Irene Karampela

Kinetics of circulating fetuin-A may predict mortality independently from adiponectin, high molecular weight adiponectin and prognostic factors in critically ill patients with sepsis: A prospective study

Purpose: Fetuin‐A and adiponectin, major hepatokine and adipokine respectively, have been implicated in systematic inflammation. Our aim was to jointly investigate whether kinetics of circulating fetuin‐A, adiponectin and its isoform HMWA predict 28‐day mortality in sepsis. Materials and methods: In a prospective study, serum fetuin‐A, adiponectin and HMWA were determined in 102 ICU patients fulfilling the diagnostic criteria of SEPSIS‐3, at enrollment and one week after, and in 102 healthy controls matched on age and gender. Results: Serum fetuin‐A was significantly lower in septic patients than controls (p < 0.001). Among septic patients, those with septic shock and nonsurvivors presented lower fetuin‐A, but higher adiponectin and HMWA compared to patients with sepsis and survivors respectively, both at baseline and day 7 (p < 0.001). Fetuin‐A exhibited negative correlations with APACHE II, CRP, procalcitonin, adiponectin and IL‐6 but a positive one with albumin. Reduced fetuin‐A as well as lower serum kinetics of fetuin‐A (HR: 0.55, 95% C.I. 0.34–0.91, p = 0.02), adiponectin but not HMWA were independently associated with 28‐day mortality adjusting for age, gender, BMI, APACHE II, septic shock and laboratory biomarkers. Conclusions: Circulating fetuin‐A kinetics may be a prognostic biomarker in septic patients. More research is essential to elucidate fetuin‐As ontological role in sepsis pathophysiology. HIGHLIGHTSSeptic patients have lower fetuin‐A but higher adiponectin and HMWA than controls.Serum fetuin‐A is reduced in septic shock compared to sepsis.Nonsurvivors present lower fetuin‐A kinetics during the first week of sepsis.Nonsurvivors show lower adiponectin and HMWA kinetics in the 1st week of sepsis.Circulating fetuin‐A kinetics is an independent predictor of mortality in sepsis.

Pulmonary aspergillosis: different diseases for the same pathogen.

Aspergillus, a ubiquitous fungus, may cause a variety of clinical syndromes in the lung, depending on immune status of the host as well as the presence of underlying lung disease. The clinical spectrum of pulmonary aspergillosis ranges from aspergilloma in patients with cavitary lung disease and allergic bronchopulmonary aspergillosis in patients with hypersensitivity to Aspergillus antigens to invasive pulmonary aspergillosis in immunocompromised patients and chronic necrotizing aspergillosis in patients with chronic lung disease or mild immunosuppression. Organ transplantation, immunosuppressive therapy, chronic lung disease, and critical illness are considered risk factors for pulmonary aspergillosis. During the last years, major advances have taken place in the diagnosis and management of these diseases with the development of newer noninvasive diagnostic techniques and antifungal agents, such as derivatives of azoles and echinocandins.

Hyperirisinemia is independently associated with subclinical hypothyroidism: correlations with cardiometabolic biomarkers and risk factors

PurposeIrisin, a newly discovered adipo-myokine, is implicated in the modulation of the adipose phenotype, increasing energy expenditure and ameliorating systemic metabolism. Our aim was to investigate circulating irisin in subclinical hypothyroidism (SH) and study its associations with cardiometabolic risk factors.MethodsIn a large case–control study, serum irisin, insulin resistance and lipid parameters, classic adipokines, inflammatory and hepatic biomarkers, and cardiovascular risk factors were determined in 120 consecutive patients with SH and 120 healthy controls matched on age, gender, and date of blood draw. Sixteen patients with SH received L-T4 treatment and, after 6 months, serum irisin and other biomarkers were assessed.ResultsSH cases exhibited significantly higher circulating irisin than controls (p < 0.001). In all participants, irisin was positively associated with TSH, anti-TG, HOMA-IR, C-peptide, lipid and inflammatory biomarkers, leptin, and cardiovascular risk factors, including Framigham score and apolipoprotein B/apolipoprotein A-I. Irisin was negatively correlated with adiponectin, HDL-C, and thyroid hormones. Serum irisin was independently associated with SH, above and beyond body mass index and cardiometabolic factors (p = 0.02). TSH was an independent predictor of circulating irisin (p = 0.003). L-T4 therapy did not reverse considerably the hyperirisinemic status in treated SH patients (p = 0.09).ConclusionsIrisin may represent an adipo-myokine counterbalancing a potential, gradual deterioration of lipid metabolism and insulin sensitivity in SH as well as reflecting a protective compensatory mechanism against oxidative muscle and thyroid cell stress. More mechanistic and prospective studies shedding light on the pathogenetic role of irisin in SH are needed to confirm and extend these data.

Chemerin as a biomarker at the intersection of inflammation, chemotaxis, coagulation, fibrinolysis and metabolism in resectable non-small cell lung cancer

OBJECTIVES Chemerin is an emerging adipocytokine at the intersection of inflammation, chemotaxis, thrombosis, fibrinolysis and metabolism. Our aims were 1) to explore circulating chemerin in resectable non-small cell lung cancer (NSCLC) taking into account its several interfaces; 2) to study its diagnostic potential; and 3) to assess its associations with clinicopathological features of NSCLC. MATERIALS AND METHODS In a large case-control study, serum chemerin, insulin resistance and lipid parameters, classic adipocytokines, inflammatory, coagulation, fibrinolysis and tumor biomarkers were determined in 110 consecutive patients with resectable NSCLC and 110 healthy controls matched on age (± 5 years), gender and date of blood draw (± 1 month). RESULTS NSCLC cases exhibited significantly elevated circulating chemerin compared to controls (p < 0.001). In NSCLC cases, chemerin was positively associated with Homeostasis model assessment score of insulin resistance (HOMA-IR), fibrinogen, plasminogen activity, tumor and inflammatory biomarkers, adiponectin, number of infiltrated lymph nodes and NSCLC stage. In control participants, circulating chemerin was positively correlated with somatometric, metabolic, lipid, hemostatic and inflammatory biomarkers, and leptin. Serum chemerin was independently associated with NSCLC, above and beyond NSCLC risk factors (OR: 2.20, 95% CI: 1.09-4.40, p = 0.03). In cases, hemostatic parameters (platelet count and plasminogen activity), HOMA-IR, CYFRA 21-1, creatinine and plant food consumption emerged as independent predictors of circulating chemerin (p < 0.05). Serum chemerin greater than 220 μg/L (cut-off point) yielded a sensitivity and a specificity of 63% and 91.8% respectively with a modest discriminative ability (AUC = 0.72, 95% C.I. 0.64-0.79) for the diagnosis of NSCLC. CONCLUSION Chemerin may represent a potentially useful biomarker in NSCLC integrating tumor-promoting networks, inflammatory and hemostatic mechanisms, and cancer-related metabolic pathways. More preclinical, prospective and longitudinal studies highlighting the pathogenetic role of chemerin in NSCLC are needed to corroborate and extend these data.

Fetuin-A to adiponectin ratio is a promising prognostic biomarker in septic critically ill patients

Fig. 1. Receiver operating characteristic (ROC) analysis of fetuin-A/adiponectin ratio, fetuin-A and adiponectin in cases versus controls at enrollment: fetuin-A/adiponectin ratio AUC (area under the curve), 0.94 (95% CI, 0.90–0.97), p b 0.001; fetuin-A AUC, 0.91 (95% CI, 0.86–0.96), p b 0.001; adiponectin AUC, 0.87 (95% CI, 0.83–0.92), p b 0.001. prognostic biomarker in septic critically ill patients