Browsing by Author "Rautiainen, Linda"

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    Assessment of ADAMTS-13 Level in Hospitalized Children with Serious Bacterial Infections as a Possible Prognostic Marker
    (2019-08) Rautiainen, Linda; Cirko, Anna; Pavare, Jana; Balmaks, Reinis; Grope, Ilze; Katirlo, Irina; Gersone, Gita; Tretjakovs, Peteris; Gardovska, Dace; Department of Paediatrics; Department of Human Physiology and Biochemistry
    Background and objectives: In children, acute infection is the most common cause of visits in the primary care or emergency department. In 2002, criteria for diagnostics of pediatric sepsis were published, and then revised in 2016 as life-threatening organ dysfunction due to a dysregulated host response to infection. In the pathophysiology of sepsis endothelial dysfunction plays a very important role. Deficient proteolysis of von Willebrand factor, due to reduced ADAMTS-13 activity, results in disseminated platelet-rich thrombi in the microcirculation. ADAMTS-13 deficiency has been detected in systemic inflammation. The clinical relevance of ADAMTS-13 during sepsis is still unclear. We aimed to investigate the possible use of ADAMTS-13 as a prognostic marker in children with serious bacterial infection (SBI). Materials and Methods: Inclusion criteria were hospitalized children with SBI, aged from 1 month to 17 years. SBI was defined based on available clinical, imaging, and later also on microbiological data. Sepsis was diagnosed using criteria by The International Consensus Conference. In all the patients, the levels of ADAMTS-13 were measured at the time of inclusion. Results: Data from 71 patients were analyzed. A total of 47.9% (34) had sepsis, 21.1% (15) were admitted to the ICU, 8.5% (6) had mechanical ventilator support, and 4.2% (3) patients had a positive blood culture. The median level of ADAMTS-13 in this study population was 689.43 ng/mL. Patients with sepsis, patients admitted to the Intensive Care Unit, and patients in need of mechanical ventilator support had significantly lower levels of ADAMTS-13. None of the patients had ADAMTS-13 deficiency. In patients with SBI, the area under the curve (AUC) to predict sepsis was 0.67. A cut-off ADAMTS-13 level of <= 730.49 had 82% sensitivity and 60% specificity for sepsis in patients with SBI. Conclusions: ADATMS-13 levels were lower in patients with SBI and sepsis, but AUC and sensitivity were too low to accept it as a prognostic marker
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    Biomarker combinations in predicting sepsis in hospitalized children with fever
    (2022-12) Rautiainen, Linda; Cirko, Anna; Pavare, Jana; Grope, Ilze; Gersone, Gita; Tretjakovs, Peteris; Gardovska, Dace; Department of Paediatrics; Department of Human Physiology and Biochemistry
    Sepsis is among the leading causes of critical illness worldwide. It includes physiologic, pathologic, and biochemical abnormalities, induced by infection. Novel methods for recognizing a dysregulated inflammatory response and predicting associated mortality must be developed. Our aim was to investigate biomarkers that characterize a pro-inflammatory and anti-inflammatory response in patients with fever by comparing predictive validity for sepsis. 165 patients with fever were enrolled in this study, 55 of them had sepsis according to pSOFA criteria. All patients had blood samples drawn at the time of inclusion and after 24 h. CRP, PCT and also IL-6, IL-8 and sFAS levels were significantly higher in patients with sepsis. The AUC of CRP to predict sepsis was 0.799, all the other biomarkers had AUC’s lower than that. Cytokines, when used as a single marker, did not show a significant diagnostic performance We analyzed various models of biomarker combinations. CRP combined with sFAS showed increase in sensitivity in predicting sepsis (88% vs. 83%). The highest AUC was achieved, when CRP, IL-6, sFAS and sVCAM-1 markers were combined 0.830 (95% CI 0.762–0.884) with a sensitivity of 70% and specificity of 84%. vs. 0.799 for CRP alone.
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    Inflammatory cytokine and chemokine patterns in paediatric patients with suspected serious bacterial infection
    (2019-01-01) Rautiainen, Linda; Pavare, Jana; Grope, Ilze; Tretjakovs, Peteris; Gardovska, Dace; Department of Paediatrics; Department of Human Physiology and Biochemistry
    Background and objectives: In children, acute infection is the most common cause of visits to the emergency department. Although most of them are self-limiting, mortality due to severe bacterial infections (SBI) in developed countries is still high. When the risk of serious bacterial infection is too high to ignore, yet too low to justify admission and hospital observation, clinicians try to improve diagnostic accuracy by performing various laboratory tests. The aim of the study was to investigate whether an early inflammatory cytokine and chemokine panel can add information in diagnostics of SBI and assessment of efficacy of early therapies in hospitalized children with fever. Methods: This study included 51 children with febrile infections that were admitted to the emergency department (ED). Clinical examination and microbiological and radiological tests were used as reference standards for the definition of SBI. Study population was categorized into two groups: (1) patients with SBI (n = 21); (2) patients without SBI (n = 30). Inflammatory cytokine and chemokine panels were analyzed from the first routine blood samples at hospital admission and after 24 h. Results: Out of 12 cytokines and chemokines, only Eotaxin and granulocyte colony-stimulating factor (G-CSF) had statistically significant differences between groups at the time of inclusion. Receiver operator characteristic analysis to predict SBI showed an area under the curve (AUC) of 0.679 for G-CSF. Conclusions: Analysis of inflammatory cytokine profiles may provide additional information in early diagnostics of SBI.
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    Levels of Inflammatory Cytokines and Chemokines in Hospitalized Children with Sepsis and Pneumonia
    (2013-12-01) Rautiainen, Linda; Ince, Svetlana; Pavare, Jana; Grope, Ilze; Tretjakovs, Peteris; Gardovska, Dace; Department of Paediatrics; Department of Human Physiology and Biochemistry
    Introduction. Pneumonia is a common childhood lower respiratory tract infection, which accounts for large number of hospitalization and death among children; its diagnosis is based mainly on clinical signs.Aim of the study was to measure inflammatory cytokine panels in children with pneumonia, and their correlation with clinically used inflammatory markers. Materials and methods. We included 20 patients, hospitalized in Children’s Clinical University hospital, with systemic inflammatory response syndrome (SIRS) and radiologically confirmed pneumonia from October 2011 to January 2013. In all patients cytokine and chemokine panels and clinical inflammatory markers were measured at the time of admission, after 24 hours and on the time of discharge.Results. 12 different inflammatory cytokines were measured. sFAS, sVCAM1, IL-8, IL-10, TNF alpha, Eotaxin, G-CSF, IL1ra, IP10 and MCP1 showed statistically significant changes between levels of inclusion in the study and levels after 24 hours. G-CSF, IL-8, IFN gamma, TNF alpha and IL-10 showed also medium strong correlation with clinically used inflammatory markers (PCT, CRO, and IL-6).Conclusions. Inflammatory cytokines show statistically significant changes during course of treatment, thus they could be used in diagnostics in septic patients with pneumonia, and also could show patients response to therapy.