Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Kassianidis Georgios
Dissertation committee:
Γεώργιος Δημόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Ι. Γιαμαρέλλος – Μπουρμπούλης Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ηρακλής Τσαγκάρης Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χριστίνα Ρούτση, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αντώνιος Παπαδόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Μισιακός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γαρυφαλλιά Πουλάκου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Ανοσολογική απόκριση του πολυτραυματία και μεταβολές στη σήψη
Translated title:
Immune response of the multi-injured patient and changes in sepsis
Summary:
The physiological response to infection of a host is a process designed to isolate and contain the invading bacterium. This is achieved by the activation and mobilisation of circulating and tissue macrophages and the production of pro-inflammatory and anti-inflammatory mediators. At the same time the repair process of damaged tissues is mobilised. A similar response is triggered in multi-injured patients where trauma-damaged tissues are the trigger mechanism for initiating the inflammatory response. The balance between pro-inflammatory and anti-inflammatory mediators is a decisive factor in the progression of the infection towards cure or deterioration. When the balance is disturbed in favour of the pro-inflammatory response then the infection becomes generalised and involves healthy tissues distant from the site of infection or injury. The timing in the transition of an inflammatory response (infection or trauma) from improvement to loss of immune balance and transition to sepsis is extremely important. Early intervention often determines the outcome as well. For early recognition of this transition, a measurable and reliable marker of normal biological processes, pathological processes or responses to therapeutic interventions is needed. An ideal biomarker for sepsis should have a high sensitivity that allows early diagnosis and be specific for pathogenic organisms that will allow appropriate treatment. The Covid- 19 period has highlighted more than ever the need for immediate biomarker discovery.Covid-19 positive patients of various severities (asymptomatic, intermediate severity, critically ill and intubated) were studied and 20 different mediators were measured within 24 hours of hospital admission.The primary endpoint was associations with severe disease and the secondary endpoint was to determine the pathways associated with mortality.Levels of proinflammatory mediators (IL)-8, IL-18, matrix metalloproteinase-9, platelet-derived growth factor (PDGF)-B and calprotectin (S100A8/A9) were significantly increased in patients with ARDS and mechanical ventilatory support.The anti-inflammatory mediators IL-1ra and IL-33r were also elevated while IL-38 was elevated in asymptomatic but significantly decreased in severely affected patients.IL-6, IL-33 and calprotectin were associated with a significant likelihood of poor outcome.More specifically, calprotectin was significantly increased in patients who deteriorated with transition to ARDS and mechanical ventilation.Further investigation and comparison with other acute phase factors such as ferritin and C-reactive protein are needed.
Main subject category:
Health Sciences
Keywords:
Sepsis, Calprotectin, S100A8/A9, IL-1RA, IL-33R, PDFG-B
Number of references:
185
File:
File access is restricted until 2025-07-12.
Kassianidis_Georgios_PhD.pdf
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File access is restricted until 2025-07-12.
