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

Plasma fibronectin levels and complete blood cell counts were assessed prospectively among 100 infants less than 3 months of age with the provisional diagnosis of "possible sepsis". Seven of the ten infants with culture-proved bacteremia, meningitis, or urinary tract infection had low plasma fibronectin levels as did 12 (13%) of 90 infants with superficial or no documented bacterial infection. The positive predictive value of a low plasma fibronectin level in conjunction with leukocytosis and elevated band ratio for discriminating serious bacterial infection was 71%. Normal white blood cell counts or fibronectin level alone or in combination predicted the absence of serious bacterial infection with an accuracy of at least 94%. Plasma fibronectin determination provides a useful adjunct to the complete blood cell count for the rapid evaluation of extent of illness in young infants with possible sepsis.
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PMID:Role of fibronectin in diagnosing bacterial infection in infancy. 339 79

Serum fibronectin (Fn) level was serially determined in nineteen septic patients. Fn concentration was found significantly decreased in septic patients (mean +/- SE, 120 +/- 11 micrograms/ml) as compared to the control (205 +/- 11 micrograms/ml). The decrease of Fn was correlated with the severity of sepsis; it was persistent and more important in severe septic cases. The lowest Fn concentration was found in nonsurviving patients (78 +/- 18 micrograms/ml). Serum Fn level may reflect the degree of organ failure and predict the evolution of sepsis.
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PMID:Serial analysis of fibronectin concentration in sera from septic patients. 339 19

Antithrombin (AT), prekallikrein (PK), and fibronectin (FN) levels were measured in the plasma of 290 patients. The mean (+/- SD) lowest AT level measured in 287 patients was 70% +/- 18% (normal, 75% to 120% of control). The mean lowest AT level in 81 septic patients (49% +/- 17%) was significantly lower than in the 206 patients without sepsis (78% +/- 22%). The mean AT level in 60 patients who died (42% +/- 22%) was significantly lower than in 227 patients who lived (78% +/- 19%). The mean lowest PK level measured in 71 patients was 42% +/- 17% (normal, 80% to 120%). The mean PK level in 32 septic patients (26% +/- 12%) was significantly lower than in 39 patients who were not septic (54% +/- 19%). The mean lowest FN level measured in 45 patients was 193 +/- 86 micrograms/mL (normal, 160 to 240 micrograms/mL). The mean FN level in 15 septic patients (128 +/- 72 micrograms/mL) was significantly lower than in the 30 nonseptic patients (266 +/- 84 micrograms/mL). Following AT, PK, and FN levels in critically ill surgical patients may allow earlier diagnosis and more effective treatment of sepsis.
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PMID:Antithrombin, prekallikrein, and fibronectin levels in surgical patients. 348 49

In patients with severe sepsis, plasma fibronectin concentrations are reduced and complement is activated. It is not known whether complement activation interferes with plasma fibronectin. Cardiopulmonary bypass is known to activate complement. We have therefore used this operation to study the effect of complement activation on plasma fibronectin in the absence of sepsis. After 15 min of bypass the percentage changes of plasma fibronectin and haematocrit were similar (65.9 +/- s.e.m. 4.8 and 67.0 per cent +/- s.e.m. 2.3, respectively), but the changes in C3 and C5 (58.4 +/- s.e.m. 4.8 per cent and 52.5 per cent +/- s.e.m. 2.1) were significantly greater than those of the haematocrit, indicating complement consumption. During the first 60 min of bypass there was a significant increase in the neutrophil count which is compatible with complement activation. It is unlikely that complement activation alone, in the absence of sepsis, contributes to the reduction of plasma fibronectin concentrations.
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PMID:Plasma fibronectin and complement activation in coronary bypass surgery. 348 98

In summary, the role of fibronectin in clinical medicine is not yet certain. Correlation of sepsis and organ failure with decreased fibronectin levels is still to some degree questionable; controlled clinical trials are urgently needed. The risk of hepatitis, AIDS, and other transfusion-transmitted diseases must be balanced by data substantiating the clinical efficacy of fibronectin therapy. To date, no results from controlled trials using purified fibronectin have been reported. Final judgement must be reserved pending results of appropriate human studies. It is likely, however, that even if fibronectin is proven to be clinically useful, the patient population which will achieve some benefit from its use will be restricted to septic and/or critically ill patients. As noted by Mosher and Grossman however, physicians treating such patients would likely welcome any new and effective therapeutic intervention.
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PMID:Fibronectin: applications to clinical medicine. 351 68

Plasma fibronectin has been postulated to be an essential mediator of normal reticuloendothelial system (RES) function. The acute depletion of fibronectin is thought to impair RES function, whereas its repletion in states of deficiency has been reported to improve RES function. In vitro studies have documented fibronectin's ability to bind to some nonbacterial microaggregates and to promote the phagocytosis of bound targets by the RES. These properties may, however, be influenced by the in vivo milieu. There is substantial evidence for a parallelism between RES function and plasma fibronectin levels following blunt trauma in animal models; however, this association is not seen in experimentally induced intravascular coagulation, acute inflammation, and sepsis. Clinically, subnormal fibronectin levels are clearly associated with the triad of intravascular coagulation, organ failure and sepsis. Fibronectin is, however, not the only plasma protein reduced in these patients, nor is it an outstanding predictor of such complications. The therapeutic efficacy of fibronectin administration remains controversial. Whereas initial reports suggested therapeutic benefits of fibronectin-enriched cryoprecipitates, subsequent studies have produced negative results. Prospective, randomized, controlled clinical trials with purified fibronectin are needed before fibronectin should be recommended as an adjunct to the established principles of intensive care.
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PMID:Plasma fibronectin: relevance for anesthesiology and intensive care. 353 38

In summary, deficiency of plasma fibronectin has now been documented in a variety of clinical entities. Persistently low fibronectin may have prognostic value, and in certain patients may provide a clue to occult sepsis and potential organ failure. The clinical benefit of infusion of fibronectin-rich cryoprecipitate or purified human plasma fibronectin has yet to be determined in well-controlled randomized clinical trials. However, if such results become available then infusion of plasma fibronectin may provide a valuable therapeutic modality in the care of the critically-ill patient.
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PMID:Fibronectin and the critically ill patient: current status. 353 39

Intravenous hyperalimentation has improved the survival of premature infants. However, long-term placement of intravenous catheters may result in the development of catheter-related sepsis. Fibronectin in plasma contains binding sites for staphylococcal species as well as marked affinity for inert plastics and therefore may provide a substrate for bacterial adherence to indwelling catheters. We determined the adherence of labeled [( 3H]leucine) coagulase-positive (CPS) and coagulase-negative (CNS) staphylococci to untreated and fibronectin-coated polyvinyl chloride (PVC) and heparin-bonded polyurethane (HBP) catheter segments and quantitated the binding of 14C-labeled, purified fibronectin to these catheters. PVC catheter segments bound significantly more CNS than CPS (P less than 0.05), while HBP catheters bound more CPS than CNS (P less than 0.05). Fibronectin significantly increased the adherence of CPS to PVC catheters (P less than 0.05) and CNS to HBP catheters (P less than 0.05). PVC catheters bound more fibronectin (P less than 0.0001) than did HBP catheters. Catheter composition may influence the spectrum of nosocomial pathogens to which infants are susceptible through different bacterial adherences and interactions with adhesive proteins.
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PMID:Staphylococcal adherence to polyvinyl chloride and heparin-bonded polyurethane catheters is species dependent and enhanced by fibronectin. 359 51

Two hundred twenty neonates with suspected early onset sepsis were prospectively studied to evaluate the ability of a sepsis screen to discriminate infected from noninfected newborn infants. A positive sepsis screen consisted of positive findings in two or more of the following tests: total white blood cell count; immature/total neutrophil ratio; C-reactive protein; micro-erythrocyte sedimentation rate; or plasma fibronectin. For proved sepsis a four-part screen excluding fibronectin yielded a sensitivity of 100%, specificity of 83%, positive predictive value of 27% and negative predictive value of 100%. In contrast the sensitivity of white blood cell count and immature/total neutrophil ratio was only 46%. Adding fibronectin to the four-part screen provided equal sensitivity and negative predictive value but decreased specificity and positive predictive value. While plasma fibronectin may play an important role in the pathogenesis of neonatal sepsis, it is not useful as a marker for infection. The screens did not identify preterm infants with late onset nosocomial sepsis. Although clinical judgment should be the primary factor in the decision to institute antibiotic therapy, a simple four-part sepsis screen provides valuable presumptive information for excluding the diagnosis of early onset neonatal sepsis.
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PMID:Sepsis screen in neonates with evaluation of plasma fibronectin. 360 90

Plasma fibronectin modulates macrophage phagocytic function and can also incorporate into the insoluble tissue pool of fibronectin where it influences endothelial cell adhesion and tissue integrity. We studied the effect of postoperative bacteremia on lung protein clearance in relation to plasma fibronectin levels using the unanesthetized sheep lung lymph fistula model and the effect of infusion of purified human plasma fibronectin on lung protein clearance. Sheep received live Pseudomonas aeruginosa (5 X 10(8) iv) at a time of normal plasma fibronectin (590 +/- 37 micrograms/ml) or 5 days later at a time corresponding to elevation of plasma fibronectin (921 +/- 114 micrograms/ml). After the first bacterial challenge, there was a 22% decrease (P less than 0.05) in plasma fibronectin. Lung lymph flow (QL) initially increased 308% (P less than 0.05) by 2 h (0 h = 4.7 +/- 1.1 ml/h; 2 h = 14.4 +/- 3.5 ml/h), and the total protein lymph-to-plasma concentration ratio (L/P) declined. This was followed by a sustained second phase response over 3-12 h which was characterized by a 202-393% elevation in QL (P less than 0.05), an increase in the L/P ratio, and a 240-480% (P less than 0.05) increase in lung transvascular protein clearance (TVPC = QL X L/P). Sheep with elevated fibronectin levels also manifested the early (2 h) elevation in QL (P less than 0.05) coupled with a decline in L/P ratio after the second bacterial challenge, but the second-phase increase in TVPC was markedly attenuated. Intravenous infusion of 500 mg of human plasma fibronectin into normal sheep to elevate the fibronectin level comparable to that in the hyperfibronectinemic sheep also attenuated (P less than 0.05) the second-phase (3-12 h) increase in lung protein clearance with sepsis. Thus elevation of plasma fibronectin during postoperative Gram-negative bacteremia may protect the lung vascular barrier. This response may be mediated by either fibronectin's opsonic support of phagocytic function or its influence on lung endothelial cell adhesion.
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PMID:Plasma fibronectin therapy and lung protein clearance with bacteremia after surgery. 365 22


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