FERNANDO GODINHO ZAMPIERI
Projetos de Pesquisa
Unidades Organizacionais
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
10 resultados
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Agora exibindo 1 - 10 de 10
- Ânion gap corrigido para albumina, fosfato e lactato é um bom preditor de íon gap forte em pacientes enfermos graves: estudo de coorte em nicho(2013) ZAMPIERI, Fernando Godinho; PARK, Marcelo; RANZANI, Otavio Tavares; MACIEL, Alexandre Toledo; SOUZA, Heraldo Possolo de; CRUZ NETO, Luiz Monteiro da; SILVA, Fabiano Pinheiro daOBJECTIVE: Corrected anion gap and strong ion gap are commonly used to estimate unmeasured anions. We evaluated the performance of the anion gap corrected for albumin, phosphate and lactate in predicting strong ion gap in a mixed population of critically ill patients. We hypothesized that anion gap corrected for albumin, phosphate and lactate would be a good predictor of strong ion gap, independent of the presence of metabolic acidosis. In addition, we evaluated the impact of strong ion gap at admission on hospital mortality. METHODS: We included 84 critically ill patients. Correlation and agreement between the anion gap corrected for albumin, phosphate and lactate and strong ion gap was evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot and calculating interclass correlation coefficient. Two subgroup analyses were performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and the other in patients with base-excess >-2mEq/L (high BE group - hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality. RESULTS: There was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression. CONCLUSION: Anion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured anions and hospital mortality.
- Influence of Body Mass Index on Inflammatory Profile at Admission in Critically Ill Septic Patients(2015) ZAMPIERI, Fernando G.; JACOB, Vanessa; SILVA, Fabiano Pinheiro da; SOUZA, Heraldo P. deIntroduction. Inflammation is ubiquitous during sepsis and may be influenced by body mass index (BMI). We sought to evaluate if BMIwas associated with serumlevels of several cytokinesmeasured at intensive care unit admission due to sepsis. Methods. 33 septic patients were included. An array of thirty-two cytokines and chemokines was measured using Milliplex technology. We assessed the association between cytokine levels and BMI by generalized additive model that also included illness severity (measured by SAPS 3 score); one model was built for each cytokine measured. Results. We found that levels of epidermal growth factor, vascular endothelial growth factor, and interleukins 4, 5, and 13 were associated with BMI in a complex, nonlinear way, independently of illness severity. Higher BMI was associated with higher levels of anti-inflammatory interleukins. Conclusion. BMI may influence host response to infection during critical illness. Larger studies should confirm these findings.
- Septic shock in older people: a prospective cohort study(2013) SILVA, Fabiano Pinheiro da; ZAMPIERI, Fernando Godinho; BARBEIRO, Denise Frediani; BARBEIRO, Hermes Vieira; GOULART, Alessandra Carvalho; TORGGLER FILHO, Francisco; VELASCO, Irineu Tadeu; CRUZ NETO, Luiz Monteiro da; SOUZA, Heraldo Possolo de; MACHADO, Marcel Cerqueira CesarBackground: Septic shock is the first cause of death in Intensive Care Units. Despite experimental data showing increased inflammatory response of aged animals following infection, the current accepted hypothesis claims that aged patients are immunocompromised, when compared to young individuals. Results: Here, we describe a prospective cohort study designed to analyze the immune profile of this population. Conclusion: Older people are as immunocompetent as the young individual, regarding the cytokines, chemokines and growth factors response to devastating infection.
- Decreased Parathyroid Hormone Levels Despite Persistent Hypocalcemia in Patients with Kidney Failure Recovering from Septic Shock(2013) SILVA, Fabiano Pinheiro da; ZAMPIERI, Fernando Godinho; BARBEIRO, Hermes Vieira; TORGGLER FILHO, Francisco; GOULART, Alessandra Carvalho; JORGETTI, Vanda; VELASCO, Irineu Tadeu; CRUZ NETO, Luiz Monteiro da; SOUZA, Heraldo Possolo deIntroduction: Hypocalcemia is a common and poorly understood finding in critically ill patients. The current study was designed to assess the association of ionized calcium, vitamin D, phosphorus and Parathyroid hormone levels in a cohort of patients with and without kidney dysfunction admitted for sepsis or non-infectious causes. Methods: Prospective cohort clinical and biochemical study. Results: We confirmed that hypocalcemia and hypovitaminosis D are a common finding in critically ill patients. Parathyroid hormone levels significantly rise in septic shock. In the recovery phase, however, despite persistent hypocalcemia, Parathyroid hormone levels abruptly decrease in patients with kidney dysfunction, but not in patients with normal renal function. Conclusions: The systemic inflammatory response syndrome probably leads to inappropriately high Parathyroid hormone levels during septic shock. In the recovery phase, Parathyroid hormone levels decrease, but calcium levels remain low, displaying evidence that the parathyroid is not responding as expected. Since Parathyroid hormone receptors and calcium-sensing receptors have been described in immune cells and other cell types, we propose that these effects may have a plethora of other deleterious effects, with important implications to the pathogenesis of septic shock.
- An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients(2014) ZAMPIERI, Fernando G.; RANZANI, Otavio T.; SABATOSKI, Viviane; SOUZA, Heraldo Possolo de; BARBEIRO, Hermes; DA NETO, Luiz Monteiro Cruz; PARK, Marcelo; SILVA, Fabiano Pinheiro daBackground: Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Mean platelet volume is a simple surrogate for platelet activation, with higher MPV being associated with worse clinical condition on a large array of clinical diagnoses. We therefore aimed to investigate associations between changes in platelet count and mean platelet volume (MPV) with prognosis and inflammatory cytokine values in critically ill patients. Methods: This study prospectively included 84 critically ill patients. Patients were stratified into four groups according to proportional changes in MPV (Delta MPV24h) and platelet count (Delta Plat(24h)) in the first 24 hours after admission. Mortality between groups was compared using the chi(2) test. Logistic regression was performed using hospital mortality as outcome and Simplified Acute Physiology Score (SAPS 3), Delta Plat(24h) and Delta MPV24h as covariates. Concentrations of the following inflammatory mediators were measured using Miliplex (R) technology: IL1 beta, IL6, IL8, IL10, epidermal growth factor, vascular endothelial growth factor, TNF alpha and IFN alpha. Cytokine concentrations were compared between groups using the Kruskal-Wallis test with Bonferroni correction. Results: Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%). According to logistic regression, Delta MPV24h was independently associated with increased mortality (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48). No strong associations between inflammatory mediators and changes in MPV and platelet count were found. Conclusion: An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.
- Cathelicidin LL-37 bloodstream surveillance is down regulated during septic shock(2013) BARBEIRO, Denise Frediani; BARBEIRO, Hermes Vieira; ZAMPIERI, Fernando Godinho; MACHADO, Marcel Cerqueira Cesar; TORGGLER FILHO, Francisco; CUNHA, Debora Maria Gomes; GOULART, Alessandra Carvalho; VELASCO, Irineu Tadeu; CRUZ NETO, Luiz Monteiro da; SOUZA, Heraldo Possolo de; SILVA, Fabiano Pinheiro daHost defense peptides are ancient weapons of the innate immunity. The human cathelicidin LL-37 protects the epithelial barrier against infection and is constitutively secreted in the bloodstream by immune cells. Current knowledge claims that LL-37 is up regulated upon infection. LL-37 can protect against bacterial infections and possesses many immunomodulatory properties. Here, we show that the human host defense peptide LL-37 is down regulated during septic shock. Furthermore, we show that these effects are not related to vitamin D serum levels, a potent inducer of LL-37 gene expression, pointing out the complex regulation of cathelicidins during septic shock.
- HLA-A*31 como marcador de suscetibilidade genetica em sepse(2013) SILVA, Fabiano Pinheiro da; PREUHS FILHO, Germano; FINGER, Eduardo; BARBEIRO, Hermes Vieira; ZAMPIERI, Fernando Godinho; GOULART, Alessandra Carvalho; TORGGLER FILHO, Francisco; PANAJOTOPOULOS, Nicolas; VELASCO, Irineu Tadeu; KALIL, Jorge; SOUZA, Heraldo Possolo de; CRUZ NETO, Luiz Monteiro da; RODRIGUES, HelcioObjective: The HLA haplotype has been associated with many autoimmune diseases, but no associations have been described in sepsis. This study aims to investigate the HLA system as a possible marker of genetic sepsis susceptibility. Methods: This is a prospective cohort study including patients admitted to an intensive care unit and healthy controls from a list of renal transplant donors. Patients with less 18 years of age; pregnant or HIV positive patients; those with metastatic malignancies or receiving chemotherapy; or with advanced liver disease; or with end-of-life conditions were excluded. The DNA was extracted from the whole blood and HLA haplotypes determined using MiliPlex® technology. Results: From October 2010 to October 2012, 1,121 patients were included (1,078 kidney donors, 20 patients admitted with severe sepsis and 23 with septic shock). HLA-A*31 positive subjects had increased risk of developing sepsis (OR 2.36, 95%CI 1.26-5.35). Considering a p value <0.01, no other significant association was identified. Conclusion: HLA-A*31 expression is associated to risk of developing sepsis.
- Neuropeptide Downregulation in Sepsis(2014) SILVA, Fabiano Pinheiro da; MACHADO, Marcel Cerqueira Cesar; SALLET, Paulo Clemente; ZAMPIERI, Fernando Godinho; GOULART, Alessandra Carvalho; TORGGLER FILHO, Francisco; BARBEIRO, Hermes Vieira; VELASCO, Irineu Tadeu; CRUZ NETO, Luiz Monteiro da; SOUZA, Heraldo Possolo deNeuropeptides are an extremely conserved arm of neurobiology. Despite their effects as neurohormones and neurotransmitters, a multitude of other effects have been described, putting in evidence their importance as regulators of immune responses, such as chemotaxis, oxidative burst, pro-inflammatory signaling, and many others. The effects of neuropeptides in the pathophysiology of sepsis, however, remain poorly investigated. A prospective cohort study to investigate the effects of neuropeptides in sepsis was carried out. Here, we describe that neuropeptides are downregulated during septic shock. We propose that it may be a protective mechanism of the host to avoid further inflammatory injury.
- Relationship between acid-base status and inflammation in the critically ill(2014) ZAMPIERI, Fernando G.; KELLUM, John A.; PARK, Marcelo; RANZANI, Otavio T.; BARBEIRO, Hermes V.; SOUZA, Heraldo P. de; CRUZ NETO, Luiz Monteiro da; SILVA, Fabiano Pinheiro daIntroduction: There is a complex interplay between changes in acid base components and inflammation. This manuscript aims to explore associations between plasma cytokines and chemokines and acid base status on admission to intensive care. Methods: We conducted a prospective cohort study in a 13-bed ICU in a tertiary-care center in Brazil. 87 unselected patients admitted to the ICU during a 2-year period were included. We measured multiple inflammatory mediators in plasma using multiplex assays and evaluated the association between mediator concentrations and acid base variables using a variety of statistical modeling approaches, including generalized linear models, multiadaptive regression splines and principal component analysis. Results: We found a positive association between strong ion gap (SIG) and plasma concentrations of interleukin (IL)6, 8, 10 and tumor necrosis factor (TNF); whereas albumin was negatively associated with IL6, IL7, IL8, IL10, TNF and interferon (IFN)alpha. Apparent strong ion difference (SIDa) was negatively associated with IL10 and IL17. A principal component analysis including SAPS 3 indicated that the association between acid base components and inflammatory status was largely independent of illness severity, with both increased SIG and decreased SIDa (both drivers of acidosis) associated with increased inflammation. Conclusion: Acid base variables (especially increased SIG, decreased albumin and decreased SIDa) on admission to ICU are associated with immunological activation. These findings should encourage new research into the effects of acid base status on inflammation.
conferenceObject Cathelicidin LL-37 bloodstream surveillance is down regulated during septic shock(2013) SILVA, Fabiano Pinheiro da; BARBEIRO, Denise; BARBEIRO, Hermes; ZAMPIERI, Fernando; MACHADO, Marcel; TORGGLER FILHO, Francisco; CUNHA, Debora; GOULART, Alessandra; VELASCO, Irineu; NETO, Luiz Cruz; SOUZA, Heraldo