S100β and neuron-specific enolase (NSE) are brain injury biomarkers, mainly used in brain trauma, cerebral stroke and hypoxic ischemia encephalopathy. The aim of this study was to study the clinical significance of serum S100β and NSE in diagnosing sepsis-associated encephalopathy (SAE) and predicting its prognosis. This was a prospective and observational study. Clinical data of septic patients were collected within 24 h after ICU admission from May 2012 to April 2013. We evaluated the level of consciousness twice per day. SAE was defined as cerebral dysfunction in the presence of sepsis that fulfilled the exclusion criteria. The infection biochemical indicators, Glasgow coma scale (GCS) score, acute physiology and chronic health evaluation score II, serum NSE and S100β were newly measured or evaluated for SAE patients. Finally, hospital mortality, bacteriological categories, length of ICU stay and length of hospital stay were also recorded for all enrolled patients. The data was analyzed with the Chi square test, two-sample t test or Mann-Whitney U test between two groups. The correlation between two factors was analyzed using the Pearson or Spearman analysis. Receiver operating characteristic (ROC) curves were used to determine the ability of S100β and NSE in diagnosing SAE and predicting the hospital mortality. In addition, cut-off points were obtained from the curves to determine the highest sum of sensitivity and specificity. Of 112 enrolled patients, 48 patients were diagnosed with SAE. The serum S100β and NSE concentrations in SAE patients were both significantly higher than in non-SAE patients 0.306 (IQR 0.157-0.880) μg/L vs. 0.095 (IQR 0.066-0.177) μg/L, 24.87 (IQR 31.73-12.73) ng/mL vs. 15.49 (IQR 9.88-21.46) ng/mL, P < 0.01]. GCS scores were related more closely to S100β than NSE (-0.595 vs. -0.337). S100β levels of 0.131 μg/L diagnosed SAE with 67.2% specificity and 85.4% sensitivity in the ROC curve, the area under the curve was 0.824 (95% confidence interval 0.750-0.898). NSE levels of 24.15 ng/mL diagnosed SAE with 82.8% specificity and 54.2% sensitivity, and the area under the curve was 0.664 (95 % confidence interval 0.561-0.767). In addition, the area under the curve for S100β for predicting hospital mortality was larger than for NSE (0.730 vs. 0.590). Serum S100β concentrations in SAE patients were significantly higher than in non-SAE patients. These may be related to the severity of SAE and may predict the outcome of sepsis. The efficacy and sensitivity of serum S100β in diagnosing SAE were high, but it had a low specificity. Moreover, compared to NSE, serum S100β was better for both diagnosing SAE and predicting the outcome of sepsis.
BackgroundElderly patients with relapsed and refractory acute lymphoblastic leukemia (ALL) have poor prognosis. Autologous CD19 chimeric antigen receptor-modified T (CAR-T) cells have potentials to cure patients with B cell ALL; however, safety and efficacy of allogeneic CD19 CAR-T cells are still undetermined.Case presentationWe treated a 71-year-old female with relapsed and refractory ALL who received co-infusion of haplo-identical donor-derived CD19-directed CAR-T cells and mobilized peripheral blood stem cells (PBSC) following induction chemotherapy. Undetectable minimal residual disease by flow cytometry was achieved, and full donor cell engraftment was established. The transient release of cytokines and mild fever were detected. Significantly elevated serum lactate dehydrogenase, alanine transaminase, bilirubin and glutamic-oxalacetic transaminase were observed from days 14 to 18, all of which were reversible after immunosuppressive therapy.ConclusionsOur preliminary results suggest that co-infusion of haplo-identical donor-derived CAR-T cells and mobilized PBSCs may induce full donor engraftment in relapsed and refractory ALL including elderly patients, but complications related to donor cell infusions should still be cautioned.Trial registrationAllogeneic CART-19 for Elderly Relapsed/Refractory CD19+ ALL. NCT02799550 Electronic supplementary materialThe online version of this article (doi:10.1186/s13045-016-0357-z) contains supplementary material, which is available to authorized users.
Microtransplant achieved a high complete remission rate in AML patients aged 60 to 85 years and higher 1-year overall survival in those aged 60 to 74 years.
BackgroundSetting lactate kinetics at >30% might improve the clinical outcomes of patients with sepsis-associated hyperlactatemia. The aim of this study was to explore the outcome benefits of stepwise lactate kinetics vs central venous oxygen saturation (ScvO2)-oriented hemodynamic therapy at 6 h as the protocol goal during early resuscitation.MethodsThe relevant parameters and adverse events after different targets in 360 randomly assigned patients with sepsis-associated hyperlactatemia were recorded and compared.ResultsHeart rate (HR) at 48 h in the ScvO2 group was higher than in the lactate kinetics group (105 ± 19 bpm vs 99 ± 20 bpm, P = 0.040). The liquid balance at 4 h, 12 h, and 24 h in the lactate kinetics group was larger than in the ScvO2 group (1535 (1271–1778) ml vs 826 (631–1219) ml, P < 0.001; 1688 (1173–1923) ml vs 1277 (962 − 1588) ml, P <0.001; and 1510 (904–2087) ml vs 1236 (740–1808) ml, P = 0.005), respectively. Mortality was higher in the ScvO2 group (27.9% vs 18.3%, P = 0.033), but there was no significant difference between the two groups in the length of stay in the ICU or mechanical ventilation. In terms of new onset organ dysfunction, there was a significant difference between the two groups in total bilirubin at 48 h and 72 h. Based on the 60-day survival curves, there was significantly more mortality in the ScvO2 group than in the lactate kinetics group (X 2 = 4.133, P = 0.042). In addition, fewer adverse events occurred in the lactate kinetics group.ConclusionsStepwise lactate kinetics-oriented hemodynamic therapy can reduce mortality in patients with sepsis-associated hyperlactatemia compared with ScvO2-oriented therapy.Trial registrationNational Institutes of Health Clinical Trials Registry, NCT02566460. Registered on 26 September 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1617-1) contains supplementary material, which is available to authorized users.
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