Feldkirch, Austria
Feldkirch, Austria

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Dietz S.,St. Marien Krankenhaus Siegen gem. GmbH | Lautenschlager C.,Martin Luther University of Halle Wittenberg | Muller-Werdan U.,Evangelisches Geriatriezentrum Berlin gGmbH | Pilz G.,Klinik fur Kardiologie | And 6 more authors.
Medizinische Klinik - Intensivmedizin und Notfallmedizin | Year: 2016

Background: The role of intravenous immune globulin (Ig) therapy in patients with severe sepsis and septic shock is discussed controversially. Low initial IgG levels could help to identify those patients who might benefit from an adjunctive Ig treatment. Objectives: To investigate the effect of initial serum IgG levels on 28-day mortality in patients with severe sepsis and septic shock. Materials and methods: In this retrospective analysis of the SBITS trial data, 543 patients were allocated to four groups (quartiles) depending on their initial serum IgG levels (1: IgG ≤ 6.1 g/l; 2: IgG 6.2–8.4 g/l; 3: IgG 8.5–11.9 g/l; 4: IgG > 11.9 g/l). The third quartile was taken as the reference quartile. For the applied logistic regression model clinically relevant confounders were defined and integrated into further risk-adjusted calculations. Results: Patients with the lowest IgG levels had a mortality rate similar to those patients with initial IgG levels in the second and third quartile, representing the physiological IgG range in healthy people. Surprisingly, patients with the highest IgG levels even showed a significantly higher mortality in a risk-adjusted calculation compared to the reference quartile (OR 1.69, CI 1.01–2.81, p = 0.05). Subgroup analyses revealed that initial IgG levels were of no prognostic value in patients presenting with vasopressor-dependent septic shock on admission as well as in patients with either gram-positive or gram-negative sepsis. Conclusions: Initially low IgG levels do not discriminate between survival and nonsurvival in patients with severe sepsis and septic shock. Therefore, low IgG cannot help to identify those patients who might benefit from an adjunctive IgG sepsis therapy. Whether a high initial IgG serum level is an independent mortality risk factor needs to be investigated prospectively. © 2016 Springer-Verlag Berlin Heidelberg


Biller K.,Medizinisches Zentrallabor | Fae P.,Ludwig Maximilians University of Munich | Germann R.,Abteilung fur Anasthesie | Walli A.K.,Institute For Klinische Chemie Klinikum Grosshadern | Fraunberger P.,Medizinisches Zentrallabor
LaboratoriumsMedizin | Year: 2011

The role of procalcitonin (PCT) plasma levels as a diagnostic tool for intensive care patients has been intensively investigated during the past years. In particular for recognition of bacterial infections, PCT levels have been shown to be superior to other clinical and biochemical markers. Furthermore, some very recent studies show that in patients with lower respiratory tract infections PCT guided antibiotic therapy reduces antibiotic use and thereby may also reduce duration of stay of patients in hospital and thus cut hospitalisation costs. However, various studies indicate that the value of PCT as a prognostic marker is limited because of false positive or negative values. Despite these limitations PCT plasma levels are currently measured in intensive care units. The present study summarises the possible clinical uses of this lab marker as a diagnostic tool for the assessment of critically of ill patients. © 2011 by Walter de Gruyter.


PubMed | Martin Luther University of Halle Wittenberg, Klinik fur Innere Medizin II, Klinik fur Kardiologie, Medizinisches Zentrallabor and 4 more.
Type: | Journal: Medizinische Klinik, Intensivmedizin und Notfallmedizin | Year: 2016

The role of intravenous immune globulin (Ig) therapy in patients with severe sepsis and septic shock is discussed controversially. Low initial IgG levels could help to identify those patients who might benefit from an adjunctive Ig treatment.To investigate the effect of initial serum IgG levels on 28-day mortality in patients with severe sepsis and septic shock.In this retrospective analysis of the SBITS trial data, 543 patients were allocated to four groups (quartiles) depending on their initial serum IgG levels (1: IgG 6.1g/l; 2: IgG 6.2-8.4g/l; 3: IgG 8.5-11.9g/l; 4: IgG> 11.9g/l). The third quartile was taken as the reference quartile. For the applied logistic regression model clinically relevant confounders were defined and integrated into further risk-adjusted calculations.Patients with the lowest IgG levels had amortality rate similar to those patients with initial IgG levels in the second and third quartile, representing the physiological IgG range in healthy people. Surprisingly, patients with the highest IgG levels even showed asignificantly higher mortality in arisk-adjusted calculation compared to the reference quartile (OR1.69, CI 1.01-2.81, p= 0.05). Subgroup analyses revealed that initial IgG levels were of no prognostic value in patients presenting with vasopressor-dependent septic shock on admission as well as in patients with either gram-positive or gram-negative sepsis.Initially low IgG levels do not discriminate between survival and nonsurvival in patients with severe sepsis and septic shock. Therefore, low IgG cannot help to identify those patients who might benefit from an adjunctive IgG sepsis therapy. Whether ahigh initial IgG serum level is an independent mortality risk factor needs to be investigated prospectively.


Boenisch S.,Medizinisches Zentrallabor | Fae P.,Abteilung fur Anasthesiologie und Intensivmedizin | Drexel H.,Vorarlberger Institute Zur Erforschung und Behandlung von Erkrankungen des Gefasssystems | Walli A.K.,Universitatsklinikum Grosshadern | Fraunberger P.,Medizinisches Zentrallabor
LaboratoriumsMedizin | Year: 2013

C-reactive protein (CRP) currently constitutes one of the most widely used parameters for the diagnosis of infections and inflammatory processes, due to simple methods and low costs. However, in recent years, other parameters, such as interleukin 6 (IL-6) and procalcitonin (PCT), have gained in importance. Although these parameters are presently not established everywhere in clinical routine, they provide significant advantages in the diagnosis and monitoring of inflammatory diseases. For instance, in intensive care, the increase in IL-6 levels may indicate inflammatory complications 24 to 48 h prior to the increase in circulating CRP levels. In contrast to CRP, PCT shows a higher specificity for bacterial infections, which facilitates the diagnosis of bacterial infections and sepsis. Therefore, PCT values provide a better evaluation of prognosis and therapeutic success and of a necessary change in therapy. These points raise the question whether CRP levels should at least in part be replaced by PCT and/or IL-6. Thus, this review seeks to examine the value of CRP in relation to PCT and IL-6 in the diagnosis of bacterial infections, in therapeutic monitoring, and regarding prognosis in critical care patients. © 2013 by Walter de Gruyter Berlin Boston 2013.


Gruber S.,Medizinisches Zentrallabor | Werner P.,Institute For Akutneurologie Und Schlaganfall Mit Stroke Unit | Germann R.,Abteilung fur Anasthesie und Intensivmedizin | Fraunberger P.,Medizinisches Zentrallabor
LaboratoriumsMedizin | Year: 2015

In 1985 interleukin 6 (IL-6) was first identified as a differentiation factor for B-cells (B-cell stimulatory factor 2) which caused B-cells to mature and produce antibodies. Numerous studies now demonstrate the pleiotropic character of IL-6, which has been shown to possess important functions in the immune system, the regulation of hematopoesis, inflammation and oncogenesis. In the central nervous system (CNS), IL-6 is involved in neurogenesis and the response of neurons and glia-cells to various injuries. CNS infections, cerebral ischaemia, CNS traumata or chronic inflammatory diseases with CNS manifestations such as neuro-lupus or neuro-sarcoidosis are associated with increased IL-6 levels in the cerebrospinal fluid (CSF). Thus, the use of IL-6 as a diagnostic and prognostic tool in these diseases is being investigated. In this review we aim to provide an overview of current studies and evaluate the diagnostic significance of CSF-IL-6. © 2015 by De Gruyter.


Fraunberger P.,Medizinisches Zentrallabor | Drexel H.,Vorarlberg Institute for Vascular Investigation and Treatment VIVIT | Walli A.K.,Ludwig Maximilians University of Munich
Deutsche Medizinische Wochenschrift | Year: 2010

Severe sepsis and septic shock are common complications in the intensive care unit and associated with high mortality. Early antimicrobial therapies together with organ-supportive measures are the major therapeutic approaches. However in the last decades immunmodulatory therapies have been investigated due to the notion of a compromised inflammatory response in septic patients. In addition to lowering circulating cholesterol, statins (HMG-CoA-reductase- inhibitors) have also been shown to possess pleiotropic anti-inflammatory potential. Recent studies indicate that these anti-inflammatory effects also modulate acute inflammatory response and therefore may play a protective role in septic patients. In this review, the pathophysiological backround and first clinical trials of statins as a new adjuvant therapy in sepsis are summarized. © Georg Thieme Verlag KG Stuttgart.


PubMed | Medizinisches Zentrallabor
Type: Journal Article | Journal: Deutsche medizinische Wochenschrift (1946) | Year: 2010

Severe sepsis and septic shock are common complications in the intensive care unit and associated with high mortality. Early antimicrobial therapies together with organ-supportive measures are the major therapeutic approaches. However in the last decades immunomodulatory therapies have been investigated due to the notion of a compromised inflammatory response in septic patients. In addition to lowering circulating cholesterol, statins (HMG-CoA-reductase-inhibitors) have also been shown to possess pleiotropic anti-inflammatory potential. Recent studies indicate that these anti-inflammatory effects also modulate acute inflammatory response and therefore may play a protective role in septic patients. In this review, the pathophysiological background and first clinical trials of statins as a new adjuvant therapy in sepsis are summarized.

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