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Zhang GM, Gu YY. Diagnostic value of Procalcitonin, C-reactive protein-to-lymphocyte ratio (CLR), C-reactive protein and neutrophil-to-lymphocyte ratio (NLR) for predicting patients with Bacteraemia in the intensive care unit. J Crit Care 2024; 81:154538. [PMID: 38354622 DOI: 10.1016/j.jcrc.2024.154538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND To explore the diagnostic value of procalcitonin (PCT), C-reactive protein-to-lymphocyte ratio (CLR), C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) for predicting patients with bacteremia in the intensive care unit (ICU). METHODS This case-control study included 359 patients with suspected bacteremia were divided into a bacteremia group (n = 152) and a control group (n = 207) from September 2018 to April 2023. Patient data were collected using a laboratory information system (LIS). ROC curves for PCT, CLR, CRP, and NLR in predicting patients with bacteremia. RESULTS For PCT, CLR, CRP and NLR to predict patients with bacteremia in the ICU, the AUCs were 0.991(95%CI: 0.974-0.998), 0.960(95%CI: 0.935-0.978), 0.955(95%CI: 0.928-0.974), and 0.898(95%CI:0.862-0.927), respectively; the optimal thresholds were 0.248 ng/mL, 47.52 mg/109, 48.32 mg/L, and 6.51, respectively; the sensitivities were 95.4(95%CI: 90.7-98.1), 88.2(95%CI: 81.9-92.8), 87.5(95%CI: 81.2-92.3), and 86.8(95%CI:80.4-91.8), respectively; and the specificities were 95.7(95%CI: 91.9-98.0), 90.8(95%CI: 86.0-94.4), 90.3(95%CI: 85.5-94.0), and 85.0(95%CI:79.4-89.6), respectively. The sensitivities of PCT, CLR, CRP and NLR for predicting bacteremia due to E. coli infection are as high as over 90%, the specificity of PCT is 100, and the sensitivity of NLR is 100. The sensitivity of CRP for predicting bacteremia due to non-Enterobacer infection is 100. CONCLUSIONS Compared with those in the control group, PCT, CLR, CRP and NLR were significantly greater in the bacteremia group. The PCT, CLR, CRP, and NLR can all predict the occurrence of bacteremia. The PCT had the highest sensitivity and specificity in predicting bacteremia in ICU patients.
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Affiliation(s)
- Guo-Ming Zhang
- Department of Laboratory Medicine, Shuyang Hospital, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang 223600, Jiangsu, China; Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China.
| | - Yuan-Yuan Gu
- Department of Laboratory Medicine, Shuyang Hospital, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang 223600, Jiangsu, China
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2
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Tielli A, Ouorou R, Pull L, Souare K, Bouchaud O, Brutus L, Gay F, Siriez JY. Might procalcitonin help predict imported falciparum malaria in children? Travel Med Infect Dis 2024; 60:102731. [PMID: 38821330 DOI: 10.1016/j.tmaid.2024.102731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/26/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Procalcitonin (PCT) has been proposed as a marker for malaria severity in adults, with a threshold of 10 ng/ml for severe falciparum disease. Whether PCT is useful in children is debated. PATIENTS & METHODS A retrospective case-control study was conducted to compare initial PCT levels in children with uncomplicated malaria and a control group, and between children with uncomplicated and severe malaria. RESULTS Results showed significantly higher PCT levels in malaria cases compared to the control group and in malaria severe cases compared to uncomplicated cases. A Receiving Operator Characteristic curve established a PCT threshold of 0.65 ng/ml with a negative predictive value of 98.8 % based on a prevalence of 10 %. Analyzing the pooled results of five studies suggested a threshold of 6.17 ng/ml for differentiating uncomplicated and severe malaria. CONCLUSION PCT might be a useful tool to help rule out malaria and predict potential disease severity in returning travelers.
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Affiliation(s)
- Alexandra Tielli
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
| | - Rachidou Ouorou
- Sorbonne Université, INSERM Institut Pierre-Louis Épidémiologie et Santé Publique, Hôpital Pitié-Salpêtrière, AP-HP, 75013, Paris, France
| | - Lauren Pull
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
| | - Karamo Souare
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
| | - Olivier Bouchaud
- Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne, AP-HP, 93000, Bobigny, France
| | - Laurent Brutus
- Département de Médecine Générale, Faculté de Médecine, Université de Nantes, 44035, Nantes Cedex, France
| | - Frédérick Gay
- Sorbonne Université, INSERM Institut Pierre-Louis Épidémiologie et Santé Publique, Hôpital Pitié-Salpêtrière, AP-HP, 75013, Paris, France.
| | - Jean-Yves Siriez
- Service D'accueil des Urgences Pédiatriques, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), 75019, Paris, France
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Qin N, Miao Y, Xie L, Ma X, Xie P. Sepsis-associated encephalopathy: Autophagy and miRNAs regulate microglial activation. Physiol Rep 2024; 12:e15964. [PMID: 38439741 PMCID: PMC10912956 DOI: 10.14814/phy2.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024] Open
Abstract
Sepsis-associated encephalopathy (SAE) describes diffuse or multifocal cerebral dysfunction caused by the systemic inflammatory response to sepsis. SAE is a common neurological complication in patients in the middle and late stages of sepsis in the intensive care unit. Microglia, resident macrophages of the central nervous system, phagocytose small numbers of neuronal cells and apoptotic cells, among other cells, to maintain the dynamic balance of the brain's internal environment. The neuroinflammatory response induced by activated microglia plays a central role in the pathogenesis of various central nervous system diseases. In this paper, we systematically describe the functions and phenotypes of microglia, summarize how microglia mediate neuroinflammation and contribute to the occurrence and development of SAE, and discuss recent progress in autophagy- and microRNA-mediated regulation of microglial activation to provide a theoretical basis for the prevention and treatment of SAE and identify related therapeutic targets.
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Affiliation(s)
- Nannan Qin
- Department of Critical Care Medicine of the Third Affiliated Hospital (The First People's Hospital of Zunyi)Zunyi Medical UniversityZunyiChina
| | - Yanmei Miao
- Department of Critical Care Medicine of the Third Affiliated Hospital (The First People's Hospital of Zunyi)Zunyi Medical UniversityZunyiChina
| | - Leiyu Xie
- Department of Critical Care Medicine of the Third Affiliated Hospital (The First People's Hospital of Zunyi)Zunyi Medical UniversityZunyiChina
| | - Xinglong Ma
- Department of Critical Care Medicine of the Third Affiliated Hospital (The First People's Hospital of Zunyi)Zunyi Medical UniversityZunyiChina
| | - Peng Xie
- Department of Critical Care Medicine of the Third Affiliated Hospital (The First People's Hospital of Zunyi)Zunyi Medical UniversityZunyiChina
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4
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Palalıoğlu B, Erdoğan S, Atay G, Tugrul HC, Özer ÖF. Diagnostic and Prognostic Value of Pentraxin 3, Interleukin-6, CRP, and Procalcitonin Levels in Patients with Sepsis and Septic Shock. Niger J Clin Pract 2024; 27:317-324. [PMID: 38528351 DOI: 10.4103/njcp.njcp_615_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/16/2023] [Indexed: 03/27/2024]
Abstract
INTRODUCTION AND PURPOSE In this prospective study, we aim to evaluate the effects of antibiotherapy on pentraxin-3 (PTX3), C-reactive protein (CRP), and interleukin-6 (IL-6) levels in patients with sepsis and septic shock. MATERIALS AND METHODS In our study, CRP, procalcitonin, IL-6, and PTX3 levels at initial and 48 hours of the antibiotherapy of patients who were admitted to the pediatric intensive care unit (PICU) with the diagnosis of sepsis and septic shock between June 2020 and March 2021 were compared. Patients were compared with the age-appropriate case-control group formed from the patients who received pre-operative routines to investigate the diagnostic value. RESULTS CRP, IL-6, and PTX3 levels of the patients were significantly higher compared to controls (P < 0.05). After the 48th hour of treatment compared to initial CRP, lactate and PCT levels were significantly lower (P < 0.05). The IL-6 and PCT levels were significantly higher in patients with mortality than in surviving patients. Surviving patients showed a significant decrease in CRP level at the 48th hour. IL-6 levels of patients with septic shock were significantly higher than those with sepsis (P = 0.010; P < 0.05). In the diagnosis of septic shock, the area under curve was 0.785 for IL-6 and the standard deviation was 0.09 (P = 0.002, cut-off value, >32 pg/mL, 88.9% sensitivity, 65.6% specifity). CONCLUSION The results of this study indicated that IL-6 level is an appropriate biomarker with high specificity in the diagnosis of sepsis and septic shock and in evaluating the response to treatment and determining the prognosis.
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Affiliation(s)
- B Palalıoğlu
- Department of Pediatrics, University of Health Sciences Zeynep Kamil Training and Research Hospital, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No:10, Istanbul, Turkey
| | - S Erdoğan
- Department of Pediatric Intensive Care, University of Health Sciences Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., Istanbul, Turkey
| | - G Atay
- Department of Pediatric Intensive Care, University of Health Sciences Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., Istanbul, Turkey
| | - H C Tugrul
- Department of Pediatric Intensive Care, University of Health Sciences Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., Istanbul, Turkey
| | - Ö F Özer
- Bezmialem Vakif University, Department of Biochemistry Adnan Menderes Bulvarı (Vatan Cad.) P.K. 34093 Fatih/Istanbul, Turkey
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5
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Wang Y, Guan M, Mi F, Geng P, Chen G. Combining multisite functionalized magnetic nanomaterials with interference-free SERS nanotags for multi-target sepsis biomarker detection. Anal Chim Acta 2023; 1272:341523. [PMID: 37355316 DOI: 10.1016/j.aca.2023.341523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/19/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
Surface-enhanced Raman scattering (SERS) is an ultra-sensitive vibration spectroscopy technology, with the advantages of multi-index and non-destructive quantitative detection, has attracted much attention in the joint detection of biomarkers. A novel SERS biosensor with multisite capture and interference-free quantification was designed for the joint detection of the sepsis biomarker interleukin-6 (IL-6) and procalcitonin (PCT). This biosensor had two interference-free core-shell SERS probes with highly efficient electromagnetic enhancement and a multisite functionalized magnetic nanomaterial with high adsorption capacity. They formed sandwich structure with the targets through boronic affinity and immunoreaction, and the multi-target quantitative analysis of biomarkers in serum was performed using a portable Raman spectrometer in the Raman-silent region. The SERS biosensor was exhibited highly sensitive with detection limits of 0.584 and 2.99 pg/mL for IL-6 and PCT, respectively. In addition, it exhibited excellent selectivity and specificity even with the interference of other proteins. As this SERS method showed excellent performance in the detection of sepsis, it has great potential for multi-index detection in clinical diagnosis of major diseases.
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Affiliation(s)
- Ying Wang
- College of Chemistry and Chemical Engineering, Xinjiang Normal University, Urumqi, 830054, China
| | - Ming Guan
- College of Chemistry and Chemical Engineering, Xinjiang Normal University, Urumqi, 830054, China.
| | - Fang Mi
- College of Chemistry and Chemical Engineering, Xinjiang Normal University, Urumqi, 830054, China
| | - Pengfei Geng
- College of Chemistry and Chemical Engineering, Xinjiang Normal University, Urumqi, 830054, China
| | - Guotong Chen
- College of Chemistry and Chemical Engineering, Xinjiang Normal University, Urumqi, 830054, China
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Abouee-Mehrizi A, Rasoulzadeh Y, Solali S, Esmaeilizadeh H, Iraji Z, Mesgari-Abbasi M. Hematotoxicity induced by simultaneous exposure to noise and toluene in New Zealand white rabbits: Synergistic and antagonistic effects. Toxicol Ind Health 2023:7482337231180404. [PMID: 37303071 DOI: 10.1177/07482337231180404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Exposure to numerous pollutants is prevalent in workplaces. Examination of combined exposure to different harmful physical factors and chemicals has offered new insights into toxicology in recent years. This study aimed to investigate the hematological alterations caused by exposure to noise and toluene. Twenty-four New Zealand white rabbits were exposed to 1000 ± 50 ppm toluene and/or 100 ± 5 dB noise for 14 consecutive days. Exposure to noise and toluene changed a number of parameters of white blood cells (WBC), red blood cells (RBC), and platelets on different days after the exposure. Simultaneous exposure to noise and toluene increased WBC, and exposure to noise and toluene alone decreased RBC. Exposure to noise and toluene alone increased basophile, monocyte, and neutrophil counts. The coefficient of variation of red blood cell distribution width (RDW-CV) and the standard deviation of red blood cell distribution width (RDW-SD) significantly increased after co-exposure to noise and toluene. Platelet levels increased in the noise-exposed and the co-exposed groups and decreased in the toluene-exposed group. Furthermore, co-exposure to noise and toluene induced dissimilar synergistic and antagonistic effects on the hematological indices. According to the results of this study, simultaneous exposure to toluene and noise can aggravate some hematotoxic effects compared to exposure to noise or toluene alone. The results also demonstrated the vital role of the modulatory mechanisms of the body in controlling the detrimental effects of stressors.
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Affiliation(s)
- Amirreza Abouee-Mehrizi
- Department of Occupational Health Engineering, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yahya Rasoulzadeh
- Department of Occupational Health Engineering, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Solali
- Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Esmaeilizadeh
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeynab Iraji
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehran Mesgari-Abbasi
- Drug Applied Research Center (DARC), Tabriz University of Medical Sciences, Tabriz, Iran
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Nitsch L, Ehrentraut SF, Grobe-Einsler M, Bode FJ, Banat M, Schneider M, Lehmann F, Zimmermann J, Weller J. The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis. Diagnostics (Basel) 2023; 13:diagnostics13071313. [PMID: 37046531 PMCID: PMC10093535 DOI: 10.3390/diagnostics13071313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Community-acquired bacterial meningitis conveys significant morbidity and mortality due to intracranial and systemic complications, and sepsis is a major contributor to the latter. While cerebrospinal fluid (CSF) analysis is essential in the diagnosis of bacterial meningitis, its predictive utility for detection of sepsis is unknown. We investigated the diagnostic performance of CSF parameters for sepsis defined by the Sepsis-3 criteria in a retrospective cohort of patients with community-acquired bacterial meningitis. Among 103 patients, 69.5% developed sepsis. CSF lactate was associated with sepsis with an odds ratio of 1.11 (p = 0.022), while CSF cell counts, glucose and protein levels were not (all p > 0.4). Employing the optimal cutoff of 8.2 mmol/L, elevated CSF lactate resulted in a sensitivity of 81.5% and specificity of 61.5% for sepsis. In exploratory analyses, CSF lactate was also associated with in-hospital mortality with an odds ratio of 1.21 (p = 0.011). Elevated CSF lactate might contribute to early diagnosis of sepsis as well as prognostication in patients with community-acquired bacterial meningitis.
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Affiliation(s)
- Louisa Nitsch
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | | | | | - Felix J. Bode
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Felix Lehmann
- Department of Anesthesiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Julian Zimmermann
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | - Johannes Weller
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
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Póvoa P, Coelho L, Dal-Pizzol F, Ferrer R, Huttner A, Conway Morris A, Nobre V, Ramirez P, Rouze A, Salluh J, Singer M, Sweeney DA, Torres A, Waterer G, Kalil AC. How to use biomarkers of infection or sepsis at the bedside: guide to clinicians. Intensive Care Med 2023; 49:142-153. [PMID: 36592205 PMCID: PMC9807102 DOI: 10.1007/s00134-022-06956-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/08/2022] [Indexed: 01/03/2023]
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In this context, biomarkers could be considered as indicators of either infection or dysregulated host response or response to treatment and/or aid clinicians to prognosticate patient risk. More than 250 biomarkers have been identified and evaluated over the last few decades, but no biomarker accurately differentiates between sepsis and sepsis-like syndrome. Published data support the use of biomarkers for pathogen identification, clinical diagnosis, and optimization of antibiotic treatment. In this narrative review, we highlight how clinicians could improve the use of pathogen-specific and of the most used host-response biomarkers, procalcitonin and C-reactive protein, to improve the clinical care of patients with sepsis. Biomarker kinetics are more useful than single values in predicting sepsis, when making the diagnosis and assessing the response to antibiotic therapy. Finally, integrated biomarker-guided algorithms may hold promise to improve both the diagnosis and prognosis of sepsis. Herein, we provide current data on the clinical utility of pathogen-specific and host-response biomarkers, offer guidance on how to optimize their use, and propose the needs for future research.
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Affiliation(s)
- Pedro Póvoa
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
- Department of Critical Care Medicine, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal
| | - Luís Coelho
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
- Department of Critical Care Medicine, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal
| | - Felipe Dal-Pizzol
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
- Clinical Research Center, São José Hospital, Criciúma, Brazil
| | - Ricard Ferrer
- Servei de Medicina Intensiva, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER), Madrid, Spain
| | - Angela Huttner
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Center for Clinical Research, Geneva University Hospitals, Geneva, Switzerland
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK
- JVF Intensive Care Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Vandack Nobre
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paula Ramirez
- Department of Critical Care Medicine, Hospital Universitario Y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red‑Enfermedades Respiratorias (CibeRes), Madrid, Spain
| | - Anahita Rouze
- CNRS, Inserm, CHU Lille, UMR 8576 - U1285 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Service de Médecine Intensive - Réanimation, Université de Lille, 59000 Lille, France
| | - Jorge Salluh
- Postgraduate Program, D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
| | | | - Daniel A. Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, La Jolla, San Diego, CA USA
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomedica En Red–Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Grant Waterer
- University of Western Australia, Royal Perth Hospital, Perth, Australia
| | - Andre C. Kalil
- Department of Internal Medicine, Division of Infectious Diseases, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
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Ozdemir K, Citaker S, Diker S, Keser I, Kurukahvecioglu O, Uyar Gocun P, Gulbahar O. Does Venipuncture Increase Lymphedema by Triggering Inflammation or Infection? An Experimental Rabbit Ear Lymphedema Model Study. Lymphat Res Biol 2023; 21:34-41. [PMID: 35687408 DOI: 10.1089/lrb.2021.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Recent guidelines recommend avoiding venipuncture to prevent lymphedema for breast cancer patients. This study investigated whether single or multiple sterile venipuncture procedures develop a systemic inflammation or infection and increase lymphedema in the rabbit ear lymphedema model. Methods and Results: Eighteen New Zealand white female rabbits were included. The right ear lymphedema model was created by surgical procedure; then, rabbits were divided into three randomized groups. Single and multiple venipuncture procedures were applied at least the 60th day after surgery for Group I and II, respectively. Group III was a control group. C-reactive protein (CRP) and procalcitonin (PCT) levels were analyzed to determine inflammation and infection. Ear thickness measurements were applied using a vernier caliper to assess the differences in lymphedema between the ears. All rabbits were euthanized on the 90th day after surgery. Histopathological analysis was performed to evaluate lymphedema by measuring tissue thicknesses. Ear thickness measurements showed that ear lymphedema was developed and maintained with surgical operation in all groups (p < 0.05). There was no difference in the ear thickness measurements between and within-groups results (p > 0.05). CRP and PCT levels were below the lower detection levels in all groups. According to the differences of histopathological ear distances, there were significant differences within-groups for all groups (p < 0.05), and no differences were identified between groups (p > 0.05). Conclusion: This experimental study demonstrated that single or multiple sterile venipuncture procedures did not trigger infection or inflammation and did not exacerbate ear lymphedema in the rabbit ear lymphedema model.
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Affiliation(s)
- Kadirhan Ozdemir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Seyit Citaker
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Seyda Diker
- Laboratory Animal Breeding and Experimental Research Center, Gazi University, Ankara, Turkey
| | - Ilke Keser
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | | | - Pinar Uyar Gocun
- Department of Medical Pathology, and Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ozlem Gulbahar
- Department of Medical Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
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Chadorneshin JR, Khaksar E, Sharif MT, Jahandideh A. The prognostic value of procalcitonin in critically ill cases of systematic inflammatory response syndrome in dogs. COMPARATIVE CLINICAL PATHOLOGY 2023; 32:91-97. [PMID: 36466191 PMCID: PMC9703405 DOI: 10.1007/s00580-022-03417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
Using markers for early diagnosis can help to reduce mortality and morbidity in systemic inflammatory response syndrome (SIRS). This study investigates the role of procalcitonin (PCT) as a prognostic value in dogs with SIRS in the intensive care unit. Fifty-five dogs were selected and studied. Blood samples were collected and investigated for PCT, white and red blood cells, iron, creatinine, platelet, glucose, albumin, urea, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), bandcell, body temperature, and hospitalized days and costs. The animals were grouped into survivors and deceased groups, and their results were compared. The results showed negative significant relations between PCT with hematocrit (r 2 = 0.294, P < 0.05) and the serum concentration of iron (r 2 = 0.280, P < 0.05) and also positive relation with IL-6 (r 2 = 0.456, P < 0.01) and TNF-α (r 2 = 0.391, P < 0.01). Significant relations were not seen between PCT with other parameters (P > 0.05). The results also showed a significant relation between glucose and albumin with body temperature (P < 0.05). The results showed that the serum concentrations of PCT, IL-6, and TNF-α were significantly higher in deceased dogs compared with survivors, while white blood cells, glucose, albumin, urea, lymphocyte, neutrophil, and body temperature were higher in survivors compared with others. PCT can be utilized as a prognostic value and helps early diagnosis in dogs with SIRS.
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Affiliation(s)
- Javad Rahnama Chadorneshin
- grid.411463.50000 0001 0706 2472Department of Clinical Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ehsan Khaksar
- grid.449232.a0000 0004 0494 0390Department of Clinical Science, Garmsar Branch, Islamic Azad University, Garmsar, Iran
| | - Maysam Tehrani Sharif
- grid.449232.a0000 0004 0494 0390Department of Clinical Science, Garmsar Branch, Islamic Azad University, Garmsar, Iran
| | - Alireza Jahandideh
- grid.411463.50000 0001 0706 2472Department of Clinical Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Kim CJ. Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs. Infect Chemother 2022; 54:674-698. [PMID: 36596680 PMCID: PMC9840952 DOI: 10.3947/ic.2022.0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
The importance of antibiotic stewardship is increasingly emphasized in accordance with the increasing incidences of multidrug-resistant organisms and accompanying increases in disease burden. This review describes the obstacles in operating an antibiotic stewardship program (ASP), and whether the use of biomarkers within currently available resources can help. Surveys conducted around the world have shown that major obstacles to ASPs are shortages of time and personnel, lack of appropriate compensation for ASP operation, and lack of guidelines or appropriate manuals. Sufficient investment, such as the provision of full-time equivalent ASP practitioners, and adoption of computerized clinical decision systems are useful measures to improve ASP within an institution. However, these methods are not easy in terms of both time commitments and cost. Some biomarkers, such as C-reactive protein, procalcitonin, and presepsin are promising tools in ASP due to their utility in diagnosis and forecasting the prognosis of sepsis. Recent studies have demonstrated the usefulness of algorithmic approaches based on procalcitonin level to determine the initiation or discontinuation of antibiotics, which would be helpful in decreasing antibiotics use, resulting in more appropriate antibiotics use.
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Affiliation(s)
- Chung-Jong Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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12
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Usefulness of Procalcitonin in the Diagnosis of Bacterial Infection in Immunocompetent Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081263. [PMID: 36010153 PMCID: PMC9406664 DOI: 10.3390/children9081263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/01/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
Abstract
Bacterial infections (BIs) need to be differentiated from non-BIs (NBIs) to enable prompt administration of antibiotics. Therefore, inflammatory biomarkers are needed as they can accurately identify BIs. This study evaluated the usefulness of procalcitonin (PCT) in the diagnosis of BI in immunocompetent children. We retrospectively reviewed the medical records of patients <18 years who underwent PCT measurements between July 2012 and June 2019. In total, 474 patients were enrolled and divided into the BI (n = 205) and NBI groups (n = 269). The BI group was subcategorized into the invasive BI (IBI; n = 94), mucosal BI (MBI; n = 31), toxigenic BI (TBI; n = 23), and localized BI (LBI; n = 57) subgroups. The NBI group was further subcategorized into the viral infection (VI; n = 118) and inflammatory disease groups (ID; n = 151). PCT was compared with the levels of C-reactive protein (CRP), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). Between the BI and NBI groups, PCT (4.2 ± 16.9 vs. 1.1 ± 2.5 ng/mL; p = 0.008) and ESR (39.1 ± 32.4 vs. 54.8 ± 28.2 mm/h; p < 0.001) were significantly different. Between the IBI and other groups, WBC (14,797 ± 7148 vs. 12,622 ± 5770 × 106/L; p = 0.007), ESR (35.3 ± 30.3 vs. 51.5 ± 30.3 mm/h; p < 0.001), and PCT (8.1 ± 23.8 vs. 1.0 ± 3.4 ng/mL; p = 0.005) were significantly different. However, none of the biomarkers were useful in differentiating BI from NBI. While WBC (area under curve (AUC) = 0.615, p = 0.003) and PCT (AUC = 0.640, p < 0.001) were useful, they fared poorly in differentiating IBI from other groups. Thus, additional studies are needed to identify more accurate biomarkers capable of differentiating BIs, especially IBIs.
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Ojuawo O, Ojuawo A, Aladesanmi A, Adio M, Iroh Tam PY. Childhood pneumonia diagnostics: a narrative review. Expert Rev Respir Med 2022; 16:775-785. [DOI: 10.1080/17476348.2022.2099842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Olutobi Ojuawo
- Global Health Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ayotade Ojuawo
- General Practice Specialty, St Helens and Knowsley Teaching Hospitals NHS Trust (Lead Employer), United Kingdom
| | | | - Mosunmoluwa Adio
- Acute Medical Unit, North Cumbria Integrated Care NHS Foundation Trust, United Kingdom
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi – Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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14
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Li J, Zhu Y, Shoemake B, Liu B, Adkins P, Wallace L. A systematic review of the utility of biomarkers as aids in the early diagnosis and outcome prediction of bovine respiratory disease complex in feedlot cattle. J Vet Diagn Invest 2022; 34:577-586. [PMID: 35321598 PMCID: PMC9266496 DOI: 10.1177/10406387221081232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bovine respiratory disease complex (BRDC) is a common, serious problem in feedlot cattle worldwide. Early diagnosis and outcome prediction are critical for making decisions to prevent economic loss and to limit antimicrobial use. Diagnosing BRDC is commonly based on visual signs and behavioral changes; both assessments are considered to have low diagnostic accuracy. Biomarkers are important for supporting the diagnosis of BRDC, determining the necessity and potential outcomes of treatment, and assisting in research in which differentiating diseased animals is required. There are few reviews summarizing the biomarkers available and utilized. We systematically evaluated the detection and prognostic potential of biomarkers from the literature published between January 1990 and December 2020. We performed a descriptive analysis of 5 biomarker categories: acute-phase proteins, stress-related hormones, other blood biomarkers, omics biomarkers, and non-blood biomarkers. The retrieved articles consisted of studies or trials that assessed the detection value and treatment and/or outcome prediction efficacy of biomarkers for BRDC in feedlot cattle; 23 manuscripts for review and analysis satisfied the selection criteria. Based on our review, we cannot recommend a specific biomarker as the sole method for the early detection or outcome prediction for BRDC, given that the application and efficacy of biomarkers varies in different situations. Our systematic review may serve as a reference for clinical and research investigations of early detection and outcome prediction of BRDC.
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Affiliation(s)
| | | | - Brian Shoemake
- Brian Shoemake, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA.
| | - Bo Liu
- Department of Clinical Sciences, College of Veterinary Medicine, China Agricultural University, Beijing, People’s Republic of China
| | - Pamela Adkins
- College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Laurie Wallace
- College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
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15
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Ratageri VH, Panigatti P, Mukherjee A, Das RR, Goyal JP, Bhat JI, Vyas B, Lodha R, Singhal D, Kumar P, Singh K, Mahapatro S, Charoo BA, Kabra SK, Jat KR. Role of procalcitonin in diagnosis of community acquired pneumonia in Children. BMC Pediatr 2022; 22:217. [PMID: 35443627 PMCID: PMC9020076 DOI: 10.1186/s12887-022-03286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The role of serum Procalcitonin (PCT) in adults in diagnosis of Community acquired pneumonia (CAP) is well established, however, role in pediatric CAP remains controversial. Objectives The objective of this study was to investigate the utility of serum procalcitonin in differentiating bacterial community-acquired lower respiratory tract infection from non-bacterial respiratory infection in children; radiologically confirmed pneumonia was used as the reference. In addition, we assessed the utility of adding the PCT assay to the clinical criteria for diagnosis of pneumonia. Study design Subanalysis of a larger prospective,multicentriccohort study. Participants Children, 2 months to 59 months of age, attending paediatric OPD of 5 urban tertiary care hospitals, suffering from acute respiratory infection (ARI). Intervention Detailed clinical history and examination findings of enrolled children were recorded on predesigned case record form. Samples for PCT were obtained at admission and were measured centrally at the end of the study except for one site using VIDAS® B.R.A.H.M.S PCT kit (Biomerieux SA, France). Outcomes Sensitivity and specificity of procalcitonin for diagnosis of radiologically confirmed pneumonia. Results Serum Procalcitonin was measured in 370 patients; median (IQR) age of these children being 12 (7, 22) months, 235 (63.5%) were boys. The median (IQR) serum procalcitonin concentration was 0.1(0.05, 0.4) ng/mL.Sensitivity and specificity of raised PCT (> 0.5 ng/mL) for pneumonia as per any CXR abnormalities were 29.7% and87.5%,(P < 0.001) respectively. Raised PCT was also significantly associated with consolidation (34.5%,79.2%,P < 0.02)and pleural effusion(54.6%,79%,P < 001). Adding PCT to the existing clinical criteria of WHO did not improve the sensitivity for diagnosis of pneumonia. PCT was significantly higher in children with severe pneumonia. Conclusion Positive PCT (> 0.5 ng/mL) is significantly associated with radiographic pneumonia but not with pneumonia based on WHO criteria.However, it can act as a surrogate marker for severe pneumonia.
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Affiliation(s)
- Vinod H Ratageri
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubballi, 580021, Karnataka, India.
| | - Puspha Panigatti
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubballi, 580021, Karnataka, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi R Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Javeed Iqbal Bhat
- Department of Pediatrics, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bhadresh Vyas
- Department of Pediatrics, MP Shah Medical College, Jamnagar, Gujrat, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Singhal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Samarendra Mahapatro
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bashir Ahmad Charoo
- Department of Pediatrics, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - K R Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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16
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Systemic Inflammatory Predictors of In-Hospital Mortality in COVID-19 Patients: A Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12040859. [PMID: 35453906 PMCID: PMC9028043 DOI: 10.3390/diagnostics12040859] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to investigate whether routine blood tests and clinical characteristics can predict in-hospital mortality in COVID-19. Clinical data of 285 patients aged 59.7 ± 10.3 yrs. (males n = 189, females n = 96) were retrospectively collected from December 2020 to June 2021. Routine blood tests were recorded within the 1st hour of admission to hospital. The inflammatory variables, such as C-reactive protein (CRP), procalcitonin (PCT), neutrophils−lymphocyte ratio (NLR) and the systemic inflammatory index (SII), exceeded the reference values in all patients and were significantly higher in deceased patients (n = 108) compared to survivors (n = 177). The log-rank test for comparing two survival curves showed that patients aged ≥60.5 years, with PCT ≥ 0.188 ng/mL or NLR ≥ 11.57 103/µL were at a greater risk of death. NLR demonstrated a high impact on the COVID-19 mortality (HR 1.317; 95%CI 1.004−1.728; p < 0.05), whereas CRP and SII showed no effect (HR 1.000; 95%CI 1.000−1.004; p = 0.085 and HR 1.078; 95%CI 0.865−1.344; p = 0.503, respectively). In the first Polish study including COVID-19 patients, we demonstrated that age in relation to simple parameters derived from complete blood cell count has prognostic implications in the course of COVID-19 and can identify the patients at a higher risk of in-hospital mortality.
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Tomasiuk R, Dabrowski J, Smykiewicz J, Wiacek M. Predictors of COVID-19 Hospital Treatment Outcome. Int J Gen Med 2022; 14:10247-10256. [PMID: 35221712 PMCID: PMC8866999 DOI: 10.2147/ijgm.s334544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background There are more than 228,394,572 confirmed cases and 4,690,186 confirmed deaths caused by COVID-19 worldwide. The magnitude of the COOVID-19 pandemic has stimulated research on the treatment and diagnosis of COVID-19 patients. Objective In this report, a battery of specific parameters was used to develop a model that allows prediction of the outcome of the COVID-19 treatment. These parameters are C-reactive protein, procalcitonin, fibrinogen, D-dimers, immature granulocytes, and interleukin-6. Methods The study was carried out on a sample of N = 49 survivors (22 men, 27 women) and 83 deceased patients (62 men, 21 women). The distribution of means and differences in means of the parameters studied between survivors and deceased patients were evaluated using the bootstrap method. Results A mathematical model that allows for the prediction of hospitalization outcome was obtained using the Naive Bayes model. The results demonstrated a statistically significant difference between survivors and deceased patients in all parameters studied. A mathematical model employing a battery of parameters provided a 97% precision in predicting the outcome of hospitalization. Conclusion This study showed that the cross-correlation of survivability with absolute levels of C-reactive protein, procalcitonin, fibrinogen, D-dimers, immature granulocytes, and interleukin-6 could be used successfully in the hospital setting as a diagnostic tool.
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Affiliation(s)
- Ryszard Tomasiuk
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Technology and Humanities, Radom, Poland
| | - Jan Dabrowski
- Department of Pharmacology, National Medicines Institute, Warsaw, Poland
| | - Jolanta Smykiewicz
- Central Medical Diagnostic Laboratory, Dr. Tytus Chałubiński Specialist Hospital in Radom, Radom, Poland
| | - Magdalena Wiacek
- Department of Physiotherapy, Faculty of Medical and Health Sciences, The University of Technology and Humanities, Radom, Poland
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18
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Nardone V, Giannicola R, Bianco G, Giannarelli D, Tini P, Pastina P, Falzea AC, Macheda S, Caraglia M, Luce A, Zappavigna S, Mutti L, Pirtoli L, Giordano A, Correale P. Inflammatory Markers and Procalcitonin Predict the Outcome of Metastatic Non-Small-Cell-Lung-Cancer Patients Receiving PD-1/PD-L1 Immune-Checkpoint Blockade. Front Oncol 2021; 11:684110. [PMID: 34195086 PMCID: PMC8236817 DOI: 10.3389/fonc.2021.684110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Peripheral-immune-checkpoint blockade (P-ICB) with mAbs to PD-1 (nivolumab and pembrolizumab) or PD-L1 (atezolizumab, durvalumab, avelumab) alone or combination with chemotherapy represents a novel active treatment for mNSCLC patients. However, this therapy can be associated to immune-related adverse events (irAEs) and high cost. Therefore, finding reliable biomarkers of response and irAEs is strongly encouraged to accurately select patients who may potentially benefit from the immuno-oncological treatment. This is a retrospective multi-institutional analysis performed on ninety-five mNSCLC patients who received real-world salvage therapy with nivolumab or atezolizumab between December 2015 and April 2020. The outcome of these patients in term of PFS and OS was evaluated in comparison with different serum levels of C-reactive protein (CRP), Erythrocyte Sedimention Rate (ESR) and Procalcitonin (PCT) by performing Kaplan-Meier and Log-rank test and multivariate analysis. We found that high baseline levels of CRP, ESR, and PCT were strongly predictive of poor outcome (P <0.05) with the worse prognosis detected in those patients with a baseline levels of both ESR and PCT over the pre-established cut off (median OS recorded in patients with no marker over the cut off vs. those with just one marker over the cut off vs. those with both markers over the cut off: 40 ± 59 vs. 15.5 ± 5.5 vs. 5.5 ± 1.6 months, respectively; P <0.0001). Our results suggest the predictive value of systemic inflammation and suggest a potential role of PCT in predicting a poor outcome in mNSCLC receiving PD-1/PD-L1 blocking mAbs. This finding also suggests a potential role of subclinical bacterial infections in defining the response to PD-1/PD-L1 blocking mAbs that deserves further and more specific investigations.
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Affiliation(s)
- Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Rocco Giannicola
- Medical Oncology Unit, Grand Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giovanna Bianco
- Medical Oncology Unit, Grand Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Diana Giannarelli
- Biostatistical Unit, National Cancer Institute "Regina Elena", IRCCS, Rome, Italy
| | - Paolo Tini
- Section of Radiation Oncology, Medical School, University of Siena, Siena, Italy
| | - Pierpaolo Pastina
- Section of Radiation Oncology, Medical School, University of Siena, Siena, Italy
| | - Antonia Consuelo Falzea
- Medical Oncology Unit, Grand Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Sebastiano Macheda
- Unit of Intensive Care Medicine and Anesthesia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Laboratory of Precision and Molecular Oncology, Institute of Genetic Research, Biogem Scarl, Ariano Irpino, Italy
| | - Amalia Luce
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Silvia Zappavigna
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Luciano Mutti
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Luigi Pirtoli
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United States.,Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Pierpaolo Correale
- Medical Oncology Unit, Grand Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, United States
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El-Deeb W, Fayez M, Alhumam N, Elsohaby I, Quadri SA, Mkrtchyan H. The effect of staphylococcal mastitis including resistant strains on serum procalcitonin, neopterin, acute phase response and stress biomarkers in Holstein dairy cows. PeerJ 2021; 9:e11511. [PMID: 34131523 PMCID: PMC8174151 DOI: 10.7717/peerj.11511] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
Staphylococcal mastitis (SM) is a frequent disease in the dairy cattle that is costly to treat. This study aimed to investigate the alterations in the levels of procalcitonin (PCT), neopterin (NPT), haptoglobin (HP), serum amyloid A (SAA), proinflammatory cytokines (IL-1β, IL-8, TNF-α, IF-γ) and oxidative stress (OS) biomarkers in Holstein dairy cows with SM under field conditions. In addition, we also evaluated the role of examined biomarkers in disease pathogenesis and their use as diagnostic biomarkers for the disease in dairy cows. Fifty-three dairy cows with SM, including those with infections caused by Staphylococcus aureus (n = 42) and methicillin resistant S. aureus (MRSA) (n = 11) were selected for this study. In addition, 20 healthy dairy cows were enrolled as a control group. Higher serum levels of PCT, NP, IL-1β, IL-8, TNF-α, IF-γ, HP and SAA and a state of OS was detected in SM group in comparison with the controls. Moreover, the levels of all examined biomarkers in mastitic cows with S. aureus when compared with those infected with MRSA was not significantly different. All examined biomarkers demonstrated a significant degree of discrimination between SM cows and healthy controls (the area under the curve (AUC) ranged from 83.6 for SAA to 100 for PCT). Our study showed that SM in dairy cows was associated with substantial changes in serum PCT, NPT, Acute phase proteins (APPs), proinflammatory cytokines, and OS levels. This study demonstrates that clinical examination in tandem with quantification of PCT, NPT, APPs and cytokines, OS biomarkers could be a useful assessment tool for SM in dairy cows.
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Affiliation(s)
- Wael El-Deeb
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Hofuf, Saudi Arabia
- Department of Internal Medicine, Infectious Diseases and Fish Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud Fayez
- Al Ahsa Veterinary Diagnostic Laboratory, Ministry of Environment, Water and Agriculture, Al-Hofuf, Al-Ahsa, Saudi Arabia
- Veterinary Serum and Vaccine Research Institute, Ministry of Agriculture, Cairo, Egypt
| | - Naser Alhumam
- Department of Microbiology and parasitology, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Al-Hofuf, Saudi Arabia
| | - Ibrahim Elsohaby
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Canada
| | - Sayed A. Quadri
- Department of Biomedical Sciences, College of Medicine, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Hermine Mkrtchyan
- School of Biomedical Sciences, University of West London, London, United Kingdom
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20
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Gianotti L, D’Agnano S, Pettiti G, Tassone F, Giraudo G, Lauro C, Lauria G, Del Bono V, Borretta G. Persistence of Elevated Procalcitonin in a Patient with Coronavirus Disease 2019 Uncovered a Diagnosis of Medullary Thyroid Carcinoma. AACE Clin Case Rep 2021; 7:288-292. [PMID: 33997278 PMCID: PMC8113110 DOI: 10.1016/j.aace.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022] Open
Abstract
Objective During the ongoing coronavirus disease 2019 pandemic, procalcitonin (PCT) levels have proven useful in assisting clinicians to diagnose bacterial superinfection. However, in the absence of signs of infection or at the resolution thereof, inappropriately and persistently high PCT levels may suggest and reveal the presence of other pathologies. We report a patient with severe acute respiratory syndrome coronavirus 2 pneumonia with initially elevated PCT levels that persisted during recovery, prompting the diagnosis of medullary thyroid carcinoma (MTC). Methods A 43-year-old man presented with a 2-day history of fever, sneezing, sore throat, and dry cough. His PCT was 94 ng/mL (normal value, 0.00-0.10 ng/mL), and he was positive for severe acute respiratory syndrome coronavirus 2 RNA. Results Empirical antibiotic therapy was administered for 7 days, but despite a clinical improvement, serum PCT remained high (84 ng/mL). Serum calcitonin (CTN) was 2120 pg/mL (normal, ≤12 pg/mL). Cytologic examination of thyroid nodules and CTN measurement of the aspiration needle washout confirmed MTC. The patient underwent total thyroidectomy with bilateral cervical lymph node dissection. Lowered CTN (986 pg/mL) and PCT (16 ng/mL) levels were observed 48 hours after surgery. A close follow-up was planned following the results of RET gene analysis. Conclusion PCT can be a useful biochemical marker of MTC suspicion in patients with inflammatory conditions and persistently elevated PCT, even after resolution. In our case, high levels of PCT in a patient with coronavirus disease 2019 pneumonia without signs of bacterial infection led to MTC diagnosis.
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Affiliation(s)
- Laura Gianotti
- Division of Endocrinology and Metabolism, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Salvatore D’Agnano
- Division of Internal Medicine, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giorgio Pettiti
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Francesco Tassone
- Division of Endocrinology and Metabolism, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giorgio Giraudo
- Division of General and Oncological Surgery, Department of Surgery. Hospital Santa Croce e Carle, Cuneo, Italy
| | - Corrado Lauro
- Division of General and Oncological Surgery, Department of Surgery. Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giuseppe Lauria
- Division of Emergency Medicine, Department of Emergency, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Giorgio Borretta
- Division of Endocrinology and Metabolism, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
- Address correspondence and reprint requests to Dr Giorgio Borretta, Division of Endocrinology and Metabolism, Department of Medicine, Carle Hospital, Via Antonio Carle 5, Confreria, Cuneo 12100, Italy.
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The Effect of Pre-TURP Bladder Irrigation with 0.2% Chlorhexidine in Patients with Foley Catheter Regarding Postoperative Bacteremia Decrease. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.101296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Transurethral resection of the prostate (TURP) has been widely used for patients suffering from bladder colonization with bacteria, increasing the probability of bacteremia and sepsis despite consuming prophylaxis antibiotics. Objectives: The study aimed to evaluate the effect of pre- TURP bladder irrigation with 0.2% chlorhexidine in reducing postoperative bacteremia. Methods: This clinical trial study was conducted on 60 benign prostatic hyperplasia (BPH) patients who were candidates for TURP in the urology department of Al-Zahra Hospital. All patients suffered from urinary catheters, and they were allocated into two groups (n = 30). Antibiotic prophylaxis was prescribed for all the patients. In the case group, the bladder was rinsed by chlorhexidine 0.2% before TURP; however, and the bladder in the control group was rinsed by distilled water. Postoperative bacteremia were evaluated using procalcitonin (PCT) measurement and BACTEC automated blood culture six hours after surgery. Results: Positive BACTEC blood culture was observed in three (10%) and no (0%) patients in the control and case groups, respectively (P = 0.071). Moreover, 6.6 % and 46.6 % of the patients in the control group had low and high PCT levels, respectively. Furthermore, 40 % and 6.66 % of the patients in the case group had low and high PCT levels, respectively. There was a significant difference between the two groups in terms of the PCT level (P < 0.01). Conclusions: The frequency of patients with a high PCT level was higher in the control group than in the case group, suggesting that chlorhexidine in the catheterized patients undergoing TURP reduced the number of bacteria in the bladder.
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Ali WA, Bazan NS, Elberry AA, Hussein RRS. A randomized trial to compare procalcitonin and C-reactive protein in assessing severity of sepsis and in guiding antibacterial therapy in Egyptian critically ill patients. Ir J Med Sci 2021; 190:1487-1495. [PMID: 33447966 DOI: 10.1007/s11845-020-02494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/19/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Procalcitonin (PCT) and C-reactive protein (CRP) are the main used biomarkers for sepsis and in guiding antibiotic therapy, although PCT high cost limits its use in developing countries. OBJECTIVE Comparing between PCT and CRP in assessing severity of sepsis and in guiding antibacterial therapy in critically ill patients. METHODS In a prospective randomized study, 60 patients were included from an Egyptian Intensive Care Unit. Patients were divided into CRP and PCT groups. CRP and PCT were measured at baseline and on days 4 and 7. Validity, sensitivity, and specificity of both biomarkers and their correlation with sepsis scores (Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sepsis-related Organ Failure Assessment (SOFA)) were evaluated. Antibacterial continuation at days 4 and 7 was assessed. RESULTS The diagnostic accuracy, specificity, and sensitivity of PCT were higher than CRP (80.79% vs 69.45%, 36% vs 28.7%, 87.6% vs 72.4%, respectively). PCT levels were significantly correlated with APACHE II score (P ≤ 0.0001) and SOFA score (P = 0.005), while CRP levels were not correlated with APACHEII and SOFA scores,(P > 0.05). PCT was associated with less antibacterial exposure (33% stopped their antibiotics on day 4 versus 6% in CRP, P = 0.009). Only 33% continued their antibacterial regimen in PCT group after 7 days versus 83% in CRP group (*P ≤ 0.0001). CONCLUSION PCT is a more accurate diagnostic and prognostic biomarker than CRP in patients with sepsis. PCT significantly shortened patients' exposure to antibacterial therapy and hospital length of stay.
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Affiliation(s)
- Walid A Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, MTI University, Cairo, Egypt
| | - Naglaa S Bazan
- Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt. .,Pharmacy Practice and Clinical Pharmacy Department, Future University in Egypt, Cairo, Egypt.
| | - Ahmed A Elberry
- Clinical Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Raghda R S Hussein
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
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Abstract
Biomarkers have been used in sepsis to assist with the diagnosis of disease as well as determining the severity of disease, that is, prognosis. These biomarkers are based on the presence of discrete molecules within the blood. Unfortunately, in 2020, a single biomarker does not have sufficient sensitivity and specificity to definitively rule in or rule out sepsis. Biomarkers have shown better performance in animal models of disease.
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Affiliation(s)
- Yachana Kataria
- Department of Pathology and Laboratory Medicine, Boston School of Medicine, Boston, MA, USA.
| | - Daniel Remick
- Department of Pathology and Laboratory Medicine, Boston School of Medicine, Boston, MA, USA.
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Song Y, Sun W, Dai D, Liu Y, Li Z, Tian Z, Liu X. Prediction value of procalcitonin combining CURB-65 for 90-day mortality in community-acquired pneumonia. Expert Rev Respir Med 2020; 15:689-696. [PMID: 33336607 DOI: 10.1080/17476348.2021.1865810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Due to its high mortality rate, immediate and reliable severity assessment and accurate prediction of prognosis at hospital admission is critical for the management of community-acquired pneumonia (CAP) patients.Methods: Consecutive patients with primary diagnosis of CAP and hospitalized at our hospital from January 2013 to December 2015 were screened for this retrospective study. Demographic information, clinical and laboratory examination, severity model scoring, and 90-day outcomes were studied. Area under the curve (AUC) of receiver operating characteristic curve (ROC) was analyzed to compare the predictive value of different prognostic scoring methods.Results: 2099 CAP patients with a median age of 60 (IQR 44.0-73.0) years-old were included in this study. Median length of stay was 10 days (IQR 8.0-13.0). The all-cause 90-day mortality was found in 2.19% (46/2099) of all patients. PCT was identified as an independent predictor for the prognosis of CAP patients. CURB-65 in combination with PCT outperformed other predictive methods in 90-day mortality with the optimal AUC of 0.900 and Youden's Index of 0.706.Conclusions: PCT is a good marker for the assessment of severity and 90-day mortality of CAP patients. The combination of PCT and CURB-65 was more accurate than other prognostic models in predicting 90-day mortality.
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Affiliation(s)
- Yu Song
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenxue Sun
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Deyu Dai
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Liu
- The Respiratory Department, Cang Zhou People's Hospital, China
| | - Zhongyi Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhennan Tian
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaomin Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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25
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El-Deeb W, Fayez M, Elsohaby I, Salem M, Alhaider A, Kandeel M. Investigation of acute-phase proteins and cytokines response in goats with contagious caprine pleuropneumonia with special reference to their diagnostic accuracy. PeerJ 2020; 8:e10394. [PMID: 33240679 PMCID: PMC7678458 DOI: 10.7717/peerj.10394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022] Open
Abstract
Acute-phase proteins (APPs) have always had valued diagnostic potentialities in response to infection. This study aimed to evaluate the diagnostic accuracy of selected APPs and proinflammatory cytokines (PIC) in goats with contagious caprine pleuropneumonia (CCPP) under field conditions. Moreover, to highlight the role of tested biomarkers in CCPP pathogenesis. Fifty-eight goats (38 confirmed cases with CCPP and 20 healthy controls) were involved in this investigation. C-reactive protein (CRP), procalcitonin (PCT), haptoglobin (HP), fibrinogen (Fb), serum amyloid A (SAA), selected PIC (IL1-α, IL1-β, IL-6, interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α)) levels were investigated in serum samples from all goats under investigation. Latex agglutination test was used for diagnosis of goats with CCPP. For microbiological investigations, nasopharyngeal swabs (from all goats), lung tissues and pleural fluids (from only necropsied goats) were collected. This study revealed that all tested parameters have a high to moderate degree of diagnostic performance for CCPP. Magnitudes of increase in levels of APPs (CRP, HP and SAA) were stronger than PIC, IFN-γ, Fb and PCT. All tested parameters showed high diagnostic accuracy (AUROC >90%), except HP (AUROC = 87.3%) and IFN-γ (AUROC = 78.8%) showed moderate accuracy in differentiation of goats with and without CCPP infection. For detecting goats with and without CCPP infection, HP had the lowest sensitivity (Se = 81.6%) and Fb had the lowest specificity (Sp = 85.0%) among the APPs parameters tested. However, PCT showed the highest Se (100%) and Sp (95.0%) to detect goats with and without CCPP infection among tested parameters. Conclusively, this study endorses the significance of selected APPs and PIC as additional screening diagnostic parameters for naturally occurring CCPP in goats. However, it does not replace traditional methods for diagnosis of CCPP in goats. Furthermore, APPs and PIC have an important role in disease pathogenesis in goats.
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Affiliation(s)
- Wael El-Deeb
- Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.,Department of Internal Medicine, Infectious Diseases and Fish Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Aldakahlia, Egypt
| | - Mahmoud Fayez
- Department of Bacteriology, Veterinary Serum and Vaccine Research Institute, Ministry of Agriculture, Cairo, Egypt.,Bacteriology, Al Ahsa Veterinary Diagnostic Laboratory, Alhofof, Al-ahsa, Saudi Arabia
| | - Ibrahim Elsohaby
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Sharkia, Egypt.,Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Mohamed Salem
- Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.,Department of Medicine and Infectious Diseases, Faulty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Abdulrhman Alhaider
- Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mahmoud Kandeel
- Department of Biomedical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia
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26
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Vujaklija Brajković A, Košuta I, Tomek D, Rora M, Babel J, Rogić D, Lončar Vrančić A, Radonić R. Utility of procalcitonin in a medical intensive care unit in Croatia. Wien Klin Wochenschr 2020; 133:832-839. [PMID: 33025258 PMCID: PMC7538271 DOI: 10.1007/s00508-020-01747-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the clinical benefit of routine procalcitonin (PCT) measurement in the medical intensive care unit (ICU) of a tertiary referral hospital. METHODS Adult patients with suspected infections were included. White blood cells, C‑reactive protein (CRP), and PCT were measured. RESULTS In this study 129 patients of median age 64 years (interquartile range 39-89 years) were prospectively included. The Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were 21 ± 14 and 7 ± 6, respectively. Intensive care unit (ICU) mortality was 22.5%. Immunocompromised patients constituted 39.5%. A significant correlation was observed between PCT and APACHE II (Spearman's rho 0.461, p < 0.01), PCT and SOFA (Spearman's rho 0.494, p < 0.01) and PCT and CRP (Spearman's rho 0.403, p < 0.01). Most patients (n = 83, 64.3%) received antibiotics before admission. No difference in PCT (1.56 ± 8 µg/L vs. 1.44 ± 13 µg/L, p = 0.6) was observed with respect to previous antibiotic therapy. Levels of PCT and CRP were significantly increased in patients with positive blood cultures, the infection caused by Gram-negative microorganism regardless of disease severity and pneumonia with complications. PCT did not differ among patients with positive vs negative urine culture (4.6 ± 16 µg/L vs. 1.76 ± 11.9 µg/L) or positive vs. negative endotracheal aspirate (1.93 ± 11.4 µg/L vs. 1.76 ± 1.11 µg/L). PCT-guided stewardship was applied in 36 patients (28%). CONCLUSION Increased initial PCT levels might point to the development of more severe disease caused by Gram-negative bacteria, regardless of previous antibiotic treatment. The results pertain to immunocompetent and immunocompromised patients. Implementation of PCT-guided stewardship in those patients is possible and relies on experience as well as knowledge of reference change value for a marker within the specific setting.
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Affiliation(s)
- Ana Vujaklija Brajković
- Department of Internal Diseases, Department of Intensive Care Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Iva Košuta
- Department of Internal Diseases, Department of Intensive Care Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Dora Tomek
- Department of Oncology and Radiotherapy, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Mia Rora
- Department of Internal Diseases, Department of Intensive Care Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Jakša Babel
- Department of Internal Diseases, Department of Intensive Care Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Ana Lončar Vrančić
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Radovan Radonić
- Department of Internal Diseases, Department of Intensive Care Medicine, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
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Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, Acosta S, Naqvi R, Burmeister-Morton F, Burmeister F, Tarriela A, Petershack M, Evans M, Hoang A, Rajasekaran K, Ahuja S, Moreira A. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine 2020; 26:100527. [PMID: 32923992 PMCID: PMC7473262 DOI: 10.1016/j.eclinm.2020.100527] [Citation(s) in RCA: 323] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome, is a new dangerous childhood disease that is temporally associated with coronavirus disease 2019 (COVID-19). We aimed to describe the typical presentation and outcomes of children diagnosed with this hyperinflammatory condition. METHODS We conducted a systematic review to communicate the clinical signs and symptoms, laboratory findings, imaging results, and outcomes of individuals with MIS-C. We searched four medical databases to encompass studies characterizing MIS-C from January 1st, 2020 to July 25th, 2020. Two independent authors screened articles, extracted data, and assessed risk of bias. This review was registered with PROSPERO CRD42020191515. FINDINGS Our search yielded 39 observational studies (n = 662 patients). While 71·0% of children (n = 470) were admitted to the intensive care unit, only 11 deaths (1·7%) were reported. Average length of hospital stay was 7·9 ± 0·6 days. Fever (100%, n = 662), abdominal pain or diarrhea (73·7%, n = 488), and vomiting (68·3%, n = 452) were the most common clinical presentation. Serum inflammatory, coagulative, and cardiac markers were considerably abnormal. Mechanical ventilation and extracorporeal membrane oxygenation were necessary in 22·2% (n = 147) and 4·4% (n = 29) of patients, respectively. An abnormal echocardiograph was observed in 314 of 581 individuals (54·0%) with depressed ejection fraction (45·1%, n = 262 of 581) comprising the most common aberrancy. INTERPRETATION Multisystem inflammatory syndrome is a new pediatric disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is dangerous and potentially lethal. With prompt recognition and medical attention, most children will survive but the long-term outcomes from this condition are presently unknown. FUNDING Parker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study.
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Affiliation(s)
- Mubbasheer Ahmed
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Shailesh Advani
- Department of Oncology, Georgetown University, Washington, DC, USA
- Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA
| | - Axel Moreira
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Sarah Zoretic
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - John Martinez
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Kevin Chorath
- Department of Otorhinolaryngology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Sebastian Acosta
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Rija Naqvi
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
- Department of Oncology, Georgetown University, Washington, DC, USA
- Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
- Department of Otorhinolaryngology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Finn Burmeister-Morton
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Fiona Burmeister
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Aina Tarriela
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Matthew Petershack
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Mary Evans
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Ansel Hoang
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, The University of Pennsylvania, Philadelphia, PA, USA
| | - Sunil Ahuja
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229-3900, USA
- Corresponding author.
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28
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El-Deeb W, Fayez M, Elsohaby I, Mkrtchyan HV, Alhaider A. Changes in blood biomarkers in Arabian horses with Clostridium difficile-induced enterocolitis. Comp Immunol Microbiol Infect Dis 2020; 73:101525. [PMID: 32877870 DOI: 10.1016/j.cimid.2020.101525] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
Clostridium difficile (CD) is considered a major health care problem both in developing and developed countries; frequently reported to be associated with enterocolitis and diarrhea in horses and other animals. In this study, we examined acute phase response (APR), cytokines response, neopterin (NP) procalcitonin (PCT) production and oxidative stress condition in horses and foals with C. difficile-induced enterocolitis (CDIE) and evaluated the effectiveness of these parameters as biomarkers for the disease. A total of 407 Arabian horses in 35 stables were examined between January 2017 to December 2018. Only 24 out of 407 horses showed two or more signs of CDIE. The blood level of serum amyloid A (SAA), haptoglobin (HP), proinflammatory cytokines (TNF-α, IL-6 and IL1-β), serum malondialdehyde (MDA), PCT and NPT in horses with CDIE were higher than in healthy horses. Nevertheless, the levels of nitric oxide (NO), superoxide dismutase (SOD) and total antioxidant concentration (TAC) were considerably lower in diseased horses compared to those that were healthy. The ROC curves for eleven selected blood parameters, both in healthy horses and horses with CDIE demonstrated that all examined blood markers had significant levels of differentiation between CDIE cases and healthy controls (AUC > 87.5). The data in this study suggest that the evaluation of acute-phase proteins, cytokines, PCT, NPT, and oxidative stress biomarkers may well be used as a tool for diagnosis and assessment of CDIE and in disease pathogenesis in Arabian horses.
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Affiliation(s)
- Wael El-Deeb
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa 31982, Al-Hofuf P.O. 400, Saudi Arabia; Department of Veterinary Medicine, Infectious Diseases and Fish Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt.
| | - Mahmoud Fayez
- Al Ahsa Veterinary Diagnostic Laboratory, Ministry of Environment, Water and Agriculture, Saudi Arabia; Veterinary Serum and Vaccine Research Institute, Ministry of Agriculture, Cairo, Egypt
| | - Ibrahim Elsohaby
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt; Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Hermine V Mkrtchyan
- School of Biomedical Sciences, University of West London, St Mary's Rd, London, W5 5RF, UK
| | - Abdulrahman Alhaider
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa 31982, Al-Hofuf P.O. 400, Saudi Arabia
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Wang G, Wan Y, Lin G, Li Z, Dong Z, Liu T. Development of a novel chemiluminescence immunoassay for the detection of procalcitonin. J Immunol Methods 2020; 484-485:112829. [PMID: 32673618 DOI: 10.1016/j.jim.2020.112829] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate the analytical performance of our previously developed chemiluminescence immunoassay (CLIA) kit for the detection of procalcitonin (PCT) and compare with the results obtained using the Vidas B.R.A.H.M.S. PCT™ test (PCT-V). DESIGN AND METHODS Our laboratory previously designed a novel CLIA kit and supporting instrument (AE-180) for the detection of PCT. We analyzed the clinical performance of this system, including the imprecision, limit of detection, and linearity of analyses of 305 serum specimens. The results were compared with measurements of the same serum samples obtained with PCT-V. RESULTS The limit of detection and blank of our kit were 0.0075 and 0.0039 ng/mL, respectively. The intra- and inter-assay coefficient of variation of the kit were both between 0.8% and 3.9%. The equation of linearity was found to be y = 1.03× + 0.06 (r = 0.99) for concentrations in the range of 0.01-110 ng/mL. The correlation coefficient with the results of PCT-V was 0.995, and the equation obtained for Passing and Bablok regression analysis was 1.061 for our CLIA PCT kit and - 0.003 for PCT-V. Our kit slightly overestimated the concentration according to comparison with PCT-V results. CONCLUSION The kit that was previously developed in our laboratory for the measurement of serum PCT concentration using CLIA technology shows excellent performance, just that the functional sensitivity is not as good as the PCT-V; therefore, we suggest that this kit is suitable for clinical use.
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Affiliation(s)
- Gang Wang
- Institute of Antibody Engineering, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou 510515, Guangdong, PR China
| | - Yong Wan
- Research Institute, Guangzhou Darui Biotechnology Co., Ltd., Guangzhou 510507, Guangdong, PR China
| | - Guanfeng Lin
- Institute of Antibody Engineering, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou 510515, Guangdong, PR China
| | - Zhixiong Li
- Research Institute, Guangzhou Darui Biotechnology Co., Ltd., Guangzhou 510507, Guangdong, PR China
| | - Zhining Dong
- Research Institute, Guangzhou Darui Biotechnology Co., Ltd., Guangzhou 510507, Guangdong, PR China
| | - Tiancai Liu
- Institute of Antibody Engineering, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou 510515, Guangdong, PR China; Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, Southern Medical University, Guangzhou 510515, Guangdong, PR China.
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30
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Thorsted A, Nielsen EI, Friberg LE. Pharmacodynamics of immune response biomarkers of interest for evaluation of treatment effects in bacterial infections. Int J Antimicrob Agents 2020; 56:106059. [PMID: 32569617 DOI: 10.1016/j.ijantimicag.2020.106059] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/27/2020] [Accepted: 06/13/2020] [Indexed: 01/08/2023]
Abstract
This mini-review discusses the pharmacodynamics of immune-related biomarkers in the area of bacterial infectious diseases that could be of interest from a pharmacokinetic (PK) and pharmacokinetic/pharmacodynamic (PK/PD) perspective in the evaluation of treatment effects. The host response to an infection is often poorly defined both in preclinical assessments and in clinical practice when it comes to characterisation of PK and PK/PD relationships. Through population modelling, the time courses and variability of immune response variables can be quantified. Incorporation of such biomarker information into PK and PK/PD models may guide the evaluation of individual response to treatment (right antibiotic, more antibiotic, less antibiotic) and when to stop treatment. Furthermore, translation of results from preclinical systems to clinical scenarios may be improved with the incorporation of biomarker information. Potential biomarkers for these purposes are discussed and a few modelling examples are provided.
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Affiliation(s)
- Anders Thorsted
- Pharmacometrics, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Elisabet I Nielsen
- Pharmacometrics, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Lena E Friberg
- Pharmacometrics, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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Abstract
Community-acquired pneumonia (CAP) is one of the respiratory infectious diseases caused by not only bacteria, but also viruses. Antibiotic agents are needed to treat only bacterial but not viral CAP. In addition, there are some non-infectious respiratory diseases in the differential diagnosis of CAP, such as malignant diseases, interstitial lung diseases, pulmonary edema, and pulmonary hemorrhage. We usually diagnose patients having CAP by comprehensive evaluation of symptoms, vital signs, laboratory examinations, and radiographic examinations. However, symptoms and vital signs are not specific for the diagnosis of CAP; therefore, we also use inflammatory biomarkers for differentiating bacterial from viral CAP and non-infectious respiratory diseases. We have used the white blood cell count, C-reactive protein (CRP), and erythrocyte sedimentation rate as common inflammatory biomarkers, but they are not specific for bacterial infection because they could be increased by malignant diseases and collagen diseases. Recently, some inflammatory biomarkers such as procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), pro-adrenomedullin (proADM), and presepsin have been developed as relatively specific biomarkers for bacterial infection. Many reports have evaluated the usefulness of PCT for diagnosing CAP. In this review, the characteristics of each biomarker are discussed based on previous studies.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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El-Deeb W, Elsohaby I, Fayez M, Mkrtchyan HV, El-Etriby D, ElGioushy M. Use of procalcitonin, neopterin, haptoglobin, serum amyloid A and proinflammatory cytokines in diagnosis and prognosis of bovine respiratory disease in feedlot calves under field conditions. Acta Trop 2020; 204:105336. [PMID: 31926143 DOI: 10.1016/j.actatropica.2020.105336] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
Bovine respiratory diseases (BRD) have long been considered a serious problem that causes major economic losses in feedlot calves (FC). This study aimed to determine the diagnostic and prognostic effect of selected biological markers including, procalcitonin (PCT), neopterin (NP), proinflammatory cytokines (IL-1β, IL-8, TNF-α, IF-γ), haptoglobin (HP) and serum amyloid A (SAA) on FC with BRD under field conditions. Sixty-nine FC that were identified to be infected with Mannheimia haemolytica and Histophilus somni and had different clinical respiratory signs (diseased group) were selected for this study. In addition, 20 healthy FC have been selected as a control group. We have detected higher serum levels of PCT, NP, HP, SAA, IL-1β, IL-8, TNF-α and IF-γ in diseased FC group compared with the control group. All tested markers revealed a high level of discrimination between BRD infected FC and healthy ones (AUC > 0.90). Moreover, the obtained data showed a high degree of prognostic accuracy for PCT, NP, IL-8, HP, IF-γ and IL-1β in predicting treatment response of FC with BRD at the selected thresholds (AUC = 0.99, 0.99, 0.97, 0.93, 0.88 and 0.82, respectively). Significant inhibition was observed for the selected biochemical markers in treated FC 7 days post-treatment. In conclusion, this study showed that BRD in FC was associated with significant alterations in serum APPs, proinflammatory cytokines, PCT and NPT levels. Furthermore, it demonstrated that these serum biomarkers are much higher in FC with BRD compared to recovered ones. Our data suggest that the measurement of PCT, NPT, APPs and cytokines together with the clinical examination may be a useful diagnostic and prognostic tool for assessment of FC naturally infected with M. haemolytica and H. somni.
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Cheng ZB, Chen H. Higher incidence of acute respiratory distress syndrome in cardiac surgical patients with elevated serum procalcitonin concentration: a prospective cohort study. Eur J Med Res 2020; 25:11. [PMID: 32228702 PMCID: PMC7106626 DOI: 10.1186/s40001-020-00409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Inflammatory response is activated during cardiopulmonary bypass (CPB), which may lead to acute respiratory distress syndrome (ARDS) and procalcitonin (PCT) increases during this inflammatory response. The objective of the study was to validate whether patients with higher serum PCT concentrations have a higher incidence of ARDS. METHODS The study was a prospective, single-center, observational cohort study. All patients who received cardiac surgery with CPB were screened for study eligibility. Patients were assigned to the PCT-elevated cohort or the control cohort according to serum PCT concentration on the first postoperative day with a cut-off value of 7.0 ng/mL. Patients were followed up until the 7th postoperative day. The primary endpoint was the incidence of ARDS, which was diagnosed according to the Berlin definition. RESULTS A total of 296 patients were enrolled, 64 patients were assigned to the PCT-elevated cohort and 232 patients were assigned to the control cohort. PCT concentration was 16.23 ± 5.9 ng/mL in the PCT-elevated cohort, and 2.70 ± 1.43 ng/mL in the control cohort (p < 0.001). The incidence of ARDS was significantly higher in the PCT-elevated cohort than in the control cohort (21.9% versus 5.6%, p < 0.001). The incidence of moderate-to-severe ARDS was also significantly higher in the PCT-elevated cohort than in the control cohort (10.9% versus 0.4%, p < 0.001). The hazard ratio of ARDS at 7 days in the PCT-elevated cohort, as compared with the control cohort, was 6.8 (95% confidence interval 2.7 to 17.4). The hazard ratio of moderate-to-severe ARDS in the PCT-elevated cohort was 57.3 (95% confidence interval 10.4 to 316.3). The positive predictive value of PCT for ARDS and moderate-to-severe ARDS were 0.242 and 0.121, respectively; the negative predictive value of PCT for ARDS and moderate-to-severe ARDS were 0.952 and 1.0, respectively. CONCLUSION Cardiac surgical patients with elevated PCT concentration have a higher incidence of ARDS. Elevated PCT may serve as a warning signal of postoperative ARDS in patients undergoing cardiac surgery with CPB. Study registration Chinese Clinical Trial Registry (ChiCTR-OCH-14005076).
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Affiliation(s)
- Zhang-Bo Cheng
- Department of Cardiosurgery, Fujian Provincial Hospital, 134 Dongjie Street, Fuzhou, Fujian, China.,Fujian Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Han Chen
- Surgical Intensive Care Unit, Fujian Provincial Hospital, 134 Dongjie Street, Fuzhou, Fujian, China. .,Fujian Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China.
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Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7170457. [PMID: 32280697 PMCID: PMC7114768 DOI: 10.1155/2020/7170457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/12/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.
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Wang S, Xie Z, Shen Z. Serum procalcitonin and C-reactive protein in the evaluation of bacterial infection in generalized pustular psoriasis. An Bras Dermatol 2019; 94:542-548. [PMID: 31777354 PMCID: PMC6857561 DOI: 10.1016/j.abd.2019.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/16/2018] [Indexed: 12/30/2022] Open
Abstract
Background There is an obvious need for more prompt and specific biomarkers of bacterial infections in generalized pustular psoriasis patients. Objective The aim of this study was to evaluate the diagnostic properties and define appropriate cut-off values of procalcitonin and C-reactive protein in predicting bacterial infection in generalized pustular psoriasis patients. Methods Sixty-four generalized pustular psoriasis patients hospitalized from June 2014 to May 2017 were included in this retrospective study. The values of procalcitonin, C-reactive protein, details of infection, and other clinical parameters were analyzed. Results Receiver operating characteristic curve analysis generated similar areas (p = 0.051) under the curve for procalcitonin 0.896 (95% CI 0.782–1.000) and C-reactive protein 0.748 (95% CI 0.613–0.883). A cut-off value of 1.50 ng/mL for procalcitonin and 46.75 mg/dL for C-reactive protein gave the best combination of sensitivity (75.0% for procalcitonin, 91.7% for C-reactive protein) and specificity (100% for procalcitonin, 53.8% for C-reactive protein). Procalcitonin was significantly positively correlated with C-reactive protein levels both in the infected (r = 0.843, p = 0.040) and non-infected group (r = 0.799, p = 0.000). Study limitations The sample size and the retrospective design are limitations. Conclusions The serum levels of procalcitonin and C-reactive protein performed equally well to differentiate bacterial infection from non-infection in generalized pustular psoriasis patients. The reference value of procalcitonin and C-reactive protein applied to predicting bacterial infection in most clinical cases may not be suitable for generalized pustular psoriasis patients. C-reactive protein had better diagnostic sensitivity than procalcitonin; however, the specificity of procalcitonin was superior to that of C-reactive protein.
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Affiliation(s)
- Siyu Wang
- Department of Dermatology, Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Zhen Xie
- Department of Dermatology, Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Zhu Shen
- Department of Dermatology, Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.
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Wolf TA, Wimalawansa SJ, Razzaque MS. Procalcitonin as a biomarker for critically ill patients with sepsis: Effects of vitamin D supplementation. J Steroid Biochem Mol Biol 2019; 193:105428. [PMID: 31323346 DOI: 10.1016/j.jsbmb.2019.105428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/22/2019] [Accepted: 07/15/2019] [Indexed: 01/24/2023]
Abstract
Early diagnosis of sepsis is often difficult in clinical practice, whilst it can be vital for positive patient outcomes in sepsis management. Any delay in diagnosis and treatment may lead to significant organ failure and can be associated with elevated mortality rates. Early diagnosis and effective management of sepsis can allow for prompt antibiotic therapy and a potential reduction in mortality; it can also minimize the unnecessary use of antibiotics. Furthermore, vitamin D supplementation, which is commonly used in the intensive care units to reduce mortality, may interfere with the ability to use procalcitonin (PCT) as a means of assessing clinical progression. This paper aims to explore the diagnostic and prognostic value of serum levels of PCT as an early marker of sepsis and to assess whether it can be used as a guide for using antibiotic therapy. Several serum-based biomarkers such as C-reactive protein, lactate, presepsin, and cytokines, such as interleukin-1 (IL-1), and IL-6 have been evaluated as early indicators of sepsis but none have been proven sensitive and/or specific enough to make a definitive diagnosis. Finally the potential benefits and disadvantages of using serum levels of PCT to diagnose and monitor patients with sepsis and septic shock will be briefly discussed.
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Affiliation(s)
- Thijs A Wolf
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | - Mohammed S Razzaque
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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Kirbas A, Kandemir FM, Celebi D, Hanedan B, Timurkan MO. The use of inflammatory markers as a diagnostic and prognostic approach in neonatal calves with septicaemia. Acta Vet Hung 2019; 67:360-376. [PMID: 31549538 DOI: 10.1556/004.2019.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The objective of this study was to evaluate the usefulness of inflammatory markers as a diagnostic and prognostic approach in neonatal calves with septicaemia. The study material consisted of 13 neonatal calves with septicaemia (septicaemic calves, SC) and ten healthy neonatal calves (control calves, CC). Blood samples were collected for biochemical, haematological and microbiological analyses. In addition, faecal samples were collected for microbiological and virological analyses. Three of neonatal calves with septicaemia were positive for E. coli (E. coli O157 serotype) by microbiological examination, but all neonatal calves with septicaemia were negative for rota- and coronaviruses. By haematological examination, there were no significant differences between SC and CC for white blood cell (WBC) and neutrophil (NEU) counts (P > 0.05). NEU counts were higher on day 0 than on day 15 in SC (P < 0.05). Red blood cell (RBC) counts and packed cell volume (PCV) values were higher on day 0 in the SC than in the CC (P < 0.05). By biochemical analyses, tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT), haptoglobin (Hp), and fibrinogen (Fb) concentrations were higher on day 0 in the SC than in the CC (P < 0.05). After treatment (on day 15), the serum IL-6, PCT, Hp, and Fb concentrations were significantly decreased in the SC compared to the CC (P < 0.05). The serum iron (Fe) concentrations were lower on day 0 in the SC than in the CC (P < 0.05), and were higher on day 15 than on day 0 in the SC (P < 0.05). The study revealed that inflammatory markers could be used for determining the diagnosis and prognosis in neonatal calves with septicaemia.
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Affiliation(s)
- Akın Kirbas
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Ataturk University, 25240 Erzurum, Turkey
| | - Fatih Mehmet Kandemir
- 2Department of Biochemistry, Faculty of Veterinary Medicine, Ataturk University, 25240 Erzurum, Turkey
| | - Demet Celebi
- 3Department of Microbiology, Faculty of Veterinary Medicine, Ataturk University, 25240 Erzurum, Turkey
| | - Basak Hanedan
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Ataturk University, 25240 Erzurum, Turkey
| | - Mehmet Ozkan Timurkan
- 4Department of Virology, Faculty of Veterinary Medicine, Ataturk University, 25240 Erzurum, Turkey
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Rhedin SA, Eklundh A, Ryd-Rinder M, Naucler P, Mårtensson A, Gantelius J, Zenk I, Andersson-Svahn H, Nybond S, Rasti R, Lindh M, Andersson M, Peltola V, Waris M, Alfvén T. Introducing a New Algorithm for Classification of Etiology in Studies on Pediatric Pneumonia: Protocol for the Trial of Respiratory Infections in Children for Enhanced Diagnostics Study. JMIR Res Protoc 2019; 8:e12705. [PMID: 31025954 PMCID: PMC6658235 DOI: 10.2196/12705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/09/2019] [Accepted: 03/24/2019] [Indexed: 01/20/2023] Open
Abstract
Background There is a need to better distinguish viral infections from antibiotic-requiring bacterial infections in children presenting with clinical community-acquired pneumonia (CAP) to assist health care workers in decision making and to improve the rational use of antibiotics. Objective The overall aim of the Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) study is to improve the differential diagnosis of bacterial and viral etiologies in children aged below 5 years with clinical CAP, by evaluating myxovirus resistance protein A (MxA) as a biomarker for viral CAP and by evaluating an existing (multianalyte point-of-care antigen detection test system [mariPOC respi] ArcDia International Oy Ltd.) and a potential future point-of-care test for respiratory pathogens. Methods Children aged 1 to 59 months with clinical CAP as well as healthy, hospital-based, asymptomatic controls will be included at a pediatric emergency hospital in Stockholm, Sweden. Blood (analyzed for MxA and C-reactive protein) and nasopharyngeal samples (analyzed with real-time polymerase chain reaction as the gold standard and antigen-based mariPOC respi test as well as saved for future analyses of a novel recombinase polymerase amplification–based point-of-care test for respiratory pathogens) will be collected. A newly developed algorithm for the classification of CAP etiology will be used as the reference standard. Results A pilot study was performed from June to August 2017. The enrollment of study subjects started in November 2017. Results are expected by the end of 2019. Conclusions The findings from the TREND study can be an important step to improve the management of children with clinical CAP. International Registered Report Identifier (IRRID) DERR1-10.2196/12705
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Affiliation(s)
- Samuel Arthur Rhedin
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
| | - Annika Eklundh
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet & Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Jesper Gantelius
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ingela Zenk
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Helene Andersson-Svahn
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Susanna Nybond
- Science for Life Laboratory, Division of Proteomics and Nanobiotechnology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Reza Rasti
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Maria Andersson
- Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Matti Waris
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tobias Alfvén
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Abedini A, Kiani A, Emami H, Touhidi MH. Serum Procalcitonin Level as a Predictor of Bacterial Infection in Patients with COPD Exacerbation. TANAFFOS 2019; 18:112-117. [PMID: 32440298 PMCID: PMC7230128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a major cause of mortality and morbidity throughout the world. Although the cause of COPD exacerbations can be bacterial or viral, use of antibiotics in exacerbations remains controversial. Procalcitonin serum level dramatically increases in bacterial infections, but not in viral or noninfectious febrile diseases. The aim of this study is to investigate whether the measurement of procalcitonin can be used to differentiate bacterial from non-bacterial causes of COPD exacerbations. MATERIALS AND METHODS Sixty-eight COPD patients admitted to the emergency department of Masih Daneshvari Hospital due to COPD exacerbation were studied. At admission and before prescribing antibiotics, we obtained sputum and blood samples for sputum gram staining and culture and measured serum C-reactive protein and procalcitonin. All results were analyzed by SPSS software version 22. RESULTS A total of 68 patients including 51 males and 17 females were studied. From 38.2% of patients a respiratory pathogen was isolated from their sputum and 23.5% of patients had elevated serum procalcitonin values. Using Fisher exact test, we found strong correlation between elevated procalcitonin levels above 0.5 ng/ml and sputum culture results (P < 0.01). We also found strong correlation between elevated procalcitonin levels above 0.5 ng/ml with abnormal C-reactive protein levels in a group of patients with positive sputum culture, using Fisher exact test (P <0.01). CONCLUSION As sputum culture and microbiologic studies are time consuming and sometimes expensive, it seems that procalcitonin could be a reliable marker of bacterial infection in COPD exacerbation, although we recommend a larger study with larger sample to consolidate the finding of this study.
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Affiliation(s)
- Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Touhidi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Touhidi MH, Address: Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
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Anush MM, Ashok VK, Sarma RI, Pillai SK. Role of C-reactive Protein as an Indicator for Determining the Outcome of Sepsis. Indian J Crit Care Med 2019; 23:11-14. [PMID: 31065202 PMCID: PMC6481256 DOI: 10.5005/jp-journals-10071-23105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aims It has been observed that after any injury which is acute and also in the setting of inflammation or infection, the synthesis and secretion of C-reactive protein (CRP) rises within a few hours. The current study monitors CRP in patients presenting with sepsis and attempts to prove that it is one of the most reliable tests in determining the resolution and predicting the outcome. Materials and methods During 12 months, 97 individuals with culture-proven sepsis were included, and a prospective observational study was done. Patients were assessed clinically by recording vitals, mean arterial pressure, Glasgow coma scale score, sequential organ failure assessment (SOFA) score as well as assessment of arterial blood gas and other blood investigations, which included CRP, total white cell count, differential count, serum creatinine, serum bilirubin on day 0, day 2 and day 5 after initiating antibiotics. To test the statistical significance of the difference in mean percentage changes of the different study variables between living and expired groups at day 2 and day 5, Wilcoxon's rank sum test was applied due to the non-normal distribution of values and small sample sizes. Results The percentage drop of the mean of CRP from day 0 to day 2 was 23.33% in the living group, and there was an increase of 4.73 % in the expired group. The percentage drop of the mean of CRP on day 5 when compared to day 0, was significant in the living group. Conclusion C-reactive protein (CRP) is a more useful tool in predicting improvement and outcome in patients admitted with sepsis when compared to scoring systems like SOFA score. Abbreviations AIMS: Amrita Institute of Medical Sciences, C1q: Complement 1q, CRP: C-reactive Protein, PCT: Procalcitonin, SOFA: Sequential organ failure assessment How to cite this article Anush MM, Ashok VK, Sarma RIN, Pillai SK. Role of C-reactive Protein as an Indicator for Determining the Outcome of Sepsis. Indian Journal of Critical Care Medicine, January 2019; 23(1):11-14.
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Affiliation(s)
- Meeval M Anush
- Kerala Institute of Medical Sciences Hospital, Trivandrum, Kerala, India
| | - Vijay K Ashok
- Department of Internal Medicine, MES Medical College, Perinthalmanna, Kerala, India
| | - Ramakrishna In Sarma
- Department of Internal Medicine, Pushpagiri Medical College, Thiruvalla, Kerala, India
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Elzouki AN, George S, Thomas M, Rafiqui S, Al Maslamani M. Procalcitonin and other inflammatory markers in patients with sepsis and septic shock: A single-center experience. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2019. [DOI: 10.4103/ijmbs.ijmbs_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Serum folic acid, PCT, CRP and ESR detection as biomarker in differentiation ulcerative colitis activity. Pteridines 2018. [DOI: 10.1515/pteridines-2018-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective: To investigate the serum concentration of folic acid, procalcitonin (PCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as biomarkers in the differentiation of the severity of ulcerative colitis (UC). Methods: Fifty one patients who had been diagnosed with UC were recruited from January 2014 to August 2017. Twenty-two of these patients had severe diseases while the remaining twenty-nine patients had mild/moderate disease, according to the Truelove-Witts classification criteria. In the same study, 26 healthy subjects which served as the healthy controls were included alongside the UC patient group. The serum folic acid, PCT, CRP and ESR were examined and compared among the healthy control, mild/moderate and severe UC groups. Results: The serum PCT, CRP and ESR in the control group were significantly lower than those of mild/moderate and severe UC groups with statistical significance (p<0.001). However, the serum folic acid in the control group was significant higher than that of mild/ moderate and severe UC groups (p<0.001). The serum folic acid (p=0.015), PCT (p<0.001) and ESR (p<0.001) were significantly different between the severe and mild/moderate groups. However, the serum CRP was not statistically significant between the mild/moderate and severe UC groups (p=0.06). Using serum folic acid, PCT, CRP and ESR as biomarkers in the differentiation of mild/moderate and severe UC, the serum PCT had good diagnostic accuracy for detecting severe UC with the diagnostic sensitivity and specificity of 85.71% (63.66~96.95%), 82.76% (64.23~94.15%), respectively under the cut off value of 0.045. The correlation between serum CRP, ESR and PCT were examined by Pearson correlation test and line regression analysis. However, there was no correlation between each of them with the exception of folic acid and ESR (r=-0.334, p=0.017). Conclusion: Serum folic acid, PCT, CRP and ESR are significantly elevated in patients with active UC thereby presenting novel and potentially promising biomarkers for the diagnosis and differentiation of mild/moderate and sever UC.
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Zhang L, Cai D, Guo H. Value of procalcitonin for diagnosing perioperative pneumonia, urinary infections and superficial surgical site infections in patients undergoing primary hip and knee arthroplasty. Exp Ther Med 2018; 15:5403-5409. [PMID: 29904419 DOI: 10.3892/etm.2018.6124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/14/2017] [Indexed: 01/09/2023] Open
Abstract
Serum procalcitonin (PCT) levels may be helpful for the diagnosis of infections during the perioperative period of arthroplasty. However, there is much debate in the literature regarding the appropriate cut-off value for different types of surgery and local bacterial infection. The present study aimed to evaluate serum PCT levels in patients undergoing arthroplasty and to determine the cut-off value that may represent perioperative pneumonia, urinary infections and superficial surgical site infections. The present retrospective study included a total of 500 patients treated between July 2014 and August 2015. The case group contained 25 patients with perioperative infections (pneumonia, urinary and superficial surgical site infections), and the control group contained 25 patients without any post-surgical complications. Serum levels of PCT and white blood cells (WBC) were measured pre-operatively (D0) and at post-operative D4, D6 and D8, and the sensitivity, specificity and predictive value of these parameters were assessed. Regarding the comparison of the mean PCT levels between the case and the control group, a significant difference was seen at D8 (P=0.007), while no significant differences were observed at D0 (P=0.010), D4 (P=0.069) and D6 (P=0.093). No statistically significant differences in WBC levels between groups were observed for (P>0.01). In the control group, the PCT levels at D4 (0.062±0.020 ng/ml) were 2-fold of the mean baseline value, followed by a decrease until D6 (0.051±0.019 ng/ml) and a return close to the normal range by D8 (0.032±0.015 ng/ml). The PCT levels in the case group had rapidly increased on D4 (0.510±1.208 ng/ml). In contrast to the control group, they continuously increased on D6 (0.527±1.360 ng/ml) and D8 (0.686±1.117 ng/ml). From a clinical point of view, infection events were indicated in these patients during post-operative follow-up. For PCT, the area under the receiver operating characteristic curve (AUC) was 0.978 [95% confidence interval (CI), 0.933-1.022], and for WBC, the AUC was 0.562 (95% CI, 0.398-0.0.726). Based on the above data, the PCT value was a significant predictor of infection (AUC>0.9). For PCT, the cut-off point of 0.0995 ng/ml was associated with a sensitivity of 96% and a specificity of 100%. However, WBC were not a significant predictor of infection (0.5<AUC<0.7), and the cut-off value of 7.05×109/l was associated with a sensitivity of 64% and a specificity of 44%. In conclusion PCT was found to be a promising marker for diagnosing bacterial infections post-arthroplasty due to its high specificity. Based on the sensitivity and the specificity, detecting PCT may be more valuable than using WBC in the diagnosis of sepsis-associated pathological changes in the perioperative period.
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Affiliation(s)
- Lixuan Zhang
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, P.R. China.,Department of Orthopaedic Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong 516001, P.R. China
| | - Daozhang Cai
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong 510630, P.R. China
| | - Hanming Guo
- Department of Orthopaedic Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong 516001, P.R. China
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Stockmann C, Ampofo K, Killpack J, Williams DJ, Edwards KM, Grijalva CG, Arnold SR, McCullers JA, Anderson EJ, Wunderink RG, Self WH, Bramley A, Jain S, Pavia AT, Blaschke AJ. Procalcitonin Accurately Identifies Hospitalized Children With Low Risk of Bacterial Community-Acquired Pneumonia. J Pediatric Infect Dis Soc 2018; 7:46-53. [PMID: 28158460 PMCID: PMC6251689 DOI: 10.1093/jpids/piw091] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/09/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lower procalcitonin (PCT) concentrations are associated with reduced risk of bacterial community-acquired pneumonia (CAP) in adults, but data in children are limited. METHODS We analyzed serum PCT concentrations from children hospitalized with radiographically confirmed CAP enrolled in the Centers for Disease Control and Prevention's Etiology of Pneumonia in the Community (EPIC) Study. Blood and respiratory specimens were tested using multiple pathogen detection methods for typical bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus), atypical bacteria (Mycoplasma pneumoniae and Chlamydophila pneumoniae), and respiratory viruses. Multivariable regression was used to assess associations between PCT concentrations and etiology and severity. RESULTS Among 532 children (median age, 2.4 years; interquartile range [IQR], 1.0-6.3), patients with typical bacteria had higher PCT concentrations (±viruses; n = 54; median, 6.10; IQR, 0.84-22.79 ng/mL) than those with atypical bacteria (±viruses; n = 82; median, 0.10; IQR, 0.06-0.39 ng/mL), viral pathogens only (n = 349; median, 0.33; IQR, 0.12-1.35 ng/mL), or no pathogen detected (n = 47; median, 0.44; IQR, 0.10-1.83 ng/mL) (P < .001 for all). No child with PCT <0.1 ng/mL had typical bacteria detected. Procalcitonin <0.25 ng/mL featured a 96% negative predictive value (95% confidence interval [CI], 93-99), 85% sensitivity (95% CI, 76-95), and 45% specificity (95% CI, 40-50) in identifying children without typical bacterial CAP. CONCLUSIONS Lower PCT concentrations in children hospitalized with CAP were associated with a reduced risk of typical bacterial detection and may help identify children who would not benefit from antibiotic treatment.
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Affiliation(s)
| | - Krow Ampofo
- University of Utah School of Medicine, Salt Lake City
| | | | | | | | | | | | | | | | | | - Wesley H Self
- Vanderbilt University School of Medicine, Nashville, Tennesse
| | - Anna Bramley
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Anne J Blaschke
- University of Utah School of Medicine, Salt Lake City,Correspondence: A. J. Blaschke, MD, PhD, Department of Pediatrics, Division of Pediatric Infectious Diseases, 295 Chipeta Way, Salt Lake City, UT 84108 ()
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45
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An SH, Cho HJ, Baek HS, Sung MS, Yoon JW, Choi SH, Sheen YH, Han MY. Clinical features of Mycoplasma pneumoniain comparison with viral pneumoina in children: A multicenter, cross-sectional study. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.3.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Se Hwan An
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hong Je Cho
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Myong Soon Sung
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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46
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Gommeren K, Desmas I, Garcia A, Bauer N, Moritz A, Roth J, Peeters D. Inflammatory cytokine and C-reactive protein concentrations in dogs with systemic inflammatory response syndrome. J Vet Emerg Crit Care (San Antonio) 2017; 28:9-19. [PMID: 29236338 DOI: 10.1111/vec.12685] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/03/2015] [Accepted: 11/15/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) kinetics in dogs with a systemic inflammatory response syndrome (SIRS) presented to an emergency service. We hypothesized serum CRP concentrations would increase and vary during hospitalization, and would correlate with plasma IL-6 and TNF-α concentrations, vary in magnitude according to the underlying disease, and predict survival. DESIGN Prospective, observational, clinical study. SETTING University emergency department. ANIMALS Sixty-nine dogs with SIRS weighing over 5 kg who could tolerate the blood sampling. INTERVENTIONS Serum and plasma were collected (and stored at -80°C) at presentation (T0), after 6 (T6), 12 (T12), 24 (T24), and 72 (T72) hours, and at a follow-up visit at least 1 month after discharge (T1m). Underlying diseases were categorized as infection (I), neoplasia (N), trauma (T), gastric-dilation and volvulus (GDV), other gastrointestinal (GI), renal (R), and miscellaneous (M) disease. MEASUREMENTS AND MAIN RESULTS Serum CRP concentration was measured using a canine-specific immunoturbidimetric assay. Biologically active plasma IL-6 and TNF-α concentrations were assessed using bioassays. Forty-four dogs survived, 8 died, and 17 were euthanized. Nineteen dogs had follow-up visits. At T0, serum CRP concentration was above the reference interval in 73.1% (49/67), and was within the reference interval (0-141.9 nmol/L) throughout hospitalization in only 6% (4/67). Serum CRP concentrations were significantly higher (P < 0.0001) at T0 (882.9 ± 1082.9 nmol/L) and at all time points during hospitalization (P < 0.0001) compared to T1m, with highest concentrations observed at T24 (906. 7 ± 859.0 nmol/L). At T1m, serum CRP concentrations were within the reference interval (22.9 ± 42.9 nmol/L) in 95% (18/19) of dogs. Logarithmic concentrations of serum CRP and plasma IL-6 were significantly correlated (P < 0.001, r = 0.479). None of the measured cytokines were associated with disease category or outcome. CONCLUSIONS Serum CRP concentration is increased in dogs with SIRS, and decreases during treatment and hospitalization. Serum CRP, plasma IL-6, and plasma TNF-α concentrations cannot predict outcome in dogs with SIRS.
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Affiliation(s)
- Kris Gommeren
- Department of Clinical Sciences, School of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Isabelle Desmas
- Department of Clinical Sciences, School of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Alexandra Garcia
- Department of Clinical Sciences, School of Veterinary Medicine, University of Liège, Liège, Belgium
| | - Natalie Bauer
- Department of Veterinary Clinical Sciences, Clinical Pathology, and Clinical Pathophysiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Andreas Moritz
- Department of Veterinary Clinical Sciences, Clinical Pathology, and Clinical Pathophysiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Joachim Roth
- Institute for Veterinary Physiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Dominique Peeters
- Department of Clinical Sciences, School of Veterinary Medicine, University of Liège, Liège, Belgium
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Bracho-Blanchet E, Dominguez-Muñoz A, Fernandez-Portilla E, Zalles-Vidal C, Davila-Perez R. Predictive value of procalcitonin for intestinal ischemia and/or necrosis in pediatric patients with adhesive small bowel obstruction (ASBO). J Pediatr Surg 2017; 52:1616-1620. [PMID: 28735976 DOI: 10.1016/j.jpedsurg.2017.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/23/2017] [Accepted: 07/10/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE Evaluate serum procalcitonin (PCT) level as a predictor of intestinal ischemia or necrosis (IN) in patients with postoperative adhesive small bowel obstruction (ASBO). METHODS Prospective cohort of consecutive patients with ASBO. Patients previously treated with antibiotics or septic were excluded. PCT was measured at the diagnosis of ASBO and every 24 h afterwards. MAIN OUTCOME intestinal ischemia or necrosis (IN). RESULTS Fifty-nine patients were included, 12 of whom were excluded; 47 patients remained in the study; male-to-female ratio = 1.9:1. MANAGEMENT medical in 15 cases (32%) and surgical in 32 (68%). MAIN OUTCOME Intestinal necrosis (IN) in 10 patients (21.3%). Mean PCT level was higher in patients with IN (15.11 ng/ml vs. 0.183 ng/ml, p=0.002), the proportion of patients with elevated PCT (>0.5 ng/dl) was higher in patients with IN (70% vs. 8.1%, p=<0.001, RR=26.4 with a 95% CI of 4.39-159.5). Elevated PCT levels at diagnosis had a 70% positive predictive value (PPV) and 91.8% negative predictive value (NPV) for prediction of IN. With a PCT value at diagnosis of >1.0 ng/dl, PPV was 87.5% and NPV, 92.3%. CONCLUSIONS PCT levels are closely related to the presence of intestinal ischemia and necrosis in children with ASBO. LEVEL OF EVIDENCE Study of Diagnostic Test, Level II.
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Affiliation(s)
- Eduardo Bracho-Blanchet
- Departamento de Cirugía General, Hospital Infantil de México Federico Gómez, Dr. Marquez 162 Col. Doctores, CP, 06720, México, D.F., Mexico.
| | - Alfredo Dominguez-Muñoz
- Departamento de Cirugía General, Hospital Infantil de México Federico Gómez, Dr. Marquez 162 Col. Doctores, CP, 06720, México, D.F., Mexico.
| | - Emilio Fernandez-Portilla
- Departamento de Cirugía General, Hospital Infantil de México Federico Gómez, Dr. Marquez 162 Col. Doctores, CP, 06720, México, D.F., Mexico.
| | - Cristian Zalles-Vidal
- Departamento de Cirugía General, Hospital Infantil de México Federico Gómez, Dr. Marquez 162 Col. Doctores, CP, 06720, México, D.F., Mexico.
| | - Roberto Davila-Perez
- Departamento de Cirugía General, Hospital Infantil de México Federico Gómez, Dr. Marquez 162 Col. Doctores, CP, 06720, México, D.F., Mexico.
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Hill DM, Sinclair SE, Hickerson WL. Rational Selection and Use of Antimicrobials in Patients with Burn Injuries. Clin Plast Surg 2017; 44:521-534. [DOI: 10.1016/j.cps.2017.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wu RX, Chiu CC, Lin TC, Yang YS, Lee Y, Lin JC, Chang FY. Procalcitonin as a diagnostic biomarker for septic shock and bloodstream infection in burn patients from the Formosa Fun Coast dust explosion. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:872-878. [PMID: 28690030 DOI: 10.1016/j.jmii.2016.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/21/2016] [Accepted: 08/26/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND/PURPOSE Infection is the most common cause of death following burn injury. The study was conducted to compare the diagnostic value of serum procalcitonin (PCT) with the other current benchmarks as early predictors of septic shock and bloodstream infection in burn patients. METHODS We included 24 patients admitted to the Burn Unit of a medical center from June 2015 to December 2015 from the Formosa Fun Coast dust explosion. We categorized all patients at initial admission into either sepsis or septic shock groups. Laboratory tests including the worst PCT and C-reactive protein (CRP) levels, platelet (PLT), and white blood cell (WBC) count were performed at <48 h after admission. Patients were also classified in two groups with subsequent bacteremia and non-bacteremia groups during hospitalization. RESULTS Significantly higher PCT levels were observed among participants with septic shock compared to those with sepsis (47.19 vs. 1.18 ng/mL, respectively; p < 0.001). Patients with bacteremia had significantly elevated PCT levels compared to patients without bacteremia (29.54 versus 1.81 ng/mL, respectively, p < 0.05). No significant differences were found in CRP levels, PLT, and WBC count between the two groups. PCT levels showed reasonable discriminative power (cut-off: 5.12 ng/mL; p = 0.01) in predicting of bloodstream infection in burn patients and the area under receiver operating curves was 0.92. CONCLUSIONS PCT levels can be helpful in determining the septic shock and bloodstream infection in burn patients but CRP levels, PLT, and WBC count were of little diagnostic value.
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Affiliation(s)
- Rui-Xin Wu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chien Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Tzu-Chao Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces, General Hospital, Kaohsiung, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi Lee
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Göde S, Turhal G, Kaya İ, Mavili Hİ, Kirazlı T. Evaluation of Procalcitonin and hs-CRP Levels in Sudden Sensorineural Hearing Loss. J Int Adv Otol 2017. [PMID: 28639554 DOI: 10.5152/iao.2017.2780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate procalcitonin and high sensitive c-reactive protein (hs-CRP) levels in idiopathic sudden sensorineural hearing loss (ISSNHL) patients and assess their correlations with the clinical prognosis. MATERIALS AND METHODS Twenty-three ISSNHL patients were included in the study (group A). The control group was consisted of 19 patients (group B). Procalcitonin and hs-CRP levels were compared between the groups. The relationship between procalcitonin and hs-CRP levels and the configuration of the audiogram, degree of hearing loss [partial or total ( > 90 dB)], and status of improvement (improvement of > 15 dB in the first month PTA) were evaluated. RESULTS The mean age was 47.91±15.73 years (range 21-73 years) and 35.16±15.67 years (range 19-79 years) in groups A and B, respectively. Seven patients (30.4%) had underlying cardiovascular risk factors. Mean procalcitonin levels were 0.057±0.025 µg/L and 0.041±0.016 µg/L in groups A and B, respectively. Mean hs-CRP levels were 0.461±1.335 mg/dL and 0.129±0.125 mg/dL in groups A and B, respectively. Procalcitonin levels were significantly higher in group A than in group B (p=0.018). Procalcitonin levels were significantly lower (0.035±0.013 µg/L vs. 0.061±0.025 µg/L) in patients with low-frequency hearing loss (p=0.04). ROC analysis of procalcitonin values revealed that area under the curve was 0.80 (p=0.005). A cut-off procalcitonin level of 0.45 µg/L yielded a sensitivity of 90% and specificity of 56.2%. CONCLUSION In conclusion, as a proinflammatory marker, procalcitonin levels were higher in ISSNHL patients than in healthy controls. The procalcitonin level was significantly lower in upsloping-type hearing loss patients. This finding could be regarded as an indirect indicator of pathogenesis.
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Affiliation(s)
- Sercan Göde
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Göksel Turhal
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - İsa Kaya
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | | | - Tayfun Kirazlı
- Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
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