endothelin-1 and Bacterial-Infections

The study was performed to assess the usefulness of two new biomarkers, midregional pro-adrenomedullin (MR-pro-ADM) and C-pro-endothelin-1 (CT-pro-ET-1), in predicting bacterial infection (BI) and especially invasive bacterial infection (IBI) in well-appearing infants with fever without source (FWS). For this purpose, a multicenter prospective study was conducted between February 2008 and March 2009 including well-appearing infants less than 36 months of age with FWS. MR-pro-ADM, CT-pro-ET-1, procalcitonin (PCT), CRP, and WBC were measured and compared. Among the 1,035 infants included, a bacterial infection was diagnosed in 75 patients (7.2 %), and 16 (1.54 %) had an invasive bacterial infection (bacterial meningitis, 8; occult bacteremia, 6; and sepsis, 1). MR-pro-ADM and CT-pro-ET-1 levels were less reliable for diagnosis than the other biomarkers. The area under receiver operating characteristic curve for infants with BI and IBI was 0.59 (95 % confidence interval (CI) 0.52-0.67) and 0.63 (95 % CI 0.46-0.80) for MR-pro-ADM and 0.58 (95 % CI 0.51-0.66) and 0.62 (95 % CI 0.47-0.67) for CT-pro-ET-1, respectively. Multivariate analysis showed that PCT ≥ 0.5 ng/mL, CRP ≥ 40 mg/L, and CT-pro-ET-1 ≥ 105 pmol/mL were independent risk factors for having a BI (odds ratio (OR) 6.12, 3.61, and 2.84, respectively). PCT was the only independent risk factor for having an IBI (OR 17.53 if PCT ≥ 0.5 ng/mL).. Although baseline MR-pro-ADM and CT-pro-ET-1 levels are significantly elevated in well-appearing febrile infants with a bacterial infection, their overall performance as diagnostic markers is very poor.

Topics: Adrenomedullin; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Endothelin-1; Female; Fever of Unknown Origin; Follow-Up Studies; Humans; Infant; Leukocyte Count; Logistic Models; Male; Multivariate Analysis; Odds Ratio; Peptide Fragments; Prospective Studies; Protein Precursors; ROC Curve; Severity of Illness Index

Topics: Adrenomedullin; Bacterial Infections; Endothelin-1; Female; Fever of Unknown Origin; Humans; Male; Peptide Fragments; Protein Precursors

Topics: Adrenomedullin; Bacterial Infections; Endothelin-1; Female; Fever of Unknown Origin; Humans; Male; Peptide Fragments; Protein Precursors

To evaluate the serum levels of three precursors of vasoactive peptide as diagnostic markers for neonatal infections.. Overall, 356 neonates (160 without infection, 114 with mild infections and 82 with severe infections) were enrolled in this study. Their serum levels of mid-regional pro-adrenomedullin (MR-pro-ADM), C-terminal pro-endothelin-1 (CT-pro-ET-1) and mid-regional pro-atrial natriuretic peptide (MR-pro-ANP) were measured by immunoassay, and receiver operating curve analysis was performed for each biomarker to evaluate their diagnostic values for neonatal infection.. The serum levels of MR-pro-ADM (2.079 ± 1.195 nM), CT-pro-ET-1 (109.4 ± 62.9 pM) and MR-pro-ANP (1221.4 ± 725.0 pM) in the severe infection group were significantly higher than those in the mild infection group (1.025 ± 0.421 nM, 86.7 ± 51.8 pM, and 687.6 ± 575.7 pM, respectively) and in the non-infection group (0.853 ± 0.488 nM, 51.3 ± 40.6 pM, and 943.3 ± 847.3 pM, respectively) (p < 0.01-0.001). Their areas under the curve were 0.72, 0.76 and 0.61, respectively. Among them, CT-pro-ET-1 had the highest sensitivity (82.65%), whereas MR-pro-ADM had the highest specificity (86.25%).. MR-pro-ADM, CT-pro-ET-1 and MR-pro-ANP may serve as useful laboratory markers to indicate bacterial infection in neonates.

Topics: Adrenomedullin; Atrial Natriuretic Factor; Bacterial Infections; Biomarkers; C-Reactive Protein; Endothelin-1; Female; Humans; Infant, Newborn; Male; Peptide Fragments; Protein Precursors; ROC Curve; Sensitivity and Specificity; Severity of Illness Index

In this article, the authors discuss three pathophysiologic mechanisms that influence the coagulation system in patients who have liver disease. First, bacterial infections may play an important role in the cause of variceal bleeding in patients who have liver cirrhosis, affecting coagulation through multiple pathways. One of the pathways through which this occurs is dependent on endogenous heparinoids, on which the authors focus in this article. Secondly, the authors discuss renal failure, a condition that is frequently encountered in patients who have liver cirrhosis. Finally, they review dysfunction of the endothelial system. The role of markers of endothelial function in cirrhotic patients, such as von Willebrand factor and endothelin-1, is discussed.

Topics: Bacterial Infections; Biomarkers; Blood Coagulation; Blood Coagulation Disorders; Endothelin-1; Endothelium, Vascular; Heparinoids; Humans; Liver Cirrhosis; Renal Insufficiency; Varicose Veins; von Willebrand Factor

Endothelin-1 (ET-1) has fibrogenic and inflammatory properties. Its pathogenic role in pulmonary fibrosis and certain inflammatory airway diseases is now well known. Its production is, in part, triggered by infectious processes. Episodes of infection are suspected to be involved in the development of bronchiolitis obliterans syndrome (BOS), which is the main feature of chronic lung rejection and the major factor limiting the long-term survival of transplanted patients. We postulated that ET-1 is upregulated during infectious complications arising from the graft and that this could partly explain the remodeling of airway structures observed in BOS. We, therefore, set up this study to assess ET-1 expression in relation to complications of the graft in human lung transplant recipients.. ET-1 mRNA was quantified by reverse transcription-competitive polymerase chain reaction in cells from 119 samples of bronchoalveolar lavage (BAL) fluid from 17 lung transplant recipients. ET-1 and big ET-1 proteins were assessed in BAL cell culture supernatants by enzyme immunoassay. Transbronchial biopsies (n=21) were stained immunohistochemically for ET-1 receptors.. Episodes of bacterial infection strongly correlated with increased ET-1 mRNA and protein expression. ET-1 receptors were also upregulated during these episodes, especially on endothelial and smooth muscle cells. Five of the seven patients with the highest ET-1 levels subsequently developed BOS.. These results raise the possibility that ET-1, part of whose production is triggered by infectious postgraft complications, might play a role in the development of BOS through its potential effects on airway remodeling.

Topics: Adult; Bacterial Infections; Bronchi; Bronchiolitis Obliterans; Bronchoalveolar Lavage Fluid; Endothelin-1; Female; Humans; Lung Diseases; Lung Transplantation; Male; Receptor, Endothelin A; Receptors, Endothelin; RNA, Messenger; Tissue Distribution; Up-Regulation