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Vol. 38. Issue 2.
Pages 73-82 (March 2014)
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Vol. 38. Issue 2.
Pages 73-82 (March 2014)
Original
DOI: 10.1016/j.medine.2013.01.008
Oxidative stress in immunocompetent patients with severe community-acquired pneumonia. A pilot study
Estrés oxidativo en pacientes inmunocompetentes con neumonía comunitaria grave. Un estudio piloto
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S. Treflera, A. Rodrígueza,b,??
Corresponding author
, I. Martín-Loechesc, V. Sanchezd, J. Marína, M. Llauradóa, M. Romeud, E. Díaze, R. Noguésc, M. Giraltc
a Critical Care Department, Hospital Universitario Joan XXIII – IISPV, Tarragona, Spain
b CIBER Enfermedades Respiratorias, Universidad Rovira i Virgili, Tarragona, Spain
c Critical Care Department, Complejo Sanitari Parc Taulí/CIBERES, Sabadell, Spain
d Farmacology Department, Facultad de Medicina y Ciencias de la Salud, Universidad Rovira i Virgili, Reus, Spain
e Critical Care Department, Hospital Moises Broggi/CIBERES, Sant Joan Despí, Spain
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Tables (7)
Table 1. Clinical characteristics of 15 patients with community-acquired pneumonia (CAP) differentiating bacterial (BCAP) and viral (VCAP) etiology.
Table 2. Oxidative stress biomarkers at ICU admission (baseline), day 3 and ICU discharge in patients with community-acquired pneumonia (CAP) differentiating bacterial (BCAP) and viral (VCAP) etiology.
Table 3. Oxidative stress according to community-acquired pneumonia etiology.
Table 4. Oxidative stress comparison between patients with community-acquired pneumonia (CAP) and control group of healthy volunteers in general and then matched by age.
Table 5. Clinical characteristics of patients with community-acquired pneumonia (CAP) and acute myocardial infarction (AMI).
Table 6. Oxidative stress biomarkers at ICU admission (baseline), day 3 and ICU discharge in the total population differentiating the study group (community-acquired pneumonia=CAP) and non-septic group (acute myocardial infarction=AMI).
Table 7. Comparison of oxidative stress biomarkers in survivors and non-survivors at baseline and day-3 of study period.
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Abstract
Objective

A comparison was made of the oxidative stress (OS) levels of patients with either viral or bacterial severe community-acquired pneumonia (sCAP) and of patients without infection (healthy volunteers (HV) and patients with acute myocardial infarction (AMI)).

Design

A prospective observational study was made.

Patients

Critically ill patients with sCAP.

Variables

The TBARS level was measured as an index of oxidative injury. SOD, CAT and redox glutathione system (GSH, GSSG, GR, GPx) activities were measured as reflecting antioxidant capacity. Severity of illness was assessed by the APACHE II, SOFA and SIRS scores.

Results

Thirty-seven subjects were included: 15 patients with CAP (12 of bacterial origin [BCAP] and 3 due to 2009 A/H1N1 virus [VCAP]), 10 HV and 12 AMI patients. Intensive care CAP mortality was 26.7% (n=4). Plasmatic TBARS levels were higher in CAP patients than in HV, but similar to those recorded in AMI patients. In contrast, VCAP was associated with lower TBARS levels, and some components of the glutathione redox system were higher in BCAP patients and HV. The OS levels did not differ between survivors and non-survivors.

Conclusion

Our results suggest the occurrence of higher OS in sCAP patients compared with HV. In contrast, lower TBARS levels were observed in VCAP patients, suggesting an increase of antioxidant activity related to the redox glutathione system. However, further research involving a larger cohort is needed in order to confirm these findings.

Keywords:
Oxidative stress
2009 Influenza A/H1N1 virus
Bacterial pneumonia
Community-acquired pneumonia
Resumen
Objetivos

Comparar el estrés oxidativo (EO) en pacientes con neumonía comunitaria grave (NCG) según su etiología y respecto de voluntarios sanos (VS) y pacientes con infarto agudo de miocardio (IAM).

Diseño

Estudio prospectivo, observacional.

Pacientes

Pacientes con NCG ingresados en unidades de cuidados intensivos.

Variables

Los niveles de lipoperoxidación (TBARS) fueron considerados como índice de oxidación, mientras que SOD, CAT y la actividad del sistema redox- glutation (GSH, GSSG, GR, GPx) fueron considerados capacidad antioxidante. La gravedad de los pacientes fue valorada mediante las escalas APACHE II, SOFA y SIRS.

Resultados

Treinta y siete sujetos fueron incluidos, 15 pacientes con NCG (12 con etiología bacteriana [NB] y 3 viral 2009 A/H1N1 [NV]), 10 VS y 12 con IAM. La mortalidad global fue del 26,7% (n=4). Los TBARS plasmáticos fueron superiores en NCG respecto de VS, pero similares al IAM. En contraste, la NV se asoció con menores niveles de TBARS e incremento de componentes del sistema redox-glutation respecto de NB y voluntarios sanos. No se observó asociación entre mortalidad y EO.

Conclusión

Nuestros resultados evidencian la presencia de EO en pacientes con NCG respecto de los controles. En contraste, la evidencia de un menor nivel de TBARS en la NV respecto de los VS sugiere un incremento de la actividad antioxidante relacionada con el sistema redox-glutation. Sin embargo, son necesarias nuevas investigaciones para confirmar estos hallazgos.

Palabras clave:
Estrés oxidativo
Gripe A 2009/H1N1
Neumonía bacteriana
Neumonía comunitaria

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