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Vogel K, Arra A, Lingel H, Bretschneider D, Prätsch F, Schanze D, Zenker M, Balk S, Bruder D, Geffers R, Hachenberg T, Arens C, Brunner-Weinzierl MC. Bifidobacteria shape antimicrobial T-helper cell responses during infancy and adulthood. Nat Commun 2023; 14:5943. [PMID: 37741816 PMCID: PMC10517955 DOI: 10.1038/s41467-023-41630-x] [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: 12/09/2022] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
Microbial infections early in life are challenging for the unexperienced immune system. The SARS-CoV-2 pandemic again has highlighted that neonatal, infant, child, and adult T-helper(Th)-cells respond differently to infections, and requires further understanding. This study investigates anti-bacterial T-cell responses against Staphylococcus aureus aureus, Staphylococcus epidermidis and Bifidobacterium longum infantis in early stages of life and adults and shows age and pathogen-dependent mechanisms. Beside activation-induced clustering, T-cells stimulated with Staphylococci become Th1-type cells; however, this differentiation is mitigated in Bifidobacterium-stimulated T-cells. Strikingly, prestimulation of T-cells with Bifidobacterium suppresses the activation of Staphylococcus-specific T-helper cells in a cell-cell dependent manner by inducing FoxP3+CD4+ T-cells, increasing IL-10 and galectin-1 secretion and showing a CTLA-4-dependent inhibitory capacity. Furthermore Bifidobacterium dampens Th responses of severely ill COVID-19 patients likely contributing to resolution of harmful overreactions of the immune system. Targeted, age-specific interventions may enhance infection defence, and specific immune features may have potential cross-age utilization.
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Affiliation(s)
- Katrin Vogel
- Department of Experimental Paediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Aditya Arra
- Department of Experimental Paediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Holger Lingel
- Department of Experimental Paediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Florian Prätsch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Denny Schanze
- Institute of Human Genetics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Silke Balk
- Department of Experimental Paediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Dunja Bruder
- Infection Immunology Group, Institute of Medical Microbiology and Hospital Hygiene, Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University, Magdeburg, Germany
- Immune Regulation Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Robert Geffers
- Genome Analytics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Thomas Hachenberg
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
- Justus-Liebig-University Gießen, University Hospital of Gießen and Marburg (UKGM), Gießen Campus, Department of Otorhinolaryngology, Head/Neck Surgery and Plastic Surgery, Gießen, Germany
| | - Monika C Brunner-Weinzierl
- Department of Experimental Paediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany.
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Magunia H, Lederer S, Verbuecheln R, Gilot BJ, Koeppen M, Haeberle HA, Mirakaj V, Hofmann P, Marx G, Bickenbach J, Nohe B, Lay M, Spies C, Edel A, Schiefenhövel F, Rahmel T, Putensen C, Sellmann T, Koch T, Brandenburger T, Kindgen-Milles D, Brenner T, Berger M, Zacharowski K, Adam E, Posch M, Moerer O, Scheer CS, Sedding D, Weigand MA, Fichtner F, Nau C, Prätsch F, Wiesmann T, Koch C, Schneider G, Lahmer T, Straub A, Meiser A, Weiss M, Jungwirth B, Wappler F, Meybohm P, Herrmann J, Malek N, Kohlbacher O, Biergans S, Rosenberger P. Machine learning identifies ICU outcome predictors in a multicenter COVID-19 cohort. Crit Care 2021; 25:295. [PMID: 34404458 PMCID: PMC8370055 DOI: 10.1186/s13054-021-03720-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Intensive Care Resources are heavily utilized during the COVID-19 pandemic. However, risk stratification and prediction of SARS-CoV-2 patient clinical outcomes upon ICU admission remain inadequate. This study aimed to develop a machine learning model, based on retrospective & prospective clinical data, to stratify patient risk and predict ICU survival and outcomes. METHODS A Germany-wide electronic registry was established to pseudonymously collect admission, therapeutic and discharge information of SARS-CoV-2 ICU patients retrospectively and prospectively. Machine learning approaches were evaluated for the accuracy and interpretability of predictions. The Explainable Boosting Machine approach was selected as the most suitable method. Individual, non-linear shape functions for predictive parameters and parameter interactions are reported. RESULTS 1039 patients were included in the Explainable Boosting Machine model, 596 patients retrospectively collected, and 443 patients prospectively collected. The model for prediction of general ICU outcome was shown to be more reliable to predict "survival". Age, inflammatory and thrombotic activity, and severity of ARDS at ICU admission were shown to be predictive of ICU survival. Patients' age, pulmonary dysfunction and transfer from an external institution were predictors for ECMO therapy. The interaction of patient age with D-dimer levels on admission and creatinine levels with SOFA score without GCS were predictors for renal replacement therapy. CONCLUSIONS Using Explainable Boosting Machine analysis, we confirmed and weighed previously reported and identified novel predictors for outcome in critically ill COVID-19 patients. Using this strategy, predictive modeling of COVID-19 ICU patient outcomes can be performed overcoming the limitations of linear regression models. Trial registration "ClinicalTrials" (clinicaltrials.gov) under NCT04455451.
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Affiliation(s)
- Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany.
| | - Simone Lederer
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Raphael Verbuecheln
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Bryant Joseph Gilot
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Michael Koeppen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Helene A Haeberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Valbona Mirakaj
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Pascal Hofmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Boris Nohe
- Center for Anaesthesia, Intensive Care and Emergency Medicine, Zollernalb Klinikum, Balingen, Germany
| | - Michael Lay
- Center for Anaesthesia, Intensive Care and Emergency Medicine, Zollernalb Klinikum, Balingen, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
| | - Andreas Edel
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
| | - Fridtjof Schiefenhövel
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin , Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine/Pain Therapy, Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Christian Putensen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Timur Sellmann
- Department of Anesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus Bethesda, Duisburg, Germany
- Chair of Anesthesiology 1, Witten/Herdecke University, Wuppertal, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Brandenburger
- Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marc Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Elisabeth Adam
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Matthias Posch
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Onnen Moerer
- Center for Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Christian S Scheer
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Daniel Sedding
- Department Cardiology, Angiology and Intensive Care Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care, Leipzig University Hospital, Leipzig, Germany
| | - Carla Nau
- Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany
| | - Florian Prätsch
- Department of Anaesthesiology and Intensive Care Therapy, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Thomas Wiesmann
- University Hospital Marburg, UKGM, Philipps University Marburg, Marburg, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen and Marburg, Justus-Liebig University Giessen, Giessen, Germany
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Klinik Und Poliklinik Für Innere Medizin II, Klinikum Rechts Der Isar der, Technischen Universität München, Munich, Germany
| | - Andreas Straub
- Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, St. Elisabethen Klinikum, Ravensburg, Germany
| | - Andreas Meiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Manfred Weiss
- Department of Anesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
| | - Bettina Jungwirth
- Department of Anesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Centre, Witten/Herdecke University, Cologne-Merheim, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University Wuerzburg, Wuerzburg, Germany
| | - Johannes Herrmann
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, University Wuerzburg, Wuerzburg, Germany
| | - Nisar Malek
- Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Oliver Kohlbacher
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Department of Computer Science, Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
| | - Stephanie Biergans
- Institute for Translational Bioinformatics and Medical Data Integration Center, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe Seyler Str. 3, 72076, Tübingen, Germany.
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Brammen D, Rickert V, Esser T, Prätsch F, Röhrig R, Hachenberg T, Ebmeyer U. [Identification and economic evaluation of anesthesiologic secondary diagnoses on the basis of intraoperative medication]. Anaesthesist 2016; 65:430-7. [PMID: 27221390 DOI: 10.1007/s00101-016-0172-5] [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: 10/11/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Complications and comorbidities are encodable in the German diagnosis related groups (G-DRG) system and can improve revenues. In this study, secondary diagnoses were identified through drug administrations during anaesthesia and were economically evaluated by regrouping these cases. METHODS All intraoperative drug administrations from 2008 were extracted from a database. After exclusion of synonyms and procedure-specific drug administrations, all remaining drugs were matched to explicit secondary diagnoses. All cases were regrouped with their newly defined secondary diagnoses by G‑DRG grouper software, and changes in cost weight were evaluated. RESULTS A total of 29 drugs could be assigned to 18 secondary diagnoses. From 22,440 anaesthesia the § 21 data record could be extracted in 1,929 cases and was regrouped with 2,976 secondary diagnoses, according to additional proceeds of 125,330.25 € in 2008 and 103,542.35 € in 2014. Intraoperative secondary diagnoses influence cost weight only in small parts. The average increase in revenue in this study could have been about 50 € per case. From 2008 to 2014 secondary diagnoses were continuously devaluated, although some of them, e. g. afibrinogenemia, have were revaluated. DISCUSSION Our retrospective method of making a diagnosis and assuming a correct indication of drug administration is inapplicable to daily routine. The anaesthesiologic documentation has to make drug administration and thereby the secondary diagnosis plausible.
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Affiliation(s)
- D Brammen
- Universitätsklinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - V Rickert
- Medizinische Klinik II, Kardiologie und internistische Intensivmedizin, St. Vincenz-Krankenhaus Paderborn, Paderborn, Deutschland
| | - T Esser
- Universitätsklinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - F Prätsch
- Universitätsklinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - R Röhrig
- Abteilung Medizinische Informatik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Th Hachenberg
- Universitätsklinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - U Ebmeyer
- Universitätsklinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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