scholarly journals A Novel Paradigm Based on ST2 and Its Contribution towards a Multimarker Approach in the Diagnosis and Prognosis of Heart Failure: A Prospective Study during the Pandemic Storm

Life ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1080
Author(s):  
Radu-Stefan Miftode ◽  
Daniela Constantinescu ◽  
Corina Maria Cianga ◽  
Antoniu Octavian Petris ◽  
Amalia-Stefana Timpau ◽  
...  
Keyword(s):  
Heart Failure ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Diagnostic Value ◽  
Control Group ◽  
Diagnosis And Prognosis ◽  
Test Kit ◽  
Positive Correlations ◽  
Lactate Levels ◽  
A Prospective Study

Background: Acute heart failure (HF) represents an increasingly common and challenging presentation in the emergency room, also inducing a great socio-economic burden. Extensive research was conducted toward finding an ideal biomarker of acute HF, both in terms of sensitivity and specificity, but today practicians’ interest has shifted towards a more realistic multimarker approach. Natriuretic peptides (NPs) currently represent the gold standard for diagnosing HF in routine clinical practice, but novel molecules, such as sST2, emerge as potentially useful biomarkers, providing additional diagnostic and prognostic value. Methods: We conducted a prospective, single-center study that included 120 patients with acute HF and 53 controls with chronic HF. Of these, 13 patients (eight with acute HF, five from the control group) associated the coronavirus-19 disease (COVID-19). The diagnosis of HF was confirmed by a complete clinical, biological and echocardiographic approach. Results: The serum levels of all studied biomarkers (sST2, NT-proBNP, cardiac troponin) were significantly higher in the group with acute HF. By area under the curve (AUC) analysis, we noticed that NT-proBNP (AUC: 0.976) still had the best diagnostic performance, closely followed by sST2 (AUC: 0.889). However, sST2 was a significantly better predictor of fatal events, showing positive correlations for both in-hospital and at 1-month mortality rates. Moreover, sST2 was also associated with other markers of poor prognosis, such as the use of inotropes or high lactate levels, but not with left ventricle ejection fraction, age, body mass index or mean arterial pressure. sST2 levels were higher in patients with a positive history of COVID-19 as compared with non-COVID-19 patients, but the differences were statistically significant only within the control group. Bivariate regression showed a positive and linear relationship between NT-proBNP and sST2 (r(120) = 0.20, p < 0.002). Conclusions: we consider that sST2 has certain qualities worth integrating in a future multimarker test kit alongside traditional biomarkers, as it provides similar diagnostic value as NT-proBNP, but is emerging as a more valuable prognostic factor, with a better predictive value of fatal events in patients with acute HF.

scholarly journals Diagnostic Value of Vaginal Microecology, Serum miR-18a, and PD-L1 for Identifying HPV-Positive Cervical Cancer

2021 ◽  
Vol 20 ◽  
pp. 153303382199528
Author(s):  
Yumei Zhang ◽  
Sujuan Qiu ◽  
Yueli Guo ◽  
Jiaqin Zhang ◽  
Xiaoqing Wu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Diagnostic Value ◽  
High Serum ◽  
Control Group ◽  
Observation Group ◽  
Positive Group ◽  
Microbial Dysbiosis ◽  
Programmed Death

Objective: We aimed to investigate the diagnostic value of the vaginal microecology, serum miR-18a, and programmed death ligand-1 (PD-L1) for human papillomavirus (HPV)-positive cervical cancer. Methods: Eighty-four patients with HPV-positive cervical cancer were assigned to the observation group, 107 HPV-positive patients without cervical cancer were assigned to the positive group, and 191 healthy women were assigned to the control group. Vaginal microecology and serum levels of miR-18a and PD-L1 on the surface of CD4+ and CD8+ T cells were compared among the 3 groups. The observation group was further divided into subgroups according to patients’ characteristics for comparison. The diagnostic value of miR-18a and PD-L1 for HPV-positive cervical cancer was investigated. Results: Women in the control group had better vaginal microecology and lower levels of miR-18a and PD-L1 than those in the observation and the positive groups (all P < 0.05). Compared with the positive group, the observation group had similar vaginal microecology (all P > 0.05) but higher levels of miR-18a and PD-L1 (all P < 0.05). Moreover, the patients at stage III had higher levels of miR-18a and PD-L1 than those at stage I and II (all P < 0.05). The values of area under the curve for miR-18a and PD-L1 in the diagnosis of HPV-positive cervical cancer were over 0.8 (all P < 0.001). Conclusion: Patients with HPV-positive cervical cancer have vaginal microbial dysbiosis and high serum levels of miR-18a and PD-L1. miR-18a and PD-L1 have diagnostic value for identifying HPV-positive cervical cancer.

Diagnostic value of thymus and activation-regulated chemokine and of periostin in eosinophilic asthma: A prospective study

2021 ◽  
Vol 42 (1) ◽  
pp. e30-e39 ◽  
Author(s):  
Burcu Yormaz ◽  
Esma Menevse ◽  
Nihal Cetin ◽  
Zeliha Esin Celik ◽  
Hasan Bakir ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Serum Levels ◽  
Diagnostic Value ◽  
Induced Sputum ◽  
Control Group ◽  
Characteristic Analysis ◽  
Eosinophilic Asthma ◽  
Cutoff Value ◽  
Healthy Control ◽  
A Prospective Study

Background: Serum thymus and activation-regulated chemokine (TARC) and periostin are reliable biomarkers in eosinophilic asthma. Objective: This study was carried out to determine the use of periostin and TARC as biomarkers in asthma and to compare the superiority of one over the other, especially in asthma with an eosinophilic phenotype. Methods: The study was conducted with 87 patients with asthma and 42 healthy control subjects. Patients with asthma were also divided into eosinophilic and non-eosinophilic phenotypes. A pulmonary function test was performed in all the participants, and serum and induced sputum TARC, periostin concentrations, eosinophils, and total immunoglobulin E values were examined. Results: TARC and periostin levels were significantly higher in the asthma group than in the control group (p < 0.001). The serum TARC level in the eosinophilic group was significantly higher than in the non-eosinophilic and control groups (p < 0.001). The induced sputum TARC level was significantly higher in the non-eosinophilic group than in the control group (p < 0.001). The TARC and periostin levels of the patients were evaluated by using receiver operator characteristic analysis. The cutoff value for TARC was determined to be 1415.39 ng/L; likewise, the cutoff value for periostin was 107.60 ng/L. The present study detected that serum levels of TARC correlated to serum levels of periostin (r = 0.54; p = 0.032). Furthermore, when evaluating correlations between serum and sputum levels, there was a correlation detected between TARC and periostin in serum, whereas this correlation was stronger in sputum: r = 0.66, p = 0.020; and r = 0.62, p = 0.028, respectively. Conclusion: Serum and sputum TARC and periostin may contribute for monitoring the improvement of patients, particularly those with asthma. Furthermore, TARC was a more reliable biomarker than periostin for patients with eosinophilic asthma.

Diagnostic value of thymus and activation-regulated chemokine and of periostin in eosinophilic asthma: A prospective study

2020 ◽  
Author(s):  
Burcu Yormaz ◽  
Esma Menevse ◽  
Nihal Cetin ◽  
Zeliha Esin Celik ◽  
Hasan Bakir ◽  
...  
Keyword(s):  
Immunoglobulin E ◽  
Serum Levels ◽  
Diagnostic Value ◽  
Induced Sputum ◽  
Control Group ◽  
Eosinophilic Asthma ◽  
Cutoff Value ◽  
Healthy Control ◽  
A Prospective Study ◽  
And Control

Background: Serum thymus and activation-regulated chemokine (TARC) and periostin are reliable biomarkers in eosinophilicasthma.Objective: This study was carried out to determine the use of periostin and TARC as biomarkers in asthma and to comparethe superiority of one over the other, especially in asthma with an eosinophilic phenotype.Methods: The study was conducted with 87 patients with asthma and 42 healthy control subjects. Patients with asthma were also divided into eosinophilic and non-eosinophilic phenotypes. A pulmonary function test was performed in all the participants,and serum and induced sputum TARC, periostin concentrations, eosinophils, and total immunoglobulin E valueswere examined.Results: TARC and periostin levels were significantly higher in the asthma group than in the control group (p < 0.001). The serum TARC level in the eosinophilic group was significantly higher than in the non-eosinophilic and control groups(p < 0.001). The induced sputum TARC level was significantly higher in the non-eosinophilic group than in the control group(p < 0.001). The TARC and periostin levels of the patients were evaluated by using receiver operator characteristic analysis.The cutoff value for TARC was determined to be 1415.39 ng/L; likewise, the cutoff value for periostin was 107.60 ng/L. Thepresent study detected that serum levels of TARC correlated to serum levels of periostin (r = 0.54; p = 0.032). Furthermore,when evaluating correlations between serum and sputum levels, there was a correlation detected between TARC and periostinin serum, whereas this correlation was stronger in sputum: r = 0.66, p = 0.020; and r = 0.62, p = 0.028, respectively.Conclusion: Serum and sputum TARC and periostin may contribute for monitoring the improvement of patients, particularly those with asthma. Furthermore, TARC was a more reliable biomarker than periostin for patients with eosinophilic asthma.

scholarly journals ENDOSCOPIC AND HISTOPATHOLOGIC GASTRIC CHANGES IN CHRONIC USERS OF PROTON-PUMP INHIBITORS

2015 ◽  
Vol 52 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Sílvia Maria Perrone CAMILO ◽  
Élia Cláudia de Souza ALMEIDA ◽  
Benito André Silveira MIRANZI ◽  
Juliano Carvalho SILVA ◽  
Rosemary Simões NOMELINI ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Serum Levels ◽  
Control Group ◽  
Upper Gastrointestinal Endoscopy ◽  
Positive Serology ◽  
Cell Hyperplasia ◽  
Sydney System ◽  
A Prospective Study ◽  
Histopathologic Findings

Background Proton-pump inhibitors have been used for at least two decades. They are among the most commonly sold drugs in the world. However, some controversy remains about the indications for their use and the consequences of their prolonged use. Objectives To evaluate and compare the endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors to changes in non-users. Methods A prospective study performed at a tertiary Public Hospital involving 105 patients undergoing upper-gastrointestinal endoscopy. Subjects included 81 proton-pump inhibitor users and 24 non-users (control group). Biopsies of the antral-type mucosa, the antral-fundic transition, and the fundus were evaluated by the Sydney System. The presence of erosion or ulceration, lymphatic follicles, reactive gastropathy, and polypoid or epithelial hyperplasia was also determined. Serum levels of gastrin were measured. Results We found two polyps, one in each group, both of which were negative for Helicobacter pylori. There were two cases of parietal cell hyperplasia in users of proton-pump inhibitors. Gastrin was elevated in 28 users of proton-pump inhibitors and in four members of the control group. We did not find statistically significant differences in the endoscopic or histopathologic findings between the two groups. Conclusions Chronic use of proton-pump inhibitors for the duration examined was not associated with significant gastric changes. An interesting finding was that the 4 chronic users of proton-pump inhibitors who had serum gastrin levels above 500 pg/mL also had positive serology for Chagas disease.

Serum β-glucuronidase activity as a biomarker for acute cholinesterase inhibitor pesticide poisoning

2018 ◽  
Vol 34 (12) ◽  
pp. 891-897 ◽  
Author(s):  
Doha M Beltagy ◽  
Kadry M Sadek ◽  
Amal S Hafez
Keyword(s):  
Serum Levels ◽  
Significant Negative Correlation ◽  
Repeated Measurements ◽  
Control Group ◽  
Pesticide Poisoning ◽  
Time Points ◽  
Diagnosis And Prognosis ◽  
Glucuronidase Activity ◽  
Reliable Marker ◽  
Group Serum

β-glucuronidase (BG) activity is a promising biomarker for diagnosis and prognosis after exposure to organophosphorous (OP) pesticides. The aim of this study was to evaluate the changes in serum BG activity in patients with acute OP poisoning and to determine whether these changes correlate with the severity of poisoning. Thirty patients with anticholinesterase pesticide poisoning were included, besides 10 healthy volunteers as a control group. Serum activities of butyrylcholinesterase (BuChE) and BG were measured for each subject on admission, then after 12 and 24 h. Serum levels of BuChE and BG in poisoned patients were significantly different from the control subjects; these differences persisted in repeated measurements. Moreover, the serum levels showed significant differences within each group of the three time points. A significant negative correlation was found between the serum activities of BuChE and BG in all groups at the three time points. In conclusion, serum BG activity seems a reliable marker for OP poisoning even when measured at 24 h after poisoning.

scholarly journals PEMERIKSAAN TINGKAT sdLDL SERUM SEBAGAI PETANDA DIAGNOSTIK STENOSIS KORONER (Serum sdLDL Level as A Diagnostic Marker of Coronary Stenosis)

2018 ◽  
Vol 22 (1) ◽  
pp. 9
Author(s):  
Indranila K Samsuria ◽  
Laily Adninta
Keyword(s):  
Predictive Value ◽  
Coronary Stenosis ◽  
Area Under The Curve ◽  
Clinical Pathology ◽  
Diagnostic Value ◽  
T Test ◽  
Cross Sectional ◽  
Increased Risk ◽  
Test Kit ◽  
Vascular Stenosis

Small dense LDL (sdLDL) is the LDL which particles are small and dense, it is pro-atherogenic. Increased levels of serum sdLDL areassociated with an increased risk of coronary stenosis. The aim of this study was to examine the diagnostic value of sd LDL in coronarystenosis. An analytical observational study with cross sectional approach was conducted at the Department of Clinical Pathology, MedicalFaculty of Diponegoro University/Dr. Kariadi Hospital and the Unit of Cardiac diseases during the period of March-October 2013. Thesubjects were 39 patients suspected of suffering a coronary stenosis. The diagnosis of coronary stenosis, degree of stenosis and numberof vascular stenosis was established at the time of cardiac catheterization. SdLDL assessment used a test kit. The statistical analysis usedwere unpaired t-test, Spearman correlation test, ROC analysis and diagnostic test. LDL levels in stenosis subjects, 35.4±9.01 mg/dL weresignificantly higher compared to levels in subjects that had no stenosis, 20.7±7.10 mg/dL (p<0.001; unpaired t-test). Correlation testresults showed a correlation between levels of serum sdLDL with severe degree of stenosis (correlation coefficient -0.64, p <0.001) and amoderate positive correlation between the number of vascular stenosis (Coefficient correlation 0.46; p=0.003; Spearman Correlation’sTest). The area under the curve of ROC was 0.9 (p <0.001). The cut off levels sdLDL were used to detect stenosis. The results showeda sensitivity of 85.2%, specificity of 75%, positive predictive value of 88.5%, negative predictive value of 69.2% and accuracy of 82%.Levels of serum sdLDL were associated with severe to extensive stenosis degree, and showed a good diagnostic value, thus, it can beused for screening to determine the presence of coronary stenosis.

Abstract 2373: The Effects of Statin Therapy on MMP Families in Patients with Acute Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Akihiro Shirakabe ◽  
Kunuya Asai ◽  
Noritake Hata ◽  
Shinya Yokoyama ◽  
Koichi Akutsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Remodeling ◽  
Patient Characteristics ◽  
Serum Levels ◽  
Statin Treatment ◽  
Control Group ◽  
Matrix Metalloprotease ◽  
Atorvastatin Group ◽  
Pharmacological Modification ◽  
And Control

Introduction: It is known that increased matrix metalloprotease (MMP) accelerated cardiac remodeling in chronic heart failure (HF). Although roles of MMPs in acute HF have not been well clarified, we also found that MMPs increased in acute HF and decreased in the improvement of HF with conventional therapy. Pharmacological modification of MMPs may be beneficial for a treatment of acute HF. Therefore we assessed the hypothesis that a statin decreased MMPs in acute HF. Methods: Serum levels of MMP-2,-3, and -9 were measured on admission (Day 1), Day 3, and Day 14 in 38 acute HF patients. The patients were randomized to either atorvastatin group (n = 20) or control group (n = 18). Atorvastatin (10 –20mg per day) was started within 12 hours after their admission and continued for two weeks. There was no limitation in HF treatment and the treatment was not different between the two groups except atorvastatin. Patient characteristics including an etiology of HF and cardiac function were also not different between the groups. Results: There were no differences in serum levels of MMP-2, -3, and-9 on Day 1 between atorvastain group (1435.3 ± 292.6 ng/ml, 72.2 ± 40.4 ng/ml, 132.9 ± 85.5 ng/ml, respectively) and control group(1284.5 ± 399.6 ng/ml, 142.0 ± 139.7 ng/ml, 88.4 ± 51.2 ng/ml, respectively). MMP-2 significantly decreased in both atorvastatin and control group on Day 3 and Day 14. But, decreases of MMP-2 on Day 3 and Day 14 from Day 1 were significantly greater in atorvastatin group (− 581.3 ± 237.3 ng/ml and − 447.7 ± 228.3 ng/ml, respectively) than in control group (− 321.3 ± 257.8 ng/ml and − 275.0 ± 179.4 ng/ml, respectively). MMP-9 significantly decreased in atorvastatin group on Day 3 and Day 14 (132.9 ± 85.5 ng/ml on Day1, 71.4 ± 48.6 ng/ml on Day 3, 53.0 ± 28.5 ng/ml on Day 14; p < 0.05), but did not change significantly in control group. MMP-3 did not significantly change in both groups. Conclusion: MMP-2 decreased with conventional HF treatment, but MMP-3 and -9 did not. Interestingly, early start of statin treatment significantly decreased both MMP-2 and -9, but not MMP-3 in acute HF. This is the first report demonstrating the effects of statin on MMPs in acute HF.

Diagnostic efficacy of serum and urinary netrin-1 in the early detection of diabetic nephropathy

2021 ◽  
pp. jim-2021-001785
Author(s):  
Rasha A Elkholy ◽  
Reham L Younis ◽  
Alzahraa A Allam ◽  
Rasha Youssef Hagag ◽  
Muhammad Tarek Abdel Ghafar
Keyword(s):  
Diabetic Nephropathy ◽  
Early Detection ◽  
Characteristic Curve ◽  
Fasting Blood Glucose ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Control Group ◽  
Diagnostic Efficacy ◽  
Significant Difference ◽  
Patients With Diabetes

This study aimed to assess the diagnostic value of serum and urinary netrin-1 in patients with type 2 diabetes mellitus (T2DM) at different stages of diabetic nephropathy (DN) and to compare its efficacy of estimation in serum with that in the urine. This study was carried out on 135 patients with T2DM and 45 healthy subjects. The patients with diabetes were divided according to urinary albumin creatinine ratio (UACR) into: T2DM with normoalbuminuria, incipient DN with microalbuminuria, and overt DN with macroalbuminuria groups. Serum and urinary levels of netrin-1 were measured by ELISA. The mean levels of serum and urinary netrin-1 were significantly higher in the microalbuminuric and macroalbuminuric patients with DN than those in the normoalbuminuric patients with T2DM, with the highest values detected in macroalbuminuric patients with DN. Urinary netrin-1 level was significantly higher in the normoalbuminuric T2DM group than control group, whereas no significant difference existed regarding serum netrin-1 level. In T2DM groups, the urinary and serum netrin-1 correlated with each other and were independently related to fasting blood glucose, UACR, and estimated glomerular filtration rate. Receiver operating characteristic curve analysis showed that the area under the curve of urinary netrin-1 was 0.916 which is significantly higher than that of serum netrin-1 (0.812) for the detection of incipient DN and reached 0.938 on coestimation of both urinary and serum netrin-1. In conclusion, netrin-1 is a potential diagnostic marker for early detection of DN with its estimation in urine has higher accuracy than that of serum.

P6287Analysis of novel cardiac markers sST2 and IL-33 in chronic heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Jirak ◽  
M Lichtenauer ◽  
B Wernly ◽  
V Paar ◽  
C Jung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Inverse Correlation ◽  
Serum Levels ◽  
Control Group ◽  
Significant Elevation ◽  
Serum Samples ◽  
Reduced Ejection Fraction ◽  
Stress Studies ◽  
Cardiac Strain

Abstract Background Soluble (s) ST-2 has been recently evaluated as a monitoring parameter in heart failure (HF). Besides being a marker for cardiac strain and hemodynamic stress, studies also found an influence of ST2 on the immune system, above all mediated through its Janus-Face ligand IL-33, an alarmin released under stress conditions or by cellular death. In contrast to sST2, the role of IL-33 in HF is yet unknown. Objective In this project, we aimed for an analysis of the ST2/IL33 pathway in patients with heart failure with reduced ejection fraction (HFrEF). Methods In total, 200 patients were included in the study: 59 with ischemic (ICM), 65 with dilated (DCM) cardiomyopathy (mean LVEF 38%), as well as 76 control patients without coronary artery disease or signs of heart failure. Serum samples were analyzed by use of ELISA after informed consent. Results sST2 showed a significant elevation in all HF patients (p<0.0001) compared to the control group. No significant differences in levels of sST2 were observed between ICM and DCM patients. In contrast to sST2, no differences between HF patients and control group were observed for IL-33. Furthermore, sST2 showed a significant correlation with CRP (p<0.001, r=0.28), NT-pro-BNP (p<0.0001, r=0.40) and an inverse correlation with ejection fraction (p<0.0001, r=−0.40). Additionally, sST2 showed a significant elevation in patients in NYHA stages I-II (p=0.030) and NYHA stages III-IV (p<0.01). Again, no significant correlations were observed between IL-33 and parameters mentioned above. Analysis of sST2 in heart failure Conclusions We observed a significant increase and correlation with disease severity of sST2 in chronic HFrEF patients of both ischemic and non-ischemic origin, but contrary to our expectations, no significant changes in serum levels of IL-33. Thus, a mechanism independent of ST2/IL33 axis could be responsible of sST2 secretion in HF. Further studies including acute decompensated patients could provide a better understanding of the IL-33 role in HF.

scholarly journals Diagnostic value of the CSF levels of D-Lactate and pro-inflammatory cytokines (TNF-alpha, IL-6, IL-8 and IL-17) in the patients with suspected nosocomial meningitis

2021 ◽  
Author(s):  
SY Goktas ◽  
AY Oral ◽  
E Yılmaz ◽  
EH Akalın ◽  
F Guvenc ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Diagnostic Value ◽  
Tnf Alpha ◽  
Control Group ◽  
Combination Model ◽  
Nosocomial Meningitis ◽  
Tnf Α ◽  
Csf Levels ◽  
Lactate Levels ◽  
Pro Inflammatory Cytokines

Introduction: This study aims to determine the diagnostic value of IL-6, IL-8, IL-17, TNF-α and D-lactate levels in the cerebrospinal fluid (CSF) in nosocomial meningitis. Methods: CSF levels of cytokines and D-lactate were compared across 29 episodes who were diagnosed with nosocomial meningitis, 38 episodes with pleocytosis but without meningitis and 54 control subjects. Results: CSF levels of IL-6, IL-8, and D-lactate were higher in the group with nosocomial meningitis compared to the control group and to the group with pleocytosis without meningitis (p<0.05). For the levels of IL-6, when the threshold was considered to be > 440 pg/mL, the sensitivity and specificity were 55.17% and 94.74%, respectively. For IL-8 levels, when the threshold was considered to be >1249 pg/mL, the sensitivity and specificity were 44.83% and 84.21%, respectively. In the patients with nosocomial meningitis, when the threshold of D-lactate levels was considered to be >1.05µmol/mL, the sensitivity and specificity were found to be 75.86% and 63.16%, respectively. In the pleocytosis without meningitis CSF samples and in the CSF samples diagnosed with nosocomial meningitis, the highest AUC was calculated for triple combination model of IL-6, IL-8, and D-lactate levels (AUC= 0.801, p<0.001), and double combination model IL-6 and IL-8 (AUC= 0.790) (p<0.001). Conclusion: In our study, we have concluded that IL-6, IL-8 and D-lactate levels could be diagnostic markers for nosocomial meningitis.

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