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- Fisher, Jane, et al.
(författare)
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Is heparin-binding protein inhibition a mechanism of albumin's efficacy in human septic shock?
- 2018
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Ingår i: Critical Care Medicine. - 0090-3493. ; 46:5, s. 364-374
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Our objectives were to determine first whether albumin prevents heparin-binding protein-induced increased endothelial cell permeability and renal cell inflammation and second, whether a plasma heparin-binding protein-to-albumin ratio predicts risk of acute kidney injury, fluid balance, and plasma cytokine levels in septic shock. Design: In vitro human endothelial and renal cell model and observation cohort of septic shock. Settings: Research laboratory and multicenter clinical trial (Vasopressin and Septic Shock Trial). Patients: Adult septic shock (norepinephrine dose > 5 μg/min for > 6 hr). Interventions: In vitro: heparin-binding protein (or thrombin) was added with or without albumin to 1) human endothelial cell monolayers to assess permeability and 2) to human renal tubular epithelial cells to assess inflammation. Measurements and Main Results: Transendothelial electrical resistance - a marker of permeability - of human endothelial cells was measured using a voltohmmeter. We measured plasma heparin-binding protein-to-albumin ratio and a panel of cytokines in septic shock patients (n = 330) to define an heparin-binding protein-to-albumin ratio that predicts risk of acute kidney injury. Albumin inhibited heparin-binding protein (and thrombin-induced) increased endothelial cell permeability at a threshold concentration of 20-30 g/L but increased renal tubular cell interleukin-6 release. Patients who developed or had worsened acute kidney injury had significantly higher heparin-binding protein-to-albumin ratio (1.6 vs 0.89; p < 0.001) and heparin-binding protein (38.2 vs 20.8 ng/mL; p < 0.001) than patients without acute kidney injury. The highest heparin-binding protein-to-albumin ratio (> 3.05), heparin-binding protein quartiles (> 69.8), and heparin-binding protein > 30 ng/mL were significantly associated with development or worsening of acute kidney injury (p < 0.001) in unadjusted and adjusted analyses and were robust to sensitivity analyses for death as a competing outcome. Heparin-binding protein and heparin-binding protein-to-albumin ratio were directly associated with positive fluid balance (p < 0.001) and with key inflammatory cytokines. Increasing quartiles of heparin-binding protein-to-albumin ratio and heparin-binding protein (but not albumin) were highly significantly associated with days alive and free of acute kidney injury and renal replacement therapy (p < 0.001), vasopressors (p < 0.001), ventilation (p < 0.001), and with 28-day mortality. Conclusions: Albumin inhibits heparin-binding protein-induced increased human endothelial cell permeability and heparin-binding protein greater than 30 ng/mL and heparin-binding protein-to-albumin ratio greater than 3.01 - but not serum albumin - identified patients at increased risk for acute kidney injury in septic shock.
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| 2. |
- Lee, Hyejin, et al.
(författare)
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Characteristics of road users’ safety behavior and attitude in Korea : findings from ESRA survey
- 2018
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Konferensbidrag (refereegranskat)abstract
- While the risky behaviors to traffic and road safety attitude have been advocated as necessary contributors for road safety policies, a few studies have examined the behavioral and attitudinal characteristics of road users in Korea. This paper conducted a questionnaire survey to road users, as the part of E-survey of road users’ attitudes (ESRA-Project), in Korea (N=1000) comparing 24 western countries (N=1000 for each country) to understand the behaviors and attitudinal characteristics of road users. The survey consists of four main parts: (Q1) safe feeling, (Q2) involvement in road crash, (Q3) road user behaviors and (Q4) personal acceptability toward risky behaviors. The survey asked responses about 8 items, which are (I-1) speeding in urban area, (I-2) speeding in freeway, (I-3) driving while drowsy, (I-4) typing text message or email while driving, (I-5) talking on hand-held mobile phone while driving, (I-6) wearing seat belt in front seat, (I-7) wearing seat belt in back seat and (I-8) installing child restraint systems. This paper aims to answer two questions: How do Korean road users perceive the importance of several risky road behaviors comparing Western road users? Are there important differences in road safety attitude and behaviors between Korea and Western countries? By ANOVA analysis and Discriminant Analysis between two groups, statistically significant differences and discriminant loadings are revealed. Results shows that road users in Korea are more lenient with several risky behaviors, such as (I-8) using child restraint systems, (I-4) typing text message or e-mails while driving and (I-6) not wearing a seatbelt in the front seat of the car. This result should be applied to road safety campaign, promotion and education for safer road in Korea. In addition, Korean road safety observatory system should be improved to tract the risky behaviors for development of road safety policies.
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