掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1111/ped.15825

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Background

Shiga toxin‐producing Escherichia coli ‐associated hemolytic uremic syndrome (STEC‐HUS) is a life‐threatening condition complicated by acute kidney injury, acute respiratory distress syndrome, and central nervous system disorders. The early identification of high‐risk patients is required to facilitate timely and appropriate treatment.

Methods

The medical records of patients with STEC‐HUS treated at 11 hospitals in Hokkaido, Japan, were reviewed retrospectively. A multi‐institutional retrospective analysis was performed in which patients were divided into two groups according to the presence or absence of severe complications requiring blood purification therapy or encephalopathy. We compared the laboratory values at diagnosis between the severe and mild groups. To identify patients at high risk of developing severe complications, a scoring system, referred to as the “STEC‐HUS severity (STEC‐HUSS) score,” was constructed based on the parameters showing significant differences.

Results

Of the 41 patients with STEC‐HUS, 11 were classified into the severe group and 30 into the mild group. Significant differences were observed between the groups in terms of white blood cell count, activated partial thromboplastin time, fibrinogen, D ‐dimer, total protein, aspartate transaminase, alanine transaminase, lactate dehydrogenase, creatinine, and C‐reactive protein levels. The STEC‐HUSS score was calculated on a scale of 0–10 by summing the number of test items that demonstrated abnormal values. The STEC‐HUSS score, when the cut‐off value was 4, showed a sensitivity of 100% and a specificity of 91% in the severe group.

Conclusion

We developed a novel scoring system to identify patients at high risk of severe STEC‐HUS.

DOI： 10.1111/ped.15833

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.clinbiochem.2023.110650

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elmer Press, Inc.  

DOI： 10.14740/jmc3940

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Background

Lower respiratory tract infections due to respiratory syncytial virus are associated with morbidity and mortality in infants and children. Thus precise elucidation of respiratory syncytial virus lower respiratory tract infection pathophysiology is important.

Methods

Medical records of hospitalized patients were reviewed. Patients were divided into three groups. Group I: patients who improved without oxygen supply. Group II: patients who received oxygen supply, but not nasal high‐flow cannula therapy. Group III: patients who received nasal high‐flow cannula. Patients were also divided by age group into the <6 months and ≥6 months groups. Parameters for differentiating the severity among groups were then evaluated. Further, serum concentration of high‐mobility group box‐1 and several cytokines (Inerleukin‐6, soluble tumor necrosis factor receptor‐1/2, Interleukin‐18, Interferon‐gamma responsive protein‐100) were evaluated.

Results

One hundred eighty‐nine were enrolled. An analysis of variance for those <6 months showed overall differences including younger age, lower pH, and increased partial pressure of carbon dioxide (pCO2), bicarbonate (HCO3‐), and base excess at the time of admission. On the other hand, analysis of variance for ≥6 months revealed that, in addition to a lower pH and increased pCO2, patients showed differences including decreased serum total protein and albumin, and increased aspartate aminotransferase (AST), alanin aminotransferase (ALT), lactate dehydrogenase (LDH), Ferritin and C‐reactive protein (CRP) levels. Further, evaluation of serum cytokines showed that IL‐6, s tumor necrotizing factor receptor‐1/2, and high‐mobility group box‐1 were higher in Group II/III among the ≥6 months age group, but not for those in the <6 months group.

Conclusions

The pathophysiology of severe respiratory syncytial virus lower respiratory tract infection varies according to the age at onset. In late infancy and childhood, a certain proportion of patients show a hyperinflammatory status.

DOI： 10.1111/ped.14720

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ped.14720