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Muster V, Raggam RB, Urbanic-Purkart T, Posch F, Gütl K, Rabensteiner J, Prüller F, von Campe G, Rief M, Brodmann M, Gary T. P11.01.B Lower-extremity deep vein thrombosis and bleeding complications in primary brain tumor patients: A prospective study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.190] [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: 11/13/2022] Open
Abstract
Abstract
Background
Primary brain tumor patients have a high risk of venous thromboembolism (VTE). Bleeding risk with prophylactic and therapeutic anticoagulation is an important concern in these patients, and data on the management of asymptomatic VTE events in this population are lacking. The aim of this prospective study is to investigate risk and risk factors for asymptomatic lower-extremity deep-vein thrombosis (LE-DVT) in patients with primary brain tumors, and to estimate the rate of bleeding complications on full, prophylactic or no anticoagulation.
Material and Methods
We included consecutive patients with primary brain tumours undergoing surgery. Screening for asymptomatic LE-DVT by compression ultrasound (CUS) was performed pre-operatively and postoperatively within 2 months after surgery. Telephone follow-up was done 6 and 12 months after surgery. The protocol pre-specified therapeutic doses of low-molecular-weight heparin (LMWH) in case of detection of an asymptomatic LE-DVT.
Results
Fifty patients were included (female: 34%, median age 58 years, WHO grade IV tumors: 78%, prophylactic-dose LMWH at baseline: 12%). During a median observation period of 9.1 months, LE-DVT was detected in 9 patients (18%). LE-DVTs included two asymptomatic events (4%) at pre-operative screening, five asymptomatic events (10%) at postoperative screening, and two symptomatic events (4%, both 4-level LE-DVT) at telephone follow-up. This corresponded to a 12-month cumulative incidence of LE-DVT of 14.9% (95%CI: 6.4-26.6). At postoperative screening, n=10 patients were on prophylactic-dose LMWH, and one of these patients had an LE-DVT event detected by screening. The two patients with symptomatic LE-DVT were not on thromboprophylaxis at the time of event. Among a variety of investigated potential risk factors, only higher age (Odds Ratio (OR) per 5 years increase=1.46, 95%CI: 1.01-2.13, p=0.05), higher neurologic assessment in neuro-oncology (NANO) scale (OR per 1 point increase=1.59, 1.00-2.54, p=0.05), higher serum Galectin-3 levels (OR per 1ng/ml increase=1.20, 1.01-1.42, p=0.041) but not D-Dimer (OR per 1mg/L increase=1.89, 0.75-4.77, p=0.178) emerged as significant predictors of any LE-DVT. Six patients (12%) developed bleeding events, including n=3 operative intracranial bleedings without LMWH, n=1 spontaneous ventricular hemorrhage without LMWH, n=1 minor subcutaneous bleeding without LMWH, and 1 intracerebral hematoma during therapeutic-dose LMWH initiated for asymptomatic distal LE-DVT.
Conclusion
In our study we detected a high-frequency of asymptomatic LE-DVT in patients with primary brain tumours. Conversely, symptomatic LE-DVT risk was low, which may be related to prior screening. Patients with primary brain tumors appear to have LE-DVT risk factors specific to this entity. Prophylactic-dose LMWH did not show any adverse safety signals regarding bleeding.
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Affiliation(s)
- V Muster
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - R B Raggam
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | | | - F Posch
- Division of Haematology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - K Gütl
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - J Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria
| | - F Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz , Graz , Austria
| | - G von Campe
- Department of Neurosurgery, Medical University Graz , Graz , Austria
| | - M Rief
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz , Graz , Austria
| | - M Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
| | - T Gary
- Division of Angiology, Department of Internal Medicine, Medical University Graz , Graz , Austria
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Kollmann M, Scheuchenegger A, Aldrian L, Herzog S, Mautner E, Lang U, Urlesberger B, Obermayer-Pietsch B, Raggam RB, Klaritsch P. Früher Haut zu Haut Kontakt nach Kaiserschnitt – eine randomisierte klinische Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1582188] [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: 10/21/2022] Open
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Raggam RB, Wagner J, Prüller F, Grisold A, Leitner E, Zollner-Schwetz I, Valentin T, Krause R, Hoenigl M. Soluble urokinase plasminogen activator receptor predicts mortality in patients with systemic inflammatory response syndrome. J Intern Med 2014; 276:651-8. [PMID: 24645798 DOI: 10.1111/joim.12238] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The soluble urokinase plasminogen activator receptor (suPAR) reflects inflammation. However, the prognostic value of suPAR measurements, particularly at the very early onset of systemic inflammatory response syndrome (SIRS), is less well defined. METHODS The prognostic potential of suPAR levels in patients with SIRS was evaluated. From November 2010 until April 2013, 902 adult patients presenting with SIRS were investigated. Blood samples for laboratory testing of inflammation markers were collected simultaneously with initial blood cultures. suPAR testing was performed using suPARnostic(©) assay. RESULTS Analyses of receiver operating characteristics curves revealed areas under the curve (AUCs) of 0.818 for predicting overall mortality within 48 h (36/902 patients died), 0.739 for 30-day mortality (117/902 died) and 0.706 for predicting 90-day mortality (151/902 died). AUCs for procalcitonin (0.777, 0.671 and 0.638), interleukin-6 (0.709, 0.593 and 0.569) and C-reactive protein (0.66, 0.594 and 0.586) as well as renal function and age were markedly lower. Using multivariable regression analyses, suPAR levels (P < 0.001) remained significant predictors of 48-h mortality, whereas suPAR levels (P < 0.001) and bacteraemia (P = 0.002 and P = 0.001, respectively) remained significant predictors of 30- and 90-day mortality. Using Kaplan-Meier survival plots, patients with suPAR <9.15 ng mL(-1) at SIRS onset had a clear benefit. CONCLUSION suPAR plasma level determined at early SIRS is predictive for mortality.
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Affiliation(s)
- R B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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Stelzer I, Kröpfl JM, Fuchs R, Pekovits K, Mangge H, Raggam RB, Gruber HJ, Prüller F, Hofmann P, Truschnig-Wilders M, Obermayer-Pietsch B, Haushofer AC, Kessler HH, Mächler P. Ultra-endurance exercise induces stress and inflammation and affects circulating hematopoietic progenitor cell function. Scand J Med Sci Sports 2014; 25:e442-50. [PMID: 25438993 DOI: 10.1111/sms.12347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 01/18/2023]
Abstract
Although amateur sports have become increasingly competitive within recent decades, there are as yet few studies on the possible health risks for athletes. This study aims to determine the impact of ultra-endurance exercise-induced stress on the number and function of circulating hematopoietic progenitor cells (CPCs) and hematological, inflammatory, clinical, metabolic, and stress parameters in moderately trained amateur athletes. Following ultra-endurance exercise, there were significant increases in leukocytes, platelets, interleukin-6, fibrinogen, tissue enzymes, blood lactate, serum cortisol, and matrix metalloproteinase-9. Ultra-endurance exercise did not influence the number of CPCs but resulted in a highly significant decline of CPC functionality after the competition. Furthermore, Epstein-Barr virus was seen to be reactivated in one of seven athletes. The link between exercise-induced stress and decline of CPC functionality is supported by a negative correlation between cortisol and CPC function. We conclude that ultra-endurance exercise induces metabolic stress and an inflammatory response that affects not only mature hematopoietic cells but also the function of the immature hematopoietic stem and progenitor cell fraction, which make up the immune system and provide for regeneration.
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Affiliation(s)
- I Stelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - J M Kröpfl
- Institute of Human Movement Sciences and Sport, Exercise Physiology Lab, ETH Zurich, Zurich, Switzerland.,Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - R Fuchs
- Institute of Pathophysiology and Immunology, Medical University of Graz, Graz, Austria
| | - K Pekovits
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - H Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,BioTechMed-Graz, Graz, Austria
| | - R B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - H-J Gruber
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - F Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - P Hofmann
- Institute of Sports Science, Karl-Franzens-University of Graz, Graz, Austria
| | - M Truschnig-Wilders
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - B Obermayer-Pietsch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - A C Haushofer
- Institute of Medical and Chemical Laboratory Diagnostics Wels-Grieskirchen, Wels-Grieskirchen, Austria
| | - H H Kessler
- Research Unit Molecular Diagnostics, IHMEM, Medical University of Graz, Graz, Austria
| | - P Mächler
- Center for Cardiac Rehabilitation, SKA-PVA St. Radegund, Graz, Austria
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Hoenigl M, Raggam RB, Wagner J, Prueller F, Grisold AJ, Leitner E, Seeber K, Prattes J, Valentin T, Zollner-Schwetz I, Schilcher G, Krause R. Procalcitonin fails to predict bacteremia in SIRS patients: a cohort study. Int J Clin Pract 2014; 68:1278-81. [PMID: 24898888 DOI: 10.1111/ijcp.12474] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/06/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Procalcitonin (PCT) has previously been proposed as useful marker to rule out bloodstream-infection (BSI). The objective of this study was to evaluate the sensitivity of different PCT cut-offs for prediction of BSI in patients with community (CA)- and hospital-acquired (HA)-BSI. METHODS A total of 898 patients fulfilling systemic-inflammatory-response-syndrome (SIRS) criteria were enrolled in this prospective cohort study at the Medical University of Graz, Austria. Of those 666 patients had positive blood cultures (282 CA-BSI, 384 HA-BSI, enrolled between January 2011 and December 2012) and 232 negative blood cultures (enrolled between January 2011 and July 2011 at the emergency department). Blood samples for determination of laboratory infection markers (e.g. PCT) were collected simultaneously with blood cultures. RESULTS Procalcitonin was significantly (p < 0.001) higher in SIRS patients with bacteremia/fungemia than in those without. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value of 0.675 for PCT (95% CI 0.636-0.714) for differentiating patients with BSI from those without. AUC for IL-6 was 0.558 (95% CI 0.515-0.600). However, even at the lowest cut-off evaluated (i.e. 0.1 ng/ml) PCT failed to predict BSI in 7% (n = 46) of patients. In the group of patients with SIRS and negative blood culture 79% (n = 185) had PCT levels > 0.1. CONCLUSION Procalcitonin was significantly higher in patients with BSI than in those without and superior to IL-6 and CRP. The clinical importance of this is questionable, because a suitable PCT threshold for excluding BSI was not established. An approach where blood cultures are guided by PCT only can therefore not be recommended.
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Affiliation(s)
- M Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Pruller F, Wagner J, Raggam RB, Hoenigl M, Kessler HH, Truschnig-Wilders M, Krause R. Automation of serum (1->3)-beta-D-glucan testing allows reliable and rapid discrimination of patients with and without candidemia. Med Mycol 2014; 52:455-61. [DOI: 10.1093/mmy/myu023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Kolovetsiou-Kreiner V, Weiss EC, Prüller F, Mutz I, Raggam RB, Pürstner P, Petru E. Humanes Epididymis Protein 4 (HE4) als Tumormarker in der Diagnostik und in Verlauf bei Patientinnen mit Ovarialkarzinom - präliminäre Daten. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347861] [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: 10/26/2022] Open
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Kolovetsiou-Kreiner V, Weiss EC, Prüller F, Mutz I, Raggam RB, Pürstner P, Petru E. Humanes Epididymis Protein 4 (HE4) als Tumormarker beim Ovarialkarzinom - ein Vergleich von zwei automatisierten Testsystemen (Abbott Architect und Roche Cobas) anhand präliminärer Daten. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1336805] [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: 10/27/2022] Open
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Hoenigl M, Strenger V, Buzina W, Valentin T, Koidl C, Wolfler A, Seeber K, Valentin A, Strohmeier AT, Zollner-Schwetz I, Raggam RB, Urban C, Lass-Florl C, Linkesch W, Krause R. European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) host factors and invasive fungal infections in patients with haematological malignancies. J Antimicrob Chemother 2012; 67:2029-33. [DOI: 10.1093/jac/dks155] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Prüller F, Drexler C, Archan S, Macher S, Raggam RB, Mahla E. Low platelet reactivity is recovered by transfusion of stored platelets: a healthy volunteer in vivo study. J Thromb Haemost 2011; 9:1670-3. [PMID: 21649849 DOI: 10.1111/j.1538-7836.2011.04392.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grisold AJ, Wendelin I, Presterl E, Raggam RB, Masoud L, Badura A, Marth E. In vitro activity of ten antibiotics, including tigecycline, against Bacteroides species in Austria. Eur J Clin Microbiol Infect Dis 2007; 26:525-7. [PMID: 17562088 DOI: 10.1007/s10096-007-0318-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A J Grisold
- Institute of Hygiene, Medical University, Universitaetsplatz 4, 8010, Graz, Austria.
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Woelkart K, Marth E, Suter A, Schoop R, Raggam RB, Koidl C, Kleinhappl B, Bauer R. Bioavailability and pharmacokinetics of Echinacea purpurea preparations and their interaction with the immune system. Int J Clin Pharmacol Ther 2007; 44:401-8. [PMID: 16995328 DOI: 10.5414/cpp44401] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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: 11/18/2022] Open
Abstract
Echinacea is a widely used herbal remedy for the prevention and treatment of the common cold. Recently, many new insights concerning the molecular mode of action of the main lipophilic constituents, the alkamides, have renewed interest in this plant. In order to compare the bioavailability of alkamides from liquid and tablet preparations of E. purpurea (Echinaforce) in humans and to study the effects on ex vivo stimulated blood cells, a randomized, single-dose, crossover study with 10 (8 test, 2 placebo) volunteers has been performed. They received either 4 ml of the standardized E. purpurea (Echinaforce) tincture or 12 E. purpurea (Echinaforce) tablets or placebo. Both doses contained the same amount (0.07 mg) of the major alkamides, dodeca-2E,4E,8Z, 10E/Z-tetraenoic acid isobutylamides. Liquid chromatography electrospray ionization ion-trap mass spectrometry was used to determine the content of alkamides in serum. It was found that the arithmetic mean C(max) of dodeca-2E,4E, 8Z,10E/Z-tetraenoic acid isobutylamides absorbed after oral application of the Echinaforce tincture appeared after 30 min (0.40 ng/ml serum). In comparison, the t(max) of tablets was 45 min with a C(max) of 0.12 ng/ml. An ex vivo stimulation of blood by LPS was carried out to measure the influence of E. purpurea on the innate and adaptive immune system. Both E. purpurea preparations led to the same effects on the immune system according to the concentration of pro-inflammatory cytokines TNF-alpha and IL-8. 23 hours after oral application a significant down-regulation of TNF-alpha and IL-8 in LPS pre-stimulated whole blood was found. However, no significant changes in the concentration of IL-6 were observed. Although a quarter of the dodeca-2E,4E,8Z, 10E/Z-tetraenoic acid isobutylamides was absorbed from the tablets, the study shows that the formulations trigger the same effects on the measured immune parameters.
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Affiliation(s)
- K Woelkart
- Institute of Pharmaceutical Sciences, Department of Pharmacognosy, Karl Franzens University, Graz, Austria
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Raggam RB, Leitner E, Mühlbauer G, Berg J, Stöcher M, Grisold AJ, Marth E, Kessler HH. Qualitative detection of Legionella species in bronchoalveolar lavages and induced sputa by automated DNA extraction and real-time polymerase chain reaction. Med Microbiol Immunol 2002; 191:119-25. [PMID: 12410352 DOI: 10.1007/s00430-002-0129-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 06/17/2002] [Indexed: 11/29/2022]
Abstract
Molecular assays for qualitative detection of Legionella spp. in clinical specimens were evaluated. DNA extraction was done either with a fully automated DNA extraction protocol on the MagNA Pure LC System or with manual DNA extraction. Amplification and detection were done by real-time polymerase chain reaction (PCR) on the LightCycler (LC) instrument. Oligonucleotides were derived from the 16S rRNA gene of Legionella spp. The assays included a specially designed DNA fragment as Legionella-specific internal control. For both molecular assays, the detection limit was determined to be 5 CFU per LC PCR run. Sixty-one clinical specimens were tested with the molecular assays. Results were compared to culture. Five samples were found to be positive with the molecular assays. Three of them were positive in culture. No inhibition was found throughout the whole study. In conclusion, the molecular assays described may lead to safe and early diagnosis of Legionnaires' disease. They proved to be suitable for the routine molecular diagnostics laboratory.
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Affiliation(s)
- R B Raggam
- Molecular Diagnostics Laboratory, Institute of Hygiene, KF-University Graz, Universitätsplatz 4, Austria
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Kessler HH, Stelzl E, Raggam RB, Haas J, Kirchmeir F, Hegenbarth K, Daghofer E, Santner BI, Marth E, Stauber RE. Effects of storage and type of blood collection tubes on hepatitis C virus level in whole blood samples. J Clin Microbiol 2001; 39:1788-90. [PMID: 11325991 PMCID: PMC88026 DOI: 10.1128/jcm.39.5.1788-1790.2001] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [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: 11/20/2022] Open
Abstract
In this study, we compared serum hepatitis C virus (HCV) RNA concentrations with HCV RNA concentrations in whole blood collection tubes, including two different types of EDTA tubes and nucleic acid stabilization tubes (NASTs). We also investigated the impact of a processing delay on HCV RNA concentration in these tubes. In NASTs, the mean HCV RNA concentration was comparable to the mean serum HCV RNA concentration at "date zero." In EDTA tubes, mean baseline HCV RNA concentrations were higher. Storage at room temperature up to 96 h did not result in a decline of HCV RNA concentration in any of the whole blood collection tubes. In NASTs, HCV RNA concentrations remained stable during the whole study period, whereas a significant increase of HCV RNA was observed in both types of EDTA tubes at 96 h compared to date zero. We concluded that HCV RNA remains stable in NASTs at room temperature for at least 96 h, allowing greater flexibility in sample collection and transport.
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Affiliation(s)
- H H Kessler
- Molecular Diagnostics Laboratory, Institute of Hygiene, Karl-Franzens-University Graz, Universitaetsplatz 4, A-8010 Graz, Austria.
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