Plasma protein biomarkers reflective of the host response in patients developing Intensive Care Unit-acquired pneumonia
-
Published:2023-07-06
Issue:1
Volume:27
Page:
-
ISSN:1364-8535
-
Container-title:Critical Care
-
language:en
-
Short-container-title:Crit Care
Author:
van Engelen Tjitske S. R.ORCID, Reijnders Tom D. Y.ORCID, Paling Fleur P.ORCID, Bonten Marc J. M.ORCID, Timbermont LeenORCID, Malhotra-Kumar SurbhiORCID, Kluytmans Jan A. J. W.ORCID, Peters-Sengers HesselORCID, van der Poll TomORCID, Wolkewitz Martin, Ali Omar, Ruzin Alexey, Timbermont Leen, Lammens Christine, Hullegie Sebastiaan, Troeman Darren, van Hout Denise, Prins Daniël, Kalyani Rubana, Eickhoff Mark, Shoemaker Kathryn, Vilken Tuba, Vlaeminck Jelle, Coppens Jasmine, van der Schalk Thomas, Xavier Basil Britto, Odisseeva Evelina, Vatcheva Rossitza, Drab Michal, Vajter Jaromir, Tamme Kadri, Fartoukh Muriel, LePape Alain, Landais Mickael, Plantefève Gaetan, Tacconelli Evelina, Kaasch Achim, Jurkinya Róbert, Zsolt Iványi, van Rijen Miranda, Cremer Olaf, Carevic Biljana, Jevdjić Jasna, Escudero Dolores, Garcia Miguel Sanchez, Prat-Aymerich Cristina, Suberviola-Cañas Borja, Arenzana-Seisdedos Angel, Bodur Hürrem, Kirakli Cenk, Bozkurt Ilkay, Long Sandra,
Abstract
Abstract
Background
Immune suppression has been implicated in the occurrence of pneumonia in critically ill patients. We tested the hypothesis that Intensive Care Unit (ICU)-acquired pneumonia is associated with broad host immune aberrations in the trajectory to pneumonia, encompassing inflammatory, endothelial and coagulation responses. We compared plasma protein biomarkers reflecting the systemic host response in critically ill patients who acquire a new pneumonia (cases) with those who do not (controls).
Methods
We performed a nested case–control study in patients undergoing mechanical ventilation at ICU admission with an expected stay of at least 48 h enrolled in 30 hospitals in 11 European countries. Nineteen host response biomarkers reflective of key pathophysiological domains were measured in plasma obtained on study inclusion and day 7, and—in cases—on the day of pneumonia diagnosis.
Results
Of 1997 patients, 316 developed pneumonia (15.8%) and 1681 did not (84.2%). Plasma protein biomarker analyses, performed in cases and a randomly selected subgroup of controls (1:2 ratio to cases, n = 632), demonstrated considerable variation across time points and patient groups. Yet, cases showed biomarker concentrations suggestive of enhanced inflammation and a more disturbed endothelial barrier function, both at study enrollment (median 2 days after ICU admission) and in the path to pneumonia diagnosis (median 5 days after ICU admission). Baseline host response biomarker aberrations were most profound in patients who developed pneumonia either shortly (< 5 days, n = 105) or late (> 10 days, n = 68) after ICU admission.
Conclusions
Critically ill patients who develop an ICU-acquired pneumonia, compared with those who do not, display alterations in plasma protein biomarker concentrations indicative of stronger proinflammatory, procoagulant and (injurious) endothelial cell responses.
Trial registration: ClinicalTrials.gov Identifier: NCT02413242, posted April 9th, 2015.
Graphical abstract
Funder
Innovative Medicines Initiative Joint Undertakings
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
Reference22 articles.
1. Melsen WG, Rovers MM, Groenwold RHH, Bergmans DCJJ, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13:665–71. https://doi.org/10.1016/s1473-3099(13)70081-1. 2. Kollef MH, Torres A, Shorr AF, Martin-Loeches I, Micek ST. Nosocomial Infection. Crit Care Med. 2021;49:169–87. https://doi.org/10.1097/ccm.0000000000004783. 3. Papazian L, Klompas M, Luyt C-E. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46:888–906. https://doi.org/10.1007/s00134-020-05980-0. 4. Saied WI, Martin-Loeches I, Timsit J-F. What is new in non-ventilated ICU-acquired pneumonia? Intensive Care Med. 2020;46:488–91. https://doi.org/10.1007/s00134-019-05859-9. 5. Venet F, Monneret G. Advances in the understanding and treatment of sepsis-induced immunosuppression. Nat Rev Nephrol. 2018;14:121–37. https://doi.org/10.1038/nrneph.2017.165.
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|