Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Meta Analysis
Predictors of mortality in adult patients with ventilator-associated pneumonia: a meta-analysis.
Studies exploring predictors of mortality in patients with ventilator-associated pneumonia (VAP) produced conflicting results. The present work is a meta-analysis of studies that enrolled only patients with microbiologically confirmed VAP and reported on mortality. Potentially eligible reports were searched in PubMed, EMBASE, CINAHL, and HEALTHSTAR with no language restrictions. ⋯ Isolation of nonfermenting gram-negative bacteria in general (OR, 1.71; 95% CI, 1.09-2.68) and Acinetobacter baumannii in specific (OR, 1.74; 95% CI, 1.02-2.96) was also associated with higher fatality. Intensive care unit admission caused by trauma, as opposed to other reasons, was linked to lower mortality (OR, 0.35; 95% CI, 0.22-0.57). These findings may help investigators to formulate appropriate predicting scores for patients with VAP and may further motivate clinicians to provide appropriate initial treatment and to manage sepsis and shock optimally in such patients.
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Recent reports have indicated that IL-1[beta] is excessively released into the circulation during sepsis, and the expression level is closely correlated with the clinical course. Polymorphisms in the promoter region of IL-1B have been shown to affect LPS-induced IL-1[beta] transcription in vitro and IL-1[beta] plasma levels in healthy adults and to confer susceptibility to inflammatory diseases. However, it is not clear whether they confer susceptibility to sepsis after major trauma. ⋯ GCT homozygote patients also showed higher multiple organ dysfunction scores than CTC homozygote patients (P = 0.048). These data suggest that the IL-1[beta] promoter polymorphisms -1470G/C, -511T/C, and -31C/T may be functional both in vitro and in vivo. It may be possible to use these polymorphisms as relevant risk estimates for sepsis in trauma patients.
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As a crucial element of innate immunity, the complement cascade becomes activated after severe trauma. Regulation of the complement cascade and protection against complement-mediated tissue destruction is provided by a selection of soluble and membrane-bound complement regulatory proteins (CRegs). To date, the leukocyte expression profile of CRegs in multiple injured patients is unknown. ⋯ CD88 expression was considerably reduced on leukocytes between 0 and 240 h after injury. CD59, CD46, and CD88 expression values on neutrophils reversely correlated with severity of injury. In summary, expression profiles of CRegs and CD88 on leukocytes are specifically altered after polytrauma in humans, indicating a trauma-induced "complementopathy."
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High-mobility group box protein 1 (HMGB1) is a nuclear protein that may be released actively from monocytes and macrophages or passively from necrotic or damaged cells. Several experimental data suggest that burn injury is accompanied by elevated plasma HMGB, but there are only few data available about its changes in burned patients. The aim of this study was to follow the time course and the prognostic value of plasma HMGB1 and cytokine changes in patients with severe burn injury affecting more than 10% of body surface area (n = 26). ⋯ Receiver operating characteristic analysis of data on admission showed that at a level of 16 ng/mL, HMGB1 indicated lethality, with 75.0% sensitivity and 85.7% specificity. Using the cutoff level of 14 pg/mL, IL-10 predicted intensive care unit mortality, with 85.7% sensitivity and 84.2% specificity. Very early HMGB1 and IL-10 release may have an important impact on the immune function of patients after burn trauma.