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Penack O, Peczynski C, Koenecke C, Polge E, Sanderson R, Yakoub-Agha I, Fegueux N, Daskalakis M, Collin M, Dreger P, Kröger N, Schanz U, Bloor A, Ganser A, Besley C, Wulf GG, Novak U, Moiseev I, Schoemans H, Basak GW, Chabannon C, Sureda A, Glass B, Peric Z. Organ complications after CD19 CAR T-cell therapy for large B cell lymphoma: a retrospective study from the EBMT transplant complications and lymphoma working party. Front Immunol 2023; 14:1252811. [PMID: 37828980 PMCID: PMC10565347 DOI: 10.3389/fimmu.2023.1252811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/04/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
We investigated ≥ grade 3 (CTC-AE) organ toxicities for commercial CD19 chimeric antigen receptor T cell (CAR-T cell) products in 492 patients (Axi-Cel; n = 315; Tisa-Cel; n = 177) with Large B-cell Lymphoma in the European Society for Blood and Marrow Transplantation (EBMT) CAR-T registry. The incidence of ≥ grade 3 organ toxicities during the first 100 days after CAR-T was low and the most frequent were: renal (3.0%), cardiac (2.3%), gastro-intestinal (2.3%) and hepatic (1.8%). The majority occurred within three weeks after CAR-T cell therapy. Overall survival was 83.1% [79.8-86.5; 95% CI] at 3 months and 53.5% [49-58.4; 95% CI] at one year after CAR-T. The most frequent cause of death was tumour progression (85.1%). Non-relapse mortality was 3.1% [2.3-4.1; 95% CI] at 3 months and 5.2% [4.1-6.5; 95% CI] at one year after CAR-T. The most frequent causes of non-relapse mortality were cell-therapy-related toxicities including organ toxicities (6.4% of total deaths) and infections (4.4% of total deaths). Our data demonstrates good safety in the European real-world setting.
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Affiliation(s)
- Olaf Penack
- Medical Clinic, Department for Haematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
- EBMT Transplant Complications Working Party, Paris, France
| | - Christophe Peczynski
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, Paris, France
- INSERM UMR-S 938, Sorbonne University, Paris, France
| | - Christian Koenecke
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Emmanuelle Polge
- EBMT Transplant Complications Working Party, Paris, France
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital, Paris, France
- INSERM UMR-S 938, Sorbonne University, Paris, France
| | - Robin Sanderson
- Kings College Hospital, Departement of Haematological Medicine, London, United Kingdom
| | | | - Nathalie Fegueux
- CHU Lapeyronie, Département d`Hématologie Clinique, Montpellier, France
| | - Michael Daskalakis
- Department of Hematology, University Hospital Bern, Bern, Switzerland
- Department of Oncology, University Hospital Bern, Bern, Switzerland
| | - Matthew Collin
- Adult HSCT Unit, Northern Centre for Bone Marrow Transplantation, Newcastle upon Tyne, United Kingdom
| | - Peter Dreger
- Department of Hematology, University of Heidelberg, Heidelberg, Germany
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Urs Schanz
- Clinic of Hematology, University Hospital, Zurich, Switzerland
| | - Adrian Bloor
- Christie NHS Trust Hospital, Adult Leukaemia and Bone Marrow Transplant Unit, Manchester, United Kingdom
| | - Arnold Ganser
- Department of Haematology, Hemostasis, Oncology, Hannover Medical School, Hannover, Germany
| | - Caroline Besley
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, United Kingdom
- Department of BMT, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Gerald G. Wulf
- Universitaetsmedizin Goettingen, Klinik für Hämatologie und Medizinische Onkologie, Göttingen, Germany
| | - Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ivan Moiseev
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Hélène Schoemans
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Grzegorz W. Basak
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, Oncology and Internal Medicine, The Medical University of Warsaw, Warsaw, Poland
| | - Christian Chabannon
- EBMT Cellular Therapy and Immunobiology Working Party, Leiden, Netherlands
- Institut Paoli-Calmettes Comprehensive Cancer Centre, Inserm CBT-1409, Aix-Marseille Université, Marseille, France
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d’Oncologia-Hospitalet, Barcelona, Spain
- Institut de Ciències Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Bertram Glass
- EBMT Lymphoma Working Party, Leiden, Netherlands
- Department of Hematology, Oncology, and Tumor ImmunologyKlinikum Berlin-Buch, Helios, Berlin, Germany
| | - Zinaida Peric
- EBMT Transplant Complications Working Party, Paris, France
- University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
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Yildirim Simsir I, Tuysuz B, Ozbek MN, Tanrikulu S, Celik Guler M, Karhan AN, Denkboy Ongen Y, Gunes N, Soyaltin UE, Altay C, Nur B, Ozalkak S, Akgun Dogan O, Dursun F, Pekkolay Z, Eren MA, Usta Y, Ozisik S, Ozgen Saydam B, Adiyaman SC, Unal MC, Gungor Semiz G, Turan I, Eren E, Kayserili H, Jeru I, Vigouroux C, Atik T, Onay H, Ozen S, Arioglu Oral E, Akinci B. Clinical features of generalized lipodystrophy in Turkey: A cohort analysis. Diabetes Obes Metab 2023; 25:1950-1963. [PMID: 36946378 DOI: 10.1111/dom.15061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/20/2023] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 03/23/2023]
Abstract
AIM To describe the Turkish generalized lipodystrophy (GL) cohort with the frequency of each complication and the death rate during the period of the follow-up. METHODS This study reports on 72 patients with GL (47 families) registered at different centres in Turkey that cover all regions of the country. The mean ± SD follow-up was 86 ± 78 months. RESULTS The Kaplan-Meier estimate of the median time to diagnosis of diabetes and/or prediabetes was 16 years. Hyperglycaemia was not controlled in 37 of 45 patients (82.2%) with diabetes. Hypertriglyceridaemia developed in 65 patients (90.3%). The Kaplan-Meier estimate of the median time to diagnosis of hypertriglyceridaemia was 14 years. Hypertriglyceridaemia was severe (≥ 500 mg/dl) in 38 patients (52.8%). Seven (9.7%) patients suffered from pancreatitis. The Kaplan-Meier estimate of the median time to diagnosis of hepatic steatosis was 15 years. Liver disease progressed to cirrhosis in nine patients (12.5%). Liver disease was more severe in congenital lipodystrophy type 2 (CGL2). Proteinuric chronic kidney disease (CKD) developed in 32 patients (44.4%) and cardiac disease in 23 patients (31.9%). Kaplan-Meier estimates of the median time to diagnosis of CKD and cardiac disease were 25 and 45 years, respectively. Females appeared to have a more severe metabolic disease, with an earlier onset of metabolic abnormalities. Ten patients died during the follow-up period. Causes of death were end-stage renal disease, sepsis (because of recurrent intestinal perforations, coronavirus disease, diabetic foot infection and following coronary artery bypass graft surgery), myocardial infarction, heart failure because of dilated cardiomyopathy, stroke, liver complications and angiosarcoma. CONCLUSIONS Standard treatment approaches have only a limited impact and do not prevent the development of severe metabolic abnormalities and early onset of organ complications in GL.
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Affiliation(s)
- Ilgin Yildirim Simsir
- Division of Endocrinology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Beyhan Tuysuz
- Department of Genetics, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Mehmet Nuri Ozbek
- Division of Pediatric Endocrinology, Mardin Artuklu University, Mardin, Turkey
| | - Seher Tanrikulu
- Division of Endocrinology, Department of Internal Medicine, Acibadem Hospital, Istanbul, Turkey
| | - Merve Celik Guler
- Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Asuman Nur Karhan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yasemin Denkboy Ongen
- Division of Pediatric Endocrinology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Nilay Gunes
- Department of Genetics, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Utku Erdem Soyaltin
- Division of Endocrinology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Banu Nur
- Division of Pediatric Genetics, Akdeniz University, Antalya, Turkey
| | - Servan Ozalkak
- Division of Pediatric Endocrinology, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Ozlem Akgun Dogan
- Department of Pediatric Genetics, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fatma Dursun
- Department of Pediatric Endocrinology and Diabetes, Istanbul University of Health Science, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Zafer Pekkolay
- Division of Endocrinology and Metabolism, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Mehmet Ali Eren
- Department of Endocrinology and Metabolism, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Yusuf Usta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Secil Ozisik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Basak Ozgen Saydam
- Division of Endocrinology and Metabolism, Yildirim Beyazit University, Yenimahalle Training Hospital, Ankara, Turkey
| | - Suleyman Cem Adiyaman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mehmet Cagri Unal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gokcen Gungor Semiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ihsan Turan
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Erdal Eren
- Division of Pediatric Endocrinology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Hulya Kayserili
- Department of Medical Genetics, Koc University School of Medicine, Istanbul, Turkey
| | - Isabelle Jeru
- Department of Medical Genetics, DMU BioGeM, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Corinne Vigouroux
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Diabetology and Reproductive Endocrinology and Department of Molecular Biology and Genetics, and Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Tahir Atik
- Division of Pediatric Genetics, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Samim Ozen
- Division of Pediatric Endocrinology and Diabetes, Ege University School of Medicine, Izmir, Turkey
| | - Elif Arioglu Oral
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Okólska M, Łach J, Matusik PT, Pająk J, Mroczek T, Podolec P, Tomkiewicz-Pająk L. Heart Rate Variability and Its Associations with Organ Complications in Adults after Fontan Operation. J Clin Med 2021; 10:jcm10194492. [PMID: 34640508 PMCID: PMC8509291 DOI: 10.3390/jcm10194492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Reduction of heart rate variability (HRV) parameters may be a risk factor and precede the occurrence of arrhythmias or the development of heart failure and complications in people with postinfarct left ventricular dysfunction and after coronary artery bypass grafting. Data on this issue in adults after a Fontan operation (FO) are scarce. This study assessed the association between HRV, exercise capacity, and multiorgan complications in adults after FO. Data were obtained from 30 FO patients (mean age 24 ± 5.4 years) and 30 healthy controls matched for age and sex. HRV was investigated in all patients by clinical examination, laboratory tests, echocardiography, a cardiopulmonary exercise test, and 24-h electrocardiogram. The HRV parameters were reduced in the FO group. Reduced HRV parameters were associated with patients’ age at the time of FO, time since surgery, impaired exercise capacity, chronotropic incompetence parameters, and multiorgan complications. Univariate analysis showed that saturated O2 at rest, percentage difference between adjacent NN intervals of >50 ms duration, and peak heart rate were associated with chronotropic index. Multivariable analysis revealed that all three variables were independent predictors of the chronotropic index. The results of this study suggest novel pathophysiological mechanisms that link HRV, physical performance, and organ damage in patients after FO.
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Affiliation(s)
- Magdalena Okólska
- Cardiological Outpatient Clinic, Department of Cardiovascular Diseases, John Paul II Hospital, 31-202 Krakow, Poland;
| | - Jacek Łach
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.Ł.); (P.P.); (L.T.-P.)
| | - Paweł T. Matusik
- Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
- Correspondence: ; Tel.: +48-12-614-23-81
| | - Jacek Pająk
- Department of Pediatric Heart Surgery and General Pediatric Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Tomasz Mroczek
- Department of Pediatric Cardiac Surgery, Jagiellonian University, 30-663 Krakow, Poland;
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.Ł.); (P.P.); (L.T.-P.)
| | - Lidia Tomkiewicz-Pająk
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.Ł.); (P.P.); (L.T.-P.)
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Qi H, Schmöhl F, Li X, Qian X, Tabler CT, Bennewitz K, Sticht C, Morgenstern J, Fleming T, Volk N, Hausser I, Heidenreich E, Hell R, Nawroth PP, Kroll J. Reduced Acrolein Detoxification in akr1a1a Zebrafish Mutants Causes Impaired Insulin Receptor Signaling and Microvascular Alterations. Adv Sci (Weinh) 2021; 8:e2101281. [PMID: 34278746 PMCID: PMC8456208 DOI: 10.1002/advs.202101281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/01/2021] [Indexed: 05/03/2023]
Abstract
Increased acrolein (ACR), a toxic metabolite derived from energy consumption, is associated with diabetes and its complications. However, the molecular mechanisms are mostly unknown, and a suitable animal model with internal increased ACR does not exist for in vivo studying so far. Several enzyme systems are responsible for acrolein detoxification, such as Aldehyde Dehydrogenase (ALDH), Aldo-Keto Reductase (AKR), and Glutathione S-Transferase (GST). To evaluate the function of ACR in glucose homeostasis and diabetes, akr1a1a-/- zebrafish mutants are generated using CRISPR/Cas9 technology. Accumulated endogenous acrolein is confirmed in akr1a1a-/- larvae and livers of adults. Moreover, a series of experiments are performed regarding organic alterations, the glucose homeostasis, transcriptome, and metabolomics in Tg(fli1:EGFP) zebrafish. Akr1a1a-/- larvae display impaired glucose homeostasis and angiogenic retina hyaloid vasculature, which are caused by reduced acrolein detoxification ability and increased internal ACR concentration. The effects of acrolein on hyaloid vasculature can be reversed by acrolein-scavenger l-carnosine treatment. In adult akr1a1a-/- mutants, impaired glucose tolerance accompanied by angiogenic retina vessels and glomerular basement membrane thickening, consistent with an early pathological appearance in diabetic retinopathy and nephropathy, are observed. Thus, the data strongly suggest impaired ACR detoxification and elevated ACR concentration as biomarkers and inducers for diabetes and diabetic complications.
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Affiliation(s)
- Haozhe Qi
- Department of Vascular Biology and Tumor AngiogenesisEuropean Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheim68167Germany
- Department of Vascular SurgeryRenji HospitalSchool of MedicineShanghai Jiaotong UniversityShanghai200127China
| | - Felix Schmöhl
- Department of Vascular Biology and Tumor AngiogenesisEuropean Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheim68167Germany
| | - Xiaogang Li
- Department of Vascular Biology and Tumor AngiogenesisEuropean Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheim68167Germany
| | - Xin Qian
- Department of Vascular Biology and Tumor AngiogenesisEuropean Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheim68167Germany
| | - Christoph T. Tabler
- Department of Vascular Biology and Tumor AngiogenesisEuropean Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheim68167Germany
| | - Katrin Bennewitz
- Department of Vascular Biology and Tumor AngiogenesisEuropean Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheim68167Germany
| | - Carsten Sticht
- NGS Core FacilityMedical Faculty MannheimHeidelberg UniversityMannheim68167Germany
| | - Jakob Morgenstern
- Department of Internal Medicine I and Clinical ChemistryHeidelberg University HospitalHeidelberg69120Germany
- German Center for Diabetes Research (DZD)Neuherberg85764Germany
| | - Thomas Fleming
- Department of Internal Medicine I and Clinical ChemistryHeidelberg University HospitalHeidelberg69120Germany
- German Center for Diabetes Research (DZD)Neuherberg85764Germany
| | - Nadine Volk
- Tissue Bank of the National Center for Tumor Diseases (NCT) HeidelbergHeidelberg UniversityHeidelberg69120Germany
| | - Ingrid Hausser
- Institute of Pathology IPHEM LabHeidelberg University HospitalHeidelberg69120Germany
| | - Elena Heidenreich
- Metabolomics Core Technology PlatformCentre for Organismal StudiesHeidelberg UniversityHeidelberg69120Germany
| | - Rüdiger Hell
- Metabolomics Core Technology PlatformCentre for Organismal StudiesHeidelberg UniversityHeidelberg69120Germany
| | - Peter Paul Nawroth
- Department of Internal Medicine I and Clinical ChemistryHeidelberg University HospitalHeidelberg69120Germany
- German Center for Diabetes Research (DZD)Neuherberg85764Germany
- Joint Heidelberg‐IDC Translational Diabetes ProgramHelmholtz‐ZentrumNeuherberg85764Germany
| | - Jens Kroll
- Department of Vascular Biology and Tumor AngiogenesisEuropean Center for Angioscience (ECAS)Medical Faculty MannheimHeidelberg UniversityMannheim68167Germany
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Cozzani E, Muracchioli A, Murdaca G, Beccalli M, Caprioli S, Zentilin P, Ameri P, Grosso M, Russo R, Carmisciano L, Parodi A. Correlation Between Skin and Affected Organs in 52 Sclerodermic Patients Followed in a Diseases Management Team: Development of a Risk Prediction Model of Organ-Specific Complications. Front Immunol 2021; 12:588753. [PMID: 34149680 PMCID: PMC8207468 DOI: 10.3389/fimmu.2021.588753] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To identify the existence of a correlation among the various organs affected, focusing primarily on immuno-dermatological aspects, and to create a risk prediction model of organ-specific complications. Material and Methods Fifty-two patients with stable scleroderma, followed between 2015 and 2019, were investigated through an extensive multidisciplinary evaluation in the last year. Results Patients with lung involvement presented a worse degree of skin fibrosis than patients without it (p <0.001). No relationship was observed for the heart, kidney, and esophagus. Patients with pulmonary involvement had a lower pressure of the low esophagus sphincter and a higher Warrick score than patients without it (p <0.05). Age was significantly higher in patients with kidney involvement. Diffuse scleroderma patients had a worse pulmonary impairment than limited scleroderma patients (p <0.05). The manometric "sclerodermic" pattern was observed to be the most frequent (55.6%, p <0.05) in dcSSc patients while the sclerodermic and normal pattern were equally represented (41.2 and 32.4% respectively, p <0.05) in lcSSc patients. When compared to the negative serological groups, anti-Scl-70 positive patients presented a worse lung involvement while anti-centromere patients presented a better lung outcome (p <0.05). PM-Scl 100/75 positive patients presented mostly a pulmonary fibrotic pattern (p <0.05) and, also, heart complications were more likely associated with anti PM-Scl 100/75 positivity (p <0.05). The risk prediction model for organ-specific complications had an accuracy of 84.4% (95%CI 78, 89) in complication-site prediction, AUC of 0.871, 86% of sensitivity, and 83% of specificity, Cohen's Kappa (k) of 0.68. Conclusions Out of all the organs studied, the skin is the one that correlates with the lung. Patients with a diffuse form of disease presented more frequently the anti Scl-70 antibody and had a worse lung and esophageal involvement (scleroderma pattern) than the negative group. Conversely, patients with limited disease presented all positive for the anti-centromere antibody with a better lung involvement than the negative group, without any difference among the esophageal manometric pattern. Anti PM-Scl 100/75 antibody patients were associated with pulmonary fibrosis and presented cardiac involvement. The model created has demonstrated excellent values of sensitivity, specificity, and accuracy, but further studies are needed for validation.
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Affiliation(s)
- Emanuele Cozzani
- Dermatologic Unit, University of Genoa, DiSSal, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Andrea Muracchioli
- Dermatologic Unit, University of Genoa, DiSSal, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Giuseppe Murdaca
- Departments of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Mirko Beccalli
- Departments of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit, University of Genova, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Simone Caprioli
- Department of Healt Sciences DiSSal, University of Genova, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Patrizia Zentilin
- Division of Gastroenterology, Department of Internal Medicine, University of Genova, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS, Ospedale-Policlinico San Martino; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Marco Grosso
- Interventional Pneumology Unit, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Rodolfo Russo
- Nephrology, Dialysis, and Transplantation, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Luca Carmisciano
- Department of Healt Sciences DiSSal, University of Genova, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
| | - Aurora Parodi
- Dermatologic Unit, University of Genoa, DiSSal, Ospedale-Policlinico San Martino, IRCCS, Genova, Italy
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Michniewicz B, Al Saad SR, Karbowski LM, Gadzinowski J, Szymankiewicz M, Szpecht D. Organ Complications of Infants with Hypoxic Ischemic Encephalopathy Before Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2020; 11:58-63. [PMID: 33155883 DOI: 10.1089/ther.2020.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Hypoxic ischemic encephalopathy (HIE) is a serious neurological complication that may develop in asphyxiated infants. Severity of encephalopathy may vary, and concurrent multiorgan dysfunctions are commonly observed. Analyzing the incidence of such complications according to severity of HIE, and how they correlate with each other, may shape clinical judgment and allow for early intervention. The study included a total of 57 HIE infants, in which 27/57 (47.37%) met Sarnat inclusion criteria for moderate stage II HIE (Group A) and 30/57 (52.63%) for severe stage III HIE (Group B). Both groups were assessed and compared for incidence of kidney dysfunction, liver dysfunction, coagulopathy, qualitative cardiac abnormalities, respiratory-related dysfunction, and bone marrow insufficiency/thrombocytopenia. All assessments were performed before initiation of therapeutic hypothermia. The complications were further assessed for the presence of correlations. Group B experienced significantly higher incidence of kidney dysfunction (A: 2/27 [7.4%] vs. B: 21/30 [70%], p < 0.001), liver dysfunction (A: 14/27 [51.8%] vs. B: 28/30 [93.3%], p < 0.001), and thrombocytopenia (A: 8/27 [29.6%] vs. B 21/30 [70%], p = 0.002) in our study group. Kidney dysfunction and bone marrow insufficiency showed the highest affiliation with other organ systems in both groups, correlating positively with each other as well as HIE severity, cardiac abnormalities, liver dysfunction, and infant death. A total of 8/57 (14%) infant deaths were observed, all originating from grade III severe HIE group (p = 0.003). Multiorgan dysfunction showed a significant difference between HIE severity (A: 12/27 [44.4%] vs. B: 28/30 [93.3%], p < 0.001). A positive correlation was obtained between multiorgan dysfunction, HIE severity, and infant death. Stage III HIE infants are more likely to experience abnormalities in the kidneys, liver, bone marrow as compared with stage II HIE infants. Correlations between organ complications are present, and should be taken into account during clinical assessment of HIE infants. The probability of mortality is higher in stage III HIE infants with observed multiorgan dysfunctions.
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Affiliation(s)
- Barbara Michniewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Salwan R Al Saad
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Lukasz M Karbowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Szymankiewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Dawid Szpecht
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
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