[show abstract][hide abstract] ABSTRACT: Severe thermal injury causes an immune dysfunction which includes a decrease of monocyte human leukocyte antigen DR (HLA-DR) expression. Interleukin-10 exerts a negative influence on this parameter in vitro. In this study we determined the prognostic value of reduced monocyte HLA-DR expression with regard to infectious complications, and the in vivo association between monocyte HLA-DR and plasma interleukin-10 concentration. Both quantities were measured serially in 19 patients with severe burns. HLA-DR expression was determined by direct immunofluorescence on a flow cytometer, and interleukin-10 was measured by ELISA. After burn trauma the percentage of HLA-DR expressing monocytes fell markedly (median: 53% at day 2, 36% at day 4, 31% at day 7, 28% at day 9, 35% at day 12, and 42% at day 14; compared to 93% for healthy volunteers). Moreover, patients who became septic showed lower monocyte HLA-DR expression than non-septic patients; the differences were significant at day 2 (p < 0.01) and day 7 (p < 0.05). Plasma concentrations of interleukin-10 increased after thermal injury (median: 40 ng/l at day 2, 43 ng/l at day 4, 77 ng/l at day 7, 120 ng/l at day 9, 63 ng/l at day 12, and 82 ng/l at day 14). Individual HLA-DR expression and interleukin-10 concentration were negatively correlated, the association reaching statistical significance at day 4 (p=0.006) and day 7 (p=0.031). Thus, after severe burn injury monocyte HLA-DR expression has prognostic value and is negatively associated with interleukin-10 plasma concentration.
Clinical Chemistry and Laboratory Medicine 04/1999; 37(3):193-8. · 3.01 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study investigates whole body potassium status and its associations with disease stage, nutritional status, and prognosis in patients with liver cirrhosis. Two hundred and twenty-five patients were assessed for disease stage, total body potassium (TBP), anthropometric muscle mass, and energy expenditure. Subsets of patients were investigated by quantitative liver function tests or followed for survival. Patients with liver disease had lost 32.6% of TBP as compared to controls or 22.0–32.9% as compared to predictive equations. Potassium loss was independent of Child–Pugh class (A, 32.1%; B, 32.4%; C, 35.2%) as was whole body muscle mass (A, 19.5 kg; B, 18.8 kg; C, 20.1 kg). Potassium loss was not associated with diuretic therapy and not enhanced in alcoholic cirrhosis. But muscle mass, resting energy expenditure (REE) and ascites grade correlated with potassium loss (multiple r=0.40, P35% had reduced survival, but this association was not independent of Child–Pugh class. Thus, TBP loss is not related to disease stage, liver function, diuretic treatment or origin of liver disease, but related to muscle mass, energy expenditure, and ascites, and therefore reflects modifications in body composition and metabolism. TBP status does, however, not add significantly to the prognostic power of the established Child–Pugh scoring system.
Hepatology Research - HEPATOL RES. 01/1999; 16(1):36-48.
[show abstract][hide abstract] ABSTRACT: High serum concentrations of procalcitonin (PCT), the 116 amino acid precursor protein of the hormone calcitonin, have been found in patients with various bacterial infections, particularly in those with sepsis. Because recent reports have shown that serum PCT constitutes a useful parameter for the diagnosis of sepsis in patients with several clinical conditions, a temporal analysis of the PCT concentrations in the plasma of 19 patients with severe burns (median body surface area burned, 32%) was conducted retrospectively. Nine patients were classified as septic on the basis of standardized clinical and laboratory parameters. Compared with the nonseptic group, these patients showed higher plasma PCT throughout the study period (median concentrations of septic vs nonseptic patient groups: 0.4 vs. 0.2 microg/L on postburn day 2; 1.0 vs. 0.3 microg/L on postburn day 4; 5.5 vs. 0.3 microg/L on postburn day 7; 10.8 vs. 0.5 microg/L on postburn day 9; 4.2 vs. 0.4 microg/L on postburn day 12; and 1.7 vs. 0.5 microg/L on postburn day 14), with differences considered to be significant (P<.05) from day 7 on. In contrast, differences in the plasma C-reactive protein concentrations were less pronounced and never reached statistical significance. PCT concentrations exceeding 15 microg/L were only observed in the 3 patients who died of sepsis-induced multiple organ failure. In addition to absolute PCT, individual time courses were also of diagnostic value. PCT is a highly efficient laboratory parameter for the diagnosis of severe infectious complications after a burn injury.
Journal of Burn Care & Rehabilitation 01/1999; 20(5):354-60. · 2.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: A prototype of the CELL-DYN 3200 haematology analyser was evaluated in a tertiary care hospital laboratory. Precision, effects of sample ageing, linearity, carry-over, and comparability of cellular blood counts and five-part leucocyte differentiation were determined in accordance with the ICSH guidelines for the evaluation of blood cell analysers; the results were satisfactory for all parameters tested: haemoglobin concentration, RBC, MCV, WBC, platelet count, and counts of neutrophils, lymphocytes, monocytes, and eosinophils. Two-hundred and forty-seven routine blood samples were used for the comparability studies. The cellular blood count results from the CELL-DYN 3200 and the Bayer Diagnostic H-1 systems corresponded closely (correlation coefficient r > 0.96 for all parameters). For 201 samples without an instrument-generated suspect flag the same was true with regard to the differential parameters, although somewhat lower correlation was observed for monocyte counts (r = 0.88). Comparisons to 400-cell microscopic differentials gave similar results (r > 0.93 for neutrophil, lymphocyte and eosinophil counts). Our results suggest that the CELL-DYN 3200 analyser will serve the needs for automated blood cell counting and differential leucocyte counting in a tertiary care hospital laboratory.
[show abstract][hide abstract] ABSTRACT: This study describes a rapid increase of serum lipase activity during an episode of severe abdominal pain in a female patient with macrolipasaemia and pancreas divisum. Serum lipase activity was persistently elevated in the patient with simultaneously low levels of amylase activity which only increased in association with endoscopic retrograde cholangiopancreatography. Polyethylene glycol precipitation experiments, as well as the results of exclusion chromatography, demonstrated that the high lipase activity was due to a macromolecule of approximately 200000 Da. Affinity chromatography and immunological investigations further indicated that the atypical time-course of lipase activity was not due to alterations of the patient's lipase, but due to lipase-binding autoantibodies resulting in the formation of immune complexes between lipase and immunoglobulin G lambda. Our results show that macrolipasaemia must be considered as a possible cause in patients with unexplained raised serum lipase activity.
Scandinavian Journal of Clinical and Laboratory Investigation 09/1997; 57(5):435-43. · 1.29 Impact Factor
[show abstract][hide abstract] ABSTRACT: The clinical relevance of malnutrition and hypermetabolism in end-stage liver disease, as well as their effects on survival after liver transplantation (LTx), are largely unknown. This study investigates the prognostic value of nutritional and metabolic parameters obtained before LTx for survival after LTx. One hundred fifty patients with end-stage liver disease undergoing LTx were assessed prospectively and followed for a mean period of 46 +/- 16 months after LTx. All patients were randomized into a study group and a validation group, each comprising 75 patients. Body composition analysis (24-hour urinary creatinine excretion, anthropometry, bioelectrical impedance analysis), deviation of measured from predicted resting energy expenditure (deltaREE), year of transplantation, and several variables known to be of prognostic relevance in patients with liver disease undergoing conservative treatment were analyzed. Kaplan-Meier and log rank analysis showed that hypermetabolic patients (deltaREE > +20%) and patients with a body cell mass (BCM) < 35% of body weight tended to have reduced survival after LTx. A risk profile on the basis of deltaREE and BCM identified patients with high risk (5-year survival rate, 54%) and low risk (5-year survival rate, 88%; P < .01). The predictive power of this risk profile was independent of the presence of ascites and clinical edema, and its validity was confirmed in the validation group (P < .01). The Child-Pugh score was not of prognostic value. We conclude that a poor nutritional state, as well as hypermetabolism, adversely affects survival after LTx. These potentially treatable presurgical factors deserve close attention in interventional studies.
[show abstract][hide abstract] ABSTRACT: In comparison to a triple wavelength procedure, the dual wavelength method for the determination of plasma haemoglobin concentration using the ACA analyzer showed considerable interference with hypertriglyceridaemic (triacylglycerols > 2.3 mmol/l) plasma. By addition of isolated human lipoprotein fractions to normotriglyceridaemic plasma, chylomicrons were identified as a major source of interference with the ACA plasma haemoglobin method, whereas VLDL was without effect up to a triacylglycerol concentration of 5.7 mmol/l. Airfuge ultracentrifugation proved to be a reliable means for removal of interfering lipid. We conclude that the extent of lipid interference with the ACA plasma haemoglobin method is highly dependent on the type of lipoprotein present. An accurate measurement of plasma haemoglobin concentrations in non-fasting plasma can only be ensured after lipid removal through airfuge ultracentrifugation.
European journal of clinical chemistry and clinical biochemistry: journal of the Forum of European Clinical Chemistry Societies 10/1996; 34(10):811-6.
[show abstract][hide abstract] ABSTRACT: The performance of the CELL-DYN 1700 (Abbott Diagnostics, Abbott Park, IL, USA) was evaluated in a tertiary care hospital laboratory using the guidelines proposed by the German Society of Clinical Chemistry. Precision, accuracy, linearity, background counts, and carry-over were satisfactory for all measured standard parameters including haemoglobin concentration, haematocrit, red blood cell count, mean corpuscular volume (MCV), red cell distribution width (RDW), white blood cell count and platelet count. With 259 selected normal and abnormal blood samples the results of the CELL-DYN 1700 (CD1700) compared very well (r > 0.96 for all parameters with exception of RDW) with those obtained with the Bayer Diagnostic H-1 and the Hoffmann-La Roche Cobas Argos systems. This study considered in particular the performance of the CD1700 three-part leucocyte differential. For those samples without instrument-generated suspect flags, the neutrophil and lymphocyte percentages were highly correlated with the results of the H-1 blood cell counter (r = 0.97 and 0.98, respectively) and with manual 400-cell differentials (r = 0.91 and 0.88, respectively). In contrast, the CD1700 mid-fraction which comprised the composite total of monocytes, eosinophils, basophils and precursor white cells (when present) could not be directly compared to the differentials from the H-1 system or from manual microscopy. For those samples with CD1700 instrument suspect flags, the neutrophil and lymphocyte differential results also compared well with both the H-1 (r = 0.93 and 0.93, respectively) and manual estimates (r = 0.89 and 0.87, respectively). In conclusion, the CD1700 is an accurate haematology analyser for cellular blood counts and three-part leucocyte differentiation.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to investigate nutritional status and protein metabolism during total parenteral nutrition (TPN) in AIDS patients with weight loss. Six patients on treatment for AIDS-associated complications were investigated and reviewed TPN that supplied energy equivalent to 1.5 times the resting energy expenditure (REE). Amino acid (AA) supply increased from 0.6 g/kg body weight (BW)/d on days 1 to 3 and 1.2 on days 4 to 6 to 1.8 on days 7 to 9. Nonprotein energy was given as equicaloric amounts of glucose and fat emulsion. There were repeated measurements of nitrogen balance and whole-body protein turnover (WBPT) using a bolus 15N-glycine method on the morning of days 3, 6, and 9. Principal findings were as follows: (1) increasing the supply of AAs significantly improves nitrogen balance in AIDS patients; (2) there is no simple linear effect of increasing amounts of AAs on WBPT in AIDS patients; (3) WBPT is high and variable in these patients; and (4) mean WBPT of each patient is significantly correlated with body cell mass (BCM) as a proportion of BW (P < .001, r = .92). We conclude that poor nutritional status in AIDS patients with weight loss is associated with high WBPT. However, these patients can attain at least transiently positive nitrogen balance with sufficient protein intake, predominantly through an increase in whole-body protein synthesis (WBPS).
[show abstract][hide abstract] ABSTRACT: In a multicentre study anticardiolipin antibodies of the IgG and IgM isotypes were measured by a solid phase enzyme immunoassay in 368 patients with systemic lupus erythematosus (SLE) who were not selected on the basis of features of antiphospholipid syndrome. Clinical and laboratory associations of increased levels of anticardiolipin antibodies were evaluated. IgG and IgM antibodies to cardiolipin were documented in 224 (60.9%) and 128 (34.8%) patients, respectively. Regarding the symptoms of antiphospholipid syndrome, elevated amounts of anticardiolipin IgG were significantly associated with spontaneous abortion (PPPPP
Rheumatology International 04/1995; 15(1):23-29. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: In a multicentre study anticardiolipin antibodies of the IgG and IgM isotypes were measured by a solid phase enzyme immunoassay in 368 patients with systemic lupus erythematosus (SLE) who were not selected on the basis of features of antiphospholipid syndrome. Clinical and laboratory associations of increased levels of anticardiolipin antibodies were evaluated. IgG and IgM antibodies to cardiolipin were documented in 224 (60.9%) and 128 (34.8%) patients, respectively. Regarding the symptoms of antiphospholipid syndrome, elevated amounts of anticardiolipin IgG were significantly associated with spontaneous abortion (P < 0.001), thrombocytopenia (P < 0.01), livedo reticularis (P < 0.01) and a positive direct Coombs test (P < 0.05), but not with thrombosis or central nervous system diseases such as epilepsy and psychosis. IgM antibodies to cardiolipin were associated with a positive direct Coombs test (P < 0.01), but with no other symptom of antiphospholipid syndrome. The predictive values of anticardiolipin antibody determinations in unselected SLE patients were poor for all features of antiphospholipid syndrome because of high proportions of false-positive and false-negative results. As for other manifestations of SLE, positive correlations between raised antibodies to double-stranded DNA and the occurrence of anticardiolipin antibodies of the IgG isotype were observed, and anticardiolipin IgM was negatively associated with nephritis.
Rheumatology International 02/1995; 15(1):23-9. · 2.21 Impact Factor