The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT
Abstract Background Invasive fungal infections (IFI) are difficult to diagnose, especially in critically ill patients. As the mannose receptor (MR) is shed from macrophage cell surfaces after exposure to fungi, we investigate whether its soluble serum form (sMR) can serve as a biomarker of IFI. Meth...
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2549-8 |
| _version_ | 1818158824390918144 |
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| author | Greet De Vlieger Ilse Vanhorebeek Pieter J. Wouters Inge Derese Michael P. Casaer Yves Debaveye Greet Hermans Philippe Meersseman Holger J. Møller Greet Van den Berghe Catherine Ingels |
| author_facet | Greet De Vlieger Ilse Vanhorebeek Pieter J. Wouters Inge Derese Michael P. Casaer Yves Debaveye Greet Hermans Philippe Meersseman Holger J. Møller Greet Van den Berghe Catherine Ingels |
| author_sort | Greet De Vlieger |
| collection | DOAJ |
| description | Abstract Background Invasive fungal infections (IFI) are difficult to diagnose, especially in critically ill patients. As the mannose receptor (MR) is shed from macrophage cell surfaces after exposure to fungi, we investigate whether its soluble serum form (sMR) can serve as a biomarker of IFI. Methods This is a secondary analysis of the multicentre randomised controlled trial (EPaNIC, n = 4640) that investigated the impact of initiating supplemental parenteral nutrition (PN) early during critical illness (Early-PN) as compared to withholding it in the first week of intensive care (Late-PN). Serum sMR concentrations were measured in three matched patient groups (proven/probable IFI, n = 82; bacterial infection, n = 80; non-infectious inflammation, n = 77) on the day of antimicrobial initiation or matched intensive care unit day and the five preceding days, as well as in matched healthy controls (n = 59). Independent determinants of sMR concentration were identified via multivariable linear regression. Serum sMR time profiles were analysed with repeated-measures ANOVA. Predictive properties were assessed via area under the receiver operating curve (aROC). Results Serum sMR was higher in IFI patients than in all other groups (all p < 0.02), aROC to differentiate IFI from no IFI being 0.65 (p < 0.001). The ability of serum sMR to discriminate infectious from non-infectious inflammation was better with an aROC of 0.68 (p < 0.001). The sMR concentrations were already elevated up to 5 days before antimicrobial initiation and remained stable over time. Multivariable linear regression analysis showed that an infection or an IFI, higher severity of illness and sepsis upon admission were associated with higher sMR levels; urgent admission and Late-PN were independently associated with lower sMR concentrations. Conclusion Serum sMR concentrations were higher in critically ill patients with IFI than in those with a bacterial infection or with non-infectious inflammation. However, test properties were insufficient for diagnostic purposes. |
| first_indexed | 2024-12-11T15:36:13Z |
| format | Article |
| id | doaj.art-ed27858cc56749a7907e7d8a8e72b670 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-11T15:36:13Z |
| publishDate | 2019-08-01 |
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| series | Critical Care |
| spelling | doaj.art-ed27858cc56749a7907e7d8a8e72b6702022-12-22T00:59:56ZengBMCCritical Care1364-85352019-08-012311910.1186/s13054-019-2549-8The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCTGreet De Vlieger0Ilse Vanhorebeek1Pieter J. Wouters2Inge Derese3Michael P. Casaer4Yves Debaveye5Greet Hermans6Philippe Meersseman7Holger J. Møller8Greet Van den Berghe9Catherine Ingels10Clinical Division of Intensive Care Medicine, UZ LeuvenLaboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenLaboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenLaboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenClinical Division of Intensive Care Medicine, UZ LeuvenClinical Division of Intensive Care Medicine, UZ LeuvenLaboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenLaboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenDepartment of Clinical Biochemistry, Aarhus University HospitalClinical Division of Intensive Care Medicine, UZ LeuvenClinical Division of Intensive Care Medicine, UZ LeuvenAbstract Background Invasive fungal infections (IFI) are difficult to diagnose, especially in critically ill patients. As the mannose receptor (MR) is shed from macrophage cell surfaces after exposure to fungi, we investigate whether its soluble serum form (sMR) can serve as a biomarker of IFI. Methods This is a secondary analysis of the multicentre randomised controlled trial (EPaNIC, n = 4640) that investigated the impact of initiating supplemental parenteral nutrition (PN) early during critical illness (Early-PN) as compared to withholding it in the first week of intensive care (Late-PN). Serum sMR concentrations were measured in three matched patient groups (proven/probable IFI, n = 82; bacterial infection, n = 80; non-infectious inflammation, n = 77) on the day of antimicrobial initiation or matched intensive care unit day and the five preceding days, as well as in matched healthy controls (n = 59). Independent determinants of sMR concentration were identified via multivariable linear regression. Serum sMR time profiles were analysed with repeated-measures ANOVA. Predictive properties were assessed via area under the receiver operating curve (aROC). Results Serum sMR was higher in IFI patients than in all other groups (all p < 0.02), aROC to differentiate IFI from no IFI being 0.65 (p < 0.001). The ability of serum sMR to discriminate infectious from non-infectious inflammation was better with an aROC of 0.68 (p < 0.001). The sMR concentrations were already elevated up to 5 days before antimicrobial initiation and remained stable over time. Multivariable linear regression analysis showed that an infection or an IFI, higher severity of illness and sepsis upon admission were associated with higher sMR levels; urgent admission and Late-PN were independently associated with lower sMR concentrations. Conclusion Serum sMR concentrations were higher in critically ill patients with IFI than in those with a bacterial infection or with non-infectious inflammation. However, test properties were insufficient for diagnostic purposes.http://link.springer.com/article/10.1186/s13054-019-2549-8Invasive fungal infectionInflammationSoluble mannose receptorsMRSoluble CD206sCD206 |
| spellingShingle | Greet De Vlieger Ilse Vanhorebeek Pieter J. Wouters Inge Derese Michael P. Casaer Yves Debaveye Greet Hermans Philippe Meersseman Holger J. Møller Greet Van den Berghe Catherine Ingels The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT Critical Care Invasive fungal infection Inflammation Soluble mannose receptor sMR Soluble CD206 sCD206 |
| title | The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT |
| title_full | The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT |
| title_fullStr | The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT |
| title_full_unstemmed | The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT |
| title_short | The soluble mannose receptor (sMR/sCD206) in critically ill patients with invasive fungal infections, bacterial infections or non-infectious inflammation: a secondary analysis of the EPaNIC RCT |
| title_sort | soluble mannose receptor smr scd206 in critically ill patients with invasive fungal infections bacterial infections or non infectious inflammation a secondary analysis of the epanic rct |
| topic | Invasive fungal infection Inflammation Soluble mannose receptor sMR Soluble CD206 sCD206 |
| url | http://link.springer.com/article/10.1186/s13054-019-2549-8 |
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