摘要:

ObjectiveMeningococcal sepsis invariably is associated with coagulopathy. We have previously reported an association between mortality rate in meningococcal disease and the functional 4G/5G promoter polymorphism of the plasminogen-activator-inhibitor (PAI)-1 gene in a small patient cohort. In a much larger cohort, we aimed to confirm these results and further investigate the role of the 4G/5G polymorphism in determining susceptibility, outcome, and complications of disease.DesignSusceptibility was investigated in two separate studies, a case-control study and a family-based transmission study, each test using a separate patient cohort. Severity was investigated using clinical diagnosis, the presence of vascular complications, Pediatric Risk of Mortality (PRISM)-predicted morality, and actual mortality.SettingUniversity hospital and laboratories.SubjectsSubjects were 510 UK pediatric patients, 210 parents of patients, and 155 UK Caucasian controls.InterventionsDNA extraction and 4G/5G PAI-1 genotyping was carried out using published techniques.Measurements and Main ResultsPredicted mortality distribution differed significantly between genotypes (p= .05) with a significantly higher median PRISM in the 4G/4G (41.1%) than the 4G/5G (23.4%) and 5G/5G (19.0%) genotyped patients combined (p= .02). Actual mortality rate was significantly associated with both genotype (chi-square = 14.8,p= .001) and allele frequencies (chi-square = 14.0,p< .0001), with more deaths in the 4G/4G (28.4%) than the 4G/5G and 5G/5G genotyped patients combined (14.9%; chi-square = 7.9;p= .005; risk ratio, 1.9; 95% confidence interval, 1.2–3.0). Logistic regression indicated a 40% and 91% reduction in the odds of dying if a patient was either 4G/5G or 5G/5G, respectively, in comparison to a 4G homozygous patient. When analyzed by clinical diagnosis, the association with death was found only in the sepsis group (chi-square = 18.7,p< .0001; risk ratio, 2.7; 95% confidence interval, 1.6–4.6). In survivors of disease, a significantly higher proportion of 4G/4G patients suffered from vascular complications (chi-square = 6.7,p= .03; risk ratio, 2.4; 95% confidence interval, 1.1–5.0). The 4G/5G polymorphism was not associated or linked with susceptibility (case-control result,p= .6; family-based transmission study results,p= .2).ConclusionsThis study confirms that Caucasian pediatric patients carrying the functional PAI-1 4G/4G genotype are at an increased risk of developing vascular complications and dying from meningococcal disease.

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo provide current information on general and specific interventions for overdoses likely to require intensive care.DesignReview of literature relevant to selected interventions for general management of overdoses and specific poisons.ResultsThe benefit of interventions to decrease absorption or enhance elimination of toxins is limited to a relatively small number of specific agents. Antidotes and certain interventions may be helpful in preventing or treating toxicity in specific poisonings when used appropriately. Intensive supportive care is also necessary to achieve good outcomes.ConclusionKnowledge of the indications and limitations of current interventions for poisonings and overdoses is important for care of the critically ill poisoned patient.

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:2003

数据来源: OVID