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Presepsin teardown- pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis

World Journal of Gastroenterology 2016年第41期22卷 9172-9185页

作者： Maria Papp tamas Tornai Zsuzsanna Vitalis Istvan Tornai David Tornai tamas dinya Andrea Sumegi Peter Antal-Szalmas Department of Internal Medicine Division of Gastroenterology University of Debrecen Faculty of Medicine Department of Laboratory Medicine University of Debrecen Faculty of Medicine Debrecen Institute of Surgery University of Debrecen Faculty of Medicine Vascular Biology Thrombosis and Haemostasis Research Group Hungarian Academy of Sciences

AIM To evaluate the diagnostic and prognostic value of presepsin in cirrhosis-associated bacterial infections. METHODS Two hundred and sixteen patients with cirrhosis were enrolled. At admission, the presence of bacterial infections and level of plasma presepsin, serum C-reactive protein(CRP) and procalcitonin(PCT) were evaluated. Patients were followed for three months to assess the possible association between presepsin level and short-term *** Present 34.7 of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without(median, 1002 pg/m L vs 477 pg/m L, P 1206 pg/m L sensitivity, specificity, positive predictive values and negative predictive values were as follows: 87.5%, 74.5%, 61.8% and 92.7%. The accuracy of presepsin, however, decreased in advanced stage of the disease or in the presence of renal failure, most probably because of the significantly elevated presepsin levels in non-infected patients. 28-d mortality rate was higher among patients with > 1277 pg/m L compared to those with ≤ 1277 pg/m L(46.9% vs 11.6%, P < 0.001). In a binary logistic regression analysis, however, only PCT(OR = 1.81, 95%CI: 1.09-3.01, P = 0.022) but neither presepsin nor CRP were independent risk factor for 28-d mortality after adjusting with MELD score and leukocyte *** Presepsin is a valuable new biomarker for defining severe infections in cirrhosis, proving same efficacy as PCT. However, it is not a useful marker of short-term mortality.

关键词： Presepsin Cirrhosis Bacterial infection Organ failure Mortality

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Anti-microbial antibodies in celiac disease:Trick or treat?

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World Journal of Gastroenterology 2009年第31期15卷 3891-3900页

作者： Maria Papp Ildiko Foldi Istvan Altorjay Eszter Palyu Miklos Udvardy Judit Tumpek Sandor Sipka Ilma Rita Korponay-Szabo Eva Nemes Gabor Veres tamas dinya Attila Tordai Hajnalka Andrikovics Gary L Norman Peter Laszlo Lakatos 2nd Department of Medicine University of Debrecen Laboratory of Clinical Immunology University of Debrecen Department of Pediatrics University of DebrecenDebrecenH-4032HungaryIlma Rita Korponay-SzaboCeliac Disease CenterHeim Pal Children's Hospital 1st Department of Pediatrics Semmelweis University Institute of Surgery University of Debrecen Department of Molecular Diagnostics Hungarian National Blood Transfusion Service INOVA Diagnostics Inc. 1st Department of Medicine Semmelweis University

AIM： To determine the prevalence of a new set ot anti-glycan and anti-outer membrane protein （anti- OMP） antibodies in a Hungarian cohort of adult Celiac disease （CD） patients. METHODS： 190 consecutive CD patients [M/F： 71/119, age：39.9 （SD：14.1） years], 100 healthy, and 48 gastrointestinal controls were tested for glycan anti-Saccharomyces cerevisiae （gASCA）, anti-laminaribioside （ALCA）, anti-chitobioside, anti-mannobioside, anti-OMP antibodies and major NOD2/CARD15 mutations. Thirty out of 82 CD patients enrolled at the time of diagnosis were re-evaluated for the same antibodies after longstanding gluten-free diet （GFD）. RESULTS： 65.9% of the CD patients were positive for at least one of the tested antibodies at the time of the diagnosis. Except anti-OMP and ALCA, antimicrobial antibodies were exclusively seen in untreated CD; however, the overall sensitivity was low. Any glycan positivity （LR＋： 3.13; 95% CI： 2.08-4.73） was associated with an increased likelihood ratio for diagnosing CD. Significant correlation was found between the levels of anti-glycan and anti-endomysial or anti-transglutaminase antibodies. Anti-glycan positivity was lost after longstanding GFD. Anti-glycan antibody titers were associated with symptoms at presentation, but not the presence of NOD2/CARD15 mutations. Patients with severe malabsorption more frequently had multiple antibodies at diagnosis （P = 0.019）. CONCLUSION： The presence of anti-glycan antibodies in CD seems to be secondary to the impaired small bowel mucosa which can lead to increased antigen presentation. Furthermore, anti-glycan positivity may be considered an additional marker of CD and dietary adherence.

关键词： Celiac disease Glycans Anti-Saccharomyces cerevisiae antibodies Anti-outer membrane protein antibody NOD2/CARD15 Gluten-free diet Presenting symptoms Bacterial translocation Crohn's disease

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