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Distinct Inflammatory Mediator Patterns Characterize Infectious and Sterile Systemic Inflammation in Febrile Neutropenic Hematology Patients

Artikel i vetenskaplig tidskrift
Författare Christine Wennerås
Lars Hagberg
Rune Andersson
Lars Hynsjö
Anders Lindahl
M. Okroj
A. M. Blom
Peter Johansson
Björn Andreasson
Johan Gottfries
Agnes E Wold
Publicerad i Plos One
Volym 9
Nummer/häfte 3
Sidor e92319
ISSN 1932-6203
Publiceringsår 2014
Publicerad vid Institutionen för biomedicin, avdelningen för klinisk kemi och transfusionsmedicin
Institutionen för medicin
Institutionen för kemi och molekylärbiologi
Institutionen för biomedicin, avdelningen för infektionssjukdomar
Sidor e92319
Språk en
Länkar dx.doi.org/10.1371/journal.pone.009...
Ämnesord SERUM ALPHA-FETOPROTEIN, C4B-BINDING PROTEIN, IMMUNE-SYSTEM, DISEASES, BLOOD, TRANSPLANTATION, BACTEREMIA, ACTIVATION, CITRULLINE, MORTALITY
Ämneskategorier Mikrobiologi, Infektionsmedicin

Sammanfattning

Background: Invasive infections and sterile tissue damage can both give rise to systemic inflammation with fever and production of inflammatory mediators. This makes it difficult to diagnose infections in patients who are already inflamed, e.g. due to cell and tissue damage. For example, fever in patients with hematological malignancies may depend on infection, lysis of malignant cells, and/or chemotherapy-induced mucosal damage. We hypothesized that it would be possible to distinguish patterns of inflammatory mediators characterizing infectious and non-infectious causes of inflammation, respectively. Analysis of a broad range of parameters using a multivariate method of pattern recognition was done for this purpose. Methods: In this prospective study, febrile (>38 degrees C) neutropenic patients (n = 42) with hematologic malignancies were classified as having or not having a microbiologically defined infection by an infectious disease specialist. In parallel, blood was analyzed for 116 biomarkers, and 23 clinical variables were recorded for each patient. Using O-PLS (orthogonal projection to latent structures), a model was constructed based on these 139 variables that could separate the infected from the non-infected patients. Non-discriminatory variables were discarded until a final model was reached. Finally, the capacity of this model to accurately classify a validation set of febrile neutropenic patients (n = 10) as infected or non-infected was tested. Results: A model that could segregate infected from non-infected patients was achieved based on discrete differences in the levels of 40 variables. These variables included acute phase proteins, cytokines, measures of coagulation, metabolism, organ stress and iron turn-over. The model correctly identified the infectious status of nine out of ten subsequently recruited febrile neutropenic hematology patients. Conclusions: It is possible to separate patients with infectious inflammation from those with sterile inflammation based on inflammatory mediator patterns. This strategy could be developed into a decision-making tool for diverse clinical applications.

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