The change of plasma inflammatory cytokine in liver transplant patients with early sepsis
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Objective To observe the dynamic change of serum inflammatory cytokine in liver transplant patients with early sepsis.Methods 19 liver transplantation patients were divided into sepsis group(HSS group,n=9) and non-sepsis group(HSNS group,n=10) according to whether the patient developed sepsis or not early after operation(within 14 days).The level of serum inflammatory cytokine was detected at 30 min pre-transplantion and on 1 d,3 d,7 d,14 d post-transplantion.Their change and difference were compared between the two groups.Results The mean time for diagnosis of sepsis was 6 days.Compared with those before transplantation,post-transplant tumor necrosis factor(TNF)-α and interleulin(IL)-10 decreased after a slight increase on post-op day 1(P0.05).Then they kept low in HSNS group,while TNF-α increased again on post-op day 7 in HSS group.High mobility group box 1 protein(HMGB1) messenger ribonucleic acid(mRNA) expression in HSNS group was elevated post transplantion and reached to its peak on day 3.Then it began to decrease and came down to the level of that pre-transplantion.HMGB1 mRNA expression in HSS group was elevated significantly post transplantion and maintained at high level.Its expression was significantly higher than that of HSNS group all the time(all in P0.05).Conclusions In liver transplant patients with early sepsis,TNF-αelevated at the same as sepsis occurred.IL-10 increased later than TNF-α,but neither of them increased persistently during sepsis.HMGB1 increases before sepsis ocurred and maintained at high level.Dynamic mornitoring of HMGB1 expression may help to predict the development of early sepsis after liver transplantation.Keywords:
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Objective:To investigate the clinical effects of ulinastain on Soluble Triggering Receptor Expressed on Myeloid Cells-1(sTREM-1) expression in septic patients.Methods:Sixty patients with sepsis were divided randomly into two groups:classical treatment group with regular therapy and the other group was classical treatment plus ulinastain 200kU iv bid for 10 days,and 30 healthy individuals as control group The concentration of sTREM1 in plasma was measured by enzyme-linked immunosorbent assay and the level of serum CRP was detected by spectrophotometer in all patients.The acute physiology and chronic health evaluation M scoring system was applied to assess the severity of sepsis at the 3rd,7th and 10th days after treatment.The survival and dead patients in two sepsis groups were observed.Results:The plasma concentration of sTREM-1 and CRP are significantly higher in septic patients than those in the control group before treatment(P 0.05 ),and there was no difference between patients of the two groups(P 0.05).At the 3rd,7th and 10th days after treatment,the serum levels of sTREM1 and CRP decreased gradually in the two groups(P 0.05 ).In the ulinastain treatment group,the concentration of sTREM-1 and CRP and APACHEⅢscoring were much lower than the routine treatment group(P 0.05).The mortality at 28th day decreased significantly in the ulinastain treatment group(P 0.05).Conclusion:The treatment with ulinastain could reduce the serum level of sTREM-1 and CRP,alleviate the inflammatory reaction and decrease the occurrence of MODS in septic patients,so as to relieve the clinical symptoms and improve the prognosis of sepsis.
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Background There is still no information on the dynamics of pro- and anti-inflammatory cytokines and mark-ers of the septic process before the clinical manifestation of sepsis. The aim of the study was to analyze the dynamics of inflammation and sepsis markers concentration in early periods in patients with urgent pathology, depending on the subsequently developed sepsis. Materials and methods. The concentration of procalcitonin, C-reactive protein, LBP, IL-6, IL-10, IL-2R in 61 patients with a high risk of sepsis was investigated starting from the first day after admission to the hospital and then with intervals of 3–5 days. The Group 1 included 29 patients with verified sepsis. All patients of this group survived. The Group 2 included 8 patients who died. The Group 3 included 24 patients who had no clinical signs of sepsis. All the patients in this group recovered. Results. We revealed significant differences in concentrations of systemic inflammatory response markers and its dynamics in the period preceding clinical manifestations of sepsis. It was found that it was possible to predict the development of sepsis and its unfavorable outcome with a high statistical probability in the study of paired samples of blood serum of patients received on day 1–3 and 4–6 from the onset of the disease or severe trauma. The predictors were multidirectional changes of IL-6, IL-10, LBP concentrations and more than three-fold IL-2R increase on the background of high concentrations of procalcitonin and C-reactive protein. Conclusion. The highest concentrations of procalcitonin, C-reactive protein, IL-10 and IL-2R were revealed within the first three days in patients who died of sepsis. High concentrations of IL-6 and IL-10 within first three days and different directions of their concentrations during the next 4–6 days indicate the development of sepsis with an unfavorable outcome. Reduction of IL-2R and IL-6 and an increase in IL-10 within the first week after the onset of the disease or trau-ma are predictors of lethal outcome.
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Objective: The aim of this study was to explore the characteristics of changes of inflammatory cytokine concentrations in patients supported with extracorporeal membrane oxygenation( ECMO). Methods:Forty two consecutive adult patients supported with ECMO because of cardiac or pulmonary failure after cardiac surgery in Fuwai hospital were recruited in this research project. The plasma concentrations of inflammatory cytokines,including interleukin-6( IL-6),interleukin-8( IL-8),tumor necrosis factor-alpha( TNF-α),and anti—inflammatory cytokine interleukin-10( IL-10),and Hign-sensitive C-Reactive protein( hs-CRP),were measured at the time points( before and 1,6,24,48,72 hrs after the initiation of the ECMO supportation,and weaning off ECMO). The patients were divided into two groups( survival group and death group) according to hospital survival status. The data measured were compared between the two groups. Results: The concentrations of TNF-α,IL-6,IL-8,IL-10 and TNF-a in both groups were all kept in at higher level than normal. The concentrations of TNF-a in the survival group were declined at 24 hours after the ECMO supportation compared with the death group( P 0. 05). The concentrations of IL-6 in the survival group were declined at 6 hours and compared with the death group( P 0. 05) after 48 hours after the ECMO supportation. The concentrations of inflammatory cytokines were kept in higher level in the death group,compared with the survival group. Conclusion: The concentrations of inflammatory cytokines were increased obviously in patients who had cardiac or pulmonary failure after cardiac surgery. The concentrations of inflammatory cytokines in the survival group were declined gradually. The sustained high level of inflammatory cytokines was associated with poor outcome.
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The aim of the present study was to investigate the increase in serum and urine levels of high mobility group box protein 1 (HMGB1) during sepsis and the effect of blood purification treatments on HMGB1 levels and patient prognosis. A total of 40 intensive care patients with sepsis were randomly assigned to different groups (n=10 per group): A control group (sepsis group), a continuous renal replacement treatment (CRRT) group, a hemoperfusion (HP) group and an HP+CRRT group. The blood purification treatments using HP and/or CRRT were performed immediately after the diagnosis of sepsis. HMGB1 levels were measured using ELISA, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores and 30‑day survival rates were evaluated. Relative to a healthy control group (n=10), HMGB1 levels were observed to be significantly upregulated during sepsis (P<0.05). Following the initiation of sepsis, serum HMGB1 continued to increase in the sepsis group and was significantly elevated at 24 h (P<0.05), whereas urine HMGB1 levels decreased significantly at 12 and 24 h (P<0.05). Serum HMGB1 levels were significantly positively correlated with APACHE II scores (r=0.7284, P<0.01) and significantly negatively correlated with urine HMGB1 levels (r=‑0.5103, P=0.026). Serum HMGB1 levels were significantly reduced in the HP and HP+CRRT groups by 12 and 24 h following the initiation of treatment (both P<0.05). Changes in the urine HMGB1 level differed in each group. Relative to the sepsis group, the APACHE II scores of all blood purification groups were significantly reduced (P<0.05) and the 30‑day survival rate of the HP+CRRT group was significantly increased (P=0.0107). The results of the present study indicate that blood purification initiated at the point of diagnosis in patients with sepsis may attenuate serum HMGB1 upregulation, promote urinary excretion of HMGB1 and improve the prognosis of sepsis.
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Objective:To investigate the relationship between early serum cytokine levels and prognosis in patients with severe abdominal sepsis. Methods:A selfcontrol study was made in 59 cases. Within 24 hours of admission, the patients were evaluated by acute physiology and chronic health evaluationⅡ(APACHEⅡ) system. The blood samples were collected on the first and second days to determine tumor necrosis factorα(TNFα), soluble tumor necrosis factor receptor (STNFR), interleukin6 (IL6), IL8, white blood cell counts and platelet counts. The patients were divided into 2 groups: survivors and nonsurvivors. Results: Of all 59 patients 15 died. The APACHEⅡ score of the nonsurvivors was higher than that of survivors (21 3±6 2 vs. 9 3±5 4, P 0 05). There were no marked differences in white blood cell counts and platelet counts between the two groups. On the first day after admission, blood TNFα levels in survivor group were higher than that of nonsurvivors, and no difference in STNFR was found between the two groups. The serum IL6 levels of nonsurvivor group were higher than that of survivor group, and so did IL8. Of the 15 dead patients, there were 11 cases whose serum IL8 levels were over 100 μg/L on the first day, while only in 3 of 44 surviving patients the values were exceeding 100 μg/L. Conclusions:Serum IL6 and IL8 levels might be correlated with the severity of abdominal sepsis, and early elevation of IL8 levels might have a prognostic value in patients with severe abdominal sepsis.
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To better understand the role of granulocyte colony-stimulating factor (G-CSF) after the inflammatory response.Serum G-CSF concentrations were measured serially in 19 trauma and 15 sepsis patients. Changes in G-CSF concentration were compared with those in the neutrophil ratio, phagocytic and bactericidal activities, and other cytokines.G-CSF concentrations in trauma patients were elevated on day 1, but quickly decreased within 7 days. G-CSF reached its maximum 3 hours after injury, parallel with peaks of interleukin-6 (IL-6) and IL-8, but not of tumor necrosis factor-alpha (TNF-alpha). In sepsis patients, G-CSF as well as TNF-alpha, IL-6, and IL-8 concentrations were markedly elevated at diagnosis and remained high during the course of the illness. These levels decreased significantly in the 11 survivors. Up to 3 days after the trauma, nonsegmented neutrophil ratios were higher than those thereafter. Neutrophil phagocytic and bactericidal activities remained normal during the course of disease in both conditions.These results suggest that G-CSF plays an important role in the maturation and maintenance of function of neutrophils during the inflammatory response to trauma and sepsis.
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