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Gavriilaki E, Mallouri D, Bousiou Z, Demosthenous C, Vardi A, Dolgyras P, Batsis I, Stroggyli E, Karvouni P, Masmanidou M, Gavriilaki M, Bouinta A, Bitsianis S, Kapravelos N, Bitzani M, Vasileiadou G, Yannaki E, Sotiropoulos D, Papagiannopoulos S, Kazis D, Kimiskidis V, Anagnostopoulos A, Sakellari I. Molecular and Clinical Characteristics of Different Toxicity Rates in Anti-CD19 Chimeric Antigen Receptor T Cells: Real-World Experience. Cancers (Basel) 2023; 15:4253. [PMID: 37686529 PMCID: PMC10487155 DOI: 10.3390/cancers15174253] [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: 07/04/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Commercially available anti-CD19 chimeric antigen receptor T cells (CARΤ cells) have offered long-term survival to a constantly expanding patient population. Given that novel toxicities including cytokine release syndrome (CRS) and neurotoxicity (ICANS) have been observed, we aimed to document the safety and toxicity of this treatment in a real-world study. We enrolled 31 adult patients referred to our center for CAR T therapy. Tisagenlecleucel was infused in 12 patients, axicabtagene ciloleucel in 14, and brexucabtagene autoleucel in 5. Cytokine release syndrome was noted in 26 patients while neurotoxicity was observed in 7. Tocilizumab was administered for CRS in 18 patients, along with short-term, low-dose steroid administration in one patient who developed grade III CRS and, subsequently, grade I ICANS. High-dose steroids, along with anakinra and siltuximab, were administered in only two MCL patients. With a median follow-up time of 13.4 months, nine patients were then in CR. The progression-free (PFS) and overall survival (OS) rates were 41.2% and 88.1% at one year, respectively. MCL diagnosis, which coincides with the administration of brexucabtagene autoleucel, was the only factor to be independently associated with poor OS (p < 0.001); meanwhile, increased LDH independently predicted PFS (p = 0.027).In addition, CRP at day 14 was associated with a poor OS (p = 0.001). Therefore, our real-world experience confirmed that commercial CAR T therapy can be administered with minimal toxicity.
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Affiliation(s)
- E. Gavriilaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
- Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - D. Mallouri
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - Z. Bousiou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - C. Demosthenous
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - A. Vardi
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - P. Dolgyras
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - I. Batsis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - E. Stroggyli
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - P. Karvouni
- Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - M. Masmanidou
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - M. Gavriilaki
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.G.); (V.K.)
| | - A. Bouinta
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - S. Bitsianis
- Department of Surgery, G. Papanicolaou Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - N. Kapravelos
- 1st Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (N.K.); (G.V.)
| | - M. Bitzani
- 2nd Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (M.B.); (S.P.)
| | - G. Vasileiadou
- 1st Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (N.K.); (G.V.)
| | - E. Yannaki
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - D. Sotiropoulos
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - S. Papagiannopoulos
- 2nd Intensive Care Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (M.B.); (S.P.)
| | - D. Kazis
- 3rd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - V. Kimiskidis
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
- 1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (M.G.); (V.K.)
| | - A. Anagnostopoulos
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
| | - I. Sakellari
- Hematology Department and Bone Marrow Transplant (BMT) Unit, G. Papanicolaou Hospital, 57010 Thessaloniki, Greece; (D.M.); (Z.B.); (C.D.); (A.V.); (P.D.); (I.B.); (E.S.); (M.M.); (A.B.); (E.Y.); (D.S.); (A.A.); (I.S.)
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Tsiftsoglou SA, Gavriilaki E, Touloumenidou T, Koravou EE, Koutra M, Papayanni PG, Karali V, Papalexandri A, Varelas C, Chatzopoulou F, Chatzidimitriou M, Chatzidimitriou D, Veleni A, Rapti E, Kioumis I, Kaimakamis E, Bitzani M, Boumpas DT, Tsantes A, Sotiropoulos D, Papadopoulou A, Sakellari I, Kokoris S, Anagnostopoulos A. Targeted genotyping of COVID-19 patients reveals a signature of complement C3 and factor B coding SNPs associated with severe infection. Immunobiology 2023; 228:152351. [PMID: 36805858 PMCID: PMC9928680 DOI: 10.1016/j.imbio.2023.152351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/19/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Abstract
We have attempted to explore further the involvement of complement components in the host COVID-19 (Coronavirus disease-19) immune responses by targeted genotyping of COVID-19 adult patients and analysis for missense coding Single Nucleotide Polymorphisms (coding SNPs) of genes encoding Alternative pathway (AP) components. We have identified a small group of common coding SNPs in Survivors and Deceased individuals, present in either relatively similar frequencies (CFH and CFI SNPs) or with stark differences in their relative abundance (C3 and CFB SNPs). In addition, we have identified several sporadic, potentially protective, coding SNPs of C3, CFB, CFD, CFH, CFHR1 and CFI in Survivors. No coding SNPs were detected for CD46 and CD55. Our demographic analysis indicated that the C3 rs1047286 or rs2230199 coding SNPs were present in 60 % of all the Deceased patients (n = 25) (the rs2230199 in 67 % of all Deceased Males) and in 31 % of all the Survivors (n = 105, p = 0.012) (the rs2230199 in 25 % of all Survivor Males). When we analysed these two major study groups using the presence of the C3 rs1047286 or rs2230199 SNPs as potential biomarkers, we noticed the complete absence of the protective CFB rs12614 and rs641153 coding SNPs from Deceased Males compared to Females (p = 0.0023). We propose that in these individuals, C3 carrying the R102G and CFB lacking the R32W or the R32Q amino acid substitutions, may contribute to enhanced association dynamics of the C3bBb AP pre-convertase complex assembly, thus enabling the exploitation of the activation of the Complement Alternative pathway (AP) by SARS-CoV-2.
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Affiliation(s)
- Stefanos A Tsiftsoglou
- Laboratory of Pharmacology, Department of Pharmaceutical Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
| | - Eleni Gavriilaki
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece.
| | - Tasoula Touloumenidou
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece
| | | | - Maria Koutra
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece
| | | | - Vassiliki Karali
- Rheumatology and Clinical Immunology Unit, University General Hospital "Attikon", Αthens, Greece
| | - Apostolia Papalexandri
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece
| | - Christos Varelas
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece
| | - Fani Chatzopoulou
- Microbiology Department, Aristotle University of Thessaloniki, Greece
| | - Maria Chatzidimitriou
- Biomedical Sciences Alexander Campus International Hellenic University, Thessaloniki, Greece
| | | | - Anastasia Veleni
- Infectious Disease Committee, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Evdoxia Rapti
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital "Attikon", NKUA, Medical School, Athens, Greece
| | - Ioannis Kioumis
- Respiratory Failure Department, G Papanicolaou Hospital-Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Milly Bitzani
- 1st Intensive Care Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Dimitrios T Boumpas
- Rheumatology and Clinical Immunology Unit, University General Hospital "Attikon", Αthens, Greece
| | - Argyris Tsantes
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital "Attikon", NKUA, Medical School, Athens, Greece
| | - Damianos Sotiropoulos
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece
| | - Anastasia Papadopoulou
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece
| | - Ioanna Sakellari
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Exochi, Thessaloniki 57010, Greece
| | - Styliani Kokoris
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital "Attikon", NKUA, Medical School, Athens, Greece
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Papadopoulou A, Karavalakis G, Papadopoulou E, Xochelli A, Bousiou Z, Vogiatzoglou A, Papayanni P, Georgakopoulou A, Giannaki M, Stavridou F, Vallianou I, Kammenou M, Varsamoudi E, Papadimitriou V, Giannaki C, Sileli M, Stergiouda Z, Stefanou G, Kourlaba G, Triantafyllidou M, Siotou E, Karaglani A, Zotou E, Chatzika G, Boukla A, Apostolou D, Pitsiou G, Morfesis P, Bartzoudis D, Imprialos K, Karampatakis T, Kapravelos N, Bitzani M, Theodorakopoulou M, Serasli E, Sakellari I, Fylaktou A, Tryfon S, Anagnostopoulos A, Yannaki E. Immunotherapy: SAFETY AND EFFICACY OF SARS-COV-2-SPECIFIC T CELLS AS ADOPTIVE IMMUNOTHERAPY FOR HIGH-RISK COVID-19 PATIENTS: A PHASE I/II, RANDOMIZED CLINICAL TRIAL. Cytotherapy 2022. [PMCID: PMC9035757 DOI: 10.1016/s1465-3249(22)00147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Asteris PG, Gavriilaki E, Touloumenidou T, Koravou E, Koutra M, Papayanni PG, Pouleres A, Karali V, Lemonis ME, Mamou A, Skentou AD, Papalexandri A, Varelas C, Chatzopoulou F, Chatzidimitriou M, Chatzidimitriou D, Veleni A, Rapti E, Kioumis I, Kaimakamis E, Bitzani M, Boumpas D, Tsantes A, Sotiropoulos D, Papadopoulou A, Kalantzis IG, Vallianatou LA, Armaghani DJ, Cavaleri L, Gandomi AH, Hajihassani M, Hasanipanah M, Koopialipoor M, Lourenço PB, Samui P, Zhou J, Sakellari I, Valsami S, Politou M, Kokoris S, Anagnostopoulos A. Genetic prediction of ICU hospitalization and mortality in COVID‐19 patients using artificial neural networks. J Cell Mol Med 2022; 26:1445-1455. [PMID: 35064759 PMCID: PMC8899198 DOI: 10.1111/jcmm.17098] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 09/29/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022] Open
Abstract
There is an unmet need of models for early prediction of morbidity and mortality of Coronavirus disease‐19 (COVID‐19). We aimed to a) identify complement‐related genetic variants associated with the clinical outcomes of ICU hospitalization and death, b) develop an artificial neural network (ANN) predicting these outcomes and c) validate whether complement‐related variants are associated with an impaired complement phenotype. We prospectively recruited consecutive adult patients of Caucasian origin, hospitalized due to COVID‐19. Through targeted next‐generation sequencing, we identified variants in complement factor H/CFH, CFB, CFH‐related, CFD, CD55, C3, C5, CFI, CD46, thrombomodulin/THBD, and A Disintegrin and Metalloproteinase with Thrombospondin motifs (ADAMTS13). Among 381 variants in 133 patients, we identified 5 critical variants associated with severe COVID‐19: rs2547438 (C3), rs2250656 (C3), rs1042580 (THBD), rs800292 (CFH) and rs414628 (CFHR1). Using age, gender and presence or absence of each variant, we developed an ANN predicting morbidity and mortality in 89.47% of the examined population. Furthermore, THBD and C3a levels were significantly increased in severe COVID‐19 patients and those harbouring relevant variants. Thus, we reveal for the first time an ANN accurately predicting ICU hospitalization and death in COVID‐19 patients, based on genetic variants in complement genes, age and gender. Importantly, we confirm that genetic dysregulation is associated with impaired complement phenotype.
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Affiliation(s)
- Panagiotis G. Asteris
- Computational Mechanics Laboratory School of Pedagogical and Technological Education Athens Greece
| | - Eleni Gavriilaki
- Hematology Department BMT Unit G Papanicolaou Hospital Thessaloniki Greece
| | | | | | - Maria Koutra
- Hematology Department BMT Unit G Papanicolaou Hospital Thessaloniki Greece
| | | | | | - Vassiliki Karali
- Rheumatology and Clinical Immunology Unit University General Hospital ‘Attikon’ Athens Greece
| | - Minas E. Lemonis
- Computational Mechanics Laboratory School of Pedagogical and Technological Education Athens Greece
| | - Anna Mamou
- Computational Mechanics Laboratory School of Pedagogical and Technological Education Athens Greece
| | - Athanasia D. Skentou
- Computational Mechanics Laboratory School of Pedagogical and Technological Education Athens Greece
| | | | - Christos Varelas
- Hematology Department BMT Unit G Papanicolaou Hospital Thessaloniki Greece
| | | | - Maria Chatzidimitriou
- Biomedical Sciences Alexander Campus International Hellenic University Thessaloniki Greece
| | | | - Anastasia Veleni
- Infectious Disease Committee G Papanicolaou Hospital Thessaloniki Greece
| | - Evdoxia Rapti
- Laboratory of Hematology and Hospital Blood Transfusion Department University General Hospital ‘Attikon’NKUAMedical School Athens Greece
| | - Ioannis Kioumis
- Respiratory Failure Department G Papanicolaou HospitalAristotle University of Thessaloniki Thessaloniki Greece
| | | | - Milly Bitzani
- 1 Intensive Care Unit G Papanicolaou Hospital Thessaloniki Greece
| | - Dimitrios Boumpas
- Rheumatology and Clinical Immunology Unit University General Hospital ‘Attikon’ Athens Greece
| | - Argyris Tsantes
- Laboratory of Hematology and Hospital Blood Transfusion Department University General Hospital ‘Attikon’NKUAMedical School Athens Greece
| | | | | | | | - Lydia A. Vallianatou
- Cath and EP Laboratory/Covid Intensive Care Unit Hellenic Red Cross Hospital Athens Greece
| | - Danial J. Armaghani
- Department of Civil Engineering Faculty of Engineering University of Malaya Kuala Lumpur Malaysia
| | - Liborio Cavaleri
- Department of Civil, Environmental, Aerospace and Materials Engineering University of Palermo Palermo Italy
| | - Amir H. Gandomi
- Faculty of Engineering & Information Technology University of Technology Sydney Ultimo NSW Australia
| | - Mohsen Hajihassani
- Department of Mining Engineering Faculty of Engineering Urmia University Urmia Iran
| | - Mahdi Hasanipanah
- Institute of Research and Development Duy Tan University Da Nang Vietnam
| | | | - Paulo B. Lourenço
- Department of Civil Engineering ISISEUniversity of Minho Guimarães Portugal
| | - Pijush Samui
- Department of Civil Engineering National Institute of Technology Patna Patna Bihar India
| | - Jian Zhou
- School of Resources and Safety Engineering Central South University Changsha China
| | - Ioanna Sakellari
- Hematology Department BMT Unit G Papanicolaou Hospital Thessaloniki Greece
| | - Serena Valsami
- Hematology Laboratory ‐ Blood Bank Aretaieion HospitalSchool of MedicineNKUA Athens Greece
| | - Marianna Politou
- Hematology Laboratory ‐ Blood Bank Aretaieion HospitalSchool of MedicineNKUA Athens Greece
| | - Styliani Kokoris
- Laboratory of Hematology and Hospital Blood Transfusion Department University General Hospital ‘Attikon’NKUAMedical School Athens Greece
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Gavriilaki E, Asteris PG, Touloumenidou T, Koravou EE, Koutra M, Papayanni PG, Karali V, Papalexandri A, Varelas C, Chatzopoulou F, Chatzidimitriou M, Chatzidimitriou D, Veleni A, Grigoriadis S, Rapti E, Chloros D, Kioumis I, Kaimakamis E, Bitzani M, Boumpas D, Tsantes A, Sotiropoulos D, Sakellari I, Kalantzis IG, Parastatidis ST, Koopialipoor M, Cavaleri L, Armaghani DJ, Papadopoulou A, Brodsky RA, Kokoris S, Anagnostopoulos A. Genetic justification of severe COVID-19 using a rigorous algorithm. Clin Immunol 2021; 226:108726. [PMID: 33845193 PMCID: PMC8043057 DOI: 10.1016/j.clim.2021.108726] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023]
Abstract
Recent studies suggest excessive complement activation in severe coronavirus disease-19 (COVID-19). The latter shares common characteristics with complement-mediated thrombotic microangiopathy (TMA). We hypothesized that genetic susceptibility would be evident in patients with severe COVID-19 (similar to TMA) and associated with disease severity. We analyzed genetic and clinical data from 97 patients hospitalized for COVID-19. Through targeted next-generation-sequencing we found an ADAMTS13 variant in 49 patients, along with two risk factor variants (C3, 21 patients; CFH,34 patients). 31 (32%) patients had a combination of these, which was independently associated with ICU hospitalization (p = 0.022). Analysis of almost infinite variant combinations showed that patients with rs1042580 in thrombomodulin and without rs800292 in complement factor H did not require ICU hospitalization. We also observed gender differences in ADAMTS13 and complement-related variants. In light of encouraging results by complement inhibitors, our study highlights a patient population that might benefit from early initiation of specific treatment.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department – BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece,Corresponding author at: Hematology Department – BMT Unit, G. Papanicolaou Hospital, Exochi, 57010, Thessaloniki, Greece
| | - Panagiotis G. Asteris
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | | | | | - Maria Koutra
- Hematology Department – BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Vassiliki Karali
- Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, Athens, Greece
| | | | - Christos Varelas
- Hematology Department – BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Fani Chatzopoulou
- Microbiology Department, Aristotle University of Thessaloniki, Greece
| | - Maria Chatzidimitriou
- Biomedical Sciences, Alexander Campus International Hellenic University, Thessaloniki, Greece
| | | | - Anastasia Veleni
- Infectious Disease Committee, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Savvas Grigoriadis
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Rapti
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital “Attikon”, NKUA, Medical School, Greece
| | - Diamantis Chloros
- Pneumonology Department, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Ioannis Kioumis
- Respiratory Failure Department, G Papanicolaou Hospital-Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Milly Bitzani
- 1st Intensive Care Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | - Dimitrios Boumpas
- Rheumatology and Clinical Immunology Unit, "Attikon" University Hospital, Athens, Greece
| | - Argyris Tsantes
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital “Attikon”, NKUA, Medical School, Greece
| | | | - Ioanna Sakellari
- Hematology Department – BMT Unit, G Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Stefanos T. Parastatidis
- Computational Mechanics Laboratory, School of Pedagogical and Technological Education, Athens, Greece
| | | | - Liborio Cavaleri
- Department of Civil, Environmental, Aerospace and Materials Engineering, University of Palermo, Palermo, Italy
| | - Danial J. Armaghani
- Department of Civil Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Robert Alan Brodsky
- Hematology Division, Department of Internal Medicine, Johns Hopkins University, Baltimore, USA
| | - Styliani Kokoris
- Laboratory of Hematology and Hospital Blood Transfusion Department, University General Hospital “Attikon”, NKUA, Medical School, Greece
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Christodoulou P, Kotoulas S, Tzimou M, Bitzani M. The impact of respiratory distress on nutrition therapy practices in ICU patients. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Georgakas I, Boutou AK, Pitsiou G, Kioumis I, Bitzani M, Matei K, Argyropoulou P, Stanopoulos I. Central Venous Oxygen Saturation as a Predictor of a Successful Spontaneous Breathing Trial from Mechanical Ventilation: A Prospective, Nested Case-Control Study. Open Respir Med J 2018; 12:11-20. [PMID: 29643948 PMCID: PMC5876926 DOI: 10.2174/1874306401812010011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/22/2018] [Accepted: 03/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Weaning from mechanical ventilation is a key element in the care of critically ill patients, and Spontaneous Breathing Trial (SBT) is a crucial step in this procedure. This nested case-control study aimed to evaluate whether central oxygen saturation (ScvO2) values and their changes could independently predict the SBT outcome among mechanically ventilated patients. Methods: A prospective cohort of patients who were mechanically ventilated for at least 48hours and fulfilled the criteria of readiness to wean constituted the study population. All patients attempted a SBT and were then categorized in SBT success group and SBT failure group, based on a combination of criteria which indicated whether SBT was successful or not. Multivariate binary logistic regression analysis was utilized to indicate the independent predictors of SBT success, while the Receiver Operating Characteristic (ROC) curves were used to demonstrate the diagnostic accuracy of these independent predictors. Results: Seventy-seven patients 69(18-86) years old; 62.3% male) constituted the study population. SBT was successful among 63.6% of them. A decrease in ScvO2 values (ΔScvO2) < 4% between the beginning and the end of the trial independently predicted the successful outcome (OR=18.278; 95% CI=4.017-83.163), along with age, Hemoglobin concentration (Hb) and arterial oxygen saturation (SaO2). Diagnostic accuracy for ΔScvO2 alone (ROC area=0.715) was slightly superior to that of either SaO2 (0.625) or Hb (0.685) to predict SBT success. Conclusion: ScvO2 is an independent predictor of the weaning outcome and its evaluation may further facilitate the accurate categorization among those patients who pass or fail the SBT.
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Affiliation(s)
- Ioannis Georgakas
- Respiratory Failure Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.,1st Intensive Care Unit, "G. Papanikolaou" Hospital, Thessaloniki, Greece.,Intensive Care Unit, General Hospital of Veroia, Veroia, Greece
| | - Afroditi K Boutou
- Respiratory Failure Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Respiratory Medicine, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Georgia Pitsiou
- Respiratory Failure Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- Pulmonary Department, Aristotle University of Thessaloniki, Greece
| | - Milly Bitzani
- 1st Intensive Care Unit, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Kristina Matei
- Intensive Care Unit, General Hospital of Veroia, Veroia, Greece
| | | | - Ioannis Stanopoulos
- Respiratory Failure Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lavrentieva A, Kontou P, Soulountsi V, Kioumis J, Chrysou O, Bitzani M. Implementation of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit. Ann Burns Fire Disasters 2015; 28:163-170. [PMID: 27279801 PMCID: PMC4883599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/17/2015] [Indexed: 06/06/2023]
Abstract
The purpose of this study was to examine the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibiotic therapy compared with empirical rules, and does not result in more adverse outcomes in burn patients with infectious complications. All burn patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections were eligible. Patients were assigned to either a procalcitonin-guided (study group) or a standard (control group) antibiotic regimen. The following variables were analyzed and compared in both groups: duration of antibiotic treatment, mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score (days 1-28), length of ICU and hospital stay. A total of 46 Burn ICU patients receiving antibiotic therapy were enrolled in this study. In 24 patients antibiotic therapy was guided by daily procalcitonin and clinical assessment. PCT guidance resulted in a smaller antibiotic exposure (10.1±4 vs. 15.3±8 days, p=0.034) without negative effects on clinical outcome characteristics such as mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score, length of ICU and hospital stay. The findings thus show that use of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit may contribute to the reduction of antibiotic exposure without compromising clinical outcome parameters.
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Affiliation(s)
| | - P. Kontou
- Burn ICU, Papanikolaou Hospital, Thessaloniki, Greece
| | - V. Soulountsi
- Burn ICU, Papanikolaou Hospital, Thessaloniki, Greece
| | - J. Kioumis
- Pulmonary Department, Papanikolaou Hospital, Thessaloniki, Greece
| | - O. Chrysou
- Burn ICU, Papanikolaou Hospital, Thessaloniki, Greece
| | - M. Bitzani
- Burn ICU, Papanikolaou Hospital, Thessaloniki, Greece
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Rodini I, Papaioannou M, Kazis D, Konoglou M, Theodoridou V, Vassiliadou G, Bitzani M. THE UTILITY OF ROUTINE EEG IN A GENERAL ICU. Intensive Care Med Exp 2015. [PMCID: PMC4798362 DOI: 10.1186/2197-425x-3-s1-a986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Karali V, Voutsas V, Loridas N, Konoglou M, Papaioannou M, Alexiou A, Hatsiou V, Fitili C, Bitzani M. Prognostic comparison of tissue Doppler indices of diastolic dysfunction and cardiac biomarkers in septic shock. Crit Care 2015. [PMCID: PMC4473046 DOI: 10.1186/cc14245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Koukiasa P, Chrisanthi N, Konoglou M, Bitzani M, Pnevmatikos I. PP022-SUN: Nutritional Needs in Mechanichally Patients with Sich. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Koukiasa P, Konoglou M, Nakou C, Bitzani M, Pnevmatikos I. PP162-SUN: Evaluation of Nutrition Support in ICU Patients with Spontaneous Intracranial Hemorrhage. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Voutsas V, Giakamozis A, Lazaridis T, Bitzani M. Post-traumatic lung pseudocysts: two case reports in ICU patients. J Thorac Dis 2013; 4 Suppl 1:74-8. [PMID: 23304444 DOI: 10.3978/j.issn.2072-1439.2012.s111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/27/2012] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The traumatic lung pseudocyst is a rare complication of closed thoracic injury. We present two cases with traumatic lung pseudocyst who were admitted in our ICU. CASE 1: A 19 year old man was admitted in the ICU after a motorcycle accident. Chest CT revealed two well defined densities in the right upper lung lobe with presence of air bubbles within them. Four days after admission chest CT showed two cavitary lesions in the upper lobe. The patient showed gradual clinical improvement. Repeated chest CT after 6 months was normal. CASE 2: A 41 year old man was involved in a car-bicycle accident. The patient was admitted in the ICU with respiratory failure and flail chest. Chest CT revealed multiple bilateral rib fractures, right pneumothorax and contusions of the right lung. Two days after admission chest CT showed formation of lung pseudocyst. The patient was gradually stabilised and 22 days after the accident the chest CT revealed resolution of the pseudocysts. DISCUSSION The traumatic lung pseudocyst is a rare complication of blunt thoracic trauma. The clinical course of traumatic lung pseudocyst is usually benign, unless complications such as pneumothorax or infection of the cavitary lesion arise. These lesions are more common in children and young adults.
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Affiliation(s)
- Vasileios Voutsas
- A' ICU, General Regional Hospital 'G. Papanikolaou', Thessaloniki, Greece
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Megalopoulos A, Soulountsi V, Vasiliadis K, Trellopoulos G, Bitzani M. Early endograft collapse following endovascular treatment of a traumatic thoracic aortic disruption: a case report. MINERVA CHIR 2009; 64:431-436. [PMID: 19648864] [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] [Indexed: 05/28/2023]
Abstract
The authors present the case of a 39-year-old man who underwent endovascular repair of a thoracic aortic disruption. Implantation of a Gore TAG stent-graft achieved total exclusion of the traumatic lesion with no contrast extravasation. However, on the third postoperative day, the patient developed complete anuria necessitating continuous venovenous hemofiltration. On the IV postoperative day there were no palpable femoral pulses and the pressure gradient between the lower and upper limbs was -80 mmHg. Given the development of severe intestinal and peripheral hypoperfusion status a possible endograft collapse was suspected. Urgent computed tomography (CT) angiography demonstrated central subtotal collapse of the device and proper distal sealing. A second TAG stent-graft was deployed successfully within the collapsed device with no contrast extravasation and good apposition of the stent-graft to the aortic wall. At 6 months, there is no sign of graft collapse or endoleak. Endovascular reintervention succeeded re-expansion of the collapsed endoprosthesis and resolution of the initial symptoms.
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Affiliation(s)
- A Megalopoulos
- 1st Surgical Department, General Regional Hospital ''George Papanikolaou'', Thessaloniki, Greece
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Karali V, Massa E, Vassiliadou G, Chouris I, Rodin I, Bitzani M. Evaluation of development of diabetes insipidus in the early phase following traumatic brain injury in critically ill patients. Crit Care 2008. [PMCID: PMC4088501 DOI: 10.1186/cc6351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lavrentieva A, Houris I, Aspragathou S, Mitka K, Kazanas K, Bitzani M. Efficacy of antithrombin administration in the acute phase of burn injury. Crit Care 2008. [PMCID: PMC4088579 DOI: 10.1186/cc6429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lavrendieva A, Parlapani A, Thomareis O, Soulountsi V, Bitzani M. Early coagulation alterations in intensive care unit burn patients. Crit Care 2007. [PMCID: PMC4095418 DOI: 10.1186/cc5525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lavrentieva A, Soulountzi B, Boutsas B, Lampanari A, Mitka A, Bitzani M. The use of transcranial Doppler ultrasonography in early outcome prediction of patients with subarachnoid hemorrhage. Crit Care 2005. [PMCID: PMC4098430 DOI: 10.1186/cc3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - B Soulountzi
- G Papanikolau Hospital – ICU, Theesaloniki, Greece
| | - B Boutsas
- G Papanikolau Hospital – ICU, Theesaloniki, Greece
| | - A Lampanari
- G Papanikolau Hospital – ICU, Theesaloniki, Greece
| | - A Mitka
- G Papanikolau Hospital – ICU, Theesaloniki, Greece
| | - M Bitzani
- G Papanikolau Hospital – ICU, Theesaloniki, Greece
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Bitzani M, Vassiliadou G, Iasonidou C, Tsaggalof S, Kontakiotis T, Riggos D. Crit Care 2003; 7:P010. [DOI: 10.1186/cc1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bitzani M, Vassiliadou G, Hatzizisi O, Iasonidou C, Kyriazis G, Riggos D. Crit Care 2003; 7:P099. [DOI: 10.1186/cc1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVE To evaluate resting energy expenditure (REE) in brain dead patients and to investigate the hypothesis that the reduction in REE results from a decrease in cerebral blood flow. DESIGN Prospective, open labeled, control study. SETTING General intensive care unit of a tertiary referral teaching hospital. PATIENTS 30 critically ill patients with isolated head injury divided in two groups: group 1 patients (n = 10) with a Glasgow Coma Scale (GCS) score of 4 to 8 and group 2 patients (n = 20), in whom the final outcome was brain death (GCS = 3). Group 2 patients were divided into two subgroups: Group 2 a (n = 11) were admitted as brain dead (GCS = 3) and group 2 b (n = 9) were admitted with a GCS > 3 and progressed to brain death. INTERVENTIONS Clinical and instrumental, using transcranial Doppler sonography (TCD), diagnosis of brain death. Cerebral blood flow studies of the middle cerebral artery bilaterally by bidimensional TCD and measurement of REE using indirect calorimetry. MEASUREMENTS AND RESULTS Measurements of REE and TCD studies were performed simultaneously on admission and after hemodynamic and neurologic stabilization. In cases with progressive neurologic deterioration, serial measurements were performed REE values were expressed as percentage of basal metabolic rate (%BMR), which were estimated according to each patient's gender, age, height, and weight. Group 1 patients, had normal TCD patterns throughout their hospitalization and their REE value was 21 +/- 11 % higher than BMR. Group 2 patients demonstrated TCD patterns compatible with brain death and their REE value was 24.5 +/- 11 % lower than BMR (p < 0.01). Group 2 a patients, who were admitted as brain dead and remained brain dead, had REE values 30 +/- 11 % lower than BMR (p < 0.01). Group 2 b patients, who were not brain dead on admission but progressed to brain death, in serial measurements revealed a significant relationship between REE and TCD findings (R = -0.77, p < 0.0001). In this subgroup of patients, with multiple regression analysis a significant relationship was found only between REE and the TCD pattern, but not with body temperature. CONCLUSIONS In brain dead patients, REE decreases to values lower than BMR. This can be attributed to the cessation of cerebral blood flow and consequently cerebral metabolism and not to hypothermia.
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Affiliation(s)
- M Bitzani
- Intensive Care Unit, "G. Papanikolaou" General Hospital, Exohi, Thessaloniki, Greece.
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Tormo C, Calvo R, Ferrandis S, Parra V, Maravall JL, Lacuevo V, Dreyfuss D, Mier L, Leviel F, Lanore JJ, Djedaïni K, Costa F, Paillard M, Del Rio F, Cardenal C, De Castro J, Blesa A, Martín-Benitez J, Hermo B, Suarez R, Martín SF, Le Cacheux P, de Ligny BH, Cardineau E, Ryckelvnck JP, Marggraf G, Schumann V, Doetsch N, Wagner K, Philipp T, Reidemeister JC, Aykaç B, Öz H, Sun S, Bozkurt P, Cotonel B, Mercatello A, HadjAïssa A, Chery C, Pozet N, Clermont N, Bégou C, Tissot E, Fisher LP, Moskovtchenko JF, Laurent V, Coronel B, Bret M, Colon S, Colpart JJ, Woittiez AJJ, Drenth IM, Jamali M, Bollaert PE, Cao T, Bauer P, Kessler M, Lambert H, Larcan A, Rogiere PE, Leeman M, Kahn RJ, Vincent JL, Nagler J, Neels H, Singer M, Screaton G, McNally T, Mackie I, Machin S, Cohen S, Haller M, Schönfelder R, Briegel J, Jauch KW, Zwiebel F, Forst H, Sicignano A, Vesconi S, Bellato V, De Pietri P, Minuto A, Foroni C, Comité C, Caprioli R, Gemignani R, Stefani M, Russo V, Mazzei A, Rusehi R, Pardelli M, Matamis D, Tsagourias M, Melekos T, Bitzani M, Rodini I, Rigos D, Inglis TJJ, Kuteifan K, Martin-Barbaz F, Man NK, Descamps JM, Bosch FH, van Genderen W, van Leusen R, de Boer JP, Creasey AA, Chang A, Roem D, Eerenberg AJM, Brouwer MC, Hack CE, Taylor FB. Kidney. Intensive Care Med 1992. [DOI: 10.1007/bf03216356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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