ROC curve of mHLA-DR expression slope (dash line) and IL-6 (full line) for predicting sepsis.

<p>Area under curves for mHLA-DR slope (days 3–4 /days 1–2) and IL-6 at days 1–2 were respectively .79 (95%CI .69; .88, p = .0001) and .75 (95%CI .64; .84, p = .0001). The best threshold was 1.1 for mHLA-DR ratio (sensitivity 82.6%, specificity 64.7%) and 67.1 pg/ml for IL-6 concentration (sensitivity 84.6% and specificity 72.5%).</p

Univariate logistic regression analysis according to the biologic test used to predict sepsis development.

<p>CI, confidence interval; D, days; IL, Interleukin; ISS, Injury Severity Score; mHLA-DR, monocyte human leukocyte antigen-DR; OR, odds ratio; SAPS II, Simple Acute Physiology Score II.</p

Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for D3–4/D1–2 mHLA-DR, D1–2 IL-6 concentration, and the combination of D3–4/D1–2 mHLA-DR and D1–2 IL-6 concentration, for the diagnosis of sepsis during the intensive care unit (ICU) stay.

<p>Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for D3–4/D1–2 mHLA-DR, D1–2 IL-6 concentration, and the combination of D3–4/D1–2 mHLA-DR and D1–2 IL-6 concentration, for the diagnosis of sepsis during the intensive care unit (ICU) stay.</p

Immunological patients’ characteristics.

<p>Parametric variables are expressed as mean ± standard deviation, and non-parametric variables as median (interquartile range) or frequencies.</p>*<p>Independent samples t-test.</p>‡<p>Mann & Whitney test.</p><p>Abbreviations: HLA, Human Leukocyte Antigen; D, day; IL, Interleukin.</p

Time course of IL-6 concentration in trauma patients, with (gray) or without (white bars) sepsis.

<p>Results (pg/ml) are expressed as median [interquartile range] (Mann & Whitney <i>U</i> test, * p<.01). At days 1–2, IL-6 concentration was significantly higher in septic patients than in non-septic patients, as at days 3–4 but with less significance.</p

Clinical patients’ characteristics.

<p>Parametric variables are expressed as mean ± standard deviation, and non-parametric variables as median (interquartile range) or frequencies.</p><p>*Independent samples t-test.</p>‡<p>Mann & Whitney test.</p>♦<p>Chi-square test</p><p>Abbreviations: ISS, Injury Severity Score; SAPS, Simple Acute Physiology Score; SOFA, Sequential Organ Failure Assessment; HLA, Human Leukocyte Antigen; ICU, Intensive Care Unit; D, day; IL, Interleukin.</p

Table_1_Circulating microbiome analysis in patients with perioperative anaphylaxis.docx

BackgroundPerioperative anaphylaxis is a rare and acute systemic manifestation of drug-induced hypersensitivity reactions that occurs following anesthesia induction; the two main classes of drugs responsible for these reactions being neuromuscular blocking agents (NMBA) and antibiotics. The sensitization mechanisms to the drugs are not precisely known, and few risk factors have been described. A growing body of evidence underlines a link between occurrence of allergy and microbiota composition. However, no data exist on microbiota in perioperative anaphylaxis. The aim of this study was to compare circulating microbiota richness and composition between perioperative anaphylaxis patients and matched controls.MethodsCirculating 16s rDNA was quantified and sequenced in serum samples from 20 individuals with fully characterized IgE-mediated NMBA-related anaphylaxis and 20 controls matched on sex, age, NMBA received, type of surgery and infectious status. Microbiota composition was analyzed with a published bioinformatic pipeline and links with patients clinical and biological data investigated.ResultsAnalysis of microbiota diversity showed that anaphylaxis patients seem to have a richer circulating microbiota than controls, but no major differences of composition could be detected with global diversity indexes. Pairwise comparison showed a difference in relative abundance between patients and controls for Saprospiraceae, Enterobacteriaceae, Veillonellaceae, Escherichia-Shigella, Pseudarcicella, Rhodoferax, and Lewinella. Some taxa were associated with concentrations of mast cell tryptase and specific IgE.ConclusionWe did not find a global difference in terms of microbiota composition between anaphylaxis patient and controls. However, several taxa were associated with anaphylaxis patients and with their biological data. These findings must be further confirmed in different settings to broaden our understanding of drug anaphylaxis pathophysiology and identify predisposition markers.</p