Axel Stachon
Research skills
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TechnicalLaboratory Medicine, Cell Culture, Flow Cytometry
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StatisticalMultiparametric Analysis
Research interests
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InterestsIntensive Care Medicine, Laboratory Medicine
Awards & achievements
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Dec 2007Award: Wyeth Sponsorship Award
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Oct 2004Award: Swiss Medlab Award
Other
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LanguagesGerman, English
Publications
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2.10Impact points
Regulation of soluble VEGFR-2 secreted by microvascular endothelial cells derived from human BPH.
Prostate cancer and prostatic diseases. 12/2011;
Background:Recently, it was reported that the soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) is secreted by microvascular endothelial cells from human BPH (HPECs). The purpose of this study was to investigate the modulation of sVEGFR-2 by common endothelial cell stimulators. In add... [more] Background:Recently, it was reported that the soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) is secreted by microvascular endothelial cells from human BPH (HPECs). The purpose of this study was to investigate the modulation of sVEGFR-2 by common endothelial cell stimulators. In addition, the physiological role of sVEGFR-2 with regard to the VEGF-stimulated proliferation of HPEC was investigated.Methods:HPECs were isolated and cultured from fresh BPH tissue. After the incubation of HPECs either with adenosine triphosphate (ATP), interleukin (IL)-6, IL-8 or IL-12, the secretion of sVEGFR-2 was measured by enzyme-linked immunosorbent assay. For measurement of HPEC proliferation influenced by sVEGFR-2, VEGF-stimulated HPEC was cultured with/without sVEGFR-2. Cell proliferation was assessed with the Alamar Blue method.Results:The sVEGFR-2 secretion was increased by ATP and decreased by IL-12 and IL-8, respectively. IL-6 did not show any significant effect on sVEGFR-2 secretion of HPECs. HPEC proliferation was significantly inhibited by sVEGFR-2.Conclusions:In this study, our data suggest that the secretion of sVEGFR-2 by microvascular endothelial cells from prostate origin is influenced by multiple endothelial cell stimulators. Furthermore, our data suggest that sVEGFR-2 acts as an antiangiogenic factor.Prostate Cancer and Prostatic Diseases advance online publication, 20 December 2011; doi:10.1038/pcan.2011.63.
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2.63Impact points
Long-term comparison of a routine laboratory parameter-based severity score with APACHE II and SAPS II.
The Journal of trauma. 04/2011; 71(6):1835-40.
Risk score models predicting mortality have tremendous value, but because of the additional effort involved, their clinical use remains low. The aim of this study is to compare three different scores that each requires different levels of effort during admission and throughout treatment: the Acute P... [more] Risk score models predicting mortality have tremendous value, but because of the additional effort involved, their clinical use remains low. The aim of this study is to compare three different scores that each requires different levels of effort during admission and throughout treatment: the Acute Physiology and Chronic Health Evaluation II (APACHE II), the Simplified Acute Physiology Score II (SAPS II), and the Dense Laboratory Whole Blood Applied Risk Estimation (DELAWARE) score. Of the three, only the DELAWARE is based solely on routine laboratory parameters. Prospective data of the three scores were collected for 268 surgical patients admitted to the intensive care unit over 1 year. The predicted hospital mortality and survival were evaluated for the first 14 days. With a cutoff value of 0.65, the sensitivity of the DELAWARE was 71.6%, the specificity, 92.5%, and the correct classification rate, 87.3%. The APACHE II and SAPS II showed values of 41.2%/96.8%/86.2% and 62.7%/87.1%/82.5%, respectively. The r2 value was 0.884 for the DELAWARE, 0.876/0.814 for the APACHE II and SAPS II. Hospital mortality rate was overestimated by 20% to 65% in all scores. The discriminatory ability of the APACHE II and SAPS II increased throughout the course of treatment. The routine laboratory-based DELAWARE provides a reliable, valid risk assessment of the surgical intensive care patient at admission. It also provides additional information without added effort or poor interobserver reliability, which leads to better data comparability. We have to state that until now the data have been collected in a single-center and their general validity is therefore limited. By the end of treatment, the SAPS II and APACHE II had increased discriminatory ability and are therefore useful as process parameters.
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1.89Impact points
Association of nucleated red blood cells in blood and arterial oxygen partial tension.
Clinical chemistry and laboratory medicine : CCLM / FESCC. 12/2010; 49(2):257-63.
Several studies suggest that the detection of nucleated red blood cells (NRBCs) in hospitalized patients indicates an increased risk of mortality. This study evaluates the impact of low arterial oxygen partial tension (pO₂) on NRBC appearance and prognosis in NRBC positive patients. NRBCs in blood, ... [more] Several studies suggest that the detection of nucleated red blood cells (NRBCs) in hospitalized patients indicates an increased risk of mortality. This study evaluates the impact of low arterial oxygen partial tension (pO₂) on NRBC appearance and prognosis in NRBC positive patients. NRBCs in blood, arterial blood gases, and other laboratory parameters were monitored daily in 234 surgical intensive care patients. pO₂ was assessed in relation to mortality and the detection of NRBCs. NRBCs were found in 67 patients (28.6%). Mortality was significantly higher in NRBC positive patients (41.8%, 28/67) than in those that were NRBC negative (3.0%, 5/167). Multivariate logistic regression showed an increased mortality in NRBC positive patients (odds ratio 5.79; 95% confidence interval (CI) 1.07-31.33, p < 0.05). NRBC positive patients showed significantly lower pO₂ levels during intensive care treatment than NRBC negative patients. Prior to the initial detection of NRBCs in the peripheral blood, pO₂ levels were significantly lower in patients who died than in surviving patients. After the first appearance of NRBCs, no significant difference in pO₂ between these groups was found. The detection of NRBCs is of prognostic significance concerning patient mortality. In NRBC positive patients, hypoxemia occurs more frequently. Low-levels of pO₂ seem to precede the appearance of NRBCs, especially in those patients with high risk of mortality.
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1.07Impact points
Prohepcidin, B-type natriuretic peptide, and iron status in a cohort of elderly women from the Rhine-Ruhr area.
Acta haematologica. 09/2010; 124(3):129-33.
No abstract available.
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1.13Impact points
Effects of Maleimide-polyethylene Glycol-modified Human Hemoglobin (MP4) on Tissue Necrosis in SKH1-hr Hairless Mice.
European journal of medical research. 04/2009; 14(3):123-9.
Objective: Tissue hypoxia after blood loss, replantation and flap reperfusion remains a challenging task in surgery. Normovolemic hemodilution improves hemorheologic properties without increasing oxygen carrying capacity. Red blood cell transfusion is the current standard of treatment with its atten... [more] Objective: Tissue hypoxia after blood loss, replantation and flap reperfusion remains a challenging task in surgery. Normovolemic hemodilution improves hemorheologic properties without increasing oxygen carrying capacity. Red blood cell transfusion is the current standard of treatment with its attendant risks. The aim of this study was to investigate the potential of the chemically modified hemoglobin, MP4, to reduce skin flap necrosis and its effect on selected blood markers and kidneys. - Materials and Methods: Tissue ischemia was induced in the ear of hairless mice (n=26). Hemodilution was performed by replacing one third of blood volume with the similar amount of MP4, dextran, or blood. The extent of non-perfused tissue was assessed by intravital fluorescent microscopy. - Results: Of all groups, MP4 showed the smallest area of no perfusion (in percentage of the ear +/- SEM: 16.3% +/- 2.4), the control group the largest (22.4% +/- 3.5). Leukocytes showed a significant increase in the MP4 and dextran group (from 8.7 to 13.6 respectively 15.4*109/l). On histology no changes of the kidneys could be observed. - Conclusion: MP4 causes an increase of leukocytes, improves the oxygen supply of the tissue and shows no evidence of renal impairment.
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2.47Impact points
Secretion of soluble VEGF receptor 2 by microvascular endothelial cells derived by human benign prostatic hyperplasia.
Growth factors (Chur, Switzerland). 03/2009;
Vascular endothelial growth factor (VEGF) is one of the most potent mitogenic factors stimulating both prostate endothelial and prostate epithelial cells. Recently, some studies reported on the endothelial secretion of a soluble VEGF receptor 2 (sVEGFR-2) that modifies the free VEGF concentration by... [more] Vascular endothelial growth factor (VEGF) is one of the most potent mitogenic factors stimulating both prostate endothelial and prostate epithelial cells. Recently, some studies reported on the endothelial secretion of a soluble VEGF receptor 2 (sVEGFR-2) that modifies the free VEGF concentration by binding VEGF. For the first time in this study, we report on the secretion and the regulation of the secretion of sVEGFR-2 by microvascular endothelial cells derived from the tissue of human benign prostatic hyperplasia (HPEC). HPEC were isolated and cultured from fresh prostate tissue. The prostate epithelial cell line BPH-1 was cultured with the supernatant of the HPEC cell culture (fractioned by fast protein liquid chromatography) and the VEGF concentration was subsequently measured. HPEC were incubated with VEGF or tumor necrosis factor alpha (TNF-alpha). Afterwards, the concentration of sVEGFR-2 in the supernatant of unstimulated and stimulated HPEC was measured by ELISA. HPEC showed a typical endothelial morphology. Under cell culture conditions sVEGFR-2 binds VEGF: The measured VEGF concentration in the supernatant of BPH-1 cells was reduced when the fractions of HPEC conditioned medium with the highest sVEGFR-2 concentration were incubated with the BPH-1 cells. The sVEGFR-2 secretion of HPEC was stimulated by VEGF and TNF-alpha. For the first time we report on the secretion of sVEGFR-2 by microvascular endothelial cells of prostate origin. The secretion of sVEGFR-2 by HPEC was stimulated by VEGF and TNF-alpha. Our data suggest that sVEGFR-2 secreted by prostate endothelial cells could modify the effect of VEGF on prostate endothelial and prostate epithelial cells.
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4.19Impact points
Salivary cortisol and psychological mechanisms in patients with acute versus chronic low back pain.
Psychoneuroendocrinology. 12/2008;
This study was designed to explore whether the basal adrenocortical activity is related with pain-related coping, nonverbal pain behavior, depressive mood, and fatigue in patients with acute and chronic nonspecific low back pain. 19 patients with acute low back pain (ALBP) and 24 with chronic low ba... [more] This study was designed to explore whether the basal adrenocortical activity is related with pain-related coping, nonverbal pain behavior, depressive mood, and fatigue in patients with acute and chronic nonspecific low back pain. 19 patients with acute low back pain (ALBP) and 24 with chronic low back pain (CLBP) participated in the study. The adrenocortical activity was assessed through the cortisol awakening response. All participants provided five saliva samples (0, 15, 30, 45, and 60min after waking) on two consecutive days off work. Pain-related coping [fear-avoidance coping (FAC) and endurance coping (EC)], nonverbal pain behavior (NPB), depressive mood, and fatigue were assessed through questionnaires. Among ALPB patients, EC was negatively associated with the cortisol release, whereas fatigue was positively associated with it. Among CLBP patients, FAC, NPB, depressive mood, and fatigue were negatively associated with the cortisol awakening response, whereas EC tended to be positively associated with it. The results indicate that pain-related coping strategies which are expected to be successful appear to lower the adrenocortical activity among ALBP patients, whereas affective distress may enhance the level of cortisol in this group. Among CLBP patients, long-term maladaptive coping strategies might contribute to hypocortisolism.
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The AQUA-FONTIS Study: Protocol of a multidisciplinary, cross-sectional and prospective longitudinal study for developing standardized diagnostics and classification of non-thyroidal illness syndrome.
BMC endocrine disorders. 11/2008; 8(1):13.
ABSTRACT: BACKGROUND: Non-thyroidal illness syndrome (NTIS) is a characteristic functional constellation of thyrotropic feedback control that frequently occurs in critically ill patients. Although this condition is associated with significantly increased morbidity and mortality, there is still contr... [more] ABSTRACT: BACKGROUND: Non-thyroidal illness syndrome (NTIS) is a characteristic functional constellation of thyrotropic feedback control that frequently occurs in critically ill patients. Although this condition is associated with significantly increased morbidity and mortality, there is still controversy on whether NTIS is caused by artefacts, is a form of beneficial adaptation, or is a disorder requiring treatment. Trials investigating substitution therapy of NTIS revealed contradictory results. The comparison of heterogeneous patient cohorts may be the cause for those inconsistencies. Objectives: Primary objective of this study is the identification and differentiation of different functional states of thyrotropic feedback control in order to define relevant evaluation criteria for the prognosis of affected patients. Furthermore, we intend to assess the significance of an innovative physiological index approach (SPINA) in differential diagnosis between NTIS and latent (so-called "sub-clinical") thyrotoxicosis. Secondary objective is observation of variables that quantify distinct components of NTIS in the context of independent predictors of evolution, survival or pathophysiological condition and influencing or disturbing factors like medication. DESIGN: The approach to a quantitative follow-up of non-thyroidal illness syndrome (AQUA FONTIS study) is designed as both a cross-sectional and prospective longitudinal observation trial in critically ill patients. Patients are observed in at least two evaluation points with consecutive assessments of thyroid status, physiological and clinical data in additional weekly observations up to discharge. A second part of the study investigates the neuropsychological impact of NTIS and medium-term outcomes. The study design incorporates a two-module structure that covers a reduced protocol in form of an observation trial before patients give informed consent. Additional investigations are performed if and after patients agree in participation. Trial Registration: ClinicalTrials.gov NCT00591032.
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2.63Impact points
Re-evaluation of Established Risk Scores by Measurement of Nucleated Red Blood Cells in Blood of Surgical Intensive Care Patients.
The Journal of trauma. 10/2008; 65(3):666-673.
BACKGROUND:: In adults, the appearance of nucleated red blood cells (NRBC) in the peripheral blood is associated with several severe diseases. When NRBC are detected in the blood, the prognosis is poor. The purpose of this study was to identify the impact of NRBC on the clinical outcomes of surgical... [more] BACKGROUND:: In adults, the appearance of nucleated red blood cells (NRBC) in the peripheral blood is associated with several severe diseases. When NRBC are detected in the blood, the prognosis is poor. The purpose of this study was to identify the impact of NRBC on the clinical outcomes of surgical intensive care patients under consideration of established risk models. METHODS:: In a prospective study, the detection of NRBC in the peripheral blood of surgical intensive care patients was analyzed with regard to the in- hospital mortality. NRBC were daily measured with a Sysmex XE-2100. The prognostic significance of NRBC in blood was analyzed under consideration of established risk scores for intensive care patients, i.e., the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Simplified Acute Physiology Score (SAPS II). RESULTS:: Two hundred seventy-one surgical intensive care patients were included in this study. The mean age was 61.3 years +/- 1.2 years (range, 18-98 years). The average APACHE II and SAPS II scores were 20.6 +/- 0.6 and 44.1 +/- 1.2, respectively. The in-hospital mortality of NRBC-positive patients was 51.7% (45 of 87). This was significantly higher (p < 0.001) than the mortality of NRBC-negative patients (12.0%, 22 of 184). The area under curve (C-statistic) was 0.77. Mortality increased with the NRBC concentration. On average, in NRBC-positive patients who died, NRBC were detected for the first time 13.3 days +/- 3.1 days (n = 45, median = 6 days) before death. Multiple logistic regression analysis under consideration of the APACHE II or the SAPS II revealed a significant association between NRBC and increased mortality, the mean odds ratio being 1.97 for each increase in the NRBC category (0/muL; 1-40/muL; 41-80/muL; 81-240/muL, >240/muL). In contrast, under consideration of the NRBC-data the mean odds ratios for the increase of one score point of the APACHE II and SAPS II were 1.10 and 1.05, respectively. Therefore, each step-up in the NRBC category is equivalent to approximately 7 APACHE II-score points and 14 SAPS II-score points, respectively. CONCLUSIONS:: The daily screening for NRBC in blood of surgical intensive care patients is of prognostic power with regard to the patients' in-hospital mortality. This prognostic significance of NRBC was independent of the scores APACHE II and SAPS II, respectively. Therefore, for prognostic purposes an adjustment of these established risk models by including the NRBC-results is feasible.
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2.09Impact points
Effectiveness of CT-Guided Percutaneous Biopsies of the Spine An Analysis of 202 Examinations.
Academic radiology. 08/2008; 15(7):901-11.
RATIONALE AND OBJECTIVES: The study goal was to retrospectively evaluate the effectiveness of computed tomography (CT)-guided spinal biopsies. MATERIAL AND METHODS: Two hundred two CT-guided vertebral biopsies performed between May 1999 and June 2004 in 187 patients were retrospectively analyzed. Pa... [more] RATIONALE AND OBJECTIVES: The study goal was to retrospectively evaluate the effectiveness of computed tomography (CT)-guided spinal biopsies. MATERIAL AND METHODS: Two hundred two CT-guided vertebral biopsies performed between May 1999 and June 2004 in 187 patients were retrospectively analyzed. Patient characteristics (age, sex, antibiotic therapy), technical parameters (depth and number of biopsies, needle approach), lesion features (spinal level, osteolysis, fluid collections, soft tissue tumor), and complications were documented. Furthermore, histopathological and microbiological diagnoses were considered. RESULTS: There were two focal hematomas in our study group (complication rate: 1%). Histopathological diagnosis was established in 74% of examinations with spondylitis (41% of cases) being most common. In spinal tumors (27% of cases), malignant lesions were found in 52 of 54 examinations (96%). Osteolysis was diagnosed in 98% of patients with spondylitis and in 87% of patients with tumors (P < .01). Spinal tumors were most commonly seen in the sacrum (53%, P < .001), whereas spondylitis typically occurred in the lumbar spine (55%, P = .001). Neither patient age nor sex, needle approach, needle depth, or vertebral abnormalities showed a significant impact on diagnostic accuracy. Microbiological tests were performed in 98 patients (49%); 62 of 98 patients (65%) received antibiotic therapy. In 12 of 62 patients (19%) with antibiotic therapy and in 9 of 36 patients (25%) without antibiotic treatment, microbiological tests were positive (P = .153). Staphylococcus aureus was found in 9 of 21 examinations (43%). CONCLUSIONS: CT-guided vertebral biopsy is a safe and effective procedure to establish final diagnosis in spinal lesions of unclear origin. Patient characteristics, lesions features, and technical considerations did not influence sample quality. In spondylitis, which was commonly caused by Staphylococcus aureus, microbiological yield was low regardless of antibiotic therapy.
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1.50Impact points
Estimation of the mortality risk of surgical intensive care patients based on routine laboratory parameters.
European surgical research. Europäische chirurgische Forschung. Recherches chirurgicales européennes. 01/2008; 40(3):263-72.
BACKGROUND: In established risk score models the collection and documentation of clinical data is time-consuming, causes labor-related costs, and is dependent on the examiner. MATERIAL AND METHODS: Based on low-cost laboratory parameters that are routinely measured at admission to the intensive care... [more] BACKGROUND: In established risk score models the collection and documentation of clinical data is time-consuming, causes labor-related costs, and is dependent on the examiner. MATERIAL AND METHODS: Based on low-cost laboratory parameters that are routinely measured at admission to the intensive care unit, a new score was developed (n = 271, study sample) and validated in an independent group of patients (n = 283, validation sample). Parameters were selected by a stepwise logistic regression analysis. This new score was compared to established risk models (APACHE II, SAPS II). RESULTS: Mean age was 61.3 +/- 1.2 years (study sample) and 63.1 +/- 1.1 years (validation sample), respectively. In-hospital mortality was 24.7% (67/271, study sample) and 23.3% (66/283, validation sample). The following parameters were used to build the new score called Dense Laboratory Whole Blood Applied Risk Estimation (DELAWARE): alanine aminotransferase, C-reactive protein, cholesterol, creatine kinase MB, leukocytes, potassium, thrombocytes, triglycerides, and age. The areas under the curves were 0.853/0.813 (study sample/validation sample). In the study sample DELAWARE correlated with APACHE II (r = 0.586) and SAPS II (r = 0.614; p < 0.001), respectively. CONCLUSIONS: A general admission risk score for surgical intensive care patients solely based on quality controlled low-cost routine laboratory parameters is feasible.
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1.89Impact points
A laboratory-based risk score for medical intensive care patients.
Clinical chemistry and laboratory medicine : CCLM / FESCC. 01/2008; 46(6):855-62.
Abstract Background: Established general risk score models for intensive care patients incorporate several clinical and laboratory data. However, the collection, documentation and classification of clinical data are time-consuming, incur labor-related costs, and are dependent on the experience of th... [more] Abstract Background: Established general risk score models for intensive care patients incorporate several clinical and laboratory data. However, the collection, documentation and classification of clinical data are time-consuming, incur labor-related costs, and are dependent on the experience of the examiner. Therefore, in the present study a general score for medical intensive care patients based solely on routine laboratory parameters is presented. Methods: Parameter selection was performed using stepwise logistic regression analysis. The maximum likelihood estimate of variable influence on mortality provided a relative weighting for each variable. The new score was compared to two established risk models (Acute Physiology And Chronic Health Evaluation II, APACHE II; and Simplified Acute Physiology Score II, SAPS II). Results: The study included 528 medical intensive care patients with a mean age of 65.4+/-0.7 years. The in-hospital mortality was 16.5% (87/528). Multiple logistic regression analysis revealed eight parameters with significant prognostic power: alanine aminotransferase, cholesterol, creatinine, leukocytes, sodium, thrombocytes, urea, and age. These parameters were used to build a new laboratory score called Critical Risk Evaluation by Early Keys (CREEK). The area under the receiver operating characteristics curve was 0.857 (0.814-0.900). Pearson correlation analysis showed significant correlation between CREEK and APACHE II (r=0.550) and SAPS II (r=0.516; p<0.001; n=387). The areas under curve of the APACHE II and the SAPS II were 0.869 and 0.874, respectively. Conclusions: We show that a general risk score for medical intensive care patients on admission based solely on routine laboratory parameters is feasible. The quality of risk estimation using CREEK is comparable to established risk models. Furthermore, this new score is based on quality controlled low-cost laboratory parameters that are routinely measured on admission to the intensive care unit. Therefore, no additional costs are involved. Clin Chem Lab Med 2008;46:855-62.
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1.46Impact points
[The cortisol awakening response in patients with acute and chronic low back pain. Relations with psychological risk factors of pain chronicity]
Schmerz (Berlin, Germany). 07/2007; 21(3):202-4, 206-11.
BACKGROUND: Peculiarities of the hypothalamic-pituitary-adrenal axis activity in stress-related pain-disorders and potential relations with psychological risk factors of pain chronicity have been discussed controversially. MATERIAL AND METHODS: The cortisol awakening responses of 31 low back pain pa... [more] BACKGROUND: Peculiarities of the hypothalamic-pituitary-adrenal axis activity in stress-related pain-disorders and potential relations with psychological risk factors of pain chronicity have been discussed controversially. MATERIAL AND METHODS: The cortisol awakening responses of 31 low back pain patients (14 acute, 17 chronic) and 14 healthy controls were compared. In addition the interrelations between awakening response and chronic stress as well as depressive mood and - for the first time - maladaptive painprocessing and -copingstrategies were investigated. RESULTS: The groups did not differ in their cortisol awakening responses. Chronic stress, depressive mood and maladaptive cognitive painprocessing did not correlate with the awakening response. There were, however, significant interrelations between awakening responses and the behavioral paincoping-strategies. CONCLUSIONS: Behavioral paincoping-strategies should be considered as a potentially important contributing psychological factor in the relation between the activity of the hypothalamic-pituitary-adrenal axis and stress-related pain disorders.
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4.93Impact points
Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study.
Critical care (London, England). 01/2007; 11(3):R62.
INTRODUCTION: In critically ill patients, the appearance of nucleated red blood cells (NRBCs) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood, the prognosis is poor. METHODS: In a prospective study, the detection of NRBCs was us... [more] INTRODUCTION: In critically ill patients, the appearance of nucleated red blood cells (NRBCs) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood, the prognosis is poor. METHODS: In a prospective study, the detection of NRBCs was used for a daily monitoring of 383 medical intensive care patients. RESULTS: The incidence of NRBCs in medical intensive care patients was 17.5% (67/383). The mortality of NRBC-positive patients was 50.7% (34/67); this was significantly higher (p < 0.001) than the mortality of NRBC-negative patients (9.8%, 31/316). Mortality increased with increasing NRBC concentration. Seventy-eight point six percent of the patients with NRBCs of more than 200/microl died. The detection of NRBCs is highly predictive of death, the odds ratio after adjustment for other laboratory and clinical prognostic indicators being 1.987 (p < 0.01) for each increase in the NRBC category (0/microl, 1 to 100/microl, 101 to 200/microl, and more than 200/microl). Each step-up in the NRBC category increased the mortality risk as much as an increase in APACHE II (Acute Physiology and Chronic Health Evaluation II) score of approximately 4 points. The mortality of patients who were NRBC-positive on the day of relocation from the intensive care unit to a peripheral ward was 27.6% (8/27). This was significantly higher than the mortality of patients who were NRBC-negative on the relocation day (8.6%, 28/325; p < 0.01). On average, NRBCs were detected for the first time 14 days (median, 3 days) before death. CONCLUSION: The routine analysis of NRBCs in blood is of high prognostic power with regard to mortality of critically ill patients. Therefore, this parameter may serve as a daily indicator of patients at high mortality risk. Furthermore, NRBC-positive intensive care patients should not be relocated to a normal ward but should obtain ongoing intensive care treatment.
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2.54Impact points
Daily monitoring of nucleated red blood cells in the blood of surgical intensive care patients.
Clinica chimica acta; international journal of clinical chemistry. 04/2006; 366(1-2):329-35.
BACKGROUND: In intensive care patients the appearance of nucleated red blood cells (NRBC) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood the prognosis is poor. MATERIAL AND METHODS: In the present study the detection of NRBCs w... [more] BACKGROUND: In intensive care patients the appearance of nucleated red blood cells (NRBC) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood the prognosis is poor. MATERIAL AND METHODS: In the present study the detection of NRBCs was used for a day-to-day monitoring of 284 surgical intensive care patients. RESULTS: NRBCs were found at least once in 32.0% of all patients. The mortality of NRBC-positive patients was 44.0% (40/91); this was significantly higher (P<0.001) than the mortality of NRBC-negative patients (4.2%, 8/193). With regard to intensive care mortality, NRBCs in blood showed sensitivity and specificity of 83.3% and 78.9%, respectively. The area under curve (C-statistic) was 0.86. Mortality increased with increasing NRBC concentration. All patients with more than 2000 NRBCs/microl died. Moreover, mortality increased with increasing frequency of occurrence. When after first detection of NRBCs in blood, during the further course of intensive care treatment the NRBCs have disappeared from the circulation, the mortality again decreased to values of NRBC-negative patients. The detection of NRBCs is associated with an increased mortality rate, the odds ratio after adjustment for other laboratory prognostic indicators being 1.8 (P<0.001) for each increase in the NRBC category (1-40/microl; 41-80/microl; 81-240/microl, >240/microl). NRBCs were detected for the first time, on average, 9 days (median 5 days) before death. CONCLUSIONS: The routine analysis of NRBC in blood is of potential prognostic power with regard to mortality of critically ill patients. Therefore, this parameter could possibly serve as a daily indicator of patients at high mortality risk.
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8.17Impact points
Gentamicin treatment in McArdle disease: failure to correct myophosphorylase deficiency.
Neurology. 02/2006; 66(2):285-6.
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1.89Impact points
Poor prognosis indicated by nucleated red blood cells in peripheral blood is not associated with organ failure of the liver or kidney.
Clinical chemistry and laboratory medicine : CCLM / FESCC. 01/2006; 44(8):955-61.
BACKGROUND: The appearance of nucleated red blood cells (NRBCs) in peripheral blood is associated with a variety of severe diseases. When NRBCs are detected in blood, this is generally associated with increased mortality. METHODS: In a prospective study, NRBCs and other laboratory parameters were me... [more] BACKGROUND: The appearance of nucleated red blood cells (NRBCs) in peripheral blood is associated with a variety of severe diseases. When NRBCs are detected in blood, this is generally associated with increased mortality. METHODS: In a prospective study, NRBCs and other laboratory parameters were measured daily in the peripheral blood of surgical intensive care patients. The appearance of NRBCs was analyzed in relation to laboratory indicators of organ injury. RESULTS: A total of 284 surgical intensive care patients were included in this study. The mortality of NRBC-positive patients was 44.0% (40/91). This was significantly higher (p<0.001) than the mortality of NRBC-negative patients (4.2%, 8/193). Mortality increased with the NRBC concentration and the length of the NRBC-positive period. Multiple logistic regression analysis of several other clinical and laboratory risk indicators revealed a significant association between NRBCs and increased mortality, with an odds ratio of 1.95 (95% CI 1.35-2.82; p<0.001) for each increment in NRBC category (0, 1-40, 41-80, 81-240 and >240 NRBC/microL). After the initial detection of NRBCs in blood, there were no significant increases in creatinine concentrations or alanine aminotransferase activity. However, the appearance of NRBCs coincided with increasing C-reactive protein and thrombocyte concentrations. CONCLUSIONS: The detection of NRBCs in blood of surgical intensive care patients is of prognostic power with regard to patient mortality. This prognostic significance of NRBCs was independent of some clinical and other laboratory risk parameters. The appearance of NRBCs in blood was not associated with kidney failure or lesion of the liver.
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0.33Impact points
[Significance of the PSA-concentration for the detection of prostate cancer]
Der Pathologe. 12/2005; 26(6):469-72.
Prostate cancer among adult males is the most common neoplasm in western countries. Prostate specific antigen (PSA) is now a well established tumor marker that aids in the early detection of localized prostate cancer. Increased PSA concentrations are found in the serum of patients with benign prosta... [more] Prostate cancer among adult males is the most common neoplasm in western countries. Prostate specific antigen (PSA) is now a well established tumor marker that aids in the early detection of localized prostate cancer. Increased PSA concentrations are found in the serum of patients with benign prostatic hyperplasia or patients with prostate cancer, respectively. Therefore, in general the specificity of this test is low. The diagnostic value of PSA can be improved in consideration of clinical data, patients age, the measurement of free or complexed PSA, and the measurement of PSA velocity, respectively. Furthermore, there is a high variability between commercial PSA assays. Finally, the pre-analytical laboratory procedures have a high impact on the PSA measurement.
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2.87Impact points
Association between nucleated red blood cells in blood and the levels of erythropoietin, interleukin 3, interleukin 6, and interleukin 12p70.
Shock (Augusta, Ga.). 08/2005; 24(1):34-9.
The appearance of nucleated red blood cells (NRBC) in the circulation is associated with a variety of severe diseases, and indicates a relatively poor prognosis. Whether a malfunction of the bone marrow leads to this phenomenon is as unknown as the possible role that cytokines could play in this pro... [more] The appearance of nucleated red blood cells (NRBC) in the circulation is associated with a variety of severe diseases, and indicates a relatively poor prognosis. Whether a malfunction of the bone marrow leads to this phenomenon is as unknown as the possible role that cytokines could play in this process. We analyzed erythropoietin, interleukin (IL)-3, IL-6, and IL-12p70 in the blood of 301 patients with circulating NRBCs. Two hundred fifty NRBC-negative patients served as controls. Multiple logistic regression revealed a significant association between the appearance of NRBCs in the blood and erythropoietin (odds ratio, 1.017; 95% confidence limits, 1.007-1.027; P < 0.001), IL-3 (odds ratio, 1.293; 95% confidence limits, 1.180-1.417; P < 0.001), IL-6 (odds ratio, 1.138; 95% confidence limits, 1.016-1.275; P < 0.05), and age (odds ratio, 1.019; 95% confidence limits, 1.009-1.030; P < 0.001), respectively. Gender and IL-12p70 were not significantly associated with the appearance of NRBC in the blood. To estimate the RBC production in the bone marrow, the increase in the reticulocyte concentration in blood was measured. The reticulocyte concentration in NRBC-positive patients was 69 +/- 2/nL, which was significantly higher than in NRBC-negative patients (60 +/- 2/nL; P < 0.01). Taken together, NRBC could be a marker that sums up hypoxic and inflammatory injuries. Thus, generally, the appearance of NRBC in blood is a valid parameter to identify patients at high mortal risk. Moreover, the increased number of reticulocytes in the blood of NRBC-positive patients may indicate that the appearance of NRBC is not associated with disturbed bone marrow function as far as the erythropoiesis is concerned.
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Making the case for adapting the abbreviated burn severity index to include erythroblast count.
Journal of wound care. 04/2005; 14(3):97-100.
The presence of erythroblasts is an accurate predictor of a poor prognosis. This study investigates whether this should be taken into account when assessing patients with burn injuries as traditional protocols may underestimate the level of risk.... [more] The presence of erythroblasts is an accurate predictor of a poor prognosis. This study investigates whether this should be taken into account when assessing patients with burn injuries as traditional protocols may underestimate the level of risk.
Following (3)
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Johannes W. Dietrich
Ruhr-Universität Bochum -
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