[show abstract][hide abstract] ABSTRACT: To establish the prognostic and discriminative value of the pro-atrial natriuretic peptide (pro-ANP) level in patients with severe sepsis or septic shock.
An observational and prospective study was conducted on 50 critically ill patients with severe sepsis or septic shock. Measurements of the level of procalcitonin (PCT) and mid-regional pro-ANP were determined in the serum of patients with commercially available immunoluminometric tests.
The median pro-ANP level was significantly higher in non-survivors than in survivors (P < 0.05) on all consecutive days. No significant differences in the pro-ANP levels were observed in patients with severe sepsis and septic shock. There was a strong correlation between the PCT and pro-ANP levels on admission in non-survivors and in septic shock patients (r = 0.56, P = 0.007 and r = 0.43, P = 0.02, respectively).
pro-ANP evaluated in severe sepsis and septic shock patients is a valuable prognostic biomarker, but, in contrast to PCT, which is routinely used as a diagnostic marker of severe sepsis and septic shock, it does not possess diagnostic and discriminative value.
[show abstract][hide abstract] ABSTRACT: To devise and evaluate quantitative indices of dynamics in lipopolysaccharide-binding protein (LBP), CRP, and procalcitonin concentrations as prognostic markers in sepsis.
Prospective observational cross-sectional study with 5-day follow-up. Simple (Δ(5-1)) and relative (chain indices-based) rates for LBP (ELISA), procalcitonin (immunoluminometry), and CRP were devised.
Admission concentrations of all markers were higher in septic patients than controls. Not the admission levels but markers' time-courses differed between survivors (declining) and non-survivors (persistently high). Simple and relative rates were greater in survivors than non-survivors. Their accuracies as outcome predictors were comparable, higher for LBP and CRP than PCT. At ~95% sensitivity, the highest specificity had LBP relative and simple rates. Except for sepsis severity scores, only LBP was independently associated with lethal outcome.
For outcome prediction, the evaluation of dynamics of sepsis mediators, expressed by simple or relative rates, is a more suitable alternative to markers' peak values.
[show abstract][hide abstract] ABSTRACT: The objective of the study was to evaluate whether severe sepsis and septic shock are related to alterations in midkine concentrations, to identify disease-related factors associated with these alterations, and to initially appraise whether midkine might serve as a biomarker in sepsis. Prospective observational cross-sectional study with 5-day follow-up. Circulating midkine was measured (enzyme-linked immunosorbent assay) in 38 septic (13 with severe sepsis, 25 with septic shock), 82 active inflammatory bowel disease (IBD) (26 with systemic inflammatory response syndrome [SIRS]) patients, and 87 healthy subjects. Midkine significantly increased along with a sequence: health-inflammation (IBD)-systemic inflammation (IBD-SIRS)-severe sepsis/septic shock. High midkine levels (>1,000 ng/L) were found in 63% of septic and in 19% of IBD-SIRS patients, whereas extremely high concentrations (>5,000 ng/L) were found in 16% vs. 4%. Although not different at admission, midkine gradually decreased in severe sepsis and remained high in shock. Similarly, persistently high midkine was observed in patients with cardiovascular insufficiency (CVI) and in mechanically ventilated as compared with normalizing levels in patients without CVI and not requiring ventilation. The differences in devised simple rates (Δ5th-1st) were significant in all these cases. Accordingly, admission midkine was higher in patients with metabolic acidosis. Concerning pathogen, gram-positive infections were associated with the highest midkine levels. In conclusion, sepsis and septic shock are associated with midkine elevation, substantially more pronounced than in inflammation, even systemic, revealing a new potential mediator of deregulation of neutrophil migration. Sepsis-related global hypoxia seems to contribute to midkine elevation. Our results substantiate further research on possible midkine application as a sepsis biomarker: in differentiating SIRS from sepsis and identifying gram-positive sepsis and septic patients at risk of CVI and shock.
[show abstract][hide abstract] ABSTRACT: Each factor infection or non-infection (surgery, burn) can be the cause of inflammatory reaction development and in turn releasing of pro- and antiinflammatory mediators. Excessive or/and uncontrol releasing of these mediators leads to endothelium damage and organ dysfunction. Standard analysis of common infection markers, i.e. peripheral blood leukocytes, C-reactive protein, reaction of Biernacki measurements, do not allow to distinguish infection and noninfection reason of systemic inflammatory response. Procalcitonin is the specific marker for bacterial and fungal infection. Its level is low during local bacterial and virus infection, autoimmunological diseases, but it is increased at the patients with sepsis, severe sepsis. In described case (patient with Wegener's granulomatosis) applying procalcitonin measurement and sensitive and specific microbiological diagnostic by using bronchio-alveolal lavage leads to successful treatment.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 11/2006; 21(124):351-3.
[show abstract][hide abstract] ABSTRACT: The transfusion of packed red blood cells (PRBCs) is a significant risk to blood recipients. Blood banking procedures permit the storage of PRBCs for up to 42 days. Storage of PRBCs can cause polymorphonuclear granulocytes (PMNs) activation and the development of neutrophil-mediated transfusion-related acute lung injury. The aim of our study was to determine if PRBC storage has an influence on the formation of arachidonic acid (AA) and advanced glycation end products (AGEs).
Twenty units of PRBCs were used to measure AA and AGE levels. The samples were taken on the 0th, 14th, 28th, and 42nd days of PRBC storage. The AA level was analyzed by gas-liquid chromatography-mass spectrometry and AGE level by an immunoenzymatic test.
During the first 14 days of PRBC storage, the AA level significantly increased and then slowly decreased. The AGE level increased continuously during the whole time of the study. In a model experiment, the AA glycoxidation product trans-2-nonenal (T2N) formed adducts in reaction with hemoglobin which were detectable with the test for AGE.
It is highly probable that the observed increase in AGE level is related to the decrease in AA in PRBCs, which can be associated with the formation of toxic aldehydes, especially T2N and 4-hydroxynonenal (HNE), from AA. Glucose in the PRBCs (preservative solution) can contribute to AGE formation as well. The formation of AGEs, HNE, and T2N in PRBCs, their influence on PMNs in vitro, and confirmation of our assumption need further studies.
[show abstract][hide abstract] ABSTRACT: Recombinant human activated protein C (drotrecogin alfa [activated]--DAA) demonstrated in Phase III controlled clinical studies significant reduction of mortality in patients with severe sepsis and high risk of death. The aim of the study was to assess the therapeutic efficacy of DAA in patients included in the National Severe Sepsis Register in Poland.
The analysis included 3233 cases of severe sepsis reported between 04.2003 and 11.2005. 302 patients (9.3%) were treated with DAA. The clinical course of the disease in DAA and non-DAA treatment groups was compared. Logistic regression models for the effects of independent variables on the risk of death (dependent variable) were developed.
In the patients treated with DAA, the relative risk of death was lower by 31% than in those who were not treated. In a multivariate logistic regression model, the use of DAA was, independently of the patient's age, severity of the clinical condition and type of organ dysfunction, the most significant mortality-reducing factor in severe sepsis.
The use of DAA in the treatment of severe sepsis proved to be a very effective method of mortality reduction. Controlled nationwide surveillance program contributed to its effective utilization. The National Severe Sepsis Register proved to be a very useful instrument for assessment of the course of the disease and treatment efficacy.
Medical science monitor: international medical journal of experimental and clinical research 04/2006; 12(3):CR107-12. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: Chronic exposure to nitrous oxide and volatile anaesthetics can threat the health of the operation theatre personnel. In Poland there are no regulations determining the maximum concentration of anaesthetic gases in the air. The results of measurement of N2O pollution of theatre atmosphere presented in the article exceed European and North American standards. Lack of appropriate technical facilities in operation rooms is aggravated by incompetence of the technical supervision staff and negligence of the anaesthesiological personnel. It is important to enforce European law and standards of work safety in operation rooms. It is of double impact, health protecting and ecological. The authors suggest introducing activities aiming toward the improvement of work conditions in operation rooms and the reduction of uncontrolled release of harmful anaesthetics.
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 12/2004; 17(101):438-42.
[show abstract][hide abstract] ABSTRACT: Severe sepsis is a clinical syndrome frequently occurring in intensive care units (ICUs) when systemic infection results in multiorgan dysfunction. No Polish data concerning treatment and prognosis in this group of patients have been available to date.
The Polish Working Group for Sepsis introduced in 2003 internet registration of severe sepsis cases treated in ICUs in Poland. Information about severe sepsis were entered including the type of infection, clinical course, methods and results of treatment.
From 20.04.2003 to 10.01.2004, 1043 severe sepsis cases were reported by 104 ICUs. Mean age of patients was 59 years. Mean duration of treatment was 19 days, with mortality rate of 55%. In 60% dysfunction of 4 or more organs was diagnosed. In 55% the underlying disease was surgical and abdominal cavity was the primary infection site (47%). Pathogens most likely to cause severe sepsis were G- (48%) and G+ (43%) bacteria, as well as fungi (21%). Positive blood culture was obtained in 45% of patients. Treatment involved antibiotic and support of organ function. Activated protein C was used in 8.2%, causing a reduction of mortality.
Severe sepsis in Polish ICUs develops most frequently in the course of intra-abdominal infections. Dysfunction of 4 or more organs caused observed high mortality (55%) Internet surveillance proved to be useful method of collecting information, widely accepted by personnel of ICUs.
Medical science monitor: international medical journal of experimental and clinical research 12/2004; 10(11):CR635-41. · 1.36 Impact Factor