التفاصيل البيبلوغرافية
| العنوان: |
Immunoparalysis and nosocomial infection in children with multiple organ dysfunction syndrome. |
| المؤلفون: |
Hall, Mark W., Knatz, Nina L., Vetterly, Carol, Tomarello, Steven, Wewers, Mark D., Volk, Hans Dieter, Carcillo, Joseph A. |
| المصدر: |
Intensive Care Medicine; Mar2011, Vol. 37 Issue 3, p525-532, 8p, 2 Charts, 2 Graphs |
| مصطلحات موضوعية: |
NOSOCOMIAL infections in children, MULTIPLE organ failure, GRANULOCYTE-macrophage colony-stimulating factor, TUMOR necrosis factors, IMMUNOSUPPRESSION, BIOMARKERS, PATIENTS |
| مستخلص: |
Purpose: Immunoparalysis defined by prolonged monocyte human leukocyte antigen DR depression is associated with adverse outcomes in adult severe sepsis and can be reversed with granulocyte macrophage colony-stimulating factor (GM-CSF). We hypothesized that immunoparalysis defined by whole-blood ex vivo lipopolysaccharide-induced tumor necrosis factor-alpha (TNFα) response <200 pg/mL beyond day 3 of multiple organ dysfunction syndrome (MODS) is similarly associated with nosocomial infection in children and can be reversed with GM-CSF. Methods: In study period 1, we performed a multicenter cohort trial of transplant and nontransplant multiple organ dysfunction syndrome (MODS) patients (≥2 organ failure). In study period 2, we performed an open-label randomized trial of GM-CSF therapy for nonneutropenic, nontransplant, severe MODS patients (≥3 organ failure) with TNFα response <160 pg/mL. Results: Immunoparalysis was observed in 34% of MODS patients ( n = 70) and was associated with increased nosocomial infection (relative risk [RR] 3.3, 95% confidence interval [1.8-6.0] p < 0.05) and mortality (RR 5.8 [2.1-16] p < 0.05). TNFα response <200 pg/mL throughout 7 days after positive culture was associated with persistent nosocomial infection, whereas recovery above 200 pg/mL was associated with resolution of infection ( p < 0.05). In study period 2, GM-CSF therapy facilitated rapid recovery of TNFα response to >200 pg/mL by 7 days ( p < 0.05) and prevented nosocomial infection (no infections in seven patients versus eight infections in seven patients) ( p < 0.05). Conclusions: Similar to in adults, immunoparalysis is a potentially reversible risk factor for development of nosocomial infection in pediatric MODS. Whole-blood ex vivo TNFα response is a promising biomarker for monitoring this condition. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
