Assessment of the Choroidal Vascular Structure in Multisystem Inflammatory Syndrome in Children.

PURPOSE: To evaluate the choroidal vascular structure in cases of multisystem inflammatory syndrome in children (MIS-C). METHODS: This prospective study included 38 eyes of 19 patients with MIS-C and 60 eyes of 30 healthy participants. Optical coherence tomography (OCT) imaging was performed at 1 month after diagnosis in the MIS-C group. Using enhanced depth imaging OCT, choroidal thickness was measured in the subfoveal, nasal, and temporal quadrants at 500 and 1,500 µm distances from the fovea (SCT, N500CT, T500CT, N1500CT, and T1500CT, respectively). The luminal, stromal, and total choroidal areas were evaluated with the binarization method in ImageJ software (National Institutes of Health). The ratio of the luminal area to the total choroidal area was determined as the choroidal vascular index (CVI). RESULTS: The age and sex distributions of the two groups without any ophthalmologic pathology were similar (P > .05). The choroidal thickness values in all quadrants except for T1500CT were similar between the two groups (P > .05). T1500CT was significantly lower in the MIS-C group (P = .02). The luminal choroidal area was 1.04 ± 0.10 mm2 in the MIS-C group and 1.26 ± 0.24 mm2 in the healthy control group (P < .001), and the CVI values were 0.52 ± 0.04 and 0.57 ± 0.09, respectively (P = .01). The stromal and total choroidal area values did not significantly differ between the two groups (P > .05). CONCLUSIONS: This is the first study to evaluate CVI in patients with MIS-C. It was observed that the choroidal vascular structure could be affected in the early period of MIS-C, as shown by a decrease in the CVI value and luminal vascular area. OCT can be used to monitor ocular vascular changes in these patients. [J Pediatr Ophthalmol Strabismus. 2024;61(2):120-126.].

Prognostic accuracy of the sequential organ failure assessment (SOFA) and quick SOFA for mortality in cancer patients with sepsis defined by systemic inflammatory response syndrome (SIRS).

PURPOSE: We aimed to assess the prognostic accuracy of SOFA and qSOFA scores in cancer patients with sepsis, and also to determine if the addition of hyperlactatemia to qSOFA increases the accuracy in predicting the 30-day mortality. MATERIAL AND METHOD: We consecutively included adult active cancer patients (age ≥ 18 years) with sepsis defined by SIRS who visited the emergency department (ED) from May 1st to July 30th, 2017. Data were collected retrospectively through reviewing medical records. The SOFA and qSOFA scores were calculated with the initial variables at the time of ED admission. The primary endpoint was 30-day mortality. RESULT: Of 1137 screened, 301 were included. The 30-day mortality was 14.3% (43 patients). Among the total 301, the SOFA score was ≥ 2 in 168 and qSOFA ≥ 2 in 23. For those with SOFA ≥ 2 and < 2, the mortality was 23.2% and 3%, respectively (P < 0.001). For those with qSOFA ≥ 2 and < 2, the mortality was 47.8% and 11.5%, respectively (P < 0.001). The AUROC of 30-day mortality for qSOFA was lower than that for SOFA (0.66 (95% CI, 0.56-0.75) vs. 0.79 (95% CI, 0.72-0.87), P = 0.004)). However, the combination of qSOFA with lactate ≥ 2 threshold considerably enhanced a discrimination capacity for mortality with an AUROC 0.77 (95% CI, 0.69-0.85), which was similar to SOFA (P = 0.11). CONCLUSION: In cancer patients with sepsis, qSOFA was inferior to SOFA in predicting mortality. However, adding lactate to qSOFA resulted in greater prognostic accuracy for short-term mortality, comparable with SOFA.

Accuracy of quick Sequential Organ Failure Assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a meta-analysis of observational studies.

OBJECTIVE: To identify sensitivity, specificity and predictive accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria to predict in-hospital mortality in hospitalized patients with suspected infection. METHODS: This meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group consensus statement for conducting and reporting the results of systematic review. PubMed and EMBASE were searched for the observational studies which reported predictive utility of qSOFA score for predicting mortality in patients with suspected or proven infection with the following search words: 'qSOFA', 'q-SOFA', 'quick-SOFA', 'Quick Sequential Organ Failure Assessment', 'quick SOFA'. Sensitivity, specificity, area under receiver operating characteristic (ROC) curves with 95% confidence interval (CI) of qSOFA and SIRS criteria for predicting in-hospital mortality was collected for each study and a 2 × 2 table was created for each study. RESULTS: Data of 406 802 patients from 45 observational studies were included in this meta-analysis. Pooled sensitivity (95% CI) and specificity (95% CI) of qSOFA ≥2 for predicting mortality in patients who were not in an intensive care unit (ICU) was 0.48 (0.41-0.55) and 0.83 (0.78-0.87), respectively. Pooled sensitivity (95% CI) of qSOFA ≥2 for predicting mortality in patients (both ICU and non-ICU settings) with suspected infection was 0.56 (0.47-0.65) and pooled specificity (95% CI) was 0.78 (0.71-0.83). CONCLUSION: qSOFA has been found to be a poorly sensitive predictive marker for in-hospital mortality in hospitalized patients with suspected infection. It is reasonable to recommend developing another scoring system with higher sensitivity to identify high-risk patients with infection.

The use of imaging technology in the assessment of the fetal inflammatory response syndrome-imaging of the fetal thymus.

The fetal inflammatory response syndrome (FIRS) describes a state of extensive fetal multi organ involvement during chorioamnionitis, and is associated with grave implications on perinatal outcome. The syndrome has been linked to the preterm parturition syndrome and is associated with inflammation/infection processes in most of the fetal organs. The fetal thymus, a major organ in the developing immune system involutes during severe neonatal disease and has been shown to be smaller in fetuses with FIRS. Various methods for imaging of the fetal thymus and measurement are described. Currently the only method to diagnose FIRS prenatally is through amniocentesis. We suggest that women who are admitted with preterm labor with intact membranes and those with PPROM should have a detailed sonographic examination of the fetal thymus as a surrogate marker of fetal involvement in intrauterine infection/inflammation processes.

Lipidomic assessment of plasma and placenta of women with early-onset preeclampsia.

INTRODUCTION: Adipose tissue is responsible for triggering chronic systemic inflammatory response and these changes may be involved in the pathophysiology of preeclampsia. OBJECTIVE: To characterize the lipid profile in the placenta and plasma of patients with preeclampsia. METHODOLOGY: Samples were collected from placenta and plasma of 10 pregnant women with preeclampsia and 10 controls. Lipids were extracted using the Bligh-Dyer protocol and were analysed by MALDI TOF-TOF mass spectrometry. RESULTS: Approximately 200 lipid signals were quantified. The most prevalent lipid present in plasma of patients with preeclampsia was the main class Glycerophosphoserines-GP03 (PS) representing 52.30% of the total lipid composition, followed by the main classes Glycerophosphoethanolamines-GP02 (PEt), Glycerophosphocholines-GP01 (PC) and Flavanoids-PK12 (FLV), with 24.03%, 9.47% and 8.39% respectively. When compared to the control group, plasma samples of patients with preeclampsia showed an increase of PS (p<0.0001), PC (p<0.0001) and FLV (p<0.0001). Placental analysis of patients with preeclampsia, revealed the PS as the most prevalent lipid representing 56.28%, followed by the main class Macrolides/polyketides-PK04 with 32.77%, both with increased levels when compared with patients control group, PS (p<0.0001) and PK04 (p<0.0001). CONCLUSION: Lipids found in placenta and plasma from patients with preeclampsia differ from those of pregnant women in the control group. Further studies are needed to clarify if these changes are specific and a cause or consequence of preeclampsia.