Predictive Biomarkers in Critically Ill Patients: New Insights and Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 7268

Special Issue Editors


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Guest Editor
Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
Interests: gastroenterology; metabolic diseases and intensive care; acute poisoning in intensive care; acute liver failure (ALF); acute-on-chronic liver failure (ACLF); multi-organ failure; sepsis; biomarkers

Special Issue Information

Dear Colleagues,

Clinical biomarkers are used in critically ill patients to assess the individual outcome, predict complications of ICU (Intensive Care Unit) treatment and multiple organ failure and to evaluate therapy effectiveness. Typically, C-reactive protein (CRP) and procalcitonin (PCT) are biomarkers of systemic inflammation that are often used in everyday clinical practice in intensive care medicine. However, these routinely used biomarkers have limited prognostic and diagnostic power in intensive care patients. Consequently, inflammatory cytokines and chemokines have been intensively investigated with respect to their prognostic potential for diagnosing sepsis due to their early systemic release in sepsis compared to acute phase proteins. At present, the ideal biomarker for differentiating between sepsis and SIRS or for predicting the clinical course has not yet been identified.
A better understanding of the pathophysiological mechanisms of multi-organ failure is mandatory in order to develop novel, effective diagnostic and treatment options for these important clinical conditions and thus to reduce the high sepsis-related mortality in critically ill patients.
The aim of the current special issue is to summarize and present novel data on diagnostic and prognostic biomarkers that permit reliable and early diagnosis and risk assessment for outcome in a clinical context.

We welcome clinical and basic research reviews, as well as original contributions, highlighting the current knowledge and concepts on Predictive Biomarkers in Critically Ill Patients.

Prof. Dr. Ralf Weiskirchen
Prof. Alexander Koch
Guest Editors

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Keywords

  • Intensive care medicine
  • Clinical/novel biomarkers
  • Sepsis Infections
  • Organ dysfunction
  • Acute-phase proteins
  • Translational medicine
  • Solid organ transplantation
  • COVID-19 in critical care

Published Papers (4 papers)

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Research

21 pages, 627 KiB  
Article
Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates
by Amna Mohamed Juma Almarashda, Syed Arman Rabbani, Martin Thomas Kurian and Ajith Cherian
J. Clin. Med. 2022, 11(9), 2439; https://doi.org/10.3390/jcm11092439 - 26 Apr 2022
Cited by 3 | Viewed by 1647
Abstract
Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this [...] Read more.
Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this single-center, analytical cross-sectional study conducted in a secondary care hospital of the UAE. A total of 585 patients were included in the study (median age, 49 years (IQR, 39–59); 66% male). Age > 45 years (OR = 2.07, 95% CI: 1.04–4.14, p = 0.040), male gender (OR = 3.15, 95% CI: 1.52–6.51, p = 0.002), presentation symptoms such as fever (OR = 3.68, 95% CI:1.34–10.11, p = 0.011) and shortness of breath/dyspnea (OR = 5.36, 95% CI: 2.69–10.67, p < 0.001), Hb < 13 g/dL (OR = 3.17, 95% CI: 1.51–6.65, p = 0.002), neutrophils > 7 × 103/mcL (OR = 4.89, 95% CI: 1.66–14.37, p=0.004), lymphocytes < 1 × 103/mcL (OR = 7.78, 95% CI: 1.01–60.19, p = 0.049), sodium < 135 mmol/L (OR = 5.42, 95% CI: 1.05–27.95, p = 0.044), potassium < 3.6 mmol/L (OR = 3.36, 95% CI: 1.03–11.01, p = 0.045), urea > 6.5 mmol/L (OR = 3.37, 95% CI: 1.69–6.73, p = 0.001) and LDH > 227 IU/L (OR = 6.26, 95% CI: 1.61–24.32, p = 0.008) were independent predictors of the severity of COVID-19. Antivirals (524, 89.6%) and corticosteroids (358, 61.2%) were prescribed for the management of COVID-19. In conclusion, older age, male gender, presentation symptoms such as fever and dyspnea, low hemoglobin, neutrophilia, lymphopenia, hyponatremia, hypokalemia, elevated levels of urea and lactate dehydrogenase were found to be independent risk factors for severe COVID-19. The pharmacotherapy of COVID-19 patients in our study was diverse, and the medications were prescribed based on the clinical condition of the patients. Full article
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9 pages, 3586 KiB  
Article
Lymphopenia and Early Variation of Lymphocytes to Predict In-Hospital Mortality and Severity in ED Patients with SARS-CoV-2 Infection
by Maxence Simon, Pierrick Le Borgne, François Lefevbre, Sylvie Chabrier, Lauriane Cipolat, Aline Remillon, Florent Baicry, Pascal Bilbault, Charles-Eric Lavoignet and Laure Abensur Vuillaume
J. Clin. Med. 2022, 11(7), 1803; https://doi.org/10.3390/jcm11071803 - 24 Mar 2022
Cited by 2 | Viewed by 2077
Abstract
(1) Introduction: Multiple studies have demonstrated that lymphocyte count monitoring is a valuable prognostic tool for clinicians during inflammation. The aim of our study was to determine the prognostic value of delta lymphocyte H24 from admission from the emergency department for mortality and [...] Read more.
(1) Introduction: Multiple studies have demonstrated that lymphocyte count monitoring is a valuable prognostic tool for clinicians during inflammation. The aim of our study was to determine the prognostic value of delta lymphocyte H24 from admission from the emergency department for mortality and severity of SARS-CoV-2 infection. (2) Methods: We have made a retrospective and multicentric study in six major hospitals of northeastern France. The patients were hospitalized and had a confirmed diagnosis of SARS-CoV-2 infection. (3): Results: A total of 1035 patients were included in this study. Factors associated with infection severity were CRP > 100 mg/L (OR: 2.51, CI 95%: (1.40–3.71), p < 0.001) and lymphopenia < 800/mm3 (OR: 2.15, CI 95%: (1.42–3.27), p < 0.001). In multivariate analysis, delta lymphocytes H24 (i.e., the difference between lymphocytes values at H24 and upon admission to the ED) < 135 was one of the most significant biochemical factors associated with mortality (OR: 2.23, CI 95%: (1.23–4.05), p = 0.009). The most accurate threshold for delta lymphocytes H24 was 75 to predict severity and 135 for mortality. (4) Conclusion: Delta lymphocytes H24 could be a helpful early screening prognostic biomarker to predict severity and mortality associated with COVID-19. Full article
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12 pages, 1467 KiB  
Article
A Three-Protein Panel to Support the Diagnosis of Sepsis in Children
by Francisco J. Pilar-Orive, Itziar Astigarraga, Mikel Azkargorta, Felix Elortza and Susana Garcia-Obregon
J. Clin. Med. 2022, 11(6), 1563; https://doi.org/10.3390/jcm11061563 - 12 Mar 2022
Cited by 6 | Viewed by 2221
Abstract
Sepsis is a syndrome without a standard validated diagnostic test. Early recognition is crucial. Serum proteome analysis in children with sepsis may identify new biomarkers. This study aimed to find suitable blood biomarkers for an early diagnosis of sepsis. An analytical observational case-control [...] Read more.
Sepsis is a syndrome without a standard validated diagnostic test. Early recognition is crucial. Serum proteome analysis in children with sepsis may identify new biomarkers. This study aimed to find suitable blood biomarkers for an early diagnosis of sepsis. An analytical observational case-control study was carried out in a single center. Children admitted to a Pediatric Intensive Care Unit with clinical diagnosed sepsis were eligible for study. A proteomic analysis conducted by mass spectrometry was performed. Forty patients with sepsis and 24 healthy donors were recruited. Proteomics results revealed 44 proteins differentially expressed between patients and healthy controls. Six proteins were selected to be validated: lactoferrin, serum amyloid-A1 (SAA-1), complement factor B, leucine-rich alpha-2 glycoprotein (LRG1), soluble interleukin-2 alpha chain receptor (sCD25) and soluble haptoglobin–hemoglobin receptor. Our results showed that sCD25, SAA-1, and LRG1 had high levels of specificity and sensitivity, as well as an excellent area under the ROC curve (>0.9). Our study provides a serum proteomic analysis that identifies new diagnostic biomarkers in sepsis. SAA-1, sCD25 and LRG1 were able to separate septic from healthy donor, so they could be used together with other clinical and analytical features to improve sepsis diagnosis in children. Full article
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12 pages, 1705 KiB  
Article
Decreased Bone Mineral Density Is a Predictor of Poor Survival in Critically Ill Patients
by Maximilian F. Schulze-Hagen, Christoph Roderburg, Theresa H. Wirtz, Markus S. Jördens, Lukas Bündgens, Samira Abu Jhaisha, Philipp Hohlstein, Jonathan F. Brozat, Philipp Bruners, Christina Loberg, Christiane Kuhl, Christian Trautwein, Frank Tacke, Tom Luedde, Sven H. Loosen and Alexander Koch
J. Clin. Med. 2021, 10(16), 3741; https://doi.org/10.3390/jcm10163741 - 23 Aug 2021
Cited by 4 | Viewed by 1851
Abstract
Alterations in bone mineral density (BMD) have been suggested as independent predictors of survival for several diseases. However, little is known about the role of BMD in the context of critical illness and intensive care medicine. We therefore evaluated the prognostic role of [...] Read more.
Alterations in bone mineral density (BMD) have been suggested as independent predictors of survival for several diseases. However, little is known about the role of BMD in the context of critical illness and intensive care medicine. We therefore evaluated the prognostic role of BMD in critically ill patients upon admission to an intensive care unit (ICU). Routine computed tomography (CT) scans of 153 patients were used to assess BMD in the first lumbar vertebra. Results were correlated with clinical data and outcomes. While median BMD was comparable between patients with and without sepsis, BMD was lower in patients with pre-existing arterial hypertension or chronic obstructive pulmonary disease. A low BMD upon ICU admission was significantly associated with impaired short-term ICU survival. Moreover, patients with baseline BMD < 122 HU had significantly impaired overall survival. The prognostic relevance of low BMD was confirmed in uni- and multivariate Cox-regression analyses including several clinicopathological parameters. In the present study, we describe a previously unrecognised association of individual BMD with short- and long-term outcomes in critically ill patients. Due to its easy accessibility in routine CT, BMD provides a novel prognostic tool to guide decision making in critically ill patients. Full article
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