Evaluation eines innovativen Biomarker-Panels bei Patienten mit akutem Brustschmerz

In dieser Arbeit wurde ein neuartiges Biomarkerpanel an Patienten mit akutem Brustschmerz in der Notaufnahme evaluiert. Acht Markerenzyme mit unterschiedlichem pathophysiologischen Hintergrund wurden bei Aufnahme und im Verlauf eines stationären Aufenthaltes bestimmt. Jeder Biomarker zeigte hinsichtlich der Entlassdiagnose ein spezifisches Verteilungsmuster der Serumkonzentrationen. Alle Marker waren in der initialen Messung bei Patienten mit Myokardinfarkt im Vergleich zu Patienten mit instabiler Angina pectoris oder Brustwandsyndrom signifikant erhöht. HsTnT hatte dabei die beste Testcharakteristik um Patienten mit einem Myokardinfarkt zu identifizieren. ANG-2 und NT-proBNP zeigten eine vergleichbar gute Leistung Patienten mit einer eingeschränkten LVEF in der Verlaufsmessung zu diagnostizieren. Ein Modell mit der Kombination aus ANG-2 und NT-proBNP konnte eine noch bessere Testcharakteristik vorweisen

Urinary N-Terminal Pro-Brain Natriuretic Peptide Predicts Acute Kidney Injury and Severe Disease in COVID-19

Introduction: The ongoing COVID-19 pandemic is placing an extraordinary burden on our health care system with its limited resources. Accurate triage of patients is necessary to ensure medical care for those most severely affected. In this regard, biomarkers could contribute to risk evaluation. The aim of this prospective observational clinical study was to assess the relationship between urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) and acute kidney injury (AKI) as well as severe disease in patients with COVID-19. Methods: 125 patients treated with an acute respiratory infection in the emergency department of the University Hospital Regensburg were analyzed. These patients were divided into a COVID-19 cohort (n = 91) and a cohort with infections not caused by severe acute respiratory syndrome-coronavirus-2 (n = 34). NT-proBNP was determined from serum and fresh urine samples collected in the emergency department. Clinical endpoints were the development of AKI and a composite one consisting of AKI, intensive care unit admission, and in-hospital death. Results: 11 (12.1%) COVID-19 patients developed AKI during hospitalization, whereas 15 (16.5%) reached the composite endpoint. Urinary NT-proBNP was significantly elevated in COVID-19 patients who suffered AKI or reached the composite endpoint (each p < 0.005). In a multivariate regression analysis adjusted for age, chronic kidney disease, chronic heart failure, and arterial hypertension, urinary NT-proBNP was identified as independent predictor of AKI (p = 0.017, OR = 3.91 [CI: 1.28–11.97] per standard deviation [SD]), as well as of the composite endpoint (p = 0.026, OR 2.66 [CI: 1.13–6.28] per SD). Conclusion: Urinary NT-proBNP might help identify patients at risk for AKI and severe disease progression in COVID-19

Dipeptidyl-peptidase 3 and IL-6: potential biomarkers for diagnostics in COVID-19 and association with pulmonary infiltrates

Coronavirus SARS-CoV-2 spread worldwide, causing a respiratory disease known as COVID-19. The aim of the present study was to examine whether Dipeptidyl-peptidase 3 (DPP3) and the inflammatory biomarkers IL-6, CRP, and leucocytes are associated with COVID-19 and able to predict the severity of pulmonary infiltrates in COVID-19 patients versus non-COVID-19 patients. 114 COVID-19 patients and 35 patients with respiratory infections other than SARS-CoV-2 were included in our prospective observational study. Blood samples were collected at presentation to the emergency department. 102 COVID-19 patients and 28 non-COVID-19 patients received CT imaging (19 outpatients did not receive CT imaging). If CT imaging was available, artificial intelligence software (CT Pneumonia Analysis) was used to quantify pulmonary infiltrates. According to the median of infiltrate (14.45%), patients who obtained quantitative CT analysis were divided into two groups (> median: 55 COVID-19 and nine non-COVID-19, ≤ median: 47 COVID-19 and 19 non-COVID-19). DPP3 was significantly elevated in COVID-19 patients (median 20.85 ng/ml, 95% CI 18.34–24.40 ng/ml), as opposed to those without SARS-CoV-2 (median 13.80 ng/ml, 95% CI 11.30–17.65 ng/ml; p < 0.001, AUC = 0.72), opposite to IL-6, CRP (each p = n.s.) and leucocytes (p < 0.05, but lower levels in COVID-19 patients). Regarding binary logistic regression analysis, higher DPP3 concentrations (OR = 1.12, p < 0.001) and lower leucocytes counts (OR = 0.76, p < 0.001) were identified as significant and independent predictors of SARS-CoV-2 infection, as opposed to IL-6 and CRP (each p = n.s.). IL-6 was significantly increased in patients with infiltrate above the median compared to infiltrate below the median both in COVID-19 (p < 0.001, AUC = 0.78) and in non-COVID-19 (p < 0.05, AUC = 0.81). CRP, DPP3, and leucocytes were increased in COVID-19 patients with infiltrate above median (each p < 0.05, AUC: CRP 0.82, DPP3 0.70, leucocytes 0.67) compared to infiltrate below median, opposite to non-COVID-19 (each p = n.s.). Regarding multiple linear regression analysis in COVID-19, CRP, IL-6, and leucocytes (each p < 0.05) were associated with the degree of pulmonary infiltrates, as opposed to DPP3 (p = n.s.). DPP3 showed the potential to be a COVID-19-specific biomarker. IL-6 might serve as a prognostic marker to assess the extent of pulmonary infiltrates in respiratory patients

Decreased GLUT1/NHE1 RNA expression in whole blood predicts disease severity in patients with COVID‐19

Aims We aimed to assess whether expression of whole‐blood RNA of sodium proton exchanger 1 (NHE1) and glucose transporter 1 (GLUT1) is associated with COVID‐19 infection and outcome in patients presenting to the emergency department with respiratory infections. Furthermore, we investigated NHE1 and GLUT1 expression in the myocardium of deceased COVID‐19 patients. Methods and results Whole‐blood quantitative assessment of NHE1 and GLUT1 RNA was performed using quantitative PCR in patients with respiratory infection upon first contact in the emergency department and subsequently stratified by SARS‐CoV‐2 infection status. Assessment of NHE1 and GLUT1 RNA using PCR was also performed in left ventricular myocardium of deceased COVID‐19 patients. NHE1 expression is up‐regulated in whole blood of patients with COVID‐19 compared with other respiratory infections at first medical contact in the emergency department (control: 0.0021 ± 0.0002, COVID‐19: 0.0031 ± 0.0003, P = 0.01). The ratio of GLUT1 to NHE1 is significantly decreased in the blood of COVID‐19 patients who are subsequently intubated and/or die (severe disease) compared with patients with moderate disease (moderate disease: 0.497 ± 0.083 vs. severe disease: 0.294 ± 0.0336, P = 0.036). This ratio is even further decreased in the myocardium of patients who deceased from COVID‐19 in comparison with the myocardium of non‐infected donors. Conclusions NHE1 and GLUT1 may be critically involved in the disease progression of SARS‐CoV‐2 infection. We show here that SARS‐CoV‐2 infection critically disturbs ion channel expression in the heart. A decreased ratio of GLUT1/NHE1 could potentially serve as a biomarker for disease severity in patients with COVID‐19

RNA-expression of adrenomedullin is increased in patients with severe COVID-19

Background!#!Myoglobin clearance in acute kidney injury requiring renal replacement therapy is important because myoglobin has direct renal toxic effects. Clinical data comparing different modalities of renal replacement therapy addressing myoglobin clearance are limited. This study aimed to compare two renal replacement modalities regarding myoglobin clearance.!##!Methods!#!In this prospective, randomized, single-blinded, single-center trial, 70 critically ill patients requiring renal replacement therapy were randomized 1:1 into an intervention arm using continuous veno-venous hemodialysis with high cutoff dialyzer and a control arm using continuous veno-venous hemodiafiltration postdilution with high-flux dialyzer. Regional citrate anticoagulation was used in both groups to maintain the extracorporeal circuit. The concentrations of myoglobin, urea, creatinine, β2-microglobulin, interleukin-6 and albumin were measured before and after the dialyzer at 1 h, 6 h, 12 h, 24 h and 48 h after initiating continuous renal replacement therapy.!##!Results!#!Thirty-three patients were allocated to the control arm (CVVHDF with high-flux dialyzer) and 35 patients to the intervention arm (CVVHD with high cutoff dialyzer). Myoglobin clearance, as a primary endpoint, was significantly better in the intervention arm than in the control arm throughout the whole study period. The clearance values for urea and creatinine were higher in the control arm. There was no measurable albumin clearance in both arms. The clearance data for β!##!Conclusions!#!Myoglobin clearance using continuous veno-venous hemodialysis with high cutoff dialyzer and regional citrate anticoagulation is better than that with continuous veno-venous hemodiafiltration with regional citrate anticoagulation.!##!Trial registration!#!German Clinical Trials Registry (DRKS00012407); date of registration 23/05/2017. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&amp;amp;TRIAL_ID=DRKS00012407

Niedrige Inzidenz von SARS-CoV‑2-Infektionen bei Krankenhausmitarbeitern eines Maximalversorgers

Hintergrund Mitarbeiter im Gesundheitswesen mit Kontakt zu COVID‑19-Patienten sind einem erhöhten Risiko einer Infektion mit SARS-CoV‑2 ausgesetzt. Ziel dieser seroepidemiologischen Studie war es, das Infektionsrisiko für Klinikmitarbeiter eines Maximalversorgers zu evaluieren. Methodik Im Rahmen einer prospektiven Kohortenstudie wurden von März bis Juli 2020 (1. Welle) bei unmittelbar in der Versorgung von COVID‑19-Patienten eingesetzten Mitarbeitern im Abstand von jeweils 2 Wochen serologische Untersuchungen auf Antikörper gegen SARS-CoV‑2 durchgeführt. Von Dezember 2020 bis Februar 2021 (2. Welle) fand eine erneute Untersuchung des Antikörperstatus statt. Ergebnisse Die Seroprävalenz von Antikörpern gegen SARS-CoV‑2 betrug am Studienende im Februar 2021 5,1 %. Die kumulative Inzidenz betrug nach einer medianen Beobachtungsdauer von 261 Tagen 3,9 %. Schlussfolgerung In der untersuchten Kohorte von Klinikmitarbeitern, die in der Akutversorgung von COVID‑19-Patienten eingesetzt werden, fand sich unter den angewandten Hygiene- und Schutzmaßnahmen ein niedriges und mit der Gesamtbevölkerung vergleichbares Risiko einer SARS-CoV-2-Infektion

Cardiac iron overload promotes cardiac injury in patients with severe COVID-19

&lt;jats:title&gt;Zusammenfassung&lt;/jats:title&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Hintergrund&lt;/jats:title&gt; &lt;jats:p&gt;Brandverletzungen bei Kindern sind für die ganze Familie ein traumatisches Erlebnis und mit emotionalen und psychischen Auswirkungen sowie schmerzhaften medizinischen Eingriffen verbunden. Bei Kindern mit einer schwerwiegenden thermischen Verletzung beginnt die edukative Begleitung der Familien bereits bei der Aufnahme ins Krankenhaus und setzt das Wissen um die Bedarfe der Betroffenen voraus.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Ziel&lt;/jats:title&gt; &lt;jats:p&gt;Aufzeigen der Edukationsbedarfe von Kindern mit Brandverletzung und deren Eltern im stationären Setting.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Methode&lt;/jats:title&gt; &lt;jats:p&gt;Es wurde ein Scoping Review durchgeführt. Die Methodik orientiert sich an dem sechsstufigen Framework von Arksey und O’Malley. Eingeschlossen wurden Studien, die Kinder mit Brandverletzungen im Alter von 0 bis 18 Jahren sowie deren Eltern während des Krankenhausaufenthaltes berücksichtigen. Die Literaturrecherche wurde in MEDLINE via PubMed durchgeführt, und Referenzen wurden gesichtet.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Ergebnisse&lt;/jats:title&gt; &lt;jats:p&gt;Insgesamt konnten 3576 Studien identifiziert werden, von denen 21 Studien eingeschlossen wurden. Es ergaben sich 10 qualitative, 7 quantitative Studien sowie 4 Übersichtsarbeiten. In den meisten Studien berichten die betroffenen Kinder und deren Eltern von einem Informations- und Aufklärungsbedarf und dem Wunsch nach emotionaler und psychosozialer Entlastung. Der überwiegende Teil der Studien fokussiert die Erfahrungen von Eltern von Kindern mit Brandverletzungen.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Schlussfolgerung&lt;/jats:title&gt; &lt;jats:p&gt;Für Betroffene ergeben sich im Rahmen der stationären Versorgung unterschiedliche Bedarfe zu verschiedenen Zeitpunkten. Besondere Etappen (z. B. die Entlassung, Verbandwechsel) erfordern einen erhöhten Bedarf an emotionaler und psychosozialer Entlastung, Unterstützung und/oder Information und Aufklärung.&lt;/jats:p&gt; &lt;/jats:sec&gt