Evaluation of neutrophil CD 64 and CD 11b expression as early predictors of sepsis severity and outcome

CD64, the high affinity Fcy receptor 1, and CDllb, an alpha-subunit of the beta[2] integrin adhesion molecule, are specific neutrophil-surface antigens activated in response to systemic inflammation, therefore, they could potentially be used as early predictors of sepsis and the associated mortality in patients with systemic inflammatory response syndrome [SIRS]. Sixty-one SIRS patients with clinically suspected infection were enrolled and subjected to sepsis work-up, within the first 24 hours of sepsis onset, including complete blood count, blood culture, serum C-reactive protein [CRP] in addition to flow cytometric analysis of CD64 and GD11b. Patients were classified prospectively on the basis of clinical observation and blood culture results into two groups: SIRS with sepsis group [n=36] and SIRS without sepsis group [n=25] served as patient control. According to outcome, patients with sepsis were classified after a follow-up period up to 28 days after inclusion into two groups: survivors [n=29] and non-survivors [n=7]. A highly significant increase of neutrophil CD64 and CD11b expression was detected in the sepsis group as compared to the non-infected group. CD64 and CDllb expression had the best diagnostic performance for prediction of early-onset sepsis. Expression of CD64 at a cut-off value of 49% had 88.9% sensitivity, 92% specificity and 90.2% efficacy, while CD1 Ib expression at a cut-off value of 71% had 86.1% sensitivity, 84% specificity and 85.2% efficacy. Combined use of both markers yielded 91.7% sensitivity, 96% specificity and 93.4% efficacy. Sepsis survivors showed significantly lower expression of CD64 and CDllb as compared to non-survivors. An optimal cut-off value of 70% expression for CD64 predicted mortality with 100% sensitivity, 96.6% specificity and 97.2% efficacy. Meanwhile, a cut-off value of 86% for CDllb predicted mortality with 85.7% sensitivity, 93.1% specificity and 91.7% efficacy. Assessment of neutrophil CD64 and CDllb expression is superior to standard laboratory tests for early detection of sepsis, within the first 24 hours of sepsis onset, before the evolution of clinical signs which would facilitate therapeutic decisions. Prediction of outcome is an additional advantage borne by these two biomarkers

Assessment of the role of polyunsaturated fatty acids in chronic kidney disease

Recent evidence suggests a relationship between abnormalities of polyunsaturated fatty acids [PUFAs] and the development of chronic kidney disease [CKD].To assess plasma concentration levels of n-6 PUFAs in CKD patients to clarify their role in the development and progression of the kidney disease in an attempt to provide an early protective therapeutic strategy. Fifty eight CKD patients as well as thirty healthy controls were enrolled and subjected to thorough clinical assessment and laboratory investigations including kidney function tests [serum urea, creatinine, total proteins and albumin], lipid profile [total cholesterol, triglycerides, high density lipoprotein-cholesterol [HDL-C], low density lipoprotein-cholesterol [LDL-C] and atherosclerotic risk ratio [T-Cholesterol/HDL-C]] in addition to analysis of PUFAs of the n-6 series which include linoleic, gamma-linolenic and arachidonic acids by high performance liquid chromatography [HPLC]. A highly significant decrease of gamma-linolenic and arachidonic acids was detected in CKD patients as compared to controls, while linoleic acid was elevated in CKD patients, however this elevation was statistically insignificant when compared to the control group. The correlation study showed that each of gamma-linolenic acid and arachidonic acid were significantly positively correlated with creatinine clearance and HDL-C and significantly negatively correlated with triglycerides, LDL-C and risk ratio. Meanwhile, linoleic acid showed a significant positive correlation with triglycerides and insignificant correlations with creatinine clearance, total cholesterol, HDL-C, LDL-C and risk ratio. The long chain n-6 fatty acids gamma-linolenic and arachidonic acids are present in insufficient amounts in plasma of CKD patients and such insufficiency increases with the severity of the kidney disease confirming the role of impaired n-6 PUFAs metabolism in the development and progression of CKD. Thus, high dietary intake of n-6 fatty acids [mainly gamma-linolenic acid] could be recommended as a new therapeutic strategy in CKD patients aiming at interrupting the irreversible process of renal fibrosis and ameliorating chronic renal injury and may also be protective against the development of cardiovascular disease among those patients

Vascular endothelial growth factor and basic fibroblast growth factor: novel markers in pituitary tumors

Twenty-four male patients with pituitary adenomas [mean age 39.9 +/- 11.2 years] were enrolled in this study. Microadenoma was present in 14 patients, while the other 10 patients had macroadenoma as diagnosed by the different imaging techniques. All patients were subjected to complete clinical examination and laboratory investigations including serum prolactin [PRL], human growth hormone [hGH], thyroid stimulating hormone [TSH], follicle stimulating hormone [FSH], luteinizing hormone [LH] and cortisol. In addition, an assessment of vascular endothelial growth factor [VEGF] and basic fibroblast growth factor [bFGF] serum levels was also done. The results were compared with those of 20 healthy age-matched control subjects. The study concluded that the elevated serum levels of both VEGF and bFGF in pituitary tumor patients indicated that both growth factors could serve as novel tumor markers for the diagnosis of pituitary tumors. Moreover, the combination of these two markers provides an additional predictive value for the presence of the disease. This is likely to have its impact on the therapeutic management of these patients, especially in view of their documented synergistic action