Hsien-Hung Cheng

Serum adhesion molecules as predictors of bacteremia in adult severe sepsis patients at the emergency department.

BACKGROUND Bacteremia is a severe bacterial infection with significant mortality. Clinical parameters that reliably predict it are less elucidated. We assessed the potential of serum adhesion molecules for predicting bacteremia and compare it with current available infection biomarkers to determine a more timely predictor of adult severe sepsis patients on admission to the emergency department (ED). METHODS Sixty-seven consecutive non-traumatic, non-surgical adult patients with severe sepsis admitted to the ED were evaluated. Serum samples were collected and assessed while serum adhesion molecules were analyzed. RESULTS Thirty-one (46.2%) study patients had bacteremia. There were significant differences in both sICAM-1 and sE-selectin on admission between bacteremic and non-bacteremic patients. By stepwise logistic regression model, only sE-selectin was independently associated with bacteremia and any 1 ng/ml increase in level increased bacteremia rate by 0.8%. The cut-off value of sE-selectin level for predicting bacteremia was 117 ng/ml (84% sensitivity and 69% specificity). CONCLUSION Although serum cell adhesion markers are not specific for predicting bacteremia in septic patients, higher mean serum cell adhesion molecules levels on admission may imply both more severe infection and presence of bacteremia. Assay of serum adhesion molecules may be added as an infectious marker among the panel of bacteremic parameters in clinical practice, especially since early diagnosis and prompt antimicrobial therapy are essentially for survival.

Circulating endothelial progenitor cells may predict outcomes in adult patients with severe sepsis in the emergency department

BACKGROUND Dysfunctional and decreased numbers of endothelial progenitor cells (EPCs) may play an essential role in the initiation of organ dysfunction caused by severe sepsis. We evaluated the role of serial circulating EPCs in outcomes of patients with severe sepsis. METHODS In total, 101 adult patients with severe sepsis and septic shock were evaluated. Circulating levels of EPCs (CD133(+)/CD34(+) and KDR(+)/CD34(+) cells) were determined at different time points. RESULTS The levels of CD133(+)/CD34(+) and KDR(+)/CD34(+) EPCs were significantly higher in the severe sepsis group than in the healthy controls. Levels of CD133(+)/CD34(+) EPCs were significantly higher in the mortality group than in the survival group on day 1 of admission (p<0.05), but decreased significantly with time among non-survivors (p<0.05), and were lowest on day 4 at the emergency department. The Sequential Organ Failure Assessment score and number of CD133(+)/CD34(+) EPCs on admission were independently associated with in-hospital mortality. CONCLUSION The level of CD133(+)/CD34(+) EPCs on admission is independently associated with in-hospital mortality, and the trend of a sharp decrease in the number of EPCs is related to outcomes in patients with severe sepsis.

The prognostic value of leukocyte apoptosis in patients with severe sepsis at the emergency department

BACKGROUND AND AIM Cell apoptosis in critically ill patients plays a pivotal role in the pathogenesis of sepsis. This study aimed to determine the prognostic value of leukocyte apoptosis in patients with severe sepsis. METHODS Leukocyte apoptosis was determined by flow cytometry. The values of annexin V, APO2.7, and 7-amino-actinomycin D (7AAD) for each subtype of leukocyte were analyzed in 87 patients with severe sepsis and 27 controls. RESULTS The percentages of apoptosis (APO2.7 [%]) in the leukocyte subsets were significantly higher in the patients with severe sepsis than in the controls. The percentages of APO2.7 in leukocyte apoptosis, APO2.7 in lymphocytes apoptosis, and annexin V+7AAD in monocytes apoptosis were significantly higher in non-survivors than in survivors. Levels of APO2.7 in lymphocytes apoptosis, annexin V+7AAD in monocytes apoptosis, and serum lactate were all independently predictive of mortality. CONCLUSION Leukocyte apoptosis is significantly higher in patients with severe sepsis. The percentages of late lymphocyte and monocyte apoptosis may be predictive of outcome in such patients. Aside from serum lactate, APO2.7 level in lymphocyte apoptosis is also a useful predictor of outcome on admission to the emergency department.

Elevated Serum Vascular Cell Adhesion Molecule-1 Is Associated with Septic Encephalopathy in Adult Community-Onset Severe Sepsis Patients

Background and Aim. Septic encephalopathy (SE) is a common complication of severe sepsis. Increased concentrations of circulating soluble adhesion molecules are reported in septic patients. This study aimed to determine whether serum adhesion molecules are associated with SE. Methods. Seventy nontraumatic, nonsurgical adult patients with severe sepsis admitted through ER were evaluated. Serum adhesion molecules were assessed for their relationship with SE, and compared with other clinical predictors and biomarkers. Results. Twenty-three (32.8%) patients had SE. SE group had higher in-hospital mortality (40% versus 11%, P = 0.009) and their sVCAM-1, sICAM-1, and lactate levels on admission were also higher than non-SE group. By stepwise logistic regression model, sVCAM-1, age, and maximum 24-hours SOFA score were independently associated with septic encephalopathy. The AUC analysis of ROC curve of different biomarkers showed that sVCAM-1 is better to predict SE. The sVCAM-1 levels in the SE group were significantly higher than those of the non-SE group at three time periods (Days 1, 4, and 7). Conclusions. Septic encephalopathy implies higher mortality in nontraumatic, nonsurgical patients with severe sepsis. VCAM-1 level on presentation is a more powerful predictor of SE in these patients than lactate concentration and other adhesion molecules on admission.

The value of serial serum cell adhesion molecules in predicting acute kidney injury after severe sepsis in adults

BACKGROUND Septic acute kidney injury (AKI) is a common complication of severe sepsis. We tested the hypothesis that serum cell adhesion molecule levels are substantially increased in early septic AKI and decreased after antimicrobial therapy and their level can predict prognosis. METHODS Seventy-two nontraumatic, nonsurgical adult patients with severe sepsis admitted to the emergency department were evaluated. Serum adhesion molecules were collected and assessed. We evaluated their relationship with early septic AKI compared with other clinical predictors and biomarkers. RESULTS Forty-five patients (62.5%) experienced early septic AKI. Patients with septic AKI also were more likely to experience septic shock and respiratory failure and had higher in-hospital mortality. Stepwise logistic regression model revealed that E-selectin level, septic shock, and respiratory failure were independently associated with septic AKI and each 1ng/ml increase in serum E-selectin level increased the risk of septic AKI by 1%. Furthermore, the E-selectin levels in the septic AKI group were significantly higher than those in the non-AKI group at two different times (days 1 and 4). CONCLUSION WE show that early septic AKI implies a higher mortality in severe sepsis patients and that E-selectin level at presentation is a powerful predictor of early septic AKI.

Manifestations and Outcomes of Patients with Parkinson’s Disease and Serious Infection in the Emergency Department

Background Several comorbidities contribute to an increased risk of infections in Parkinsons disease (PD) as the disease progresses. However, few studies have examined the correlation between sepsis and PD. Aim The aim of this study is to disclose the presentation and outcome of serious infection in patients with PD in the emergency department. Methods This retrospective cohort study enrolled patients with PD who had serious infection and were admitted to the emergency department between January 2007 and December 2013. For clinical comparison, we compared the clinical features, laboratory data, and outcomes with those of age- and sex-matched patients who had serious infection but not PD. Results There were a total of 1,200 episodes of infected PD patients and 2,400 age- and sex-matched infected patients without PD as disease controls. PD patients had fewer comorbidities and lower severity of infectious disease but longer hospital stays than control group patients. The incidences of respiratory tract and urinary tract infections were higher in PD patients. The levels of inflammatory and organ dysfunction biomarkers in PD were lower and compatible with the severity of infectious disease. A total of 86 (7.2%) infected PD patients died during the 28-day admission compared to 339 (14.1%) in non-PD patients. Serum C-reactive protein, bandemia, and lactate could be used to predict mortality in infected PD patients. Conclusions In infected patients with PD, respiratory and urinary tract infections were the two most common infectious sources. Empiric therapy based on experience could treat both respiratory and urinary tract infections. Early diagnosis and treatment are essential for survival.