Reduced hemolytic complement activity in the classical pathway (CH50) is a risk factor for poor clinical outcomes of patients with infections: a retrospective analysis of health insurance claims in Japan

PurposeTo evaluate whether low CH50 (a comprehensive measure of hemolytic activity of the classical complement pathway) is associated with infection-related coagulopathy, organ dysfunction, and poor clinical outcomes.MethodsThis was a retrospective study using Japanese health insurance claim data (2014-2023). Adult patients whose CH50 values were measured within one week of admission were included. We divided the patients into three groups based on the normal CH50 range: Low CH50 (< 25 U/mL; n=168), Normal CH50 (25 ≤, < 48 U/mL; n=1273), and High CH50 (48 ≤ U/mL; n=1285).ResultsOf 2,726 patients who met the inclusion criteria, logistic regression models demonstrated that decreased CH50 is a significant predictor of 180-day mortality (OR: 0.98-0.99). Cumulative survival rates in the Low CH50 group at 28 days and 180 days were both unfavorable (both p < 0.0001, Log-rank test). CH50 was significantly inversely correlated with SOFA, SIC, ISTH-overt DIC, and JAAM-2 DIC scores, and was also correlated with C3 and C4 levels. Diminished CH50 may be particularly useful in diagnosing SIC (specificity; 79.2%) and excluding ISTH-overt DIC (sensitivity; 90.5%). Moreover, patients with low levels of both CH50 and C3 had an extremely high mortality rate (25.0%).ConclusionLow CH50 after infection is not only significantly associated with multiple organ failure and coagulopathy but is also an independent risk factor for poor prognosis. Complement activation after infection may help to avert organ damage and to improve clinical outcomes

Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by Gram-negative bacillus infection

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Relationship between nutritional therapy and beneficial bacteria ratio in severe disease

Objective: To evaluate relationship between changes in the beneficial bacteria in intensive care unit (ICU) patients and nutritional therapy type. Methods: Ten patients aged ≥18 years admitted to the ICU between January and December 2020, were included. Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding. The ratio of beneficial bacteria at the first and second bowel movements after each patient's admission was calculated and the patients were classified into the increase or decrease group. Among all patients, five each were in the increase and decrease groups. We investigated patient background, changes in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores, nutritional doses or methods, and clinical outcomes. Results: No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHE II scores at the time of admission. The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group (4/5 vs. 0/5, P=0.01). Conclusions: An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition. In the future, accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective

Expression of the adhesion molecule spermatogenic immunoglobulin superfamily (SgIGSF) in mouse tissues

金沢大学大学院医学系研究科がん細胞学Spermatogenic immunoglobulin superfamily (SgIGSF) is an adhesion molecule originally isolated from adult mouse testis. In the testis, SgIGSF is expressed specifically in spermatogenic cells and may be involved in spermatogenesis. SgIGSF may also be involved in synapse formation and tumor suppression. In the present study, we examined the expression and cellular localization of SgIGSF in the entire adult mouse organs and tissues using Western blot analysis and immunohistochemistry at light and electron microscopic levels. Western blot analysis revealed that SgIGSF is expressed not only in the testis but also in the liver, lung, and nervous system including the cerebrum, cerebellum and sciatic nerve. The nervous system as well as testis showed multiple immunoreactive bands ranging from 45 to 100 kDa, whereas the liver and lung showed a single 100 kDa band. Immunohistochemisfry demonstrated that in the nervous system, SgIGSF is localized to the membranes of synapses, axons and Schwann cells. In contrast, in the lung and liver SgIGSF was localized to the membranes of apposing respiratory epithelial cells, hepatocytes and biliary epithelial cells. These results suggested that SgIGSF plays multiple physiological roles in the adult mouse as an adhesion molecul