Τίτλος:
Macrophage activation-like syndrome: An immunological entity associated with rapid progression to death in sepsis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: A subanalysis of a randomized clinical trial indicated sepsis survival benefit from interleukin (IL)-1 blockade in patients with features of the macrophage activation-like syndrome (MALS). This study aimed to investigate the frequency of MALS and to develop a biomarker of diagnosis and prognosis. Methods: Patients with infections and systemic inflammatory response syndrome were assigned to one test cohort (n = 3417) and a validation cohort (n = 1704). MALS was diagnosed for patients scoring positive either for the hemophagocytic syndrome score and/or having both hepatobiliary dysfunction and disseminated intravascular coagulation. Logistic regression analysis was used to estimate the predictive value of MALS for 10-day mortality in both cohorts. Ferritin, sCD163, IL-6, IL-10, IL-18, interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) were measured in the blood the first 24 h; ferritin measurements were repeated in 747 patients on day 3. Results: The frequency of MALS was 3.7% and 4.3% in the test and the validation cohort, respectively. In both cohorts, MALS was an independent risk factor for 10-day mortality. A ferritin level above 4420 ng/ml was accompanied by 66.7% and 66% mortality after 28 days, respectively. Ferritin levels above 4420 ng/ml were associated with an increase of IL-6, IL-18, INF-γ, and sCD163 and a decreased IL-10/TNF-α ratio, indicating predominance of pro-inflammatory phenomena. Any less than 15% decrease of ferritin on day 3 was associated with more than 90% sensitivity for unfavorable outcome after 10 days. This high mortality risk was also validated in an independent Swedish cohort (n = 109). Conclusions: MALS is an independent life-threatening entity in sepsis. Ferritin measurements can provide early diagnosis of MALS and may allow for specific treatment. © 2017 The Author(s).
Συγγραφείς:
Kyriazopoulou, E.
Leventogiannis, K.
Norrby-Teglund, A.
Dimopoulos, G.
Pantazi, A.
Orfanos, S.E.
Rovina, N.
Tsangaris, I.
Gkavogianni, T.
Botsa, E.
Chassiou, E.
Kotanidou, A.
Kontouli, C.
Chaloulis, P.
Velissaris, D.
Savva, A.
Cullberg, J.-S.
Akinosoglou, K.
Gogos, C.
Armaganidis, A.
Giamarellos-Bourboulis, E.J.
on behalf of the Hellenic Sepsis Study Group
Εκδότης:
BioMed Central Ltd.
Λέξεις-κλειδιά:
CD163 antigen; ferritin; gamma interferon; interleukin 10; interleukin 18; interleukin 6; tumor necrosis factor; ferritin; interleukin 18, Article; cohort analysis; controlled study; death; disease association; disseminated intravascular clotting; early diagnosis; ferritin blood level; hemophagocytic syndrome; hepatobiliary disease; human; immunopathology; infection; macrophage activation like syndrome; major clinical study; mortality; mortality risk; predictive value; prognosis; protein analysis; protein blood level; risk factor; sensitivity analysis; sepsis; Swedish citizen; systemic inflammatory response syndrome; validation process; adult; aged; complication; female; macrophage activation syndrome; male; metabolism; middle aged; pathology; prospective study; randomized controlled trial; reproducibility; sepsis; young adult, Adult; Aged; Cohort Studies; Female; Ferritins; Humans; Interleukin-18; Macrophage Activation Syndrome; Male; Middle Aged; Prognosis; Prospective Studies; Reproducibility of Results; Sepsis; Young Adult
DOI:
10.1186/s12916-017-0930-5
