Civil Hospital of Legnano

San Giorgio su Legnano, Italy

Civil Hospital of Legnano

San Giorgio su Legnano, Italy
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Righi S.,Civil Hospital of Legnano | Santambrogio L.,Civil Hospital of Legnano | Monsagrati A.,Civil Hospital of Legnano | Saliu M.,Civil Hospital of Legnano | And 2 more authors.
Infectious Diseases in Clinical Practice | Year: 2014

Background: Infections are one of the major causes of morbidity and mortality in critically ill patients. Severe infections should be treated at earlier stages, but the diagnosis is difficult as the clinical presentation results are unspecific. Recently, the neutrophils Fc gamma receptor, recognized by monoclonal antibodies cluster of differentiation 64 (CD64), has been proposed as an infection marker. The aim of the present study was to evaluate CD64 as a marker of infection in our polyvalent intensive care unit, distinguishing early infection from noninfected inflammation. Methods: We evaluated 93 consecutive patients presenting with infection signs on admission. CD64, C-reactive protein (CRP), and white blood cell count were collected. After a test for normal distribution, data were analyzed nonparametrically and reported as median and interquartile range (IQR); then, Kruskal-Wallis and Mann-Whitney tests were performed. Statistically significant difference was defined as P < 0.05. Results: C-reactive protein (median, 17.4 mg/L; IQR, 11.4-27.2 mg/L vs median, 10.1 mg/L; IQR, 7.5-13.7mg/L) and CD64 (median, 3842 antibody-binding capacity [ABC]; IQR, 2799-5283 ABC vs median, 768.5 ABC; IQR, 532.3-1269.3 ABC) showed a significant difference between septic and nonseptic patients, respectively. Receiver operating characteristic curves of CD64, CRP, and white blood cell count showed the superiority of CD64: considering a cutoff of 2000 antibody-binding capacity for infection, sensitivity was 90.2% and specificity was 96.9% in comparison with CRP (sensitivity, 85.2%; and specificity, 46.9% for cutoff of 10 mg/L). CD64 expression, but not CRP, was able to differentiate the septic stages (P < 0.001). Conclusions: Neutrophil CD64 represents a sensitive and specific marker for the early diagnosis of systemic infections in adult patients admitted to intensive care unit, superior to traditional hematological parameters and CRP. Copyright © 2013 by Lippincott Williams & Wilkins.


Libetta C.,University of Pavia | Esposito P.,University of Pavia | Sepe V.,University of Pavia | Guastoni C.,Civil Hospital of Legnano | And 3 more authors.
European Cytokine Network | Year: 2011

Background. Peritoneal dialysis (PD) is associated with a depression of T cell function, as suggested by the impaired production of cytokines by Th cells collected from PD patients. Although treatment biocompatibility could be implicated in this immune dysfunction, it has been poorly investigated, thus far. Therefore, we undertook a study aiming to analyze the effects of different peritoneal dialysis fluids on the Th1/Th2 balance in PD patients. Methods. Twenty three patients on continuousambulatory peritoneal dialysis (CAPD) were evaluated. Seven patients were on CAPD with icodextrin solution (ICO-PD), seven with glucose and lactate/bicarbonate-buffered solution (LAC/BIC-PD), and nine with glucose and lactate-buffered solution (LAC-PD). The Th1/Th2 balance was evaluated by measuring IFN-γ(Th1 subset) and IL-4 (Th2 subset), both in circulating and peritoneum-derived Th lymphocytes unstimulated or stimulated by phytohemoagglutinin (PHA). Moreover inflammatory, nutritional and dialysis-related parameters were recorded. Eight normal subjects comprised the control group (CON). Results. Circulating T cells: IFN-γ was significantly lower in the LAC-PD group (p<0.05) compared to the ICO-PD and LAC/BIC-PD groups. The IFN-γ/IL-4-producing cell ratio was significantly lower in PD patients than in CON. Peritoneal T cells: after 24-h PHA stimulation, IFN-γincreased in all patients, but the rise was less pronounced in the LAC-PD group (p<0.05) than in the other two PD groups. The Th1/Th2 ratio was significantly lower in the LAC-PD group when compared both to LAC/BIC-PD and ICO-PD groups. In addition, the LAC-PD group presented a significantly higher rate of peritoneal infections compared to the other PD groups. Conclusions. CAPD with lactate-buffered peritoneal fluid has deleterious effects on the Th1 cell subset, while the use of more biocompatible fluids, bicarbonate-buffered and icodextrin, is associated with a more physiologically representative Th1/Th2 balance and a reduced peritonitis rate.

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