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001-es BibID:	BIBFORM071451
Első szerző:	Dinya Tamás (sebész szakorvos, onkológus szakorvos)
Cím:	Functional polymorphisms of innate immunity receptors are not risk factors for the non-SBP type bacterial infections in cirrhosis / Dinya Tamás, Tornai Tamás, Vitális Zsuzsanna, Tornai István, Balogh Boglárka, Tornai Dávid, Antal-Szalmás Péter, Sümegi Andrea, Andrikovics Hajnalka, Bors András, Tordai Attila, Papp Mária
Dátum:	2018
ISSN:	1478-3223 1478-3231
Megjegyzések:	Background&Aims: Pattern recognition receptors (PRRs) have a key role in the innate host defense. Functional polymorphisms of various PRRs have been established to contribute to an increased susceptibility to spontaneous bacterial peritonitis (SBP). Their role in the development of cirrhosis-associated bacterial infections (BI), beyond SBP or progressive disease course related to pathological bacterial translocation (BT) remains unknown. Methods: 349 patients with cirrhosis were genotyped for common NOD2 (R702W, G908R and L1007PfsinsC), TLR2 (-16934T>A), and TLR4 (D299G) gene variants. Incidence of BIs, decompensating events (ascites, variceal bleeding and hepatic encephalopathy) and liver-related death were assessed in a 5-year follow-up observational study. Pathological BT was assessed based on the presence of anti-microbial antibodies or lipopolysaccharide-binding protein (LBP) level. Results: In patients with ascites (n=88) only NOD2 gene variants were associated with an increased cumulative probability of SBP compared to wild-type (76.9%?19.9% vs. 30.9%?6.9%, PLogRank=0.047). Neither individual polymorphisms, nor combined PRR genetic profiles were associated with the risk of non-SBP type BI. Advanced disease stage (HR,[95%CI]: 2.11 [1.38-3.25]) and prior history of a BI episode (HR: 2.42 [1.58-3.72]) were the major clinical risk factors of a subsequent BI. The risk of a non-SBP type BI in patients with advanced disease and a prior BI was even higher (HR: 4.74 [2.68-8.39]). The frequency of anti-microbial antibodies and LBP levels did not differ between various PRR genotypes. Correspondingly, PRR genetic profile was not able to predict the long-term disease course. Conclusions: In cirrhosis, functional polymorphisms of PRRs did not improve the identification of patients with high risk of BI beyond SBP or progressive diseases course.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk pattern recognition receptors genetic polymorphisms cirrhosis bacterial infection complication mortality
Megjelenés:	Liver International. - 38 : 7 (2018), p. 1242-1252. -
További szerzők:	Tornai Tamás István (1984-) (belgyógyász) Vitális Zsuzsanna (1963-) (belgyógyász, gasztroenterológus) Tornai István (1954-) (belgyógyász, gasztroenterológus) Balogh Boglárka (1993-) (belgyógyász) Tornai Dávid (1989-) (hepatológia, biomarker kutatás) Antal-Szalmás Péter (1968-) (laboratóriumi szakorvos) Sümegi Andrea (1969-) (biológus) Andrikovics Hajnalka Bors András Tordai Attila Papp Mária (1975-) (belgyógyász, gasztroenterológus)
Pályázati támogatás:	OTKA-115818 OTKA
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001-es BibID:	BIBFORM065752
Első szerző:	Papp Mária (belgyógyász, gasztroenterológus)
Cím:	Presepsin teardown : pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis / Maria Papp, Tamas Tornai, Zsuzsanna Vitalis, Istvan Tornai, David Tornai, Tamas Dinya, Andrea Sumegi, Peter Antal-Szalmas
Dátum:	2016
Megjegyzések:	AIM: Bacterial infections are frequent complications in cirrhosis with significant mortality. Early laboratory diagnosis is essential but challenging. We aimed to evaluate the diagnostic and prognostic value of presepsin in cirrhosis associated bacterial infections. METHODS: 216 patients with cirrhosis were enrolled. At admission, presence of bacterial infections and level of plasma presepsin, serum CRP and PCT were evaluated. Patients were followed for three months to assess the possible association between presepsin level and short-term mortality. RESULTS: 34.7% of patients had bacterial infection. Presepsin levels were significantly higher in patients with infection than without (median, 1002 vs. 477 pg/mL, p<0.001), increasing with the severity of infection (organ failure[OF]Yes vs. No: 2358 vs. 710 pg/mL, p<0.001). Diagnostic accuracy of presepsin for severe infections was similar to PCT and superior to CRP (AUC-ROC: 0.85, 0.85 and 0.66, respectively, p=NS for presepsin vs. PCT and p<0.01 for presepsin vs. CRP). At the optimal cut-off value of presepsin>1206 pg/mL sensitivity, specificity, PPV and NPV were as follows: 87.5%, 74.5%, 61.8% and 92.7%. The accuracy of presepsin, however, decreased in advanced stage of the disease or in the presence of renal failure, most probably because of the significantly elevated presepsin levels in non-infected patients. 28-day mortality rate was higher among patients with >1277 pg/mL compared to those with ?1277 pg/mL (46.9% vs. 11.6%, p<0.001). In a binary logistic regression analysis, however, only PCT [OR: 1.81, (95%CI: 1.09?3.01), p=0.022] but neither presepsin and nor CRP were independent risk factor for 28-day mortality after adjusting with MELD score and leukocyte count.CONCLUSION: Presepsin is a valuable new biomarker for defining severe infections in cirrhosis proving same efficacy as PCT. However, it is not a useful marker of short-term mortality.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban presepsin cirrhosis bacterial infection organ failure mortality
Megjelenés:	World Journal of Gastroenterology 22 : 41 (2016), p. 1-14. -
További szerzők:	Tornai Tamás István (1984-) (belgyógyász) Vitális Zsuzsanna (1963-) (belgyógyász, gasztroenterológus) Tornai István (1954-) (belgyógyász, gasztroenterológus) Tornai Dávid (1989-) (hepatológia, biomarker kutatás) Dinya Tamás (1974-) (sebész szakorvos, onkológus szakorvos) Sümegi Andrea (1969-) (biológus) Antal-Szalmás Péter (1968-) (laboratóriumi szakorvos)
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001-es BibID:	BIBFORM045007
Első szerző:	Papp Mária (belgyógyász, gasztroenterológus)
Cím:	High prevalence of IgA class anti-neutrophil cytoplasmic antibodies (ANCA) is associated with increased risk of bacterial infection in patients with cirrhosis / Maria Papp, Nora Sipeki, Zsuzsanna Vitalis, Tamás Tornai, Istvan Altorjay, Istvan Tornai, Miklos Udvardy, Kai Fechner, Silvia Jacobsen, Bianca Teegen, Andrea Sumegi, Gabor Veres, Peter Laszlo Lakatos, Janos Kappelmayer, Peter Antal-Szalmas
Dátum:	2013
ISSN:	0168-8278
Megjegyzések:	Background&Aims: Anti-neutrophil cytoplasmic antibodies(ANCA) are a non-uniformfamily of antibodies recognizing diverse components of neutrophil granulocytes. ANCA formation might be induced by protracted bacterial infections or probably reflect an abnormal immune response to commensal microorganisms. Bacterial infections are common complications in cirrhosis with high incidence of episodes caused by enteric organisms, therefore, we sought to study the presence and clinical importance of ANCA in cirrhosis. Methods: Sera of 385 patients with cirrhosis of different etiologies were assayed for ANCA of IgG, IgA, IgA1, IgA2 and secretory IgA subtypes by indirect immunofluorescence and ELISAs. Control group comprised of 202 patients with chronic liver diseases without cirrhosis and 100 healthy subjects. In cirrhosis, a 2-year follow-up, observational study was conducted to assess possible association between presence of ANCA and clinically significant bacterial infections. Results: Prevalence of ANCA IgA was significantly higher in cirrhosis(52.2%) compared to chronic liver diseases(18.6%) or healthy controls (0%, p 0.001for both). ANCA IgA subtyping assays revealed marked increase in the proportion of IgA2 subtype (46% of total ANCA IgA) and presence of the secretory component concurrently. Presence of ANCA IgA was associated to disease-specific clinical characteristics (Child-Pugh stage and presence of ascites, p 0.001). During a 2-year follow-up period, risk of infectionswas higher among patients with ANCA IgA compared to those without (41.8% vs. 23.4%, p 0.001). ANCA IgA positivity was associated with a shorter time to the first infectiouscomplication (pLogRank0.001) in Kaplan?Meier analysis and was identified as anindependent predictor in multivariate Cox-regression analysis (HR:1.74, 95%CI:1.18?2.56, p=0.006). Conclusions: Presence of IgA type ANCA is common in cirrhosis. Involvement of gut mucosal immune system is in center of the formation and probably reflects sustained exposure to bacterial constituents.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban anti-neutrophil cytoplasmic antibodies cirrhosis bacterial infection
Megjelenés:	Journal of Hepatology. - 59 : 3 (2013), p. 457-466. -
További szerzők:	Sipeki Nóra (1987-) (általános orvos) Vitális Zsuzsanna (1963-) (belgyógyász, gasztroenterológus) Tornai Tamás István (1984-) (belgyógyász) Altorjay István (1954-) (belgyógyász, gasztroenterológus, onkológus) Tornai István (1954-) (belgyógyász, gasztroenterológus) Udvardy Miklós (1947-) (belgyógyász, haematológus) Fechner, Kai Jacobsen, Silvia Teegen, Bianca Sümegi Andrea (1969-) (biológus) Veres Gábor (1969-2020) (csecsemő- és gyermekgyógyász, gasztroenterológus) Lakatos Péter (Semmelweis Egyetem) Kappelmayer János (1960-) (laboratóriumi szakorvos) Antal-Szalmás Péter (1968-) (laboratóriumi szakorvos)
Pályázati támogatás:	T046694 OTKA TÁMOP-4.2.1./B-09/1/KONV-2010-0007 TÁMOP TÁMOP-4.2.2.A-11/1/KONV-2012-0025 TÁMOP
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001-es BibID:	BIBFORM089190
Első szerző:	Tornai Dávid (hepatológia, biomarker kutatás)
Cím:	Increased sTREM-1 levels identify cirrhotic patients with bacterial infection and predict their 90-day mortality / Tornai David, Vitális Zsuzsanna, Jónás Alexa, Janka Tamás, Földi Ildikó, Tornai Tamás, Sipeki Nóra, Csillag Anikó, Balogh Boglárka, Sümegi Andrea, Földesi Róza, Papp Mária, Antal-Szalmás Péter
Dátum:	2021
Megjegyzések:	Background & Aims: Patients with cirrhosis are susceptible to bacterial infections (BIs) that are major causes of specific complications and mortality. However, the diagnosis of BIs can often be difficult in advanced disease stage since their symptoms may overlap with the ones of acute decompensation (AD). Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is released from monocytes/macrophages and neutrophils during activation and has been reported to correlate with activity of various inflammatory processes. We investigated its diagnostic and prognostic performance in patients with cirrhosis and BI. Methods: Sera of 269 patients were assayed for sTREM-1 by ELISA (172 outpatients and 97 patients with AD of whom 56 had BI). We investigated capacity of sTREM-1 to identify patients with BI and conducted a 90-day follow-up observational study to assess its possible association with short-term mortality. Results: sTREM-1 levels were significantly higher in patients with more severe liver disease, BI, and acute-on-chronic liver failure than in patients without these conditions. sTREM-1 had similar accuracy to CRP identifying BI [sTREM-1: AUROC (95%CI) 0.804 (0.711-0.897), p<0.0001, CRP: 0.791 (0.702-0.881) p<0.0001)] among AD patients. The combination of these two molecules and the presence of ascites into a composite score significantly increased their discriminative power (AUROC:0.878, 95%CI:0.812-0.944, p<0.0001). High sTREM-1 level (>660 pg/mL) was an independent predictor of 90-day mortality in patients with BI [HR: 2.941, (95%CI: 1.009-8.573), p=0.048] in our multivariate model. Conclusions: Use of sTREM-1 could increase the recognition of BIs in cirrhosis and help clinicians in mortality risk assessment of these patients.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk sTREM-1 bacterial infection cirrhosis acute decompensation mortality
Megjelenés:	Clinics and Research in Hepatology and Gastroenterology. - 45 : 5 (2021), p. 1-12. -
További szerzők:	Vitális Zsuzsanna (1963-) (belgyógyász, gasztroenterológus) Jónás Alexa Janka Tamás Földi Ildikó (1981-) (orvos) Tornai Tamás István (1984-) (belgyógyász) Sipeki Nóra (1987-) (általános orvos) Csillag Anikó (1979-) (immunológus, biológus, angol-magyar szakfordító) Balogh Boglárka (1993-) (belgyógyász) Sümegi Andrea (1969-) (biológus) Földesi Róza (1967-) (klinikai laboratóriumi kutató, PhD hallgató) Papp Mária (1975-) (belgyógyász, gasztroenterológus) Antal-Szalmás Péter (1968-) (laboratóriumi szakorvos)
Pályázati támogatás:	GINOP-2.3.2-15-2016-00048 GINOP EFOP-3.6.1-16-2016- 00022 EFOP EFOP- 3.6.2-16-2017-00006 EFOP ÚNKP-19-4 ÚNKP
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