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Acharya S, Mishra S, Ghosh A, Patro S. A prospective observational study on the efficacy of procalcitonin as a diagnostic test to exclude lower urinary tract infection and to minimize antibiotic overuse. Urol Ann 2024; 16:169-174. [PMID: 38818426 PMCID: PMC11135356 DOI: 10.4103/ua.ua_73_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/25/2023] [Accepted: 01/15/2024] [Indexed: 06/01/2024] Open
Abstract
Background Urinary tract infection (UTI) stands out as the third-most common infection following gastrointestinal and respiratory tract infections. Over the past decade, the biomarker procalcitonin (PCT) has gained prominence to facilitate the detection of bacterial infections and reduce excessive antibiotic exposure. Objective The objective of this study was to mitigate the overuse of antibiotics, by promoting the noninitiation or early discontinuation of empirical antibiotics, which would significantly help minimize the proliferation of multidrug-resistant bacteria. Methodology A prospective observational study was carried out at the tertiary care center in the Department of General Medicine of Kalinga Institute of Medical Sciences, Bhubaneswar, involving 200 patients with symptoms of lower UTI such as increased frequency, urgency, burning micturition, retention, and suprapubic tenderness with or without positive urinalysis. Detailed demographic profiles along with symptoms at the time of admission were recorded in a pretested structured format. To determine a positive diagnosis of UTI, signs and symptoms of UTI with or without urinary cultures were tested. The PCT level was estimated using enhanced chemiluminescence technique. Other routine tests such as complete blood count, renal function test, liver function test, urine routine microscopy, culture, chest X-ray, and ultrasonography abdomen pelvis were done and recorded. All patients, who had an initial serum PCT level of < 0.5 ng/mL, were kept under observation with only conservative and symptomatic treatments. Patients were further reviewed for improvement in symptoms and repeat urine microscopy. All patients, who had an initial serum PCT level of > 0.5 ng/mL, were initiated with antibiotics as per the culture and sensitivity reports. Patients were followed up for improvement in symptoms with reports of repeated urinalysis. Results Our study reported the fact that 9.5% of the patients with initial serum PCT ≥ 0.5 ng/mL showed no improvement in symptoms despite starting antibiotics while significantly higher number of symptomatic patients (60%) with initial serum PCT < 0.5 ng/ml showed improvement in symptoms with conservative treatment without antibiotics. Conclusion A lower PCT level rules out bacterial invasion and thus can be used as a novel marker in antibiotic stewardship.
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Affiliation(s)
- Swastik Acharya
- Department of General Medicine, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Sanjukta Mishra
- Department of Biochemistry, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Arpan Ghosh
- School of Biotechnology, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Shubhransu Patro
- Department of General Medicine, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
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Ren X, Fu Q. C3AR1 is a regulatory factor associated with coagulation cascade and inflammation in sepsis. Medicine (Baltimore) 2024; 103:e37519. [PMID: 38489677 PMCID: PMC10939674 DOI: 10.1097/md.0000000000037519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/20/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Sepsis is a leading cause of mortality in intensive care units. Sepsis is associated with activation of the coagulation cascade and inflammation. The aim of this study was to identify coagulation-related genes in sepsis that may provide translational potential therapeutic targets. The datasets GSE28750, GSE95233, and GSE65682 were downloaded from the gene expression omnibus database. Consensus-weighted gene co-expression network analysis (WGCNA) was used to identify sepsis modules. Gene set enrichment analysis was used to identify genes enriched in the coagulation cascade. The value of hub-gene in immunological analysis was tested in the validation sets (GSE95233). The value of hub-gene in clinical prognosis was tested in the validation sets (GSE65582). One thousand one hundred seventy-six genes with high connectivity in the clinically significant module were identified as hub genes. Ten genes were found to be enriched in coagulation-related signaling pathways. C3AR1 was selected for further analysis. The immune infiltration analysis showed that lower expression of C3AR1 was associated with immune response in sepsis and could be an independent predictor of survival status in sepsis patients. Meanwhile, univariate and multivariate Cox analysis showed that C3AR1 had a significant correlation with survival. C3AR1 may become an effective biomarker for worse outcomes in sepsis patients associated with immune and coagulation cascade.
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Affiliation(s)
- Xuanrong Ren
- The Faculty of Chinese Medicine, Macao University of Science and Technology, Macao, China
| | - Qinghui Fu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Koozi H, Lidestam A, Lengquist M, Johnsson P, Frigyesi A. A simple mortality prediction model for sepsis patients in intensive care. J Intensive Care Soc 2023; 24:372-378. [PMID: 37841294 PMCID: PMC10572475 DOI: 10.1177/17511437221149572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Sepsis is common in the intensive care unit (ICU). Two of the ICU's most widely used mortality prediction models are the Simplified Acute Physiology Score 3 (SAPS-3) and the Sequential Organ Failure Assessment (SOFA) score. We aimed to assess the mortality prediction performance of SAPS-3 and SOFA upon ICU admission for sepsis and find a simpler mortality prediction model for these patients to be used in clinical practice and when conducting studies. Methods A retrospective study of adult patients fulfilling the Sepsis-3 criteria admitted to four general ICUs was performed. A simple prognostic model was created using backward stepwise multivariate logistic regression. The area under the curve (AUC) of SAPS-3, SOFA and the simple model was assessed. Results One thousand nine hundred eighty four admissions were included. A simple six-parameter model consisting of age, immunosuppression, Glasgow Coma Scale, body temperature, C-reactive protein and bilirubin had an AUC of 0.72 (95% confidence interval (CI) 0.69-0.75) for 30-day mortality, which was non-inferior to SAPS-3 (AUC 0.75, 95% CI 0.72-0.77) (p = 0.071). SOFA had an AUC of 0.67 (95% CI 0.64-0.70) and was inferior to SAPS-3 (p < 0.001) and our simple model (p = 0.0019). Conclusion SAPS-3 has a lower prognostic value in sepsis than in the general ICU population. SOFA performs less well than SAPS-3. Our simple six-parameter model predicts mortality just as well as SAPS-3 upon ICU admission for sepsis, allowing the design of simple studies and performance monitoring.
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Affiliation(s)
- Hazem Koozi
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Kristianstad Central Hospital, Anaesthesia and Intensive Care, Kristianstad, Sweden
| | - Adina Lidestam
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
| | - Maria Lengquist
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, Lund, Sweden
| | - Patrik Johnsson
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, Malmö, Sweden
| | - Attila Frigyesi
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Skåne University Hospital, Intensive and Perioperative Care, Lund, Sweden
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4
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Fu S, Yu W, Fu Q, Xu Z, Zhang S, Liang TB. Prognostic value of APTT combined with fibrinogen and creatinine in predicting 28-Day mortality in patients with septic shock caused by acute enteric perforation. BMC Surg 2023; 23:274. [PMID: 37700315 PMCID: PMC10498602 DOI: 10.1186/s12893-023-02165-6] [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: 01/27/2022] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Septic shock is one of the leading causes of mortality in intensive care units. This retrospective study was carried out to evaluate the association of clinical available factors with 28-day mortality. PATIENTS AND METHOD In this observational study, patients with perioperative septic shocks secondary to intra-abdominal infection caused by enteric perforation were included. A total of 328 sepsis patients were admitted to the surgical intensive care units from January 2012 to December 2016. A total of 138 patients met the enrolment criteria and were included in the study. The data of demographic, clinical and laboratory were all recorded. RESULT All these 138 patients received abdominal surgery prior to surgical intensive care units caused by acute enteric perforation. These patients were all met the diagnostic criteria of septic shock according to Sepsis-3. Statistical analysis showed that lactic acid, blood platelet, fibrinogen, creatinine and activated partial thromboplastin time were found to be associated with 28-day mortality. A combination of serum activated partial thromboplastin time combined with fibrinogen and creatinine could predict in-hospital 28-day mortality. The area under the curve of serum activated partial thromboplastin time combined with fibrinogen and creatinine is 0.875 (0.806-0.944). CONCLUSION In conclusion, this pilot study demonstrated that these factors can predict the prognosis of septic shock caused by enteric perforation. In order to reduce the mortality, surgeons and intensive care units physician may consider these data in perioperative period.
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Affiliation(s)
- Shuiqiao Fu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Wenqiao Yu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Qinghui Fu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Zhipeng Xu
- The Department of SICU, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Shaoyang Zhang
- The Department of Emergency, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China
| | - Ting-Bo Liang
- The Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun street 79th, Hangzhou, 310003, Zhejiang Province, China.
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Xian J, Wang L, Zhang C, Wang J, Zhu Y, Yu H, Zhang X, Tan Q. Efficacy and safety of acupuncture as a complementary therapy for sepsis: a systematic review and meta-analysis. Acupunct Med 2023; 41:3-15. [PMID: 35579024 DOI: 10.1177/09645284221086288] [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: 01/19/2023]
Abstract
BACKGROUND Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection. Acupuncture is used for treatment of inflammatory diseases; however, its effectiveness and safety as a complementary therapy for sepsis has not been fully explored. METHODS Data were retrieved from eight databases. Randomized controlled trials (RCTs) that compared acupuncture plus conventional therapies versus conventional therapies alone were included. Pre-specified primary outcomes were mortality at 28 days and Acute Physiologic and Chronic Health Evaluation (APACHE) II scores. RESULTS A total of 17 studies with 1099 participants were included in this study. In terms of the primary outcomes, acupuncture plus routine therapy reduced mortality at 28 days (risk ratio (RR)): 0.69, 95% confidence interval (CI): 0.52 to 0.91, p < 0.001) and APACHE II scores (mean difference (MD): -2.84, 95% CI: -4.09 to -1.58, p < 0.001) at day 7 after treatment compared with routine therapy alone. In terms of secondary outcomes, acupuncture plus routine therapy reduced white blood cell counts and levels of procalcitonin (PCT), tumor necrosis factor (TNF)-α, interleukin (IL)-6 and lactic acid and intra-abdominal pressure (IAP), and improved CD3+, CD4+ and monocytes of human leukocyte antigen (HLA)-DR at day 7 after treatment compared with routine therapy alone. However, acupuncture plus routine therapy had no significant effects on levels of IL-10, C-reactive protein (CRP), CD8+ and CD4+/CD8+ ratios compared with routine therapy alone. Quality of evidence was low to very low for all parameters (GRADE). CONCLUSION The available evidence showed that combination of acupuncture and routine therapy may have benefit for sepsis compared with use of routine therapy only. Due to the low degree of certainty regarding its effects, further research is required. TRIAL REGISTRATION NUMBER ICRD42019141491 (PROSPERO).
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Affiliation(s)
- Jin Xian
- Shandong University of Traditional Chinese Medicine, Jinan, China.,Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ling Wang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Changyun Zhang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jian Wang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yushuo Zhu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Huijuan Yu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xin Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qiwen Tan
- Shandong University of Traditional Chinese Medicine, Jinan, China
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Qian F, Zhou W, Liu Y, Ge Z, Lai J, Zhao Z, Feng Y, Lin L, Shen Y, Zhang Z, Zhang W, Fan T, Zhao Y, Chen Z. High C-reactive protein to lymphocyte ratio predicts mortality outcomes of patients with severe fever with thrombocytopenia syndrome: A multicenter study in China. J Med Virol 2023; 95:e28546. [PMID: 36734063 DOI: 10.1002/jmv.28546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/01/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a life-threatening infectious disease caused by the SFTS virus (SFTSV). This study aimed to evaluate the predictive power of C-reactive protein to lymphocyte ratio (CLR) and establish an early-warning model for SFTS mortality. We retrospectively analyzed hospitalized SFTS patients in six clinical centers from May 2011 to 2022. The efficacy of CLR prediction was evaluated by the receiver operating characteristic (ROC) analysis. A nomogram was established and validated. Eight hundred and eighty-two SFTS patients (median age 64 years, 48.5% male) were enrolled in this study, with a mortality rate of 17.8%. The area under the ROC curve (AUC) of CLR was 0.878 (95% confidence interval [CI]: 0.850-0.903, p < 0.001), which demonstrates high predictive strength. The least absolute shrinkage and selection operator regression selected seven potential predictors. Multivariate logistic regression analysis determined three independent risk factors, including CLR, to construct the nomogram. The performance of the nomogram displayed excellent discrimination and calibration, with significant net benefits in clinical uses. CLR is a brand-new predictor for SFTS mortality. The nomogram based on CLR can serve as a convenient tool for physicians to identify critical SFTS cases in clinical practice.
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Affiliation(s)
- Fang Qian
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhou
- Department of Infectious Diseases, Dalian Sixth People's Hospital, Dalian, China
| | - Yuanni Liu
- Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Ziruo Ge
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianming Lai
- Department of Infectious Disease, Qing Dao No 6 People's Hospital, Qingdao, China
| | - Zhenghua Zhao
- Department of Infectious Disease, Taian City Central Hospital, Taian, China
| | - Yang Feng
- Department of Infectious Disease, Taian City Central Hospital, Taian, China
| | - Ling Lin
- Department of Infectious Disease, Yantai City Hospital for Infectious Disease, Yantai, China
| | - Yi Shen
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Zhonglu Zhang
- Department of Infectious Diseases, Dalian Sixth People's Hospital, Dalian, China
| | - Wei Zhang
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tianli Fan
- Department of Infectious Disease, Qing Dao No 6 People's Hospital, Qingdao, China
| | - Yongxiang Zhao
- Department of Infectious Diseases, Dandong Infectious Disease Hospital, Dandong, China
| | - Zhihai Chen
- Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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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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Huang H, Chen J, Dang H, Liu C, Fu YQ. Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study. Front Pediatr 2022; 10:1001565. [PMID: 36313890 PMCID: PMC9608626 DOI: 10.3389/fped.2022.1001565] [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: 07/23/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We assessed the outcomes and characteristics of culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in pediatric intensive care unit (PICU). METHODS We performed a retrospective study on the data of children admitted to the PICU due to septic shock between January 2018 and December 2021. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay (LOS) of hospital, the need for mechanical ventilation (MV) and continue renal replacement therapy (CRRT). RESULTS Overall, 238 patients were enrolled. 114 patients (47.9%) had positive cultures (60 blood samples, 41 sputum samples, 17 pus samples, and 19 others), 18 of whom were cultured positive at two sites, 1 at three sites, and 3 had two different types of bacteria at same site. The in-hospital mortality was 47.1%. There were no significant differences in the in-hospital mortality (47.6% vs. 46.5%, P = 0.866), PRISM-III score (10 vs. 12, P = 0.409), PIM-3 score (0.08 vs. 0.07, P = 0.845), pSOFA score (10 vs. 10, P = 0.677) or the need for MV (64.5% vs. 68.4%, P = 0.524) and CRRT (29.8% vs. 34.2%, P = 0.470) between the CNSS group and the CPSS group. The Procalcitonin (8.89 ng/ml vs. 28.39 ng/ml, P = 0.001) and C-reactive protein (28 mg/L vs. 58 mg/L, P = 0.001) levels were significantly lower in the CNSS group than in the CPSS group, while WBC count (9.03 × 109/L vs. 5.02 × 109/L, P = 0.002) and serum sodium (137 mmol/L vs. 132 mmol/L, P = 0.001) was significantly higher in CNSS. The LOS of hospital was significantly longer (16 days vs. 11 days, P = 0.011) in the CPSS group than in the CNSS group, while the LOS of PICU (5 days vs. 4 days, P = 0.094) stay was not significantly different. CONCLUSION Compared with children with CNSS, children with CPSS had higher PCT and CRP levels, but lower WBC count. Children with CPSS had longer LOS of hospital. However, positive or negative culture results were not associated with in-hospital mortality, the LOS of PICU, the need for MV or CRRT in children with septic shock.
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Affiliation(s)
- Haixin Huang
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Chen
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongxing Dang
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chengjun Liu
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue-Qiang Fu
- Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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He F, Zheng X, Zhang Z. Clinical features of severe fever with thrombocytopenia syndrome and analysis of risk factors for mortality. BMC Infect Dis 2021; 21:1253. [PMID: 34906106 PMCID: PMC8669668 DOI: 10.1186/s12879-021-06946-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background To understand the clinical characteristics of and explore the risk factors for mortality in patients with severe fever with thrombocytopenia syndrome (SFTS). Methods Data from SFTS patients diagnosed by laboratory examination at Chaohu Hospital affiliated with Anhui Medical University from June 2017 to January 2021 were retrospectively analysed. According to the clinical results, all confirmed patients were divided into the surviving group (80 patients) and non-surviving group (20 patients). The two groups were compared in terms of general characteristics, clinical symptoms and signs, laboratory indicators and other aspects. The independent risk factors for mortality in SFTS patients were analysed by multivariate binary logistic regression. Results Univariate analysis showed a significant difference in age and the incidence of consciousness disturbance, respiratory failure, haemorrhagic manifestations, renal dysfunction, shock, aspartate aminotransferase (AST) ≥400 U/L, creatine kinase (CK)≥1000 U/L, creatine kinase isoenzymes (CK-MB) ≥100 U/L, lactate dehydrogenase (LDH) ≥1000 U/L, serum creatinine ≥100 mmol/L, blood urea nitrogen ≥7.5 mmol/L and C-reactive protein ≥8 mg/L between the two groups (P < 0.05). Conclusions Consciousness disorder, haemorrhagic manifestations, renal dysfunction, AST ≥ 400 U/L, and LDH ≥ 1000 U/L are independent risk factors for mortality in SFTS patients and merit close attention in clinical treatment to avoid fatal consequences.
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Affiliation(s)
- Feng He
- Department of Infectious Diseases, Chaohu Hospital Affiliated With Anhui Medical University, Hefei, China.
| | - Xinxin Zheng
- Department of Infectious Diseases, Chaohu Hospital Affiliated With Anhui Medical University, Hefei, China
| | - Zhaoru Zhang
- Department of Infectious Diseases, Chaohu Hospital Affiliated With Anhui Medical University, Hefei, China
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Multiple organ dysfunction due to a rare complication of Nuss procedure for pectus excavatum: A case report. Chin J Traumatol 2021; 24:306-310. [PMID: 34384669 PMCID: PMC8563856 DOI: 10.1016/j.cjtee.2021.07.011] [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: 06/22/2020] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 02/04/2023] Open
Abstract
A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department. With organ function supportive treatment, the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib, which damaged the heart repeatedly and induced the consequent acute cardiac tamponade. After operation, the patient was successfully managed and discharged. Follow-ups till three years indicated a good recovery.
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Gómez de Oña C, Alvarez-Argüelles ME, Rojo-Alba S, Casares H, Arroyo M, Rodríguez J, de Oña M, Melón S. Alterations in biochemical markers in adenovirus infection. Transl Pediatr 2021; 10:1248-1258. [PMID: 34189083 PMCID: PMC8193001 DOI: 10.21037/tp-20-333] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Analyze possible relationships between HAdV and markers for inflammation, specifically the C-reactive protein (CRP) and procalcitonin (PCT) tests, along with other haematological markers. METHODS Retrospective study of 487 children presenting with fever and/or acute respiratory symptoms in the Paediatric Emergency Department. Analyses included viral presence/absence (both HAdV and other respiratory viruses) in respiratory exudates, CRP and PCT alterations in plasma, and haematological markers in whole blood. RESULTS Viral load was >500 copies/103 cells of HAdV in 127 cases (26.1%), of which 66 (52%, P<0.0001) had alterations in PCT, and 112 (88.1%, P<0.0001) in CRP. Haematological markers were similar either HAdV was present or not, although many HAdV positive patients demonstrated leukocytosis (66%). Bacterial cultures from 141 samples showed altered PCT in 27 (60%) with HAdV infection, in 3 (18.7%) with bacterial infection, and 13 (26.5%) without either viral or bacterial infection (P<0.05). CRP was altered in 88.9% of HAdV infected children and in 87% infected with bacteria, although the percentage was greater than in cases where other respiratory viruses were present (61.3% P<0.05). CONCLUSIONS Results demonstrate a clear relationship between HAdV infection and alterations in PCT and CRP which should be taken into account in paediatric patient management.
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Affiliation(s)
| | | | - Susana Rojo-Alba
- Microbiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Helena Casares
- Pediatric Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Mireia Arroyo
- Pediatric Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julián Rodríguez
- Pediatric Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María de Oña
- Microbiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Santiago Melón
- Microbiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Carbonell R, Moreno G, Martín-Loeches I, Gomez-Bertomeu F, Sarvisé C, Gómez J, Bodí M, Díaz E, Papiol E, Trefler S, Nieto M, Estella A, Jiménez Herrera M, Vidal Cortés P, Guardiola JJ, Solé-Violán J, Rodríguez A. Prognostic Value of Procalcitonin and C-Reactive Protein in 1608 Critically Ill Patients with Severe Influenza Pneumonia. Antibiotics (Basel) 2021; 10:antibiotics10040350. [PMID: 33810263 PMCID: PMC8066504 DOI: 10.3390/antibiotics10040350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Procalcitonin (PCT) and C-Reactive protein (CRP) are well-established sepsis biomarkers. The association of baseline PCT levels and mortality in pneumonia remains unclear, and we still do not know whether biomarkers levels could be related to the causative microorganism (GPC, GNB). The objective of this study is to address these issues. Methods: a retrospective observational cohort study was conducted in 184 Spanish ICUs (2009–2018). Results: 1608 patients with severe influenza pneumonia with PCT and CRP available levels on admission were included, 1186 with primary viral pneumonia (PVP) and 422 with bacterial Co-infection (BC). Those with BC presented higher PCT levels (4.25 [0.6–19.5] versus 0.6 [0.2–2.3]ng/mL) and CRP (36.7 [20.23–118] versus 28.05 [13.3–109]mg/dL) as compared to PVP (p < 0.001). Deceased patients had higher PCT (ng/mL) when compared with survivors, in PVP (0.82 [0.3–2.8]) versus 0.53 [0.19–2.1], p = 0.001) and BC (6.9 [0.93–28.5] versus 3.8 [0.5–17.37], p = 0.039). However, no significant association with mortality was observed in the multivariate analysis. The PCT levels (ng/mL) were significantly higher in polymicrobial infection (8.4) and GPC (6.9) when compared with GNB (1.2) and Aspergillus (1.7). The AUC-ROC of PCT for GPC was 0.67 and 0.32 for GNB. The AUROC of CRP was 0.56 for GPC and 0.39 for GNB. Conclusions: a single PCT/CRP value at ICU admission was not associated with mortality in severe influenza pneumonia. None of the biomarkers have enough discriminatory power to be used for predicting the causative microorganism of the co-infection.
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Affiliation(s)
- Raquel Carbonell
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (G.M.); (S.T.)
- Correspondence: ; Tel.: +34-687047670
| | - Gerard Moreno
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (G.M.); (S.T.)
| | - Ignacio Martín-Loeches
- Department of Anaesthesia and Critical Care, St James’s University Hospital, Trinity Centre for Health Sciences, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin 8, Ireland;
| | | | - Carolina Sarvisé
- Microbiology, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (F.G.-B.); (C.S.)
| | - Josep Gómez
- Tarragona Health Data Research Working Group (THeDaR)-ICU Hospital Joan XXIII, 43005 Tarragona, Spain;
| | - María Bodí
- Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (M.B.); (A.R.)
| | - Emili Díaz
- Critical Care Department/CIBERES, Hospital Parc Taulí, 08208 Sabadell, Spain;
| | - Elisabeth Papiol
- Critical Care Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Sandra Trefler
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (G.M.); (S.T.)
| | - Mercedes Nieto
- Critical Care Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Angel Estella
- Critical Care Department, Hospital de Jerez, 11407 Jerez de la Frontera, Spain;
| | | | - Pablo Vidal Cortés
- Critical Care Department, Complejo Hospitalario Universitario Ourense, 32005 Ourense, Spain;
| | - Juan José Guardiola
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, Louisville, KY 40202, USA;
| | - Jordi Solé-Violán
- Critical Care Department Hospital Universitario Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - Alejandro Rodríguez
- Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (M.B.); (A.R.)
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Cioni G, Canini J, Pieralli F. Procalcitonin in clinical practice: from diagnosis of sepsis to antibiotic therapy. ITALIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4081/itjm.2021.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A diagnostic algorithm that allows for the rapid identification of sepsis and possibly guides the appropriate antimicrobial therapy application is the cornerstone to obtaining effective treatment and better results. The use of emerging surrogate markers could significantly improve clinical practice, but the validity and clinical utility have been proved only for very few of them, and their availability in clinical routine is limited. For this purpose, numerous scientific evidence has indicated procalcitonin as a marker linked to sepsis and its evolution. This review aims to retrace the main evidence relating to the use of procalcitonin in sepsis. We analyzed the primary studies in the literature and the existing meta-analysis evaluating the behavior of procalcitonin as a marker of bacterial sepsis, its prognostic power, and its ability to influence antibiotic therapy. Recent evidence has suggested that procalcitonin could be an efficient marker for diagnosing sepsis and its therapeutic management in many types of patients. The choice of the appropriate timing to initiate and suspend antibiotic therapy, with obvious clinical advantages, the favorable effects could also include reducing health costs, both avoiding the administration of inappropriate antibiotic therapies, and reducing the duration of hospitalization. Moreover, limited studies reported high procalcitonin levels in coronavirus disease 2019 patients with a worse prognosis. Despite the considerable evidence in favor of the potential of procalcitonin as an index for managing septic patients, there are conflicting data that deserve specific and detailed studies.
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Patnaik R, Azim A, Mishra P. Should serial monitoring of procalcitonin be done routinely in critically ill patients of ICU: A systematic review and meta-analysis. J Anaesthesiol Clin Pharmacol 2021; 36:458-464. [PMID: 33840923 PMCID: PMC8022053 DOI: 10.4103/joacp.joacp_388_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/13/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022] Open
Abstract
Sepsis is a life-threatening condition with dysregulated host response to infection. It is a major determinant of mortality in the intensive care unit (ICU). Procalcitonin (PCT) is widely investigated for prognosis in patients with sepsis. Most of the studies have cited that elevated PCT concentrations and PCT non-clearance are associated with poor outcomes in patients with sepsis and some studies have cited as having no additional benefit. Most of the studies have evaluated single PCT measurement and correlated with prognosis and outcome in septic patients. Limited literature is there about serial PCT levels and its impact on the outcome of patients with sepsis. We searched literature through PubMed, Embase, Web of Knowledge, and the Cochrane Library from 2007 to 2017 and present a systematic review and meta-analysis of studies evaluating the utility of serial measurement of PCT for prognosis in critically ill patients. Articles that assessed PCT non-clearance as a marker of mortality data were included. The primary objective of this meta-analysis was to pool the results of all the available studies on serial PCT non-clearance as a mortality predictor and formulate overall area under receiver operating curve (AUROC). To find out the overall proportion of mortality in PCT non-clearance was our secondary objective. To detect the mortality using PCT non-clearance, ROC curve analysis was done. Area under curve (AUC) of the studies was varying between 0.52 and 0.86. Overall AUC was observed 0.711 (95% confidence interval (CI): 0.662–0.760) under fixed effect model and 0.708 (95% CI: 0.648–0.769) under random effect model. There was moderate variation among the studies, i.e., I2 50.80% (95% CI: 0.00–80.42%). The overall proportion of mortality was 37.54% with much heterogeneity (I2 88.24%) among the studies. PCT non-clearance is a fair predictor of mortality. Further studies are needed to define optimal cut off point for PCT non-clearance in ICU patients with sepsis.
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Affiliation(s)
- Rupali Patnaik
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
How to cite this article: Kandasamy S. Is It All Clear if Procalcitonin Clears in Acute Pancreatitis? Indian J Crit Care Med 2020;24(3):149-150.
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Affiliation(s)
- Subramani Kandasamy
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
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16
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Usefulness of procalcitonin clearance to predict mortality in abdominal sepsis. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220942631] [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
To evaluate the plasma levels and clearance of procalcitonin (PCTc) as prognostic biomarkers for patients with abdominal sepsis. A retrospective study of 103 patients with abdominal sepsis was conducted in our intensive care unit (ICU) from 2016 to 2018. Procalcitonin (PCT) plasma levels were measured at the time of diagnosis of abdominal sepsis and daily over the next 5 days. PCTc was calculated from day 3 to day 5. The prognostic accuracy of PCTc was expressed as the area under the receiver operating characteristic curve (AUROC). The Kaplan–Meier method was used to compare the survival curves by log-rank test. Logistic regression analysis was used to predict the 28-day mortality. The primary outcome was 28-day mortality since admission to ICU. Serum PCT levels from day 1 to day 5 did not differ significantly between survivors and non-survivors, while PCTc on day 5 was statistically significantly higher in survivors than that in non-survivors (86.4% vs 38.7%, P < 0.001). The cutoff value for PCTc-day 5 was 70%, with AUROC of 0.726, sensitivity of 64.6%, and specificity of 78.3%. The 28-day mortality was significantly lower among those with PCTc-day 5 >70% compared with those with PCTc-day 5 <70% (9.1% vs 38.3%, log-rank test, P < 0.001), and odds ratio (OR) was 0.16 (95% confidence interval (CI): 0.05–0.48, P < 0.001). The ability to decrease PCT by at least 70% on day 5 was an independent predictor of 28-day mortality after admission to ICU with moderate accuracy.
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Nassar AP, Nassif BN, Santos DVVD, Caruso P. Procalcitonin Clearance at 24, 48, 72, and 96 Hours and Mortality in Patients With Cancer and Sepsis: A Retrospective Cohort Study. J Intensive Care Med 2019; 35:1297-1301. [PMID: 31284812 DOI: 10.1177/0885066619861588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Previous studies have evaluated procalcitonin clearance (PCTc) as a marker of sepsis severity but at different time points and cutoffs. We aimed to assess the predictive performance of PCTc at different time points of sepsis management in patients with cancer. METHODS This retrospective cohort study included patients with cancer admitted to an intensive care unit between 2013 and 2016. We calculated PCTc at 24, 48, 72, and 96 hours after admission. Its predictive performance for hospital and 90-day mortality was analyzed with receiver operating characteristic curves and areas under the curves (AUCs). Sensitivity and specificity were calculated for different time points using different cutoffs. RESULTS We included 301 patients. Areas under the curves ranged from 0.62 for PCTc at 24 hours to 0.68 for PCTc at 72 and 96 hours for hospital mortality prediction, and from 0.61 for PCTc at 24 hours to 0.68 for PCTc at 72 hours for 90-day mortality prediction. For hospital mortality prediction, PCTc at 72 hours ≤80% showed the best sensitivity (96.0%; 95% confidence interval [CI]: 90.8%-98.7%), and PCTc at 96 hours ≤50% showed the best specificity (70.7%; 95% CI: 54.5%-83.9%). CONCLUSIONS Procalcitonin clearance at 24, 48, 72, and 96 hours poorly predicted hospital and 90-day mortality. Therefore, daily PCT measurement should not be used to predict mortality for patients with cancer and sepsis.
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Affiliation(s)
| | | | | | - Pedro Caruso
- Intensive Care Unit, 139300A.C. Camargo Cancer Center, São Paulo, Brazil.,Intensive Care Unit, Discipline of Pulmonology, University of São Paulo, São Paulo, Brazil
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Bachler M, Hell T, Schausberger L, Schlömmer C, Schäfer V, Liebensteiner M, Schäffler K, Schenk B, Fries D, Innerhofer P, Niederwanger C. Response patterns of routinely measured inflammatory and coagulatory parameters in sepsis. PeerJ 2019; 7:e7147. [PMID: 31275752 PMCID: PMC6590445 DOI: 10.7717/peerj.7147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background Sepsis is characterized by a pro-inflammatory and pro-coagulatory shift which can induce life-threatening complications. Close monitoring and risk stratification of sepsis patients is crucial for proper treatment and consequently patient outcome. Therefore, this study focuses on the response patterns of inflammatory and coagulatory parameters used in clinical routines to estimate the course of sepsis. Methods A total of 1,110 patients diagnosed with sepsis were retrospectively analyzed to identify response patterns for risk stratification of routine parameters measured at the peak level of C-reactive protein. Cluster analysis was used and the differences in the patient characteristics and 28-day survival were assessed. Cox proportional hazards regression model for survival stratified by the clusters was performed. Results The analyses revealed the parameters to have five distinct response patterns. These clusters reflect the etiology as well as the course of sepsis associated with different mortalities. Here, impairment of the liver plays a crucial role in the ability to appropriately respond to sepsis. Of the routinely measured parameters, C-reactive protein and antithrombin seem to be unspecific for stratification of septic patients. Adjusted for the individual clusters, survival was associated with an increase in fibrinogen (p = 0.0042), platelets (p = 0.0003) and PT (p = 0.001) as well as a decrease in leukocytes (p = 0.034). Conclusions This study reveals that patients have distinct response patterns of inflammatory and coagulatory parameters depending on disease etiology. These patterns are associated with different mortalities although the patients have similar levels of C-reactive protein. Independently of the type of response, good coagulatory capacity seems to be crucial for patient survival.
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Affiliation(s)
- Mirjam Bachler
- University for Health Sciences, Medical Informatics and Technology, Institute for Sports Medicine, Alpine Medicine and Health Tourism, Hall, Austria
| | - Tobias Hell
- Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Innsbruck, Austria
| | - Lukas Schausberger
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Schlömmer
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Volker Schäfer
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlies Liebensteiner
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Schäffler
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Schenk
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Petra Innerhofer
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Niederwanger
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
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Hu W, Xie S, Yu F, Hao W. Characteristics of pathogens and mortality predictors of older Chinese patients with nosocomial urinary tract infections. Geriatr Gerontol Int 2019; 19:541-546. [PMID: 30950159 DOI: 10.1111/ggi.13661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 02/05/2023]
Abstract
AIM The aim of the present study was to investigate predominant pathogens and predictors of 28-day mortality of older Chinese patients with nosocomial urinary tract infections (NUTI). METHODS We retrospectively studied 1122 older patients (aged ≥60 years) with culture-positive NUTI in Guangdong General Hospital, Guangzhou, China, from January 2009 to December 2014. The clinical features, microbial distributions and outcomes of these patients were recorded and compared between survival and death patients. Multivariate logistic regression was carried out to identify independent predictors of 28-day mortality. RESULTS The present results showed the all-cause mortality was 8.3%, and NUTI mortality was 1.43%. The proportions of Candida albicans (P = 0.004), Acinetobacter baumannii (P = 0.045) and Candida tropicalis (P < 0.001) in the death group were significantly higher than those in the survival group. Multivariate analysis showed two novel risk factors for mortality of older patients with NUTI, which were higher Charlson Comorbidity Index (odds ratio [OR] 1.205, 95% confidence interval (CI) 1.088-1.334] and lower level of serum prealbumin (OR 0.995, 95% CI 0.990-0.999). Furthermore, previous use of antibiotics (OR 1.984, 95% CI 1.106-3.559), inappropriate antimicrobial therapy (OR 1.883, 95% CI 1.144-3.098), intensive care unit stay (OR 4.082, 95% CI 2.469-6.749) and higher concentration of serum C-reactive protein (OR 1.005, 95% CI 1.001-1.010) were independent prognostic factors for 28-day mortality in older patients with NUTI. CONCLUSIONS NUTI is associated with a high 28-day in-hospital mortality rate in older patients. We should evaluate the comorbidity, nutritional status, inflammatory markers, department staying and drug sensitivity test, and choose systematic therapy strategies for these older patients with NUTI. Geriatr Gerontol Int 2019; 19: 541-546.
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Affiliation(s)
- Wenxue Hu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
| | - Shaoling Xie
- Department of Nephrology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Feng Yu
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
| | - Wenke Hao
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China
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The Importance of Serological Procalcitonin Levels After Autologous Microsurgical Transplantation. J Craniofac Surg 2019; 30:e278-e281. [PMID: 30817542 DOI: 10.1097/scs.0000000000005431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Published data on procalcitonin (PCT) levels after microsurgical interventions are very scarce, although infection within these patients is not only associated with severe morbidity but also significantly higher mortality rates. MATERIAL AND METHODS Retrospective study on 20 patients, who were operated on by a single experienced plastic and reconstructive surgeon within one year (June 2017-June 2018). The authors included all patients, who received microvascular transplants for reconstruction of soft tissue defects. Furthermore, age above 18 years and appropriate documentation allowing sufficient data collection were defined as inclusion criteria. The authors excluded all patients with perioperative systemic inflammation and transplant loss, as our aim was to solely determine and evaluate potential alterations of serological PCT levels after microsurgical interventions. RESULTS The PCT cutoff level to differentiate physiological and pathological levels was defined as 0.1 μg/L. There was no detectable increase in procalcitonin in all of our 20 patients, for whom the authors performed microvascular transplantation to reconstruct soft tissue defects. CONCLUSION Serological PCT levels remain stable after the considered surgical interventions and therefore PCT levels might be utilized to identify systemic inflammation, thus helping to reduce severe complications by early individualized antiinfective treatment strategies.
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Lendak DF, Mihajlović DM, Novakov-Mikić AS, Boban JM, Ubavić M, Brkić SV. APRIL and sTACI could be predictors of multiorgan dysfunction syndrome in sepsis. Virulence 2018; 9:946-953. [PMID: 29781374 PMCID: PMC7000195 DOI: 10.1080/21505594.2018.1462636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 12/29/2022] Open
Abstract
Although the role of B cells in sepsis immunoregulation has become an interesting topic, there is lack of data on the role of B cell function regulators in prediction of multiorgan dysfunction syndrome (MODS). The aim of this study was to evaluate the prognostic value of A Proliferation Inducing Ligand (APRIL) and soluble Transmembrane Activator and CAML Interactor Protein (sTACI), the main B cell function regulators, in prediction of MODS development within the first 48 h after admission to intensive care unit, among septic patients. We included 112 patients with sepsis, treated at Clinic for Infectious Diseases and Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia. Plasma concentrations of APRIL and sTACI were determined at the admission and potential development of MODS was confirmed in the first 48 h. Concentrations of APRIL (p = 0.003) and sTACI (p<0.001) were higher in patients who developed MODS (n = 30). ROC curve analysis showed that AUC for sTACI (AUC = 0.764) was greater than that for procalcitonin (AUC = 0.719) and APRIL (AUC = 0.673) in MODS development prediction. Multivariate regression analysis showed that sTACI, as an anti-inflammatory biomarker stimulating the apoptosis of B cells, was the only independent predictor of MODS, beside SOFA score. Elevated level of sTACI could be the alarm for the increased B cell apoptosis and development of immune paralysis. Including these biomarkers into predictive scores specific for septic patients may potentially improve their sensitivity and specificity. Measurement of their concentrations dynamics could contribute to better assessment of sepsis evolution and timely introduction of immunomodulatory therapy.
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Affiliation(s)
- Dajana F. Lendak
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad; Clinic for Infectious Diseases, Clinical centre of Vojvodina; Hajduk Veljkova 3, Novi Sad, Serbia
| | - Dunja M. Mihajlović
- Department of Anesthesiology and Perioperative Medicine, Faculty of Medicine, University of Novi Sad; Emergency Center, Clinical centre of Vojvodina, Hajduk Veljkova 3, Novi Sad, Serbia
| | - Aleksandra S. Novakov-Mikić
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Novi Sad; Clinical Center of Vojvodina, Clinic of Gynecology and Obstetrics, Hajduk Veljkova 1, Novi Sad, Serbia
| | - Jasmina M. Boban
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 1, Novi Sad, Serbia
| | - Milan Ubavić
- Health Care Institution for Laboratory Diagnostics „Medlab“, Ilije Ognjanovića 1, Novi Sad, Serbia
| | - Snežana V. Brkić
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad; Clinic for Infectious Diseases, Clinical centre of Vojvodina; Hajduk Veljkova 3, Novi Sad, Serbia
- Department of Infectious Diseases, Faculty of Medicine, University of Novi Sad, Clinic for Infectious Diseases, Clinical centre of Vojvodina, Hajduk Veljkova 1, Novi Sad, Serbia
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Kumar S, Tripathy S, Jyoti A, Singh SG. Recent advances in biosensors for diagnosis and detection of sepsis: A comprehensive review. Biosens Bioelectron 2018; 124-125:205-215. [PMID: 30388563 DOI: 10.1016/j.bios.2018.10.034] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/28/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022]
Abstract
Sepsis is one of the leading causes of mortality among critically ill patients globally. According to WHO report 2018, it is estimated to affect beyond 30 million people worldwide every year. It causes loss of human lives, which arise from infection and inflammation and long term stay in intensive care unit (ICU) in hospitals. Despite the availability of satisfactory prognostic markers contributing to the diagnosis of sepsis, millions of people die even after admission to the hospitals. Correct and early diagnosis of sepsis leads to rapid administration of appropriate antibiotics can thus potentially avert the attainment to critical stages of sepsis, thereby saving human lives. Conventional diagnostic practices are costly, time consuming and they lack adequate sensitivity and selectivity, provoking an urgent need for developing alternate sepsis diagnosis systems. Nevertheless, biosensors have the much-treasured scope for reasonable sepsis diagnosis. Advancement in nano-biotechnology has provided new paradigm for biosensor platforms with upgraded features. Here, we provide an overview of the recent advances in biosensors with a brief introduction to sepsis, followed by the conventional methods of diagnosis and bio-sensing. To conclude, a proactive role and an outlook on technologically advanced biosensor platforms are discoursed with possible biomedical applications.
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Affiliation(s)
- Sanni Kumar
- Amity Institute of Biotechnology, Amity University, Jaipur, Rajasthan 303002, India.
| | | | - Anupam Jyoti
- Amity Institute of Biotechnology, Amity University, Jaipur, Rajasthan 303002, India.
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Xu X, Sun Z, Liu J, Zhang J, Liu T, Mu X, Jiang M. Analysis of clinical features and early warning indicators of death from severe fever with thrombocytopenia syndrome. Int J Infect Dis 2018; 73:43-48. [DOI: 10.1016/j.ijid.2018.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 10/16/2022] Open
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Shin HJ, Kang SH, Moon HS, Sung JK, Jeong HY, Kim JS, Joo JS, Lee ES, Kim SH, Lee BS. Serum procalcitonin levels can be used to differentiate between inflammatory and non-inflammatory diarrhea in acute infectious diarrhea. Medicine (Baltimore) 2018; 97:e11795. [PMID: 30095641 PMCID: PMC6133584 DOI: 10.1097/md.0000000000011795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, we assess the possibility of using procalcitonin levels to differentiate between inflammatory diarrhea and non-inflammatory diarrhea in acute infectious diarrhea.We reviewed the records of 1176 patients who had symptoms of diarrhea, fever (≥37.8 °C), and abdominal pain between March 2011 and May 2015. After applying exclusion criteria, a sample of 514 patients was considered for study. The patient sample was divided into Group A and Group B for inflammatory diarrhea and non-inflammatory diarrhea, respectively. The assessment involved comparing the laboratory characteristics with the clinical characteristics of the groups.The characteristics of Group A, such as white blood cell (WBC), C-reactive protein (CRP), absolute neutrophil count (ANC), and procalcitonin levels, were relatively higher than those of Group B (P < .001 for Group A). A receiver operator characteristic (ROC) analysis revealed that the highest area-under-the-curve (AUC) value of procalcitonin (0.797; 95% confidence interval [CI] [0.760, 0.831]; P < .001), could be used to differentiate between the 2 groups. Procalcitonin exhibited a sensitivity and a specificity of 87.03% and 68.75%, respectively, at a 0.08 ng/mL cut-off level.Procalcitonin was a good candidate biomarker of inflammatory diarrhea than other inflammatory markers.
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Affiliation(s)
- Hae Jin Shin
- Division of Gastroenterology, Department of Internal Medicine, Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Chungcheongbuk-do
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hee Seok Moon
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jae Kyu Sung
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Ju Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jong Seok Joo
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Eaum Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Seok Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Byung Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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Procalcitonin Clearance and Prognosis in Sepsis: Are There Really an Optimal Cutoff and Time Interval? Crit Care Med 2017; 45:e1097-e1098. [PMID: 28915193 DOI: 10.1097/ccm.0000000000002552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA, Runyon MS, Self WH, Courtney DM, Nowak RM, Gaieski DF, Ebmeyer S, Johannes S, Wiemer JC, Schwabe A, Shapiro NI. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med 2017; 45:781-789. [PMID: 28257335 PMCID: PMC5389588 DOI: 10.1097/ccm.0000000000002321] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. DESIGN Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-approved protocol. SETTING Thirteen U.S.-based emergency departments and ICUs. PATIENTS Consecutive patients meeting criteria for severe sepsis or septic shock who were admitted to the ICU from the emergency department, other wards, or directly from out of hospital were included. INTERVENTIONS Procalcitonin was measured daily over the first 5 days. MEASUREMENTS AND MAIN RESULTS The primary analysis of interest was the relationship between a procalcitonin decrease of more than 80% from baseline to day 4 and 28-day mortality using Cox proportional hazards regression. Among 858 enrolled patients, 646 patients were alive and in the hospital on day 4 and included in the main intention-to-diagnose analysis. The 28-day all-cause mortality was two-fold higher when procalcitonin did not show a decrease of more than 80% from baseline to day 4 (20% vs 10%; p = 0.001). This was confirmed as an independent predictor in Cox regression analysis (hazard ratio, 1.97 [95% CI, 1.18-3.30; p < 0.009]) after adjusting for demographics, Acute Physiology and Chronic Health Evaluation II, ICU residence on day 4, sepsis syndrome severity, antibiotic administration time, and other relevant confounders. CONCLUSIONS Results of this large, prospective multicenter U.S. study indicate that inability to decrease procalcitonin by more than 80% is a significant independent predictor of mortality and may aid in sepsis care.
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Affiliation(s)
- Philipp Schuetz
- 1Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; and Medical Faculty, University of Basel, Switzerland. 2Department of Emergency Medicine, New York Methodist Hospital, New York, NY. 3Emergency Departments, Sinai Grace Hospital and Detroit Receiving Hospital, Detroit, MI. 4Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS. 5Department of Emergency Medicine, Stony Brook University, Stony Brook, NY. 6Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC. 7Department of Emergency Medicine, Vanderbilt University, Nashville, TN. 8Department of Emergency Medicine, Northwestern University, Chicago, IL. 9Department of Emergency Medicine, Henry Ford Health System, Detroit, MI. 10Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. 11Global Medical Affairs, B·R·A·H·M·S GmbH, Hennigsdorf, Germany. 12Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Zhang B, Sun GZ, Zhu ML, Li Y, Sun DJ, Zhang B, Bai XP. The plasma levels of CST and BCKDK in patients with sepsis. Peptides 2016; 86:80-84. [PMID: 27773658 DOI: 10.1016/j.peptides.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/09/2016] [Accepted: 10/18/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES CST has been recently identified as a mediator of various beneficial effects in animal models of sepsis. At present, no data are available concerning the levels of CST in sepsis patients. In sepsis the plasma amino acid pattern is characterized by decreased branced chain amino acids (BCAAs). We investigated the levels of plasma CST or branched-chain α-ketoacid dehydrogenase kinase (BCKDK) and their relationship to component traits in patients with sepsis. DESIGN AND METHODS We studied 228 patients and divided them into two groups based on severity of infection. Blood samples were taken at study entry, and CST, BCKDK were measured. RESULTS CST and BCKDK levels were significantly higher in patients with sepsis than in controls: the median plasma CST concentration was 103.1ng/ml (range, <83.13-189.7ng/ml) in patients with sepsis and 49.69ng/ml (range, <19.38-100.8ng/ml) in controls (p=0.0022); the median plasma BCKDK concentration was 801.7ng/ml in sepsis group and 745ng/ml in controls (p=0.0292). Additionally, there was correlation between the plasma concentrations of CST and BCKDK in sepsis patients (r2=0.6357, p<0.01). CONCLUSIONS We conclude that the plasma levels of CST in sepsis patients were higher than in controls, and there is a relationship between CST and BCKDK in sepsis patients. Future experimental and clinical studies are needed to evaluate CST as a novel prognostic tool in sepsis patients and its potential therapeutic use in sepsis.
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Affiliation(s)
- Bo Zhang
- Department of Cardiology, The fourth affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Gui-Zhi Sun
- Department of Cardiology, The fourth affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Min-Ling Zhu
- Department of Emergency, First affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yue Li
- Department of ICU, Second affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Dian-Jun Sun
- Center for Endemic Disease Control, Harbin Medical University, Harbin 150086, China
| | - Bo Zhang
- Department of Cardiology, The fourth affiliated Hospital of Harbin Medical University, Harbin 150001, China.
| | - Xiu-Ping Bai
- Department of Cardiology, The fourth affiliated Hospital of Harbin Medical University, Harbin 150001, China.
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Serum Procalcitonin and Procalcitonin Clearance as a Prognostic Biomarker in Patients with Severe Sepsis and Septic Shock. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1758501. [PMID: 27088084 PMCID: PMC4818793 DOI: 10.1155/2016/1758501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/29/2022]
Abstract
We evaluated the tendency of the plasma concentration and procalcitonin (PCT) clearance (PCTc) to act as biomarkers of prognosis in patients with severe sepsis and septic shock. From 2011 to 2013, we prospectively analyzed patients with sepsis admitted to the intensive care unit (ICU). The serum PCT was evaluated at the time of sepsis diagnosis and again after 48 h (day 3) and 96 h (day 5). PCTc after 48 h (PCTc-day 3) and 96 h (PCTc-day 5) was also calculated to evaluate the prognostic value for survival in patients with sepsis. A total of 48 patients were included. Overall mortality was 16.7% (8 patients). PCTc was higher in survivors than in nonsurvivors, with significant differences on day 3 and day 5 (p = 0.033; p = 0.002, resp.); however, serum PCT levels on day 1, day 3, and day 5 were not significant prognostic factors for survival. The prognosis of patients with severe sepsis and septic shock may be associated with PCTc. Dynamic changes of PCT reflected as PCTc at 48 h (day 3) and 96 h (day 5) after admission to the ICU may serve as a predictor of survival in critically ill patients with severe sepsis.
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Biron BM, Ayala A, Lomas-Neira JL. Biomarkers for Sepsis: What Is and What Might Be? Biomark Insights 2015; 10:7-17. [PMID: 26417200 PMCID: PMC4571989 DOI: 10.4137/bmi.s29519] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 12/29/2022] Open
Abstract
Every year numerous individuals develop the morbid condition of sepsis. Therefore, novel biomarkers that might better inform clinicians treating such patients are sorely needed. Difficulty in identifying such markers is in part due to the complex heterogeneity of sepsis, resulting from the broad and vague definition of this state/condition based on numerous possible clinical signs and symptoms as well as an incomplete understanding of the underlying pathobiology of this complex condition. This review considers some of the attempts that have been made so far, looking at both the pro- and anti-inflammatory response to sepsis, as well as genomic analysis, as sources of potential biomarkers. Irrespective, for functional biomarker(s) of sepsis to successfully translate from the laboratory to a clinical setting, the biomarker must be target specific and sensitive as well as easy to implement/interpret, and be cost effective, such that they can be utilized routinely in patient diagnosis and treatment.
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Affiliation(s)
- Bethany M Biron
- Division of Surgical Research, Department of Surgery, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Alfred Ayala
- Division of Surgical Research, Department of Surgery, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Joanne L Lomas-Neira
- Division of Surgical Research, Department of Surgery, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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Liu D, Su L, Han G, Yan P, Xie L. Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0129450. [PMID: 26076027 PMCID: PMC4468164 DOI: 10.1371/journal.pone.0129450] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/09/2015] [Indexed: 02/06/2023] Open
Abstract
Procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. However, studies have produced conflicting results. The purpose of the present meta-analysis is to explore the diagnostic accuracy of a single PCT concentration and PCT non-clearance in predicting all-cause sepsis mortality. We searched PubMed, Embase, Web of Knowledge and the Cochrane Library. Articles written in English were included. A 2 × 2 contingency table was constructed based on all-cause mortality and PCT level or PCT non-clearance in septic patients. Two authors independently evaluated study eligibility and extracted data. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I2 index to test heterogeneity. Twenty-three studies with 3,994 patients were included. An elevated PCT level was associated with a higher risk of death. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05–3.30) using a random-effects model (I2 = 63.5%). The overall area under the summary receiver operator characteristic (SROC) curve was 0.77 (95% CI, 0.73–0.80), with a sensitivity and specificity of 0.76 (95% CI, 0.67–0.82) and 0.64 (95% CI, 0.52–0.74), respectively. There was significant evidence of heterogeneity for the PCT testing time (P = 0.020). Initial PCT values were of limited prognostic value in patients with sepsis. PCT non-clearance was a prognostic factor of death in patients with sepsis. The pooled RR was 3.05 (95% CI, 2.35–3.95) using a fixed-effects model (I2 = 37.9%). The overall area under the SROC curve was 0.79 (95% CI, 0.75–0.83), with a sensitivity and specificity of 0.72 (95% CI, 0.58–0.82) and 0.77 (95% CI, 0.55–0.90), respectively. Elevated PCT concentrations and PCT non-clearance are strongly associated with all-cause mortality in septic patients. Further studies are needed to define the optimal cut-off point and the optimal definition of PCT non-clearance for accurate risk assessment.
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Affiliation(s)
- Dan Liu
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Medical School, Nankai University, 94 Weijin Road, Tianjin, 300071, China
- Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin, 300070, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100005, China
| | - Gencheng Han
- Laboratory of Immunology, Institute of Basic Medical Sciences, Beijing, 100850, China
| | - Peng Yan
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Lixin Xie
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- * E-mail:
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Poddar B, Gurjar M, Singh S, Aggarwal A, Singh R, Azim A, Baronia A. Procalcitonin kinetics as a prognostic marker in severe sepsis/septic shock. Indian J Crit Care Med 2015; 19:140-6. [PMID: 25810608 PMCID: PMC4366911 DOI: 10.4103/0972-5229.152755] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS To evaluate the prognostic value of change (fall) in serum procalcitonin level (PCT) in critically ill adults with severe sepsis/septic shock. METHODS This was a prospective observational study in a general purpose Intensive Care Unit of a teaching Institute. PCT was measured at admission (D0) and after 72-96 h (D4) by electrochemi-luminescence immunoassay (BRAHMS PCT kit) in adults (>18 years) admitted with severe sepsis or septic shock. Change in procalcitonin values from D0 to D4 was correlated with the primary outcome, that is, 28 days mortality. All results are reported as median (interquartile range). RESULTS A total of 171 (100 males) of 181 patients were included. The median age was 46 years (range 19-79). 137 patients were in septic shock and 34 in severe sepsis. The sequential organ failure assessment (SOFA) score in all patients was 11 (9-14).91 (53.2%) patients survived at 28 days (survivors). The baseline procalcitonin was similar in two groups (3.48 [1.04-15.85] vs. 5.27 [1.81-23.57] ng/ml in survivors and nonsurvivors [NS] respectively). The procalcitonin change was 1.58 (0.20-8.52) in survivors and 0.28 (-1.38-6.17) in NS (P = 0.01). The C-statistic of percentage change in procalcitonin from D0 to D4 to predict survival was 0.73 (95% confidence interval [CI]: 0.65-0.82) when compared to 0.78 (95% CI: 0.71-0.86) for change of SOFA score. For an absolute fall in procalcitonin of >1 ng/ml, a 70% fall predicted survival with 75% sensitivity and 64% specificity. CONCLUSIONS In critically ill-patients with severe sepsis/septic shock, change (fall) in procalcitonin is associated with good outcome.
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Affiliation(s)
- Banani Poddar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushma Singh
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ratender Singh
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arvind Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Prognostic evaluation of severe sepsis and septic shock: procalcitonin clearance vs Δ Sequential Organ Failure Assessment. J Crit Care 2014; 30:219.e9-12. [PMID: 25241933 DOI: 10.1016/j.jcrc.2014.08.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the study is to compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the 48-hour Δ Sequential Organ Failure Assessment (SOFA). MATERIALS AND METHODS Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The PCT-c was determined at the diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of intensive care unit admission and after 48 hours. RESULTS One hundred thirty adult patients with severe sepsis and septic shock were studied over an 18-month period. The 24- and 48-hour PTC-c scores were significantly higher in survivors (P < .0001). In nonsurvivors, the initial SOFA was significantly higher, and the 48-hour Δ SOFA was significantly smaller (P = .01). The area under the receiver operating characteristic curve was 0.68 for Δ SOFA and 0.76 for 24- and 48-hour PCT-c. CONCLUSIONS The 48-hour Δ SOFA score and the clearance of 24- and 48-hour PCT are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should prompt the reassessment of the appropriateness and adequacy of treatment.
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García de Guadiana-Romualdo LM, Rebollo-Acebes S, Esteban-Torrella P, Jiménez-Sánchez R, Hernando-Holgado A, Ortín-Freire A, Viqueira-González M, Trujillo-Santos J, Jiménez Santos E, Pedregosa Díaz J, Albaladejo-Otón MD, Allegue-Gallego JM. [Prognostic value of lipopolysaccharide binding protein and procalcitonin in patients with severe sepsis and septic shock admitted to intensive care]. Med Intensiva 2014; 39:207-12. [PMID: 24953001 DOI: 10.1016/j.medin.2014.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 04/21/2014] [Accepted: 04/24/2014] [Indexed: 01/17/2023]
Abstract
AIMS 1) To assess the prognostic value of levels on admission and serial measurements of lipopolysaccharide binding protein (LBP) and procalcitonin (PCT) in relation to in-hospital mortality; and 2) to determine whether the addition of these parameters to severity scores (APACHE II and SOFA) is able to improve prognostic accuracy. DESIGN A single-center, prospective observational study was carried out. SETTING Intensive Care unit of a university hospital. PATIENTS One hundred severe sepsis and septic shock patients were included. DATA COLLECTED Demographic data, APACHE II and SOFA scores, PCT and LBP levels on admission and after 48 hours, and in-hospital mortality. RESULTS The best area under the curve for predicting in-hospital mortality corresponded to APACHE II on admission and SOFA after 48 h (AUC ROC: 0.75 for both). PCT and LBP levels on admission and LBP clearance were not statistically different between in-hospital survivors and non-survivors. Only PCT clearance was higher among in-hospital survivors than in non-survivors (AUC ROC: 0.66). The combination of severity scores and PCT clearance did not result in superior areas under the curve. CONCLUSIONS LBP and PCT levels on admission and LBP clearance showed no prognostic value in severe sepsis and septic shock patients. Only PCT clearance was predictive of in-hospital mortality. The prognostic accuracy was significantly better for APACHE on admission and SOFA after 48 h than for any of the analyzed biomarkers, and the addition of PCT clearance did not improve their prognostic value.
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Affiliation(s)
| | - S Rebollo-Acebes
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | - P Esteban-Torrella
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - R Jiménez-Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | - A Hernando-Holgado
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - A Ortín-Freire
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | - M Viqueira-González
- Servicio de Microbiología y Parasitología, Hospital Universitario Santa Lucía, Cartagena, España
| | - J Trujillo-Santos
- Servicio de Medicina Interna, Hospital Universitario Santa Lucía, Cartagena, España
| | - E Jiménez Santos
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - J Pedregosa Díaz
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - M D Albaladejo-Otón
- Servicio de Análisis Clínicos, Hospital Universitario Santa Lucía, Cartagena, España
| | - J M Allegue-Gallego
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
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Julián-Jiménez A, Candel-González FJ, González del Castillo J. Utilidad de los biomarcadores de inflamación e infección en los servicios de urgencias. Enferm Infecc Microbiol Clin 2014; 32:177-90. [DOI: 10.1016/j.eimc.2013.01.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/17/2012] [Accepted: 01/08/2013] [Indexed: 11/15/2022]
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Procalcitonin clearance for early prediction of survival in critically ill patients with severe sepsis. Crit Care Res Pract 2014; 2014:819034. [PMID: 24719759 PMCID: PMC3955692 DOI: 10.1155/2014/819034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 12/19/2022] Open
Abstract
Introduction. Serum procalcitonin (PCT) diagnosed sepsis in critically ill patients; however, its prediction for survival is not well established. We evaluated the prognostic value of dynamic changes of PCT in sepsis patients. Methods. A prospective observational study was conducted in adult ICU. Patients with systemic inflammatory response syndrome (SIRS) were recruited. Daily PCT were measured for 3 days. 48 h PCT clearance (PCTc-48) was defined as percentage of baseline PCT minus 48 h PCT over baseline PCT. Results. 95 SIRS patients were enrolled (67 sepsis and 28 noninfectious SIRS). 40% patients in the sepsis group died in hospital. Day 1-PCT was associated with diagnosis of sepsis (AUC 0.65 (95% CI, 0.55 to 0.76)) but was not predictive of mortality. In sepsis patients, PCTc-48 was associated with prediction of survival (AUC 0.69 (95% CI, 0.53 to 0.84)). Patients with PCTc-48 > 30% were independently associated with survival (HR 2.90 (95% CI 1.22 to 6.90)). Conclusions. PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; however, the small sample size, and a single-centre study, may limit the generalisability of the finding. This would benefit from replication in future multicentre study.
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Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis. Mater Sociomed 2013; 25:277-81. [PMID: 24511275 PMCID: PMC3914751 DOI: 10.5455/msm.2013.25.277-281] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/20/2013] [Indexed: 01/22/2023] Open
Abstract
The clinical utility of serum procalcitonin (PCT) levels continues to evolve. PCT is regarded as a promising candidate marker for making a diagnosis and antibiotic stewardship in patients with systemic infections. The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and to discuss the reliability of this marker when used with validated diagnostic algorithms.
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Affiliation(s)
- Snjezana Mehanic
- Clinic for Infectious diseases, Clinical Centre University of Sarajevo 2, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Rusmir Baljic
- Clinic for Infectious diseases, Clinical Centre University of Sarajevo 2, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina
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Papel de las quimioquinas solubles circulantes en el shock séptico. Med Intensiva 2013; 37:510-8. [DOI: 10.1016/j.medin.2012.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/13/2012] [Accepted: 09/24/2012] [Indexed: 01/31/2023]
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Sotillo-Díaz JC, Bermejo-López E, García-Olivares P, Peral-Gutiérrez JA, Sancho-González M, Guerrero-Sanz JE. [Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis]. Med Intensiva 2013; 38:337-46. [PMID: 24035696 DOI: 10.1016/j.medin.2013.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia. DESIGN A systematic review of publications prospectively assessing the diagnostic role of PCT in ventilator-associated pneumonia was carried out. The search was performed using Medline, Embase, the Cochrane Collaboration and MEDION, with reviewing of the references of retrieved articles. We extracted data that allowed the calculation of sensitivity, specificity, likelihood ratios and diagnostic odds ratio. Intervention Metaregression was performed to determine whether exposure to previous antibiotic treatment, the time to occurrence of ventilator-associated pneumonia and the type of patients had an impact upon the diagnostic performance of procalcitonin. RESULTS Seven studies were considered (373 patients, 434 episodes). We found no publication bias or threshold effect. High plasma PCT levels were associated to an increased risk of suffering ventilator-associated pneumonia (OR: 8.39; 95% CI: 5.4-12.6). The pooled data on sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio found were 76% (69-82), 79% (74-84), 4.35 (2.48-7.62), 0.26 (0.15-0.46) and 17.9 (10.1-31.7), respectively. Diagnostic yield was modified by prior exposure to antibiotics (rDOR 0.11, 0.02-0.069), but not by the type of critically ill patient or the time to occurrence of ventilator-associated pneumonia. CONCLUSIONS Our results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness.
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Affiliation(s)
- J C Sotillo-Díaz
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - E Bermejo-López
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P García-Olivares
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J A Peral-Gutiérrez
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Sancho-González
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J E Guerrero-Sanz
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, España
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Ruiz-Rodríguez J, Rello J. Predicting treatment failure in severe sepsis and septic shock: looking for the Holy Grail. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:180. [PMID: 24004571 PMCID: PMC4057107 DOI: 10.1186/cc12877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Procalcitonin has been proposed as a specific biomarker of bacterial infections and has been related to the severity of sepsis. The prognostic ability of the initial concentrations of procalcitonin in sepsis is controversial. Some studies find higher initial concentrations in non-survivors but others find no differences. Prognostic assessment based on follow-up of procalcitonin levels may be better than evaluation of the initial levels of procalcitonin. The persistence of elevated procalcitonin levels is indicative of poor prognosis and is associated with mortality. Procalcitonin kinetics could be a tool for assessing the evolution of severe sepsis and sepsis shock. Procalcitonin should find its place as a biomarker for predicting treatment failure of severe sepsis and septic shock.
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Suberviola B, Castellanos-Ortega A, Ruiz Ruiz A, Lopez-Hoyos M, Santibañez M. Hospital mortality prognostication in sepsis using the new biomarkers suPAR and proADM in a single determination on ICU admission. Intensive Care Med 2013; 39:1945-52. [PMID: 23949703 DOI: 10.1007/s00134-013-3056-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 07/29/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE The soluble form of the urokinase-type plasminogen activator receptor (suPAR) and proadrenomedullin (proADM) are two new and promising sepsis biomarkers. We assessed the prognostic value of a single determination of proADM and suPAR, comparing them with C-reactive protein (CRP) and procalcitonin (PCT), and evaluating whether their addition to severity scores (APACHE II and SOFA) could improve their prognostic accuracy. METHODS A single-centre prospective observational study conducted in an adult intensive care department at Marques de Valdecilla University Hospital in Spain. APACHE II and SOFA scores, CRP, PCT, suPAR and proADM levels on the day of ICU admission were collected. RESULTS A total of 137 consecutive septic patients were studied. The best area under the curve (AUC) for the prediction of in-hospital mortality was for APACHE II (0.82) and SOFA (0.75) scores. The ROC curve for suPAR yielded an AUC of 0.67, higher than proADM (0.62), CRP (0.50) and PCT (0.44). Significant dose-response trends were found between hospital mortality and suPAR (OR Q4 = 4.83, 95% CI 1.60-14.62) and pro-ADM (OR Q4 = 3.00, 95% CI 1.06-8.46) quartiles. Non-significant associations were found for PCT and CRP. The combination of severity scores and each biomarker did not provide superior AUCs. CONCLUSIONS SuPAR and, to a lesser extent, proADM levels on ICU admission were better tools in prognosticating in-hospital mortality than CRP or PCT. However, neither of the two new biomarkers has been demonstrated to be excessively useful in the current setting. The prognostic accuracy was better for severity scores than for any of the biomarkers.
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Affiliation(s)
- B Suberviola
- Intensive Care Department, University Hospital Marques de Valdecilla-IFIMAV, Avenida de Valdecilla s/n, 39008, Santander, Spain,
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Substantially elevated C-reactive protein (CRP), together with low levels of procalcitonin (PCT), contributes to diagnosis of fungal infection in immunocompromised patients. Support Care Cancer 2013; 21:2733-42. [DOI: 10.1007/s00520-013-1844-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 05/07/2013] [Indexed: 02/06/2023]
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Consideraciones en relación con el valor pronóstico de la procalcitonina en la sepsis grave y el shock séptico. Med Intensiva 2013; 37:123-4. [DOI: 10.1016/j.medin.2012.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 11/19/2012] [Indexed: 11/23/2022]
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Suberviola B, Castellanos-Ortega A, Ballesteros M, Zurbano F, Naranjo S, Miñambres E. Early identification of infectious complications in lung transplant recipients using procalcitonin. Transpl Infect Dis 2012; 14:461-7. [DOI: 10.1111/j.1399-3062.2012.00780.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/01/2012] [Accepted: 04/26/2012] [Indexed: 11/28/2022]
Affiliation(s)
- B. Suberviola
- Intensive Care Department; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - A. Castellanos-Ortega
- Intensive Care Department; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - M.A. Ballesteros
- Intensive Care Department; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - F. Zurbano
- Department of Respiratory Medicine; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
| | - S. Naranjo
- Department of Thoracic Surgery; University Hospital Marqués de Valdecilla-IFIMAV; Santander; Spain
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Moretti D, Ramírez MM, Settecase CJ, Bagilet DH, Quaglino MB. [Usefulness of procalcitonin upon admission to intensive care in the diagnosis and prognosis of sepsis]. Med Intensiva 2012; 37:156-62. [PMID: 22658964 DOI: 10.1016/j.medin.2012.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/29/2012] [Accepted: 03/31/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the usefulness of procalcitonin (PCT) upon admission to the Intensive Care Unit (ICU) in the diagnosis and prognosis of sepsis DESIGN A 12-month prospective observational cohort study was carried out SETTING An 11-bed polyvalent ICU Belonging to a University hospital PATIENTS Fifty patients with systemic inflammatory response syndrome (SIRS) were included. The mean age of the patients was 51.66 years, and 68% of them were males VARIABLES OF INTEREST Upon admission, the concentration of PCT and C-reactive protein (CRP) was assessed. At discharge, the final diagnosis and outcome were reviewed RESULTS Thirty-six patients had sepsis. Mean PCT ± SD was higher in sepsis than in non-infectious SIRS (19.3 ± 4.9 vs. 0.65 ± 0.2) ng/ml) (P=.001). PCT had greater discriminating power than CRP (AUC 0.932 vs. 0.827). The cut-off value of PCT for the diagnosis of sepsis was 0.92 ng/dl, with a sensitivity of 80.56%, specificity 85.71%, positive predictive value 93.55% and negative predictive value 63.16%, LR+ 5.64 and LR- 0.23. Mortality was higher in patients with sepsis (52.78% vs. 21.43%) (P=.039). Mean PCT ± SD upon admission among survivors and deceased patients with sepsis was 18.7 ± 6.7 and 19.5 ± 7.5 ng/ml, respectively (P=.934). CONCLUSIONS PCT upon admission to the ICU is useful for the diagnosis of sepsis, and is more effective than PCR in this respect. However, it is of no help in estimating the short-term prognosis.
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Affiliation(s)
- D Moretti
- Unidad de Terapia Intensiva, Hospital Escuela Eva Perón, Granadero Baigorria (Gran Rosario), Santa Fe, Argentina.
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