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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The transferrins are iron-binding proteins with molecular weights of around 80,000, which interact with a maximum of two ferric atoms per each protein molecule. The best known transferrins are the serotransferrins from animal sera, lactoferrins from milk, and conalbumin from egg-white. The iron-deficient transferrins will inhibit the growth of certain bacteria and fungi by making iron unavailable for bacterial metabolism. Such activity is abolished if the transferrin is saturated with iron. Many organisms can produce small molecular-weight iron-binding compounds called siderophores that can successfully utilize the iron sequestered by the transferrins. Such organisms are very virulent. Overwhelming evidence is now available to indicate that the transferrins play an important role in mammalian host-defense mechanisms. Thus, iron injections into animals infected with virulent bacteria result in increased death rates, and parenteral iron administration to human infants predisposes them to fatal septicemia. On the other hand, in cases of systemic infection, the organism responds by lowering its total serum iron, so as to make the serotransferrin present less saturated with iron. This phenomenon is called nutritional immunity. The iron apparently moves into the storage tissues from the circulation, and furthermore, it is withheld from circulation by the reticuloendothelial system. Laboratory results in such cases indicate low total serum iron levels and high unsaturated iron-binding activity values, thus increasing the bacteriostatic effects of the serotransferrins. Increased lactoferrin levels are observed in the milks of mastitic cattle.
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PMID:Antimicrobial properties of iron-binding proteins. 645 38

It is difficult to select and combine the nutritional parameters most useful in predicting the outcome of major gastrointestinal surgery. The aim of this study was to define retrospectively a multifactorial prognostic nutritional index adapted to this purpose. Seventy-eight patients on whom one or more total or partial visceral resection were performed in nonemergency conditions were included in this study. Statistical analysis was carried out to determine correlations between the preoperative nutritional parameters and the postoperative complications such as: a) wound rupture and anastomotic leakage; b) severe sepsis; c) death. Delayed hypersensitivity, assessed as normal or abnormal, together with plasmatic albumin and transferrin levels, the thresholds of which were respectively determined at 35 g/l and 2.2 g/l, were selected as the factors with the greatest predictive value. For the prognosis of postoperative severe complications and death, the sensitivity and specificity of an index using the association of these three parameters were respectively 82.7 p. 100 and 51 p. 100 with positive and negative predictive values of 50 p. 100 and 83.3 p. 100.
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PMID:[Prognostic nutritional index in digestive surgery]. 665 71

A prospective nutritional evaluation of 84 unselected patients admitted to a multidisciplinary ICU was performed using anthropometric measurements, creatinine height index (CHI), and serum protein assays. All values tested were significantly lower than those of 40 healthy controls. A matrix of correlation coefficients showed many similarities among the variables studied. Fatal outcome and poor prognosis indices, such as sepsis and renal failure, were analyzed separately. Anthropometric measurements and CHI were not different in the separate groups. Albumin (Alb) and transferrin (Tr) were not different in patients with or without sepsis. Retinol binding prealbumin was significantly higher in patients with renal failure. Thyroxin-binding prealbumin (TBPA) was significantly lower in all the groups. We emphasize the interest of this rapid turnover protein in evaluating nutritional status. We suggest: (1) a systematic nutritional assessment, and (2) an aggressive nutritional support in the ICU patient.
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PMID:Nutritional status in intensive care patients: evaluation in 84 unselected patients. 682 85

An acute depletion of plasma fibronectin or FN has been observed in critically ill, surgical, or trauma patients, but there is little information on the relationships between FN levels and the final outcome in such cases, and on the simultaneous behaviour of other serum proteins. The daily values of FN, antithrombin III, IgG, C3, prealbumin, and transferrin were monitored in 98 intensive care patients after major elective surgery or trauma. According to their clinical course, they were divided retrospectively into three groups. Group A (33 patients) had sepsis. Group B (31 patients) had nonseptic complications, and group C (34 patients) had no complications in the ICU. The individual, nadir levels of FN, AT III, prealbumin, and transferrin were lower (p less than 0.01) in the septic group A than in B and C. Within the septic group, the nadir levels of AT III, but not those of FN, were lower (p less than 0.01) in the 14 nonsurvivors than in the 19 survivors. The FN and AT III levels had returned at least temporarily to the normal range in the six ultimate fatalities from sepsis who survived for more than two weeks. In the septic group, transferrin showed the highest percentages of actually subnormal levels and differed from FN in this respect with p less than 0.05. Furthermore, all six proteins showed a significant overall pattern (p less than 0.01) of parallel variations. The results confirm other reports on the behavior of fibronectin in septic patients as a group, but it was not informative as to the individual outcome, and its reduction might be viewed as part of a general plasma protein depletion associated with acute septic disease. This pattern is probably attributable to a combination of intravascular consumption and an overall excess of protein catabolism over synthesis.
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PMID:Plasma fibronectin and associated variables in surgical intensive care patients. 683 Mar 38

Urine ketone levels were measured in patients receiving peripheral amino acid solutions, and the results were correlated with changes in nitrogen balance. Thirty well-nourished patients who were to undergo cystectomy were placed on liquid, noncarbohydrate diets 3 days before operation, and no oral intake was allowed until 7 days after operation. Crystalline amino acid (1.3 to 1.5 gm/kg/day) solutions were infused continuously from 3 days before to 7 days after operation. Blood was obtained 3 days before and 3, 7, and 10 days after operation; 24-hour urine outputs were determined daily. Qualitative urine acetone levels were determined four times daily. During the infusion period, 14 (47%) patients developed ketonuria (group I); 16 patients did not (group II). The mean serum glucose levels ranged from 99 to 107 mg/dl in group I and from 108 to 113 mg/dl in group II (P less than 0.05). The mean serum transferrin level decreased after operation to 117 mg/dl in group I and 97 mg/dl in group II. The mean cumulative adjusted nitrogen balance was -24 +/- 8 gm in group I and -47 +/- 9 gm in group II (P less than 0.05). No patient developed sepsis. Qualitative testing of urinary ketones correlated with significant alterations in blood urea nitrogen, serum glucose, transferrin, and cumulative adjusted nitrogen balance. The bedside determination of urinary ketones may be useful in assessing a patient's adaptation to peripheral amino acid infusions.
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PMID:Adaptation to amino acid infusion in patients undergoing operation. 683 5

161 children followed up postoperatively following splenectomy, 29% had spherocytosis, 14% Hodgkin's disease, 12% traumatic rupture of the spleen, 11% portal hypertension and 7% idiopathic thrombocytopenia. Postoperatively a slight wound infection occurred in 5% of the children, while complications were seen in 2% which could be interpreted as directly caused by the operation; in 23 patients, however, (i.e. 15%), severely infections occurred such as pneumonia, meningitis and sepsis. The lethality rate of the infected children was 31.8%. Postoperatively we determined the leucocyte count, thrombocytes and erythrocyte count, the immunoglobulins IgG, IgA, IgM and IgE, the serum concentrations of the complement components C3, C4 and the serum proteins alpha 1-antitrypsin and transferrin. The data obtained were compared with the corresponding data reported in the literature.
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PMID:[Complications of splenectomy in childhood (author's transl)]. 704 92

The potential of nutritional assessment parameters in predicting sepsis in burn patients was investigated. Sixty-two consecutive patients (mean age 41 years) with an average burn size of 19% were studied. Values were obtained on postburn day 10 for serum albumin, transferrin, nitrogen balance, total lymphocyte count, skin test reactivity, and percentage of ideal body weight. Parameters predictive of imminent septic episode included serum albumin less than 3.0 g/dl (p less than 0.001), total lymphocyte count less than 1500/mm3 (p less than 0.001), anergy (p less than 0.001), and serum transferrin less than 150 mg/dl (p less than 0.001). Nitrogen balance and percentage of ideal body weight were not found to contribute to group discrimination.
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PMID:Nutritional indicators of postburn bacteremic sepsis. 719 89

Factors that might predict sepsis and mortality were investigated in 282 hospitalized patients referred for metabolic and nutritional therapy. Routine assessment parameters, including delayed hypersensitivity response to recall skin antigens, serum albumin and transferrin, total lymphocyte count, and anthropometric measurements were evaluated with respect to ultimate outcome. A discriminant function (0.91 (albumin) - 1.00 delayed hypersensitivity - 1.44 (sepsis) + 0.98 (diagnosis) - 1.09) was developed having an overall predictive value for subsequent hospital mortality of 72%, a sensitivity of 74%, and a specificity of 66%. Serum albumin was found to be the best single indicator of concurrent sepsis and anergy, and predictor of mortality; an initial albumin less than 2.2 g/dl was associated with a greater than 75% chance of having concurrent anergy and sepsis and dying. An improvement in delayed hypersensitivity response was the most accurate predictor of an improved prognosis (overall predictive value 86%, sensitivity 93%, specificity 63%). Thus, the use of serum albumin, delayed hypersensitivity response to recall skin antigens, clinical status, i.e., septic or not septic, and presence or absence of cancer cachexia can serve to identify high risk patients in an objective fashion and evaluate the effectiveness of hospital therapy. This information may also assist the hospital team in allocation of resources.
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PMID:Biological measures for the formulation of a hospital prognostic index. 729 33

Infections with Vibrio vulnificus resulting in septicemia and high mortality have been correlated with pre-existing liver disease and hemochromatosis. As these conditions are associated with impaired iron metabolism and as iron availability in the host has been implicated in the pathogenicity of a number of bacterial infections, the role of iron as a possible factor in the pathogenesis of V. vulnificus was examined. Injection of mice with iron resulted in a lowering of the 50% lethal dose from 10(6) to 1.1 cells and in a reduction in the time of death postinfection. Elevated serum iron levels were also produced by damaging livers with injections of CCl4. The inoculum size required to kill these mice was directly correlated with serum iron levels. Since the portal of infection of this organism may be ingestion of contaminated seafood, the effects of iron upon orally induced infection were also studied. The effects of adding iron, transferrin, or Desferal (an iron chelate) upon the growth of V. vulnificus in human and rabbit sera were also examined. Iron appeared to be the limiting factor in the ability of this organism to survive or grow in mammalian sera. These results, both in vitro and in vivo, provided strong evidence that iron may play a major role in the pathogenesis of V. vulnificus.
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PMID:Role of iron in the pathogenesis of Vibrio vulnificus infections. 730 36

Humoral immunity (immunoglobulins and C3) as well as nutritional conditions (serum albumin, transferrin) have been investigated in 23 patients in the acute phase after surgery and/or trauma. Immunoglobulin deficiency, well correlated with the severity of trauma, was observed in the most critically ill patients in the very early phase, followed by a rapid rise to near to normal values and typical immunologic response. There is no evidence that this depression of humoral immunity may enhance the risk of infectious complications in the postoperative period. Very different immunological patterns were observed in surgical patients with chronic sepsis.
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PMID:[Changes in the parameters of humoral immunity due to surgical operations or trauma]. 731 80


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