Biology subjects

Bermejo-Martin, J. F.

Publications and source records attributed to Bermejo-Martin, J. F..

3 recordsLinked to original sources

bioRxiv2017

Lymphopenic community acquired pneumonia, an unnoticed phenotype associated to mortality in non immuno-suppressed patients: a retrospective cohort study

BackgroundThe role of neutrophil and lymphocyte counts as predictors of prognosis in Community Acquired Pneumonia (CAP) has not been appropriately studied.\n\nMethodsThis was a retrospective study to evaluate by multivariate regression analysis, the association between neutrophil and lymphocyte counts with mortality at 30-days post discharge in two large cohorts of hospitalized patients with CAP and no prior immunosupression: a multicentric with 1550 patients recruited at 14 hospitals in Spain and a unicentric with 2840 patients recruited at the Hospital Clinic-Barcelona.\n\nFindingsThe unicentric cohort accounted with a higher proportion of critically ill patients: 586 (20{middle dot}6%) vs 131 (8{middle dot}5%) and non survivors 245 (8{middle dot}6%) vs 74 (4{middle dot}8%). Lymphopenia (< 1000 lymphocytes/mm3) was present in the 52{middle dot}8% of the patients in both cohorts. A sub-group of lymphopenic patients, those with lymphocyte counts below decil 3 (677 lymphocytes/mm3 in the multicentric cohort and 651 lymphocytes/mm3 in the unicentric one), showed > 2-fold increase in the risk of mortality, independently of the CURB-65 score, critical illness and receiving an appropriated antibiotic treatment: (OR [CI95%], p) (2{middle dot}18 [1{middle dot}21- 3{middle dot}92], 0{middle dot}009) and (2{middle dot}33 [1{middle dot}61-3{middle dot}33], <0{middle dot}001) respectively. Neutrophil counts were not associated with mortality risk.\n\nInterpretationLymphopenia is present in a half of the patients with CAP needing of hospitalization, in absence of antecendents of immunosupression. Lymphopenic CAP with lymphocyte counts < 664 lymphocytes/mm3 constitutes a particular immunological phenotype of the disease which is associated to an increased risk of mortality.\n\nFundingCibeRes, 2009 Support to Research Groups of Catalonia 911, IDIBAPS, SEPAR, SVN

immunology↗

bioRxiv2017

The Protective Association Of Endogenous Immunoglobulins Against Sepsis Mortality Is Restricted To Patients With Moderate Organ Failure.

Backgroundpre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity.\n\nMethodsthis was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score al ICU admission (SOFA < 8, n = 122 and SOFA [≥] 8, n = 156) and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan Meier and multivariate logistic regression analysis.\n\nResultsICU / hospital mortality in the SOFA < 8 group was 14.8% / 23.0%, compared to 30.1 % / 35.3% in the SOFA [≥] 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG <407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated to a reduction in the survival mean time of 6.6 days in the first 28 days, and was a robust predictor of mortality risk either during the acute and the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosupression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG <407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA [≥] 8 group, we found no immunoglobulin thresholds associated to neither ICU nor to hospital mortality.\n\nConclusionsendogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortality.

immunology↗

bioRxiv2016

Mortality prediction in sepsis via gene expression analysis: a community approach

Improved risk stratification and prognosis in sepsis is a critical unmet need. Clinical severity scores and available assays such as blood lactate reflect global illness severity with suboptimal performance, and do not specifically reveal the underlying dysregulation of sepsis. Here three scientific groups were invited to independently generate prognostic models for 30-day mortality using 12 discovery cohorts (N=650) containing transcriptomic data collected from primarily community-onset sepsis patients. Predictive performance was validated in 5 cohorts of community-onset sepsis patients (N=189) in which the models showed summary AUROCs ranging from 0.765-0.89. Similar performance was observed in 4 cohorts of hospital-acquired sepsis (N=282). Combining the new gene-expression-based prognostic models with prior clinical severity scores led to significant improvement in prediction of 30-day mortality (p<0.01). These models provide an opportunity to develop molecular bedside tests that may improve risk stratification and mortality prediction in patients with sepsis, improving both resource allocation and prognostic enrichment in clinical trials.

bioinformatics↗