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Titolo:
Increased incidence of sepsis and altered monocyte functions in severely injured type A - glucose-6-phosphate dehydrogenase-deficient African American trauma patients
Autore:
Spolarics, Z; Siddiqi, M; Siegel, JH; Garcia, ZC; Stein, DS; Ong, H; Livingston, DH; Denny, T; Deitch, EA;
Indirizzi:
Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Anat Cell Biol & Injury Sci, Newark, NJ 07103 USA Univ Med & Dent New Jersey Newark NJ USA 07103 Sci, Newark, NJ 07103 USA New Jersey Med Sch, Dept Pediat, Newark, NJ USA New Jersey Med Sch NewarkNJ USA ey Med Sch, Dept Pediat, Newark, NJ USA New Jersey Med Sch, Dept Surg, Newark, NJ USA New Jersey Med Sch Newark NJ USA rsey Med Sch, Dept Surg, Newark, NJ USA
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 4, volume: 29, anno: 2001,
pagine: 728 - 736
SICI:
0090-3493(200104)29:4<728:IIOSAA>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
BLOOD-CELL DEFORMABILITY; INFLAMMATORY RESPONSE; CYTOKINE PRODUCTION; OXIDATIVE STRESS; ORGAN FAILURE; NITRIC-OXIDE; SEPTIC SHOCK; G6PD; APOPTOSIS; SEVERITY;
Keywords:
trauma; glucosed-phosphate dehydrogenase deficiency; genetic polymorphism; sepsis; systemic inflammatory response syndrome; anemia; infection; monocyte; neutrophil; cytokine; oxidative stress; cell adhesion; apoptosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
53
Recensione:
Indirizzi per estratti:
Indirizzo: Spolarics, Z Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Anat Cell Biol & Injury Sci, 185 S Orange Ave, Newark, NJ 07103 USA Univ Med & DentNew Jersey 185 S Orange Ave Newark NJ USA 07103
Citazione:
Z. Spolarics et al., "Increased incidence of sepsis and altered monocyte functions in severely injured type A - glucose-6-phosphate dehydrogenase-deficient African American trauma patients", CRIT CARE M, 29(4), 2001, pp. 728-736

Abstract

Objective: To determine whether trauma patients with the common, type A- glucose-6-phosphate dehydrogenase (G6PD) deficiency have an aggravated inflammatory response, increased incidence of septic complications, and/or more profound alterations in leukocyte functions compared with nondeficient trauma patients. Settings: Intensive and surgical care units of a trauma center and flow cytometry and experimental laboratories at a teaching university hospital. Design:Prospective cohort clinical study with measurements on days 2 and 5postinjury. Monocyte and neutrophil oxidant content, apoptosis, and CD11b expression and plasma cytokine levels were compared between G6PD-deficient and nondeficient patients. Patients: A total of 467 male African American trauma patients were screened for the deficiency. Forty-four type A-(202/376) G6PD-deficient patients were identified and enrolled in the study; 43 nondeficient patients were also enrolled and were matched by age, clinical criteria of injury severity, and type of trauma. Main Results:After severe injury (Injury Severity Score, greater than or equal to 16), 50% of the deficient and 6.2% of nondeficient patients developed sepsis with positive bacterial blood cultures. In deficient patients, the frequency of bronchial (75%) and wound infections (25%) was also increased compared with nondeficient patients (32% and 0%). The durations of systemic inflammatory response syndrome, Sepsis Syndrome, and days on antibioticswere three times longer in deficient than in nondeficient individuals. However, adult respiratory distress syndrome occurred in 37% of both groups. Anemia was more severe in the deficient than nondeficient patients from day 10 posttrauma. On day 5, the peroxide content was doubled, apoptosis was decreased, and CD11b expression was increased in monocytes from deficient patients compared with cells from nondeficient patients. On day 5, the plasma interleukin (IL)-10 concentration was significantly lower in deficient thannondeficient patients, whereas tumor necrosis factor-ru, IL-6, and IL-8 levels were similar. After moderate injuries (Injury Severity Score, 9-16), the deficiency was not associated with adverse clinical effects, and the trauma-induced changes in leukocyte function were similar in deficient and nondeficient patients. Conclusions:The common type A- G6PD deficiency predisposes septic complications and anemia in trauma patients after severe injuries as defined by an Injury Severity Score of greater than or equal to 16. This adverse clinicalcourse is accompanied by altered monocyte functions manifested as augmented oxidative stress, a decreased apoptotic response, increased cell adhesionproperties, and a diminished IL-10 response.

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Documento generato il 12/07/20 alle ore 06:46:03