Arnab Nandy1, Tanushree Mondal2, Mihir Sarkar3, Shankha Subhra Nag1, Soumita Chel4, Divyoshanu M Ivan5, Avijit Hazra6, Rakesh Mondal7. 1. Department of Pediatrics, NB Medical College, Darjeeling, India. 2. Department of Community Medicine, Medical College, Kolkata, India. 3. Department of Pediatrics, Medical College, Kolkata, India. 4. Department of Data Science, University of Glasgow, Glasgow, Scotland. 5. Department of Biotechnology, Delhi Technological University, Delhi, India. 6. Department of Pharmacology, IPGMER and SSKM Hospital, Kolkata, India. 7. Division of Rheumatology, Department of Pediatric Medicine, Medical College, Kolkata, India.
Abstract
OBJECTIVE: To assess macrophage activation syndrome (MAS) in septic shock leading to multiorgan dysfunction syndrome (MODS). METHODS: A prospective observational study was conducted at a tertiary care hospital to evaluate the MAS criteria in different stages of sepsis. Children aged 6 months to 12 years in different stages of septic shock were recruited. The Paediatric Rheumatology International Trials Organisation Collaborative Initiative (PRINTO) criteria of MAS were applied initially at the stage of septic shock and subsequently at the stage of MODS (MODS cohort) or following recovery from septic shock without going through MODS (non-MODS cohort). RESULTS: A total of 127 subjects were studied, with 53 comprising the MODS cohort and the rest 74 the non-MODS cohort. At the initial assessment, a comparable proportion of subjects in the MODS and non-MODS groups satisfied the MAS criteria (20.75% and 25.68%, respectively; p=0.529). However, by the time of progression to MODS, 81.13% of the subjects satisfied the MAS criteria in the MODS group, whereas only 16.18% subjects in the non-MODS group continued to satisfy the MAS criteria (p<0.001). Thus, there was a definite increase in the proportion of subjects showing MAS by the time they progressed to multiorgan dysfunction (p<0.001). In contrast, the proportion declined significantly (25.68% to 16.18%; p=0.008) in the subjects who had recovered. CONCLUSION: The findings bear out the hypothesis that MODS in sepsis is a reflection of MAS secondary to sepsis. However, studies in larger cohorts are needed to validate these findings and explore the therapeutic implications.
OBJECTIVE: To assess macrophage activation syndrome (MAS) in septic shock leading to multiorgan dysfunction syndrome (MODS). METHODS: A prospective observational study was conducted at a tertiary care hospital to evaluate the MAS criteria in different stages of sepsis. Children aged 6 months to 12 years in different stages of septic shock were recruited. The Paediatric Rheumatology International Trials Organisation Collaborative Initiative (PRINTO) criteria of MAS were applied initially at the stage of septic shock and subsequently at the stage of MODS (MODS cohort) or following recovery from septic shock without going through MODS (non-MODS cohort). RESULTS: A total of 127 subjects were studied, with 53 comprising the MODS cohort and the rest 74 the non-MODS cohort. At the initial assessment, a comparable proportion of subjects in the MODS and non-MODS groups satisfied the MAS criteria (20.75% and 25.68%, respectively; p=0.529). However, by the time of progression to MODS, 81.13% of the subjects satisfied the MAS criteria in the MODS group, whereas only 16.18% subjects in the non-MODS group continued to satisfy the MAS criteria (p<0.001). Thus, there was a definite increase in the proportion of subjects showing MAS by the time they progressed to multiorgan dysfunction (p<0.001). In contrast, the proportion declined significantly (25.68% to 16.18%; p=0.008) in the subjects who had recovered. CONCLUSION: The findings bear out the hypothesis that MODS in sepsis is a reflection of MAS secondary to sepsis. However, studies in larger cohorts are needed to validate these findings and explore the therapeutic implications.
Authors: Angelo Ravelli; Francesca Minoia; Sergio Davì; AnnaCarin Horne; Francesca Bovis; Angela Pistorio; Maurizio Aricò; Tadej Avcin; Edward M Behrens; Fabrizio De Benedetti; Lisa Filipovic; Alexei A Grom; Jan-Inge Henter; Norman T Ilowite; Michael B Jordan; Raju Khubchandani; Toshiyuki Kitoh; Kai Lehmberg; Daniel J Lovell; Paivi Miettunen; Kim E Nichols; Seza Ozen; Jana Pachlopnik Schmid; Athimalaipet V Ramanan; Ricardo Russo; Rayfel Schneider; Gary Sterba; Yosef Uziel; Carol Wallace; Carine Wouters; Nico Wulffraat; Erkan Demirkaya; Hermine I Brunner; Alberto Martini; Nicolino Ruperto; Randy Q Cron Journal: Arthritis Rheumatol Date: 2016-02-09 Impact factor: 10.995
Authors: Jonathan S Boomer; Kathleen To; Kathy C Chang; Osamu Takasu; Dale F Osborne; Andrew H Walton; Traci L Bricker; Stephen D Jarman; Daniel Kreisel; Alexander S Krupnick; Anil Srivastava; Paul E Swanson; Jonathan M Green; Richard S Hotchkiss Journal: JAMA Date: 2011-12-21 Impact factor: 56.272
Authors: S Balasubramanian; Neha Mohan Rao; Anu Goenka; Marion Roderick; Athimalaipet V Ramanan Journal: Indian Pediatr Date: 2020-04-09 Impact factor: 1.411
Authors: Angela Ceribelli; Francesca Motta; Maria De Santis; Aftab A Ansari; William M Ridgway; M Eric Gershwin; Carlo Selmi Journal: J Autoimmun Date: 2020-04-02 Impact factor: 7.094
Authors: María Teresa Hernández-Huerta; Alma Dolores Pérez-Santiago; Laura Pérez-Campos Mayoral; Luis Manuel Sánchez Navarro; Francisco Javier Rodal Canales; Abraham Majluf-Cruz; Carlos Alberto Matias-Cervantes; Eduardo Pérez-Campos Mayoral; Carlos Romero Díaz; Gabriel Mayoral-Andrade; Margarito Martínez Cruz; Judith Luna Ángel; Eduardo Pérez-Campos Journal: Biomolecules Date: 2021-10-20