitkul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yehuda Carmeli
- Laboratory for Microbiology and Infection Control, Tel Aviv University, Tel Aviv, Israel
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - George Daikos
- School of Medicine, National and Kapodistrian University of Athens
| | - Sorabh Dhar
- Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania "Luigi Vanvitelli" and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - Achilles Gikas
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Irákleio, Greece
| | | | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Emmanuelle Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
| | - Michael Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit
| | - Michael Samarkos
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens
| | | | - Dora Tancheva
- Centre for Burns and Plastic Surgery, Pirogov Emergency Medicine Hospital, Sofia, Bulgaria
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School
| | - Daniel Kett
- University of Miami Hospital, Jackson Memorial Hospital
| | - Gopi Patel
- Division of Infectious Diseases, Mount Sinai Hospital, New York
| | - David Calfee
- Division of Infectious Disease, Weill Cornell Medicine, New York
| | | | | | | | | | - Laura Susick
- Department of Public Health Sciences, Henry Ford Health, Detroit
| | - Katie Latack
- Department of Public Health Sciences, Henry Ford Health, Detroit
| | - Jolene Daniel
- Division of Allergy, Immunology, and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christine Chiou
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - George W Divine
- Department of Public Health Sciences, Henry Ford Health, Detroit
| | - Varduhi Ghazyaran
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Jason M Pogue
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor
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10
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Bali T, Georgakopoulou VE, Kamiliou A, Vergos I, Adamantou M, Vlachos S, Ermidis G, Sipsas NV, Samarkos M, Cholongitas E. Abnormal liver function tests and coronavirus disease 2019: A close relationship. J Viral Hepat 2023; 30:79-80. [PMID: 36369662 PMCID: PMC9878169 DOI: 10.1111/jvh.13772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Triada Bali
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - Vasiliki E. Georgakopoulou
- Pulmonology Department, Laiko General Hospital, Medical SchoolNational and Kapodistrian University of AthensAthensGreece,Infectious Diseases and COVID‐19 Unit, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - Aikaterini Kamiliou
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - Ioannis Vergos
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - Magdalini Adamantou
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - Stefanos Vlachos
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - George Ermidis
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - Nikolaos V. Sipsas
- Infectious Diseases and COVID‐19 Unit, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece,Pathophysiology Department, Medical SchoolNational and Kapodistrian University of Athens, and General Hospital of Athens LaikoAthensGreece
| | - Michael Samarkos
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece,Infectious Diseases and COVID‐19 Unit, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General HospitalMedical School of National and Kapodistrian University of AthensAthensGreece
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11
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Papafotiou C, Roussos S, Sypsa V, Bampali S, Spyridopoulou K, Karapanou A, Moussouli A, Samarkos M, Daikos GL, Psichogiou M. Predictive score for patients with carbapenemase-producing enterobacterales colonization upon admission in a tertiary care hospital in an endemic area. J Antimicrob Chemother 2022; 77:3331-3339. [PMID: 36203392 DOI: 10.1093/jac/dkac321] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Carbapenemase-producing Enterobacterales (CPE) comprise important nosocomial pathogens worldwide. Colonized patients are the source of further dissemination in healthcare settings. Considering that timely detection of CPE carriers is pivotal but universal screening is unfeasible, we aimed to develop and validate a prediction score to detect patients harbouring CPE on hospital admission. METHODS The study was conducted in a tertiary care hospital located in a CPE endemic area. Rectal swabs were obtained from 2303 patients, screened shortly after hospital admission. The Enterobacterales isolated in cultures were examined for the presence of blaVIM, KPC, NDM, OXA-48 by PCR. Demographic data and patient history of the previous 6 months were recorded. Risk factors for CPE carriage were identified using a multivariable logistic regression model and a points-system risk score was developed. The discriminative ability of the risk score was assessed using the AUC and its predictive performance was validated in a second dataset of 1391 patients in a different time period. RESULTS Seven predictors were identified: previous CPE colonization or infection, prior hospitalization, stay in a long-term health care facility, history of ≥2 interventions, renal replacement therapy, diabetes with end-organ damage and Karnofsky score. The developed risk score in the derivation dataset ranged between 0 and 79 points, with an AUC of 0.84 in the derivation and 0.85 in the validation dataset. CONCLUSIONS This prediction tool may assist in identifying patients who are at risk of harbouring CPE on hospital admission in an endemic area and guide clinicians to implement prompt and appropriate infection control measures.
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Affiliation(s)
- Chrysanthe Papafotiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sofia Bampali
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kalliopi Spyridopoulou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Amalia Karapanou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasia Moussouli
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - George L Daikos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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12
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Georgakopoulou V, Bali T, Adamantou M, Asimakopoulou S, Makrodimitri S, Samara S, Triantafyllou M, Voutsinas P, Eliadi I, Karamanakos G, Basoulis D, Chatzipanagiotou O, Adamopoulou E, Alevizou A, Athanasiadis M, Spandidos D, Papalexis P, Tarantinos K, Sipsas N, Samarkos M, Cholongitas E. Acute hepatitis and liver injury in hospitalized patients with COVID‑19 infection. Exp Ther Med 2022; 24:691. [PMID: 36277149 PMCID: PMC9535623 DOI: 10.3892/etm.2022.11627] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a systemic illness with an increased host inflammatory response that affects multiple extra-pulmonary organs, including the gastrointestinal tract. Abnormalities in liver biochemistry have been observed in a significant proportion of patients with COVID-19 upon admission, and this proportion increases with hospitalization. These abnormalities are typically manifested as elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, with less frequently detected elevations in the levels of cholestatic enzymes. Elevated aminotransaminase levels have been linked to an increased risk of mortality and complications, indicating the severity of COVID-19 infection. The present study evaluated the prevalence and the baseline factors associated with the development of acute hepatitis (ΑΗ), liver injury (LI) and associated patterns, as well as the presence of abnormalities in the levels of aminotransferases at discharge in the same cohort. For this purpose, 1,304 patients with confirmed COVID-19 infection were enrolled in the study. According to the results obtained, AST levels at baseline were the only independent factor for AH during hospital stay, while AST, alkaline phosphatase and ferritin levels were independent baseline factors for the development of LI. The patients with hepatocellular, compared to those with cholestatic LI, exhibited similar survival rates, as well as similarities in the development of acute kidney injury and the need for oxygen via high-flow nasal cannula and/or mechanical ventilation. In addition, age and ALT were independent risk factors for persistent abnormal values of AST and ALT at discharge.
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Affiliation(s)
- Vasiliki Georgakopoulou
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Triada Bali
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Magdalini Adamantou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stavroula Asimakopoulou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sotiria Makrodimitri
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Stamatia Samara
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Triantafyllou
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pantazis Voutsinas
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Eliadi
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Karamanakos
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Basoulis
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Odysseas Chatzipanagiotou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Adamopoulou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Antonia Alevizou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Menelaos Athanasiadis
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Demetrios Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Petros Papalexis
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Nikolaos Sipsas
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michael Samarkos
- Infectious Diseases and COVID‑19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Samarkos M, Papanikolaou K, Sourdi A, Paisios N, Mainas E, Paramythiotou E, Antoniadou A, Sambatakou H, Gargalianos-Kakolyris P, Skoutelis A, Daikos GL. The Effect of Different Colistin Dosing Regimens on Nephrotoxicity: A Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11081066. [PMID: 36009935 PMCID: PMC9405298 DOI: 10.3390/antibiotics11081066] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: It is not known whether different daily dosing schemes have different effects on colistin nephrotoxicity. We examined the effect of once- versus twice- or thrice-daily doses of colistin on renal function. (2) Methods: We performed a multicenter retrospective cohort study of hospitalized patients with a baseline glomerular filtration rate ≥ 50 mL/min who received intravenously the same colistin dose once (regimen A), twice (regimen B) or thrice daily (regimen C). The primary endpoint was acute kidney injury (AKI), defined as fulfilment of any of the RIFLE (Risk-Injury-Failure-Loss-End stage renal disease) criteria. (3) Results: We included 306 patients; 132 (43.1%) received regimen A, 151 (49.3%) regimen B, and 23 (7.5%) regimen C. Ninety-nine (32.4%) patients developed AKI; there was no difference between regimen A vs. B and C [45 (34.1%) vs. 54 (31.0%), p = 0.57]. In a propensity score−matched cohort, AKI was similar in patients receiving Regimen A, Regimen B, and Regimen C (31.6% vs. 33.3%, p = 0.78). On logistic regression analysis, diabetes was an independent predictor of AKI (OR = 4.59, 95% CI 2.03−10.39, p = 0.001) while eGFR > 80 mL/min (OR = 0.50, 95% CI 0.25−0.99, p = 0.048) was inversely associated with AKI. (4) Conclusions: Colistin once daily is not more nephrotoxic than the standard colistin regimens. The only independent predictor of nephrotoxicity was diabetes mellitus, while eGFR > 80 mL/min had a protective effect.
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Affiliation(s)
- Michael Samarkos
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Athena Sourdi
- 1st Propaedeutic Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Paisios
- 1st Department of Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece
| | - Efstratios Mainas
- 2nd Department of Medicine, Ippokrateion General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Helen Sambatakou
- 2nd Department of Medicine, Ippokrateion General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | - George L. Daikos
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
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Anastasopoulou A, Gkoufa A, Diamantopoulos P, Kazanas S, Eliadi I, Samarkos M, Gogas H. Clinical course of COVID-19 infection in a melanoma patient treated with nivolumab and bempegaldesleukin: a case report. Immunotherapy 2022; 14:1015-1020. [PMID: 35852114 PMCID: PMC9295713 DOI: 10.2217/imt-2021-0331] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The exact impact of immune checkpoint inhibitors in the course and outcome of COVID-19 in cancer patients is currently unclear. Herein, we present the first description of an elderly melanoma patient who developed COVID-19 pneumonia while under treatment with nivolumab and bempegaldesleukin in combination with an investigational PEGylated interleukin (IL-2). We present the clinical characteristics and the laboratory and imaging findings of our patient during the course of COVID-19 pneumonia. Moreover, we discuss the currently available data regarding the mechanism of action of immune checkpoint inhibitors and IL-2 analogs in the treatment of COVID-19. The administration of these agents did not have a negative effect on the outcome of COVID-19 pneumonia in an elderly melanoma patient. Immune checkpoint inhibitors represent a major advance in the treatment of several solid malignancies, including melanoma. Bempegaldesleukin is an investigational PEGylated IL-2 that is being evaluated, in combination with nivolumab, in the management of a variety of cancers. The immunomodulation caused by these agents may also modify the immune response in COVID-19. Currently available data regarding the impact of immune checkpoint inhibitors in reducing the severity of COVID-19 in patients with cancer are mixed, whereas no clinical data are available for bempegaldesleukin. Herein, we report the case of an elderly female melanoma patient who developed COVID-19 pneumonia while under treatment with nivolumab and bempegaldesleukin. The administration of these agents did not have a negative effect on the outcome of COVID-19 pneumonia in our patient.
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Affiliation(s)
- Amalia Anastasopoulou
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Aikaterini Gkoufa
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Panagiotis Diamantopoulos
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Spyridon Kazanas
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Irene Eliadi
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Helen Gogas
- First Department of Internal Medicine, Laikon General Hospital, Medical School of National & Kapodistrian University of Athens, Athens, 11527, Greece
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Georgakopoulou VE, Vlachogiannis NI, Basoulis D, Eliadi I, Georgiopoulos G, Karamanakos G, Makrodimitri S, Samara S, Triantafyllou M, Voutsinas PM, Ntziora F, Psichogiou M, Samarkos M, Sfikakis PP, Sipsas NV. A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients. J Clin Med 2022; 11:jcm11071810. [PMID: 35407418 PMCID: PMC8999885 DOI: 10.3390/jcm11071810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
We aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020−20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutive unvaccinated patients without underlying medical conditions (n = 241, 49 year-old median, 71% males), 22 (9.1%) developed critical disease and 2 died (0.8%). White-blood-cell counts, neutrophils, neutrophil-to-lymphocyte ratio, CRP, fibrinogen, ferritin, LDH and γ-GT at admission were each univariably associated with critical disease. ROC-defined cutoffs revealed that CRP > 61.8 mg/L, fibrinogen > 616.5 mg/dL and LDH > 380.5 U/L were each associated with critical disease development, independently of age, sex and days from symptom-onset. A score combining higher-than-cutoff CRP (0/2), LDH (0/1) and fibrinogen (0/1) predicted critical disease (AUC: 0.873, 95% CI: 0.820−0.926). This score performed well in an unselected patient cohort (n = 1228, 100% unvaccinated) predominantly infected by the alpha variant (AUC: 0.718, 95% CI: 0.683−0.753), as well as in a mixed cohort (n = 527, 65% unvaccinated) predominantly infected by the delta variant (AUC: 0.708, 95% CI: 0.656−0.760). Therefore, we propose that a combination of standard biomarkers of acute inflammatory response, cell death and hypercoagulability reflects the severity of COVID-19 per se independently of comorbidities, age and sex, being of value for risk stratification in unselected patients.
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Affiliation(s)
- Vasiliki E. Georgakopoulou
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Nikolaos I. Vlachogiannis
- First Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.I.V.); (F.N.); (P.P.S.)
| | - Dimitrios Basoulis
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Irene Eliadi
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgios Karamanakos
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Sotiria Makrodimitri
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Stamatia Samara
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Maria Triantafyllou
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Pantazis M. Voutsinas
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Fotinie Ntziora
- First Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.I.V.); (F.N.); (P.P.S.)
| | - Mina Psichogiou
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Michael Samarkos
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.I.V.); (F.N.); (P.P.S.)
| | - Nikolaos V. Sipsas
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
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16
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Liodaki M, Spanakos G, Samarkos M, Daikos GL, Christopoulou V, Piperaki ET. Molecular screening of cat and dog ectoparasites for the presence of Bartonella spp. in Attica, Greece. Acta Vet Hung 2022. [PMID: 35258479 DOI: 10.1556/004.2022.00004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/28/2022] [Indexed: 11/19/2022]
Abstract
The purpose of this study was the molecular detection of Bartonella spp. in fleas and ticks parasitizing cats and dogs from 39 locations in Attica, Greece. One hundred and forty five ectoparasites (104 fleas and 41 ticks) from 92 cats and 53 dogs were investigated individually using PCRs targeting the 16S-23S ribosomal RNA intergenic spacer (ITS) and the citrate synthase (gltA) genetic loci. Bartonella spp. were detected in 14 out of 104 fleas (13.5%) and in none of the ticks examined. Consequent sequence analysis of the amplicons from the two loci identified 3 strains as Bartonella henselae, and 11 as Bartonella clarridgeiae. Οur study demonstrates the presence of B. henselae and B. clarridgeiae in Ctenocephalides felis fleas from cat and dog in Greece. We also report a novel ITS sequence for B. clarridgeiae. Considering that fleas could pose a risk for human bartonellosis from their infected hosts, further studies on the public health risk of Bartonella presence in animal ectoparasites are warranted.
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Affiliation(s)
- Maria Liodaki
- 1 Department of Public and Community Heath, School of Public Health, University of West Attica, Athens, Greece
- 2 Department of Microbiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Michael Samarkos
- 4 First Department of Medicine, Laikon Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George L Daikos
- 5 Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Varvara Christopoulou
- 2 Department of Microbiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia-Theophano Piperaki
- 2 Department of Microbiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Cholongitas E, Bali T, Georgakopoulou VE, Giannakodimos A, Gyftopoulos A, Georgilaki V, Gerogiannis D, Basoulis D, Eliadi I, Karamanakos G, Mimidis K, Sipsas NV, Samarkos M. Prevalence of abnormal liver biochemistry and its impact on COVID-19 patients’ outcomes: a single-center Greek study. Ann Gastroenterol 2022; 35:290-296. [PMID: 35599935 PMCID: PMC9062840 DOI: 10.20524/aog.2022.0709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/14/2022] [Indexed: 12/31/2022] Open
Abstract
Background Abnormalities in aminotransferases are frequently observed in hospitalized COVID-19 patients, but their clinical impact is poorly characterized. Methods A total of 1046 patients hospitalized to the non-intensive care unit ward with documented COVID-19 were included retrospectively. Demographic, clinical and laboratory characteristics on admission and during hospital stay, including the presence of liver injury (LI), defined as aspartate aminotransferase (AST) >200 IU/L, were recorded. Results On admission, 363 (34.7%) and 269 (25.7%) patients had abnormal AST and ALT values (i.e., >40 IU/L), respectively, while during hospitalization 53 (5%) patients fulfilled the criteria for LI. In multivariate logistic regression analysis, AST (odds ratio [OR] 1.023, 95% confidence interval [CI] 1.016-1.029; P<0.001), and ferritin (OR 1.01, 95%CI 1.001-1.02; P<0.001) were the baseline factors independently associated with the development of LI during hospital stay. One hundred twenty-three (11.7%) patients died during hospitalization. The independent variables associated with mortality were: age (hazard ratio [HR] 1.043, 95%CI 1.029-1.056; P<0.001), ferritin (HR 1.1, 95%CI 1.05-1.2; P<0.001), platelets (HR 0.996, 95%CI 0.994-0.999; P=0.003), and administration of remdesivir (HR 0.50, 95%CI 0.30-0.85; P=0.009). The patients with abnormal baseline AST (i.e., >40 IU/L), compared to those with normal AST values, had worse outcomes (log rank test: 8.8, P=0.003). Conclusions Elevated aminotransferases are commonly seen in COVID-19 patients. They possibly reflect disease severity and may be associated with in-hospital mortality.
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Affiliation(s)
- Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
- Correspondence to: Evangelos Cholongitas, MD, PhD, Associate Professor, First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Agiou Thoma 17, Athens 11527, Greece, e-mail:
| | - Triada Bali
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
| | - Vasiliki E. Georgakopoulou
- Pulmonology Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Vasiliki E. Georgakopoulou)
- Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Nikolaos V. Sipsas, Michael Samarkos)
| | - Alexios Giannakodimos
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
| | - Argyrios Gyftopoulos
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
| | - Vasiliki Georgilaki
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
| | - Dimitrios Gerogiannis
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
| | - Dimitrios Basoulis
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
- Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Nikolaos V. Sipsas, Michael Samarkos)
| | - Irene Eliadi
- Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Nikolaos V. Sipsas, Michael Samarkos)
| | - Georgios Karamanakos
- Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Nikolaos V. Sipsas, Michael Samarkos)
| | - Konstantinos Mimidis
- First Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece (Konstantinos Mimidis)
| | - Nikolaos V. Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and Laiko General Hospital of Athens, Athens, Greece (Nikolaos V. Sipsas)
- Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Nikolaos V. Sipsas, Michael Samarkos)
| | - Michael Samarkos
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Evangelos Cholongitas, Triada Bali, Alexios Giannakodimos, Argyrios Gyftopoulos, Vasiliki Georgilaki, Dimitrios Gerogiannis, Dimitrios Basoulis, Michael Samarkos)
- Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece (Dimitrios Basoulis, Eirini Iliadi, Georgios Karamanakos, Nikolaos V. Sipsas, Michael Samarkos)
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Pogue JM, Rybak MJ, Stamper K, Marchaim D, Thamlikitkul V, Carmeli Y, Chiu C, Daikos GL, Dhar S, Mangoni ED, Gikas A, Kotanidou A, Paul M, Roilides E, Samarkos M, Sims M, Tancheva D, Tsiodras S, Divine G, Ghazaryan V, Kaye KS. 630. Emergence of Colistin Resistance in the OVERCOME Trial: Impact of Combination Therapy with Meropenem. Open Forum Infect Dis 2021. [PMCID: PMC8644241 DOI: 10.1093/ofid/ofab466.828] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Colistin (COL) remains an important therapeutic option for carbapenem-resistant (CR) Gram-negative bacilli (GNB). COL is often utilized in combination with meropenem (MEM), in part due to concerns regarding the development of COL resistance with monotherapy. We recently completed a randomized controlled trial comparing outcomes in patients receiving COL + placebo to those receiving COL + MEM; herein we present data on the emergence of COL resistance in this trial. Methods OVERCOME was an international, multicenter, randomized, double-blind, placebo-controlled study comparing COL and COL + MEM for the treatment of bloodstream infection and/or pneumonia due to CR GNB. Subjects were included in the modified intent to treat population (mITT) if their enrollment pathogen had a COL MIC ≤2 mg/L, as determined by broth microdilution (BMD). Daily blood and/or respiratory samples were obtained in patients per protocol until two consecutive negatives were obtained or the end of study treatment. All subsequent isolates were evaluated for COL resistance via BMD, defined as MIC ≥ 4 mg/L. Results Of the 425 patients in the mITT population, 380 (191 COL; 189 COL + MEM) were evaluable for the endpoint of COL resistance development. The median age of the cohort was 70, 38% were female, 47% were white, and 45% were Asian. 70% had an index infection of pneumonia, 68% were in the intensive care unit at the onset of their infection, and A. baumannii was the most common pathogen (78% of patients). Baseline characteristics, infection type, severity of illness, and index pathogen were similar amongst treatment arms. No significant difference in resistance development was seen between the COL and COL + MEM groups overall (12% vs. 8%; p = 0.31), or in any subgroup (Table). In patients with A. baumannii, there was a trend towards decreased resistance development with COL + MEM (13.3% vs 7.5%; p = 0.13). Conclusion We were unable to identify a significant difference in resistance emergence between treatment arms, but given the low incidence of this outcome, were underpowered to do so. The impact of COL + MEM on preventing emergence of COL resistance in A. baumannii warrants further clinical study. ![]()
Disclosures Jason M Pogue, PharmD, BCPS, BCIDP, Merck (Consultant)QPex (Consultant)Shionogi (Consultant)Utility Therapeutics (Consultant)VenatoRX (Consultant) Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support) Emmanuel Roilides, MD, PhD, FIDSA, FAAM, FESCMID, Merck Sharp & Dohme Corp. (Consultant, Grant/Research Support) Matthew Sims, MD, PhD, Astra Zeneca (Independent Contractor)Diasorin Molecular (Independent Contractor)Epigenomics Inc (Independent Contractor)Finch (Independent Contractor)Genentech (Independent Contractor)Janssen Pharmaceuticals NV (Independent Contractor)Kinevant Sciences gmBH (Independent Contractor)Leonard-Meron Biosciences (Independent Contractor)Merck and Co (Independent Contractor)OpGen (Independent Contractor)Prenosis (Independent Contractor)Regeneron Pharmaceuticals Inc (Independent Contractor)Seres Therapeutics Inc (Independent Contractor)Shire (Independent Contractor)Summit Therapeutics (Independent Contractor)
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Affiliation(s)
- Jason M Pogue
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
| | | | - Dror Marchaim
- Assaf Harofeh (Shamir) medical center, Beer Yaakov, HaMerkaz, Israel
| | | | | | - Cheng Chiu
- Chang Gung Memorial Hospital, Taoyuan, Taipei, Taiwan
| | | | - Sorabh Dhar
- John D Dingell VA Medical Center, Detroit, Michigan
| | | | - Achilleas Gikas
- University Hospital of Heraklion, Heraklion, Iraklion, Greece
| | | | - Mical Paul
- Rambam Health Care Campus, Haifa, HaZafon, Israel
| | - Emmanuel Roilides
- Aristotle University and Hippokration General Hospital, Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Sotirios Tsiodras
- Athens Medical School, National and Kapodistrian University of Athens, Athens, Attiki, Greece
| | | | - Varduhi Ghazaryan
- NIAID (National Institute of Allergy and Infectious Diseases), Rockville, Maryland
| | - Keith S Kaye
- University of Michigan Medical School, Ann Arbor, MI
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Pogue JM, Rybak MJ, Stamper K, Marchaim D, Thamlikitkul V, Carmeli Y, Chiu C, Daikos GL, Dhar S, Mangoni ED, Gikas A, Kotanidou A, Paul M, Roilides E, Samarkos M, Sims M, Tancheva D, Tsiodras S, Divine G, Ghazaryan V, Kaye KS. 638. The Impact of in vitro Synergy Between Colistin and Meropenem on Clinical Outcomes in Invasive Carbapenem-resistant Gram-negative Infections: A Report from the OVERCOME Trial. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Consensus guidelines caution against colistin (COL) monotherapy due to efficacy and resistance development concerns. The COL + meropenem (MEM) combination often displays in vitro synergy against carbapenem-resistant (CR) Gram-negative bacilli (GNB). We recently completed a clinical trial comparing outcomes in patients receiving COL vs. COL + MEM. Herein we assess if, amongst patients receiving COL + MEM, outcomes differed as a function of the presence (or absence) of in vitro synergy against the index pathogen.
Methods
OVERCOME was an international, multicenter, randomized, double-blind, placebo-controlled study comparing COL + placebo and COL + MEM for the treatment of pneumonia and/or bloodstream infection (BSI) due to CR GNB. Baseline isolates were COL susceptible (MIC ≤ 2 mg/L) and underwent synergy testing to COL + MEM in 24-hour time kill experiments (TKE). Synergy was defined as a >2-log CFU/ml reduction with combination therapy compared to the most active single agent. Outcomes assessed included 28-day mortality, clinical failure, and the development of COL resistance (MIC ≥ 4 mg/L) for both the overall cohort and the subgroup with A. baumannii.
Results
Of the 211 patients who received COL + MEM in OVERCOME, 186 had baseline synergy testing performed and were eligible for this analysis. The median age of the cohort was 70 years, 35% were female, 48% were white, and 44% Asian. Sixty-eight percent were in the intensive care unit (ICU) at infection onset. A. baumannii was the most common pathogen (78%) and pneumonia was the most common infection (68%). Synergy was demonstrated in most isolates (76%). Baseline characteristics, clinical, and microbiological outcomes were similar amongst patients infected with isolates against which COL + MEM demonstrated synergy and those where no synergy was demonstrated (Table 1). In patients with A. baumannii infections, the presence of in vitro synergy was associated with a decrease in clinical failure (53% vs. 79%; p = 0.04). No significant impact of synergy on 28-day mortality or development of COL resistance was demonstrated (Table 2).
Conclusion
The presence of in vitro synergy via TKE was associated with a decrease in clinical failure in patients treated with COL + MEM for invasive infections due to CR A. baumannii.
Disclosures
Jason M Pogue, PharmD, BCPS, BCIDP, Merck (Consultant)QPex (Consultant)Shionogi (Consultant)Utility Therapeutics (Consultant)VenatoRX (Consultant) Michael J. Rybak, PharmD, MPH, PhD, Paratek Pharmaceuticals (Research Grant or Support) Emmanuel Roilides, MD, PhD, FIDSA, FAAM, FESCMID, Merck Sharp & Dohme Corp. (Consultant, Grant/Research Support) Matthew Sims, MD, PhD, Astra Zeneca (Independent Contractor)Diasorin Molecular (Independent Contractor)Epigenomics Inc (Independent Contractor)Finch (Independent Contractor)Genentech (Independent Contractor)Janssen Pharmaceuticals NV (Independent Contractor)Kinevant Sciences gmBH (Independent Contractor)Leonard-Meron Biosciences (Independent Contractor)Merck and Co (Independent Contractor)OpGen (Independent Contractor)Prenosis (Independent Contractor)Regeneron Pharmaceuticals Inc (Independent Contractor)Seres Therapeutics Inc (Independent Contractor)Shire (Independent Contractor)Summit Therapeutics (Independent Contractor)
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Affiliation(s)
- Jason M Pogue
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Michael J Rybak
- Wayne State University / Detroit Medical Center, Detroit, Michigan
| | | | - Dror Marchaim
- Assaf Harofeh (Shamir) medical center, Beer Yaakov, HaMerkaz, Israel
| | | | | | - Cheng Chiu
- Chang Gung Memorial Hospital, Taoyuan, Taipei, Taiwan
| | | | - Sorabh Dhar
- John D Dingell VA Medical Center, Detroit, Michigan
| | | | - Achilleas Gikas
- University Hospital of Heraklion, Heraklion, Iraklion, Greece
| | | | - Mical Paul
- Rambam Health Care Campus, Haifa, HaZafon, Israel
| | - Emmanuel Roilides
- Aristotle University and Hippokration General Hospital, Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Sotirios Tsiodras
- Athens Medical School, National and Kapodistrian University of Athens, Athens, Attiki, Greece
| | | | - Varduhi Ghazaryan
- NIAID (National Institute of Allergy and Infectious Diseases), Rockville, Maryland
| | - Keith S Kaye
- University of Michigan Medical School, Ann Arbor, MI
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Papadopoulos A, Machairas N, Tsourouflis G, Chouliaras C, Manioti E, Broutas D, Kykalos S, Daikos GL, Samarkos M, Vagianos C. Risk Factors for Surgical Site Infections in Patients Undergoing Emergency Surgery: A Single-centre Experience. In Vivo 2021; 35:3569-3574. [PMID: 34697196 DOI: 10.21873/invivo.12660] [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: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Surgical site infections (SSI) are associated with increased morbidity and mortality, and they occur more frequently during unplanned emergency surgical (ES) procedures rather than elective. Our aim was to determine the incidence of SSI within our ES cohort and to identify risk factors for SSI. PATIENTS AND METHODS Data from consecutive patients undergoing ES in a single institution during a 5-year period were prospectively collected and analyzed. RESULTS A total of 838 consecutive patients were included. The median age was 52 (IQR=25-71) years and some 368 (44%) were female. 157 (18.7%) of those patients developed SSI. The most commonly isolated pathogen was E. Coli (55.4%) followed by Staphylococcus Aureus (40.1%). The 30-day mortality rate of patients who presented SSIs was 14.6% compared to 6.8% of patients without SSI (p=0.002). Multivariable analysis showed that the type of wound, American Society of Anesthesiology score, severity and duration of surgery >90 min were independent risk factors for the occurrence of SSI. CONCLUSION Identification of modifiable causative factors for SSI within an ES unit is paramount as they can critically impact postoperative outcomes.
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Affiliation(s)
| | - Nikolaos Machairas
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Tsourouflis
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Manioti
- 1st Department of Surgery, Nikaia General Hospital, Nikaia, Greece
| | | | - Stylianos Kykalos
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - George L Daikos
- 1 Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Samarkos
- 1 Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantine Vagianos
- 2 Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, 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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Theocharopoulos C, Lialios PP, Samarkos M, Gogas H, Ziogas DC. Antibody-Drug Conjugates: Functional Principles and Applications in Oncology and Beyond. Vaccines (Basel) 2021; 9:1111. [PMID: 34696218 PMCID: PMC8538104 DOI: 10.3390/vaccines9101111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/28/2022] Open
Abstract
In the era of precision medicine, antibody-based therapeutics are rapidly enriched with emerging advances and new proof-of-concept formats. In this context, antibody-drug conjugates (ADCs) have evolved to merge the high selectivity and specificity of monoclonal antibodies (mAbs) with the cytotoxic potency of attached payloads. So far, ten ADCs have been approved by FDA for oncological indications and many others are currently being tested in clinical and preclinical level. This paper summarizes the essential components of ADCs, from their functional principles and structure up to their limitations and resistance mechanisms, focusing on all latest bioengineering breakthroughs such as bispecific mAbs, dual-drug platforms as well as novel linkers and conjugation chemistries. In continuation of our recent review on anticancer implication of ADC's technology, further insights regarding their potential usage outside of the oncological spectrum are also presented. Better understanding of immunoconjugates could maximize their efficacy and optimize their safety, extending their use in everyday clinical practice.
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Affiliation(s)
| | | | | | | | - Dimitrios C. Ziogas
- First Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 115 27 Athens, Greece; (C.T.); (P.-P.L.); (M.S.); (H.G.)
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23
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Giamarellos-Bourboulis EJ, Daikos GL, Gargalianos P, Gogos C, Lazanas M, Panagopoulos P, Poulakou G, Sambatakou H, Samarkos M. The Role of Macrolides for the Management of Community-Acquired Pneumonia and Pneumonia by the Novel Coronavirus SARS-CoV-2 (COVID-19): A Position Paper by Four Medical Societies from Greece. Infect Dis Ther 2021; 10:1-15. [PMID: 34155472 PMCID: PMC8208612 DOI: 10.1007/s40121-021-00471-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/26/2021] [Indexed: 10/28/2022] Open
Abstract
In light of the accumulating evidence for survival benefit coming from the use of macrolides for community-acquired pneumonia (CAP), a group of experts from the field of internal medicine and infectious diseases frame a position statement on the use of macrolides for the management of bacterial CAP and for infection by the novel coronavirus (COVID-19). The statement is framed taking into consideration existing publications and own research experience. The main content of this statement is that the combination of one β-lactam and a macrolide should be the first treatment of choice for patients with severe bacterial CAP. Severity is assessed as scoring 2 or more points on the CURB65 scoring system of severity or as pneumonia severity index III to V or C-reactive protein more than 150 mg/l; the suggested macrolide is either azithromycin or clarithromycin. The experts also suggest that in COVID-19 pneumonia, the combination of one β-lactam and a macrolide should be reserved only when there is strong suspicion of bacterial co-infection.
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Affiliation(s)
| | - George L. Daikos
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Charalambos Gogos
- Department of Internal Medicine, Medical School, University of Patras, Patras, Greece
| | - Marios Lazanas
- Department of Internal Medicine, Iaso General Athens Hospital, Athens, Greece
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Garyphallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Psichogiou M, Samarkos M, Mikos N, Hatzakis A. Reactivation of Varicella Zoster Virus after Vaccination for SARS-CoV-2. Vaccines (Basel) 2021; 9:572. [PMID: 34205861 PMCID: PMC8228758 DOI: 10.3390/vaccines9060572] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Seven immunocompetent patients aged > 50 years old presented with herpes zoster (HZ) infection in a median of 9 days (range 7-20) after vaccination against SARS-CoV-2. The occurrence of HZ within the time window 1-21 days after vaccination defined for increased risk and the reported T cell-mediated immunity involvement suggest that COVID-19 vaccination is a probable cause of HZ. These cases support the importance of continuing assessment of vaccine safety during the ongoing massive vaccination for the COVID-19 pandemic and encourage reporting and communication of any vaccination-associated adverse event.
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Affiliation(s)
- Mina Psichogiou
- First Department of Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Michael Samarkos
- First Department of Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Nikolaos Mikos
- Allergology Department, Laiko General Hospital, 11527 Athens, Greece;
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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Samarkos M, Skouloudi M, Anastasopoulou A, Markogiannakis A. Restricted antimicrobial prescribing in an area of highly prevalent antimicrobial resistance. Infect Dis Now 2021; 51:526-531. [PMID: 33991719 DOI: 10.1016/j.idnow.2021.05.002] [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: 02/15/2021] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the predictive value for infection with multidrug-resistant organisms (MDROs) of reasons for empirical prescription of restricted antibiotics (rABX), in a setting with high resistance rates. METHODS We prospectively studied all rABX prescriptions in a 550-bed tertiary teaching hospital from April 15 to June 14, 2018 and from September 1 to October 30, 2018. Prescribing physicians had to justify their decision by choosing one or more prespecified reasons. RESULTS We reviewed 172 empirical prescriptions of rABX, which accounted for 67.2% of all rABX prescriptions. Stated reasons for empirical prescription of rABX were recent hospitalization (72.7%), escalation due to non-response to previous antimicrobials (47.7%), treatment for severe sepsis/septic shock (45.9%), escalation due to recurrence or deterioration (22.1%), prior MDRO infection (12.8%), and prior MDRO colonization (7.6%). Empirical treatment for septic shock or severe sepsis was the only significant predictor of MDRO isolation (OR=5.26, 95% CI: 1.5-18.4, P=0.009), while recent hospitalization had a high negative predictive value for MDRO (97.4%). Fourteen per cent of microbiologically documented infections were associated with MDROs resistant to the prescribed rABX. CONCLUSIONS Empirical treatment for severe sepsis or septic shock was the only independent predictor of MDRO isolation. Recent hospitalization had a high negative predictive value for MDRO infection. The isolation of pathogens resistant to the prescribed rABX suggests that in a setting with widespread antimicrobial resistance, it could be difficult to reduce the empirical use of rABX without risking inadequate treatment.
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Affiliation(s)
- Michael Samarkos
- 1st Department of Medicine, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Amalia Anastasopoulou
- 1st Department of Medicine, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Papazoglou N, Samarkos M, Vergadis C, Cholongitas E. Abdominal aorta aneurysm endograft infection mimicking bacteraemic urinary tract infection. Hippokratia 2021; 25:91-93. [PMID: 35937509 PMCID: PMC9347350] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND Endograft infection complicating endovascular aneurysm repairs is infrequent and presents various symptoms and findings, the most common being abdominal pain, fever, fatigue, and gastrointestinal bleeding. DESCRIPTION OF THE CASE Α 75-year-old male patient with endovascular graft infection presented with a three-day history of fever and was initially misdiagnosed as a bacteremic urinary tract infection. Due to high surgical risk, a drainage tube was placed, and the patient was treated with intravenous antibiotics for three weeks and then with oral antibiotics for two months. On the six-month follow-up, there were no signs of infection recurrence. CONCLUSION Endovascular graft infections generally require antibiotic therapy combined with surgical debridement and revascularization. This case illustrates a successful alternative management strategy with percutaneous drainage of the aortic sac abscess combined with long-term oral antibiotic therapy. This case also underlines the high index of suspicion necessary for the accurate and timely diagnosis and management of endovascular graft infections. HIPPOKRATIA 2021, 25 (2) 91-93.
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Affiliation(s)
- N Papazoglou
- 1st Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - M Samarkos
- 1st Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - C Vergadis
- Interventional Radiology Unit, Department of Radiology, Laikon General Hospital, Athens, Greece
| | - E Cholongitas
- 1st Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Patavoukas G, Samarkos M, Mavroudis A, Kavvouri D, Lakiotaki E, Sakellariou S, Vergadis C, Cholongitas E. Hepatosplenic cat scratch disease: The usefulness of liver biopsy. Indian J Gastroenterol 2021; 40:88-90. [PMID: 33230753 DOI: 10.1007/s12664-020-01115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/28/2020] [Indexed: 02/04/2023]
Affiliation(s)
- George Patavoukas
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527, Athens, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527, Athens, Greece
| | - Andreas Mavroudis
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527, Athens, Greece
| | - Dimitra Kavvouri
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527, Athens, Greece
| | - Eleutheria Lakiotaki
- Department of Pathology, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Stratigoula Sakellariou
- Department of Pathology, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527, Athens, Greece.
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Markogiannakis A, Korantanis K, Gamaletsou MN, Samarkos M, Psichogiou M, Daikos G, Sipsas NV. Impact of a non-compulsory antifungal stewardship program on overuse and misuse of antifungal agents in a tertiary care hospital. Int J Antimicrob Agents 2020; 57:106255. [PMID: 33279582 DOI: 10.1016/j.ijantimicag.2020.106255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/06/2020] [Revised: 11/02/2020] [Accepted: 11/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the impact of an antifungal stewardship (AFS) program on appropriate use, consumption and acquisition costs of antifungals, and on clinical outcomes (in-hospital-mortality, in-hospital-length-of-stay). METHODS The study was conducted at a 535-bed tertiary-care hospital and had three consecutive periods. A) Observational period (10 months): all antifungal prescriptions were prospectively evaluated. B) Educational intervention to increase the awareness on proper antifungals use. C) Implementation of a non-compulsory AFS program (10 months) based on prospective audit and feedback. Interrupted time series analysis has been used to assess the impact of the intervention. RESULTS During the pre-interventional period 198 AF prescriptions for 147 patients, have been evaluated compared to 181 prescriptions in 138 patients during the AFS period. Statistical analysis showed a significant immediate drop of inappropriate prescriptions after intervention with a significantly declining trend thereafter, and a significant drop of the total consumption of antifungals immediately after the intervention with a significant declining trend thereafter. All-cause, in-hospital- mortality was stable during the pre-intervention period with a significant declining trend after the AFS program implementation, although no immediate intervention effect could be established. Comparison of pre-and post-interventional periods showed significant reduction in acquisition costs (-26.8%, p<0.001) but no difference regarding the total number of bed-days (107,654 vs. 102,382), and mean length of hospital-stay (5.19 vs. 4.96 days, p=NS). CONCLUSIONS The implementation of a non-compulsory AFS program resulted in significant improvement in the quality of prescriptions and reduction in antifungals consumption and acquisitions costs, without affecting the overall in-hospital-mortality and mean in-hospital-length-of-stay.
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Affiliation(s)
| | - Konstantinos Korantanis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Maria N Gamaletsou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, School of Medicine, National and Kapodistrian University of Athens and General Hospital of Athens Laiko, Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, School of Medicine, National and Kapodistrian University of Athens and General Hospital of Athens Laiko, Athens, Greece
| | - George Daikos
- First Department of Medicine, School of Medicine, National and Kapodistrian University of Athens and General Hospital of Athens Laiko, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
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Karapanou A, Vieru AM, Sampanis MA, Pantazatou A, Deliolanis I, Daikos GL, Samarkos M. Failure of central venous catheter insertion and care bundles in a high central line-associated bloodstream infection rate, high bed occupancy hospital. Am J Infect Control 2020; 48:770-776. [PMID: 31911066 DOI: 10.1016/j.ajic.2019.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our hospital has several characteristics different from the settings in which the central venous catheter (CVC) care bundle has been implemented so far, that is, care bundles or protocols are not systematically used, and the prevalence of central line-associated bloodstream infections (CLABSI) is high, as is bed occupancy rate. We examined the effectiveness of CVC care bundles. METHODS Modified CVC bundles were implemented across all settings of our hospital. During both phases of the study, we collected data on CLABSI, and we monitored CVC insertion and management practices with direct observation audits. RESULTS We have studied 913 CVC insertions (454 in PRE and 459 in POST) for 11,871 catheter-days. The incidence of CLABSI was 8.3 per 1,000 catheter-days PRE, and 7.6 per 1,000 catheter-days POST (incidence rate ratio, 0.92; 95% confidence interval, 0.60-1.40). Compliance with the CVC insertion bundle increased from 8.4%-74.3% (P < .0001). The CVC management bundle compliance also increased from 11.4%-57.7% (P < .0001). CONCLUSIONS Despite improved compliance after the intervention, implementation of a modified CVC bundle failed to decrease CLABSI incidence. Higher bundle compliance rates may be necessary for a significant decrease in the incidence of CLABSI, along with the appropriate organizational culture and levels of staffing.
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Anastasopoulou A, Ziogas DC, Samarkos M, Kirkwood JM, Gogas H. Reactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: current evidence and clinical practice recommendations. J Immunother Cancer 2019; 7:239. [PMID: 31484550 PMCID: PMC6727332 DOI: 10.1186/s40425-019-0717-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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: 05/10/2019] [Accepted: 08/23/2019] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors (ICBs) have revolutionized cancer treatment producing remarkable and durable responses for a range of malignancies. However, the additional modulation of immune response by ICBs may rarely cause immune-related infectious complications, including re-activation of latent tuberculosis infection (LTBC) with detrimental effects on those patients’ outcome. Here, we present two “real-world” melanoma cases that were treated in our department with blockade of PD-1/PD-L1 and developed active Mycobacterium tuberculosis (MTB) during immunotherapy. In view of these cases, we review the literature for ICB-associated MTB reactivation and discuss our considerations about the possible interactions of immunotherapy and the underlying co-existent mycobacterial infection. Based on the current evidence from preclinical findings prior to this experience, we raise questions regarding cancer patients who are at higher risk for developing MTB infection, whether ICB-treated patients should be considered immunocompromised, and how they should be managed for latent and/or active tuberculosis. Aside from the well-established clinical benefit of immunotherapy, the blockade of PD-1/PD-L1 axis may concurrently disrupt the immune control of specific opportunistic infections such as tuberculosis that should be carefully and expectantly managed in order to avoid compromising the outcome of cancer treatment and the affected patient’s survival.
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Affiliation(s)
- Amalia Anastasopoulou
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece
| | - Dimitrios C Ziogas
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece
| | - John M Kirkwood
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Helen Gogas
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, 11527, Athens, Greece.
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Abstract
We report a case of septic thrombosis of the right cavernous sinus in a diabetic woman in her late 70's due to ipsilateral sphenoid sinusitis. The diagnosis was delayed and made only after the abrupt and dramatic appearance of the manifestations of sinus thrombosis. The patient developed, among the other symptoms, right peripheral facial palsy, which is a very rare manifestation in cavernous sinus thrombosis (CST). She was treated with broad-spectrum antibiotics and enoxaparin. The day of the scheduled drainage of sphenoid sinus-24 hours after the initiation of anticoagulation-she developed fatal subarachnoid haemorrhage. Our case demonstrates the difficulty of timely diagnosis of acute sphenoid sinusitis which has emerged as the most common primary infectious source potentially leading in CST. It also underscores the uncertainty concerning the use of anticoagulation in cerebral sinus thrombosis of infectious origin.
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Affiliation(s)
| | | | - Sofia Katsila
- 3rd Department of Medicine, Evaggelismos General Hospital, Athens, Greece
| | - Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, Athens, Greece.,National and Kapodistrian University of Athens - Faculty of Medicine, Athens, Greece
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Nikolaras GP, Papaparaskevas J, Samarkos M, Tzouvelekis LS, Psychogiou M, Pavlopoulou I, Goukos D, Polonyfi K, Pantazatou A, Deliolanis I, Smilakou S, Daikos GL. Changes in the rates and population structure of methicillin-resistant Staphylococcus aureus (MRSA) from bloodstream infections: A single-centre experience (2000-2015). J Glob Antimicrob Resist 2018; 17:117-122. [PMID: 30553117 DOI: 10.1016/j.jgar.2018.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/19/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the rate of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and the population structure of MRSA isolates recovered between 2000-2015 in a tertiary-care hospital in Athens, Greece. METHODS Non-duplicate MRSA blood isolates recovered during the study period were examined. Antimicrobial susceptibility testing was performed by Kirby-Bauer and gradient strip methods. Carriage of PVL and mecA genes was examined by PCR. Genetic relatedness of the isolates was studied by SCCmec, spa and multilocus sequence typing. RESULTS A total of 398 MRSA BSI cases were identified. A decreasing trend in incidence from 1.69/10 000 patient-days in 2000 to 1.39/10 000 patient-days in 2015 (P=0.038) and in prevalence from 64.7% to 36.4% (P=0.008), respectively, was observed, whereas the incidence of methicillin-susceptible S. aureus BSI increased. MRSA isolates exhibiting resistance to common antistaphylococcal agents (excluding glycopeptides and the newer antistaphylococcals) decreased from 84.8% in 2000 to 0% in 2011 and were progressively 'replaced' by more susceptible phenotypes. A strong association between antimicrobial resistance phenotype and molecular type was observed. The pandemic HA-MRSA clone ST239-III progressively declined in parallel with increasing isolation frequency of two clonal complexes (CCs): HA-MRSA CC5, with the majority of isolates belonging to ST5-II; and CA-MRSA CC80, represented mainly by ST80-IV-t044, PVL+. CONCLUSION The decline in MRSA BSI rates observed in our institution was associated with changes in population structure of the organism. This decline may be related to biological properties of the prevailing MRSA clones.
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Affiliation(s)
| | - Joseph Papaparaskevas
- Department of Microbiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, 'Laikon' General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Leonidas S Tzouvelekis
- Department of Microbiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Mina Psychogiou
- First Department of Medicine, 'Laikon' General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ioanna Pavlopoulou
- School of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Demetrios Goukos
- First Department of Medicine, 'Laikon' General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Katerina Polonyfi
- First Department of Medicine, 'Laikon' General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Ioannis Deliolanis
- Department of Microbiology, 'Laikon' General Hospital, 11527 Athens, Greece
| | - Stavroula Smilakou
- Department of Microbiology, 'Laikon' General Hospital, 11527 Athens, Greece
| | - George L Daikos
- First Department of Medicine, 'Laikon' General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
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Vaiopoulos AG, Kapsimali V, Kanakis MA, Vaiopoulos G, Samarkos M, Zouboulis CC, Kaklamanis PG. The frequency of arthritis in Adamantiades-Behçet's disease in Greek patients. J Eur Acad Dermatol Venereol 2018; 33:416-420. [PMID: 30394611 DOI: 10.1111/jdv.15326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVES Musculoskeletal manifestations are frequent in Adamantiades-Behçet's disease (ABD) but only represent non-specific clinical findings. They have not been included in the two commonly used sets of classification criteria. The occurrence of musculoskeletal manifestations at ABD onset may even delay or obscure the diagnosis; therefore, detailed knowledge of the different musculoskeletal manifestations is essential. Our objective was to describe musculoskeletal signs and their clinical course in Greek ABD patients. METHODS We conducted a retrospective cohort study, which included all patients with ABD, who had been examined in our Rheumatology Outpatient Division from 1995 to 2010. The study included 224 ABD patients (140 male, 84 female) that fulfilled the International Criteria for the diagnosis of BD. For statistical analysis, we have used chi-square and Fisher's exact tests. RESULTS Arthritis as a presenting sign was seen in 10.2% of our patients. During the follow-up period, the frequency of arthritis was 58.4%. Monoarthritis was found in 32.8% and 22.6% of male and female patients, respectively (ns). During the follow-up period, polyarthritis was only occasionally observed in male patients (2.14%). Oligoarthritis was assessed in 20.0% and 41.6% of male and female patients, respectively (P < 0.001), and was the only significantly different manifestation between sexes. CONCLUSIONS Musculoskeletal manifestations are common in ABD both at presentation and during the disease course. The most frequent sign is mooarthritis. Oligoarthritis was the only significantly different articular manifestation between sexes (more common in women) in our study group.
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Affiliation(s)
- A G Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - V Kapsimali
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Heart Surgery Centre, Athens, Greece
| | - G Vaiopoulos
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Samarkos
- First Department of Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - P G Kaklamanis
- Athens Medical Centre, Rheumatology Clinic, Athens, Greece
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Samarkos M, Papaxoinis G, Athanasoula K, Benopoulou Ο, Bouros S, Anastasopoulou A, Diamantopoulos P, Gogas H, Mantzourani M. Significance of survivin mRNA blood levels in patients with melanoma. J BUON 2018; 23:96-103. [PMID: 30722117] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Survivin represents a key anti-apoptotic molecule that is highly expressed in the vast majority of tumors. The aim of the study was to examine the significance of survivin mRNA blood levels in melanoma patients. METHODS In this prospective translational research study, survivin mRNA blood levels were measured in melanoma patients treated with adjuvant interferon or systemic treatment for advanced disease. RESULTS Sixty-four patients with melanoma and 40 healthy controls were included. The majority of them had tumor stages III and IV. The upper 95% confidence interval (95%CI) of survivin levels in controls was set as normal cut-off. Fifty-two (81.3%) patients had survivin levels above normal cut-off. Melanoma patients had higher survivin levels than controls (p<0.0001). Survivin levels were non-significantly higher in stage III compared to stage IV patients. Patients with survivin levels above vs. below median had median progression-free survival (PFS) 19.5 months vs. 7.4 months (p=0.045), but median overall survival (OS) not reached vs. 18.4 months (p=0.091). Cox proportional hazard models showed that only tumor stage was associated with PFS and OS. There was no statistically significant change in survivin levels between baseline and during treatment (p=0.845) or during follow-up (p=0.101). CONCLUSION Although melanoma patients had significantly higher survivin levels than controls, the study showed that survivin mRNA blood levels did not represent an independent prognostic factor for patients with melanoma. The role of circulating survivin should be further examined in larger studies.
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Affiliation(s)
- Michael Samarkos
- First Department of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Samarkos M, Mantzourani M, Nika C, Kalotychou V. A delayed diagnosis: recurrent fever and beta thalassaemia. BMJ Case Rep 2018; 2018:bcr-2018-225802. [DOI: 10.1136/bcr-2018-225802] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Familial Mediterranean fever and beta-thalassaemia are two genetic disorders, with a largely common geographical distribution. However, they have not much else in common, as the first is an autoinflammatory disorder, while the other is a haemoglobinopathy. We describe a patient with known beta-thalassaemia intermedia who presented with recurrent fevers and he was diagnosed with familial Mediterranean fever 2 years later. We discuss whether there is an association between the two disorders and the cognitive biases that lead to the delay in the diagnosis of familial Mediterranean fever.
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36
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Oikonomou T, Papatheodoridis GV, Samarkos M, Goulis I, Cholongitas E. Clinical impact of microbiome in patients with decompensated cirrhosis. World J Gastroenterol 2018; 24:3813-3820. [PMID: 30228776 PMCID: PMC6141334 DOI: 10.3748/wjg.v24.i34.3813] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/11/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
Cirrhosis is an increasing cause of morbidity and mortality. Recent studies are trying to clarify the role of microbiome in clinical exacerbation of patients with decompensated cirrhosis. Nowadays, it is accepted that patients with cirrhosis have altered salivary and enteric microbiome, characterized by the presence of dysbiosis. This altered microbiome along with small bowel bacterial overgrowth, through translocation across the gut, is associated with the development of decompensating complications. Studies have analyzed the correlation of certain bacterial families with the development of hepatic encephalopathy in cirrhotics. In general, stool and saliva dysbiosis with reduction of autochthonous bacteria in patients with cirrhosis incites changes in bacterial defenses and higher risk for bacterial infections, such as spontaneous bacterial peritonitis, and sepsis. Gut microbiome has even been associated with oncogenic pathways and under circumstances might promote the development of hepatocarcinogenesis. Lately, the existence of the oral-gut-liver axis has been related with the development of decompensating events. This link between the liver and the oral cavity could be via the gut through impaired intestinal permeability that allows direct translocation of bacteria from the oral cavity to the systemic circulation. Overall, the contribution of the microbiome to pathogenesis becomes more pronounced with progressive disease and therefore may represent an important therapeutic target in the management of cirrhosis.
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Affiliation(s)
- Theodora Oikonomou
- Fourth Department of Internal Medicine, Hippokration General Hospital, Medical School of Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - George V Papatheodoridis
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Michael Samarkos
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokration General Hospital, Medical School of Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
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Samarkos M, Mastrogianni E, Kampouropoulou O. The role of gut microbiota in Clostridium difficile infection. Eur J Intern Med 2018; 50:28-32. [PMID: 29428498 DOI: 10.1016/j.ejim.2018.02.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 12/30/2017] [Revised: 02/02/2018] [Accepted: 02/04/2018] [Indexed: 02/07/2023]
Abstract
Clostridium difficile infection has emerged as a major health problem. Because it is a spore-forming microorganism, C. difficile is difficult to eradicate and recurrences of the infection are frequent. The strong association of CDI with prior use of antibiotics led to the recognition that disturbances in the gut microbiota apparently plays a central role in CDI. Except for antibiotics, several other risk factors for CDI have been recognised, such as advanced age and use of proton pump inhibitors. The common characteristic of these factors is that they are associated with changes in the composition of gut microbiota. Data from human studies have shown that the presence of C. difficile, either as a colonizer or as a pathogen, is associated with reduced microbiota diversity. C. difficile infection per se seems to be associated with changes in the representation of specific microbial populations (e.g. taxa) which either may act protectively against C. difficile colonization of the gut or may increase susceptibility for C. difficile infection. Therapeutic gut microbiota manipulation can be achieved by faecal microbiota transplantation, which is highly effective for the treatment of CDI.
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Affiliation(s)
- Michael Samarkos
- 1st Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Elpida Mastrogianni
- 1st Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Olga Kampouropoulou
- 1st Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Greece
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Abstract
We report the case of a 53-year-old healthy man, presenting with confusion. The patient had been clinically diagnosed with cat-scratch disease (CSD) and prescribed a 10-day course of doxycycline orally. Approximately a week after he had completed the treatment, he was admitted to our department with confusion. Neurological examination revealed expressive dysphasia with no motor or sensory deficits. Cerebrospinal fluid (CSF) examination showed only increased content. Imaging with CT and MRI of the brain did not reveal any abnormalities, and funduscopy was normal. Serology confirmed Bartonella henselae infection. CSD-associated encephalopathy was confirmed based on the clinical manifestations, CSF findings and positive serology. The patient was treated with a combination of doxycycline and rifampin and he rapidly improved with complete neurological recovery within 7 days. Encephalopathy is an unusual manifestation of CSD in adults with excellent prognosis.
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Affiliation(s)
- Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, Athens, Greece.,1st Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Aristeidis G Vaiopoulos
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- 1st Department of Medicine, Laikon Hospital, Athens, Greece.,1st Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Bonou M, Kapelios CJ, Samarkos M, Benetos G, Tampaki M, Pianou N, Georgakopoulos A, Moyssakis I, Anagnostopoulos CD, Barbetseas J. Early diagnosis of right ventricle–pulmonary artery conduit endocarditis by PET/CT. Int J Infect Dis 2018; 68:24-25. [DOI: 10.1016/j.ijid.2017.12.020] [Citation(s) in RCA: 3] [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: 11/18/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022] Open
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Tofas P, Samarkos M, Piperaki ET, Kosmidis C, Triantafyllopoulou ID, Kotsopoulou M, Pantazatou A, Perlorentzou S, Poulli A, Vagia M, Daikos GL. Pseudomonas aeruginosa bacteraemia in patients with hematologic malignancies: risk factors, treatment and outcome. Diagn Microbiol Infect Dis 2017; 88:335-341. [DOI: 10.1016/j.diagmicrobio.2017.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/12/2017] [Accepted: 05/07/2017] [Indexed: 11/29/2022]
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Abstract
INTRODUCTION Castleman's disease (CD), also known as giant or angiofolicular lymphoid hyperplasia or lymphoid hamartoma, is a group of atypical lymphoproliferative disorders that share common lymph node histological features and may be localized either to a single lymph node (unicentric) or occur systemically (multicentric). PATIENT AND METHOD Herein, we present a rare case of a of 75-year-old female patient who was referred to our department and after a thorough work-up, underwent splenectomy with synchronous resection of an accessory spleen, splenic artery lymph nodes, and splenic hilar lymph nodes due to splenic involvement in a multicentric CD. RESULTS The pathology of the specimens led to the conclusion that it was a case of polycentric HHV-8-positive CD, affecting the spleen, the accessory spleen, and the lymph nodes. CONCLUSIONS Incidence of this rare condition is believed to be approximately 0.001-0.05%. CD has been linked to the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), and is associated with malignancies. The pathogenesis mechanism is considered to be a dysregulation and hypersecretion of cytokines, either idiopathic or secondary to a viral infection, with the latter considered the most frequent. Solid organ involvement is very rare as is splenic involvement.
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Affiliation(s)
- Dimitrios Mantas
- 2nd Department of Propedeutic Surgery, Athens Medical School, National and Kapodistrian University of Athens, Goudi, Athens, Greece
| | - Christos Damaskos
- 2nd Department of Propedeutic Surgery, Athens Medical School, National and Kapodistrian University of Athens, Goudi, Athens, Greece
| | - Panagiota Dailiani
- Department of Pathology, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Penelope Korkolopoulou
- Department of Pathology, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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42
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Eliadi I, Tsoumi G, Kampouropoulou O, Theofanis V, Mantzourani M, Samarkos M. Characterization of the medical admissions in a tertiary Greek hospital. Eur J Intern Med 2017; 40:e15-e16. [PMID: 28119030 DOI: 10.1016/j.ejim.2017.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Irene Eliadi
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgia Tsoumi
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Olga Kampouropoulou
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Vasileios Theofanis
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Marina Mantzourani
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Michael Samarkos
- 1st Department of Medicine, Laikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
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Armenis I, Kalotychou V, Tzanetea R, Kollia P, Kontogeorgiou Z, Anastasopoulou D, Mantzourani M, Samarkos M, Pantos K, Konstantopoulos K, Rombos I. Prognostic value of T786C and G894T eNOS polymorphisms in sickle cell disease. Nitric Oxide 2017; 62:17-23. [DOI: 10.1016/j.niox.2016.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/08/2016] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
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Armenis I, Kalotychou V, Tzanetea R, Kollia P, Kontogeorgiou Z, Anastasopoulou D, Mantzourani M, Samarkos M, Pantos K, Konstantopoulos K, Rombos I. Data on eNOS T786 and G894T polymorphisms and peripheral blood eNOS mRNA levels in Sickle Cell Disease. Data Brief 2016; 10:192-197. [PMID: 27995153 PMCID: PMC5154968 DOI: 10.1016/j.dib.2016.11.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 11/25/2022] Open
Abstract
In this article, we present data on endothelial Nitric Oxide Synthase (eNOS) gene T786C and G894T polymorphisms in Greek steady-state Sickle Cell Disease patients in comparison to healthy controls. Moreover, eNOS mRNA levels were determined in peripheral blood samples from 18 patients and 9 controls. This article complements our recently published article named “Prognostic value of eNOS T786C and G894T polymorphisms in Sickle Cell Disease” (I. Armenis, V. Kalotychou, R. Tzanetea, Z. Kontogeorgiou, D. Anastasopoulou, M. Mantzourani, M. Samarkos, K. Pantos, K. Konstantopoulos, I. Rombos, 2016) [1].
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Affiliation(s)
- Iakovos Armenis
- 1st Department of Internal Medicine, "Laiko" Hospital, NKUA, Medical School, Athens, Greece
| | - Vassiliki Kalotychou
- 1st Department of Internal Medicine, "Laiko" Hospital, NKUA, Medical School, Athens, Greece
| | - Revekka Tzanetea
- 1st Department of Internal Medicine, "Laiko" Hospital, NKUA, Medical School, Athens, Greece; Metropolitan Hospital, Athens, Greece
| | | | - Zoi Kontogeorgiou
- 1st Department of Internal Medicine, "Laiko" Hospital, NKUA, Medical School, Athens, Greece; Department of Biology, NKUA, Athens, Greece
| | - Dimitra Anastasopoulou
- 1st Department of Internal Medicine, "Laiko" Hospital, NKUA, Medical School, Athens, Greece; Department of Biology, NKUA, Athens, Greece
| | - Marina Mantzourani
- 1st Department of Internal Medicine, "Laiko" Hospital, NKUA, Medical School, Athens, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, "Laiko" Hospital, NKUA, Medical School, Athens, Greece
| | | | - Kostas Konstantopoulos
- Department of Hematology, "Laiko" General Hospital, NKUA, Medical School, Athens, Greece
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Meletis J, Dalekou M, Samarkos M, Paravasiliou E, Meletis C, Konstantopoulos K, Apostolidou E, Komninaka V, Terpos E, Benopoulou O, Korovesis K, Variami E, Loukopoulos D. Fetal Erythropoiesis after Allogeneic Bone Marrow Transplantation Estimated by the Peripheral Blood Erythrocytes Containing Hemoglobin F (F-cells). ACTA ACUST UNITED AC 2016; 5:447-53. [PMID: 27419348 DOI: 10.1080/10245332.2001.11746542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
During bone marrow engraftment following BMT there is a re-establishment of fetal erythropoiesis, expressed by the increase of F-cells. This seems to depend on several factors such as underlying disease, conditioning before therapy and other mechanisms concerning both the donor and the recipient bone marrow. The aim of this work was to study the factors influencing F-cell production during bone marrow engraftment following transplantation. We studied 28 patients who underwent allogeneic bone marrow transplantation, for various hematological malignancies (CML, AML, ALL, CMML and SAA). F-cells were estimated on peripheral blood smears by indirect immunofluorescence. Overall, there was an F-cell increase after BMT in comparison with values before BMT; this increase was significant on days 15-50 (p <.01). F-cell on days 18, 25, 32 and 40 following transplantation were significantly higher (p <.01) in patients who have had increased F-cell numbers post-chemotherapy before BMT, compared with the patients who did not show any increase of the F-cell number post chemotherapy. During the first month following transplantation (day 7 to day 40) patients who were transplanted from high F-cell donors failed to show any significant differences in their F-cell numbers in comparison to those transplanted from low F-cell donors. However, the F-cell increase became significantly higher in the former group between days 50 and 120. This observation implies that the stressed erythropoiesis of the initial phase does not allow revealing the varying F-cell production of the capacities donor bone marrow, while later, when the graft has settled, the high F-cell donors reveal this property of the host.
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Affiliation(s)
- J Meletis
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - M Dalekou
- b Bone Marrow Transplantation Unit , Evagelismos Hospital , Greece
| | - M Samarkos
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - E Paravasiliou
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - C Meletis
- c Department of Electrical and Computer Engineering , National Technical University of Athens , Greece
| | - K Konstantopoulos
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - E Apostolidou
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - V Komninaka
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - E Terpos
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - O Benopoulou
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - K Korovesis
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - E Variami
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
| | - D Loukopoulos
- a First Department of Internal Medicine , University of Athens School of Medicine , Laiko General Hospital , Greece
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Samarkos M, Theofanis V, Eliadi I, Vlachogiannakos J, Polyzos A. Tenofovir-associated Fanconi syndrome in a patient with chronic hepatitis B. J Gastrointestin Liver Dis 2014; 23:342. [PMID: 25267967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | | | - Irene Eliadi
- 1st Department of Internal Medicine, Athens, Greece
| | - John Vlachogiannakos
- Department of Gastroenterology, University of Athens Medical School, Laikon Hospital, Athens, Greece
| | - Aris Polyzos
- 1st Department of Internal Medicine, Athens, Greece
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Asimakopoulos JV, Terpos E, Papageorgiou L, Kampouropoulou O, Christoulas D, Giakoumis A, Samarkos M, Vaiopoulos G, Konstantopoulos K, Angelopoulou MK, Vassilakopoulos TP, Meletis J. The presence of CD55- and/or CD59-deficient erythrocytic populations in patients with rheumatic diseases reflects an immune-mediated bone-marrow derived phenomenon. Med Sci Monit 2014; 20:123-39. [PMID: 24463881 PMCID: PMC3915003 DOI: 10.12659/msm.889727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/14/2022] Open
Abstract
Background Complement has the potential to provoke severe impairment to host tissues, as shown in autoimmune diseases where complement activation has been associated with diminished CD55 and/or CD59 expression on peripheral blood cell membranes. The aim of this study was to evaluate the presence of CD55- and/or CD59-deficient erythrocytic populations in patients with different rheumatic diseases and to investigate possible correlations with clinical or laboratory parameters. Material/Methods CD55 and CD59 expression was evaluated in erythrocytes of 113 patients with rheumatic diseases, 121 normal individuals, and 10 patients with paroxysmal nocturnal hemoglobinuria (PNH) using the Sephacryl gel microtyping system. Ham and sucrose tests were also performed. Results Interestingly, the majority of patients (104/113, 92%) demonstrated CD55- and/or CD59-deficient erythrocytes: 47 (41.6%) with concomitant deficiency of CD55 and CD59, 50 (44.2%) with isolated deficiency of CD55, and 6 (6.2%) with isolated deficiency of CD59. In normal individuals, only 2 (1%) had concomitant CD55/CD59 negativity and 3 (2%) had isolated CD55 or CD59 deficiency. All PNH patients exhibited simultaneous CD55/CD59 deficiency. Positive Ham and sucrose tests were found only in PNH patients. There was no association between the CD55- and/or CD59-deficient erythrocytes and hemocytopenias or undergoing treatment. However, CD55 expression significantly influenced hemoglobin values (F=6.092, p=0.015). Conclusions This study provides evidence supporting the presence of erythrocytes with CD55 and/or CD59 deficiency in patients with rheumatic diseases. Moreover, CD55 deficiency on red cells influences hemoglobin concentration. Further studies using molecular techniques will clarify the exact pathophysiological mechanisms of this deficiency.
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Affiliation(s)
- John V Asimakopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, "Alexandra" General Hospital, Athens, Greece
| | - Loula Papageorgiou
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Olga Kampouropoulou
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Dimitris Christoulas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, "Alexandra" General Hospital, Athens, Greece
| | - Anastasios Giakoumis
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Michael Samarkos
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - George Vaiopoulos
- 1st Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Konstantinos Konstantopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - Theodoros P Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
| | - John Meletis
- Department of Hematology and Bone Marrow Transplantation Unit, National and Kapodistrian University of Athens, School of Medicine, "Laiko" General Hospital, Athens, Greece
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Kanakis MA, Kapsimali V, Vaiopoulos AG, Vaiopoulos GA, Samarkos M. The lung in the spectrum of antiphospholipid syndrome. Clin Exp Rheumatol 2013; 31:452-457. [PMID: 23415021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/25/2012] [Indexed: 06/01/2023]
Abstract
Patients with antiphospholipid syndrome may develop various lung manifestations. The lung complications that have been described so far are pulmonary thromboembolic disease, pulmonary hypertension, acute respiratory distress syndrome, primary thrombosis of large and small lung vessels, diffuse alveolar haemorrhage, fibrosing alveolitis and postpartum syndrome. Clinicians should be aware of these conditions as in most of these cases, timely diagnosis and treatment is needed.
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Samarkos M, Mylona E, Kapsimali V. The role of complement in the antiphospholipid syndrome: a novel mechanism for pregnancy morbidity. Semin Arthritis Rheum 2012; 42:66-9. [PMID: 22405029 DOI: 10.1016/j.semarthrit.2012.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Despite the experimental research data on antiphospholipid syndrome (APS), the pathogenesis of thrombosis and fetal loss remains unknown. The objective of this study was to analyze the major advances in the field of complement activation as a possible thrombosis mechanism in the APS. METHODS The authors conducted a systemic analysis of the English literature and summarized both animal and human data that indicate the inappropriate complement activation as a mechanism causing thrombosis in the APS. RESULTS The important role of complement activation in the pathogenesis of fetal loss was established using mice deficient in a complement regulatory protein. Further studies have shown that the infusion of human IgG antiphospholipid antibodies (aPL) induced fetal loss in pregnant mice, an effect that was abrogated by the concurrent administration of a C3 convertase inhibitor. Further studies suggested that C5a and neutrophils were the key components responsible for fetal injury. Moreover, use of F(ab)'2 fragments of aPL suggested the complement activation occurred mainly via the classical pathway. Other studies using models of induced thrombosis suggested that antibodies against β2GPI required the presence of terminal complement components to induce thrombus formation, and mice deficient in C3 or C5 were found to be resistant to aPL-induced thrombosis. Based on the aforementioned findings, it has been suggested that heparin prevents fetal loss in patients with APS by inhibiting complement activation rather than by its anticoagulant effect. CONCLUSIONS The studies on complement are significant because they shift the focus of research in APS from thrombosis to inflammation. However, as human data are limited, more clinical research is necessary before the above findings translate in changes in the management of APS.
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Affiliation(s)
- Michael Samarkos
- 5th Department of Medicine, Evagelismos Hospital, Athens, Greece
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Samarkos M, Giannopoulou C, Karantoni E, Papastamopoulos V, Baraboutis I, Skoutelis A. Syphilitic periostitis of the skull and ribs in a HIV positive patient. Sex Transm Infect 2010; 87:44-5. [DOI: 10.1136/sti.2010.044461] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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