Pentraxin-3 as a marker of disease severity and risk of death in patients with necrotizing soft tissue infections: a nationwide, prospective, observational study

Hansen, Marco Bo; Rasmussen, Lars S.; Garred, Peter; Bidstrup, Daniel; Madsen, Martin Bruun; Hyldegaard, Ole

doi:10.1186/s13054-016-1210-z

Cited by 39 publications

(35 citation statements)

References 39 publications

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“…However, this should be tested in future studies specifically designed to elucidate this. Additionally, Ficolin-2 might be combined with biomarkers such as PTX3, which has shown interesting results in this group of patients [13], together with clinical information and scores in order to provide good and reliable information for prognosis assessment as well as a timely, individualized treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

“…The study was conducted as previously described in detail [12]; some data from the present cohort have been published elsewhere [13]. The study is registered at ClinicalTrials.gov (NCT02180906; https://clinicaltrials.gov/ct2/show/NCT02180906?term=NCT02180906&rank=1).…”

Section: Methodsmentioning

confidence: 99%

“…Analyses were performed using Statistical Package for the Social Sciences 22.0 software (SPSS Inc., Chicago, Ill., USA) and GraphPad Prism 6.0 software (GraphPad Inc., La Jolla, Calif., USA). Sample size calculation was determined by planned recruitment of at least 82 patients based on previous studies using the same analysis [19] as described in another article [13]. …”

Section: Methodsmentioning

confidence: 99%

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The Lectin Complement Pathway in Patients with Necrotizing Soft Tissue Infection

Hansen¹,

Rasmussen²,

Pilely³

et al. 2016

J Innate Immun

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Background: Mannose-binding lectin (MBL) and ficolins are pattern recognition molecules (PRMs) that play an important role during infection through activation of the lectin complement pathway. We assessed whether plasma PRM levels were associated with mortality in patients with necrotizing soft tissue infection (NSTI). Methods: We conducted a prospective, observational study over 25 months involving 135 NSTI patients with a maximum follow-up of 2.7 years. Blood samples were taken upon admission. Non-infected patients served as controls. Results: PRM levels were significantly lower compared with controls. A baseline Ficolin-2 level below the median was associated with mortality at the end of follow-up (p = 0.007). No significant association was found for MBL, Ficolin-1 and Ficolin-3. A Ficolin-2 level below the median had a negative predictive value of 0.94 for 28-day mortality, and a level below the optimal cut-off was independently associated with 28-day mortality when adjusted for age, sex and chronicity [hazard ratio 6.27 (95% confidence interval 2.28-17.21), p < 0.0001], also when Simplified Acute Physiology Score II was included in the analysis [hazard ratio 3.16 (95% confidence interval 1.03-9.73), p = 0.045]. Conclusions: All PRMs were significantly lower in patients with NSTI than in controls. Only baseline Ficolin-2 was associated with short- and long-term mortality. A high baseline Ficolin-2 level indicated a 94% chance of surviving the first 28 days after admission.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Lectin Complement Pathway in Patients with Necrotizing Soft Tissue Infection

Hansen¹,

Rasmussen²,

Pilely³

et al. 2016

J Innate Immun

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“…Local production of PTX3 can be measured in bronchoalveolar lavage (BAL) where it predicts pneumonia in critically ill, intubated patients, and in urine of patients with urinary tract infections caused by UPEC, where it correlates with disease severity. High PTX3 levels observed in patients with necrotizing soft tissue infections (NSTI) at time of admission were associated with septic shock, renal replacement therapy, amputation, and risk of death …”

Section: Ptx3 As Diagnostic/prognostic Marker During Inflammation Andmentioning

confidence: 99%

“…High PTX3 levels observed in patients with necrotizing soft tissue infections (NSTI) at time of admission were associated with septic shock, renal replacement therapy, amputation, and risk of death. 166 Several studies have analyzed single-nucleotide polymorphisms…”

Section: Ptx3 As Diagnostic/prognostic Marker During Inflammation Amentioning

confidence: 99%

Pentraxins in the activation and regulation of innate immunity

Daigo

Inforzato

Barajon

et al. 2016

Immunological Reviews

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Humoral fluid phase pattern recognition molecules (PRMs) are a key component of the activation and regulation of innate immunity. Humoral PRMs are diverse. We focused on the long pentraxin PTX3 as a paradigmatic example of fluid phase PRMs. PTX3 acts as a functional ancestor of antibodies and plays a non-redundant role in resistance against selected microbes in mouse and man and in the regulation of inflammation. This molecule interacts with complement components, thus modulating complement activation. In particular PTX3 regulates complement-driven macrophage-mediated tumor progression, acting as an extrinsic oncosuppressor in preclinical models and selected human tumors. Evidence collected over the years suggests that PTX3 is a biomarker and potential therapeutic agent in humans, and pave the way to translation of this molecule into the clinic.

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Necrotizing Soft Tissue Infections

McDermott,

Kao,

Keeley

et al. 2024

JAMA Surg

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ImportanceNecrotizing soft tissue infections (NSTIs) are severe life- and limb-threatening infections with high rates of morbidity and mortality. Unfortunately, there has been minimal improvement in outcomes over time.ObservationsNSTIs are characterized by their heterogeneity in microbiology, risk factors, and anatomical involvement. They often present with nonspecific symptoms, leading to a high rate of delayed diagnosis. Laboratory values and imaging help increase suspicion for NSTI, though ultimately, the diagnosis is clinical. Surgical exploration is warranted when there is high suspicion for NSTI, even if the diagnosis is uncertain. Thus, it is acceptable to have a certain rate of negative exploration. Immediate empirical broad-spectrum antibiotics, further tailored based on tissue culture results, are essential and should be continued at least until surgical debridement is complete and the patient shows signs of clinical improvement. Additional research is needed to determine optimal antibiotic duration. Early surgical debridement is crucial for improved outcomes and should be performed as soon as possible, ideally within 6 hours of presentation. Subsequent debridements should be performed every 12 to 24 hours until the patient is showing signs of clinical improvement and there is no additional necrotic tissue within the wound. There are insufficient data to support the routine use of adjunct treatments such as hyperbaric oxygen therapy and intravenous immunoglobulin. However, clinicians should be aware of multiple ongoing efforts to develop more robust diagnostic and treatment strategies.Conclusions and RelevanceGiven the poor outcomes associated with NSTIs, a review of clinically relevant evidence and guidelines is warranted. This review discusses diagnostic and treatment approaches to NSTI while highlighting future directions and promising developments in NSTI management.

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Pentraxin-3 as a marker of disease severity and risk of death in patients with necrotizing soft tissue infections: a nationwide, prospective, observational study

Cited by 39 publications

References 39 publications

The Lectin Complement Pathway in Patients with Necrotizing Soft Tissue Infection

The Lectin Complement Pathway in Patients with Necrotizing Soft Tissue Infection

Pentraxins in the activation and regulation of innate immunity

Necrotizing Soft Tissue Infections

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