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1.
Clin Chem Lab Med ; 49(9): 1525-32, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21663571

RESUMO

BACKGROUND: In a previous study, a relation between decreased serum angiotensin-converting enzyme (ACE) activity and physiological parameters was observed in patients with community-acquired pneumonia. The present study aims to further assess the prognostic value of serum ACE activity for outcome of community-acquired pneumonia. METHODS: This was a prospective observational study including two cohorts of patients with community-acquired pneumonia (2004-2006; n=157 and 2007-2010; n=138). Serum ACE activity was measured at time of hospital admission. Based on reference values in healthy persons, patients were divided into subgroups of serum ACE activity: normal, low and extremely low. Physiological parameters, clinical outcomes and etiology were compared between the subgroups. RESULTS: A total of 265 patients were enrolled in this study. Mean age was 60±19 years. In patients with low serum ACE activity (<20 U/L, n=53), compared to patients with normal serum ACE activity (≥20 U/L, n=212), C-reactive protein (CRP) was significantly increased, systolic blood pressure was significantly lower and there was a trend for higher heart rate and leukocyte counts. Furthermore, Streptococcus pneumoniae was significantly more identified in patients with low serum ACE activity. Serum ACE activity <24 U/L was independently associated with bacteremia (adjusted OR 3.93 [95% CI 1.57-9.87]). Low serum ACE activity was not prognostic for length of hospital stay nor mortality. CONCLUSIONS: This study did not show prognostic value for serum ACE activity regarding clinical outcome in patients with community-acquired pneumonia. Serum ACE activity <24 U/L at time of hospitalization appeared an independent indicator for the presence of bacteremia. Further research should elucidate the role of ACE in systemic infection and sepsis during pneumonia.


Assuntos
Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/diagnóstico , Peptidil Dipeptidase A/sangue , Pneumonia/sangue , Pneumonia/diagnóstico , Bacteriemia/sangue , Bacteriemia/diagnóstico , Biomarcadores/sangue , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
2.
Clin Vaccine Immunol ; 16(7): 1087-90, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19494086

RESUMO

Community-acquired pneumonia (CAP) can be caused by a variety of microorganisms but is most frequently associated with Streptococcus pneumoniae and gram-negative bacteria like Haemophilus influenzae. Encapsulated bacteria are able to escape phagocytosis, unless they are bound by immunoglobulin G2 subclass antibodies. These antibodies interact with Fcgamma receptor IIa (Fcgamma-RIIa), thereby facilitating opsonophagocytosis of the encapsulated bacteria. We studied the relationship between the Fcgamma-RIIa-R/H131 polymorphism and the clinical course of CAP and pathogen-specific susceptibility. Regarding methodology, the Fcgamma-RIIa genotype R/H131 was determined in 200 patients with CAP and in 313 healthy controls and was correlated with the clinical course, laboratory parameters, and causative microorganism. The Fcgamma-RIIa-R/R131 genotype was found more frequently in patients with severe sepsis (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.30 to 5.00; P < 0.01). The majority of patients in this group suffered from invasive pneumococcal disease. The duration of hospital stay was longer for patients with the Fcgamma-RIIa-R/R131 genotype. Fcgamma-RIIa genotypes were not associated with an increased risk of CAP in general; however, the Fcgamma-RIIa-R/R131 genotype was found more frequently in patients with CAP caused by H. influenzae than in controls (OR, 3.03; CI, 1.04 to 9.09; P < 0.05). In conclusion, the Fcgamma-RIIa-R/R131 genotype is associated with severity of CAP and is more frequent in CAP caused by H. influenzae.


Assuntos
Infecções Comunitárias Adquiridas/genética , Predisposição Genética para Doença , Pneumonia Bacteriana/genética , Polimorfismo Genético , Receptores de IgG/genética , Sepse/genética , Idoso , Idoso de 80 Anos ou mais , Substituição de Aminoácidos/genética , Infecções Comunitárias Adquiridas/imunologia , Feminino , Frequência do Gene , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Mutação de Sentido Incorreto , Pneumonia Bacteriana/imunologia , Sepse/imunologia
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