Universität zu Köln

van Vught, Lonneke A., Scicluna, Brendon P., Wiewel, Maryse A., Hoogendijk, Arie J., Klouwenberg, Peter M. C. Klein, Franitza, Marek, Toliat, Mohammad R., Nuernberg, Peter, Cremer, Olaf L., Horn, Janneke, Schultz, Marcus J., Bonten, Marc M. J. and van der Poll, Tom (2016). Comparative Analysis of the Host Response to Community-acquired and Hospital-acquired Pneumonia in Critically Ill Patients. Am. J. Respir. Crit. Care Med., 194 (11). S. 1366 - 1375. NEW YORK: AMER THORACIC SOC. ISSN 1535-4970

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Abstract

Rationale: Preclinical studies suggest that hospitalized patients are susceptible to infections caused by nosocomial respiratory pathogens at least in part because of immune suppression caused by the condition for which they were admitted. Objectives: We aimed to characterize the systemic host response in hospital-acquired pneumonia (HAP) when compared with community-acquired pneumonia (CAP). Methods: We performed a prospective study in two intensive care units (ICUs) in 453 patients with HAP (n = 222) or CAP (n = 231). Immune responses were determined on ICU admission by measuring 19 plasma biomarkers reflecting organ systems implicated in infection pathogenesis (in 192 patients with HAP and 183 patients with CAP) and by applying genome-wide blood gene expression profiling (in 111 patients with HAP and 110 patients with CAP). Measurements and Main Results: Patients with HAP and CAP presented with similar disease severities and mortality rates did not differ up to 1 year after admission. Plasma proteome analysis revealed largely similar responses, including systemic inflammatory and cytokine responses, and activation of coagulation and the vascular endothelium. The blood leukocyte genomic response was greater than 75% common in patients with HAP and CAP, comprising proinflammatory, antiinflammatory, T-cell signaling, and metabolic pathway gene sets. Patients with HAP showed overexpression of genes involved in cell-cell junction remodeling, adhesion, and diapedesis, which corresponded with lower plasma levels of matrix metalloproteinase-8 and soluble E-selectin. In addition, patients with HAP demonstrated underexpression of a type-I interferon signaling gene signature. Conclusions: Patients with HAP and CAP present with a largely similar host response at ICU admission.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code van Vught, Lonneke A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Scicluna, Brendon P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wiewel, Maryse A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoogendijk, Arie J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Klouwenberg, Peter M. C. Klein UNSPECIFIED UNSPECIFIED UNSPECIFIED Franitza, Marek UNSPECIFIED UNSPECIFIED UNSPECIFIED Toliat, Mohammad R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Nuernberg, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Cremer, Olaf L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Horn, Janneke UNSPECIFIED UNSPECIFIED UNSPECIFIED Schultz, Marcus J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bonten, Marc M. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED van der Poll, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-254629
DOI:	10.1164/rccm.201602-0368OC
Journal or Publication Title:	Am. J. Respir. Crit. Care Med.
Volume:	194
Number:	11
Page Range:	S. 1366 - 1375
Date:	2016
Publisher:	AMER THORACIC SOC
Place of Publication:	NEW YORK
ISSN:	1535-4970
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CONSENSUS CONFERENCE; IMMUNE-RESPONSE; ICU PATIENTS; SEPSIS; OUTCOMES; EPIDEMIOLOGY; DEFINITIONS; INFECTION Multiple languages Critical Care Medicine; Respiratory System Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/25462