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Koho N, Rajamäki MM, Viitanen SJ. Serum procalcitonin as a diagnostic biomarker in dogs with bacterial respiratory diseases. Vet Clin Pathol 2024; 53:273-279. [PMID: 38730224 DOI: 10.1111/vcp.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/11/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Procalcitonin (PCT) is a useful biomarker in humans in the identification of bacterial respiratory infections. OBJECTIVES The aim of this study was to investigate the utility of serum PCT measurements as a diagnostic biomarker in canine bacterial lower respiratory tract diseases. METHODS PCT concentrations were measured in serum samples with an ELISA method previously validated for dogs. All dogs underwent thorough clinical examinations, and the diagnosis of respiratory disease was based on clinical and laboratory findings, diagnostic imaging, as well as cytology and bacterial culture of respiratory samples. PCT concentrations between different cohorts of dogs were compared with an ANOVA-model. RESULTS Sixty-two privately owned dogs with respiratory diseases, 25 with bacterial pneumonia (BP), 17 with bacterial bronchitis caused by Bordetella bronchiseptica (BB), and 20 with chronic bronchitis (CB) as well as 44 healthy controls were included in the study. Serum PCT concentrations in dogs with bacterial respiratory diseases (BP mean 51.8 ng/L ± standard deviation [SD] 40.6 ng/L and BB mean 61.4 ng/L ± SD 35.3 ng/L) were not significantly different when compared with dogs with a non-bacterial respiratory disease (CB mean 89.7 ± SD 73.5 ng/L) or healthy dogs (mean 51.0 ng/L ± SD 37.5 ng/L, p > .05 in all comparisons). CONCLUSIONS These results indicate that despite being a valuable diagnostic, prognostic, and follow-up marker in humans with pneumonia, serum PCT concentrations are not elevated in dogs with bacterial respiratory diseases and, therefore, cannot be used as a diagnostic biomarker in dogs.
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Affiliation(s)
- N Koho
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - M M Rajamäki
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - S J Viitanen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Adamkova V, Adamkova VG, Kroneislova G, Zavora J, Kroneislova M, Huptych M, Lahoda Brodska H. Increasing Rate of Fatal Streptococcus pyogenes Bacteriemia-A Challenge for Prompt Diagnosis and Appropriate Therapy in Real Praxis. Microorganisms 2024; 12:995. [PMID: 38792824 PMCID: PMC11124258 DOI: 10.3390/microorganisms12050995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Streptococcus pyogenes, group A streptococci (GAS) bacteriaemia, is a life-threatening infection with high mortality, requiring fast diagnosis together with the use of appropriate antibiotic therapy as soon as possible. Our study analysed data from 93 patients with GAS bacteraemia at the General University Hospital in Prague between January 2006 and March 2024. In the years 2016-2019 there was an increase in GAS bacteraemia. Mortality in the period 2006-2019 was 21.9%; in the period 2020-2024, the mortality increased to 41.4%, p = 0.08. At the same time, in the post-2020 period, the time from hospital admission to death was reduced from 9.5 days to 3 days. A significant predictor of worse outcome in this period was high levels of procalcitonin, >35.1 µg/L (100% sensitivity and 82.35% specificity), and lactate, >5 mmol/L (90.91% sensitivity and 91.67% specificity). Myoglobin was a significant predictor in both compared periods, the AUC was 0.771, p = 0.044, and the AUC was an even 0.889, p ≤ 0.001, respectively. All isolates of S. pyogenes were susceptible to penicillin, and resistance to clindamycin was 20.3% from 2006-2019 and 10.3% in 2020-2024. Appropriate therapy was initiated in 89.1%. and 96.6%, respectively. We hypothesise that the increase in mortality after 2020 might be due to a decrease in the immune status of the population.
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Affiliation(s)
- Vaclava Adamkova
- Clinical Microbiology and ATB Centre, General University Hospital, 128 08 Prague, Czech Republic
| | | | - Gabriela Kroneislova
- Clinical Microbiology and ATB Centre, General University Hospital, 128 08 Prague, Czech Republic
| | - Jan Zavora
- Clinical Microbiology and ATB Centre, General University Hospital, 128 08 Prague, Czech Republic
- Department of Medical Microbiology, Palacky University, 779 00 Olomouc, Czech Republic
| | - Marie Kroneislova
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Department of Surgery, University Hospital Bulovka, 180 00 Prague, Czech Republic
| | - Michal Huptych
- Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University in Prague, 160 00 Prague, Czech Republic
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Roch PJ, Ecker C, Jäckle K, Meier MP, Reinhold M, Klockner FS, Lehmann W, Weiser L. Interleukin-6 as a critical inflammatory marker for early diagnosis of surgical site infection after spine surgery. Infection 2024:10.1007/s15010-024-02271-4. [PMID: 38709460 DOI: 10.1007/s15010-024-02271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Early diagnosis of surgical site infections (SSIs) could prevent surgical revision. Inflammatory markers (IMs), such as procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α), seem more accurate in diagnosing SSI than C-reactive protein (CRP) and white blood cell (WBC) count. The aim was to compare the predictive values of CRP, WBC count, PCT, IL-6, and TNF-α in SSI detection. METHODS A total of 130 patients undergoing dorsal spondylodesis from 2019 to 2024 were enrolled in a prospective diagnostic study at a maximum care spine center. IMs were measured preoperatively and on the postoperative days (PODs) 1, 2, 3, 5, and 7. Patients with high suspicion of SSI underwent revision surgery. SSI was diagnosed when the microbiological evidence was positive. Patients were divided a posteriori into the non-infection and infection groups. RESULTS IMs of 118 patients (66.9 ± 13.0 years, 61.0% females) were measured. Fifteen of the 118 patients (12.7%) developed an SSI. The groups differed with respect to existing hypertension, number of instrumented segments, region of surgery, CRPPOD1,7, PCTPOD7, and IL-6POD3,5,7. Binary logistic regression for SSI detection including these parameters showed an area under the curve (AUC) of 0.88 (95% CI 0.79-0.98; P < 0.001). The main effect for SSI detection was maintained by IL-6POD7 (odds ratio = 1.13; 95% CI 1.05-1.23; P = 0.001), which itself showed an AUC of 0.86 (95% CI 0.75-0.97). CONCLUSION Compared to CRP, WBC count, PCT, and TNF-α, IL-6 seems to be the critical IM for the early detection of an SSI. TRIAL REGISTRATION drks.de: DRKS00033773, date of registration: 29.02.2024, retrospectively registered; Postoperative Markers of Inflammation in Spine Surgery (POMIS) Trial.
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Affiliation(s)
- Paul Jonathan Roch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Carolin Ecker
- Department of Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Katharina Jäckle
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Marc-Pascal Meier
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Maximilian Reinhold
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Friederike Sophie Klockner
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Lukas Weiser
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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4
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Girardi P, Buono R, Bisazza C, Marchi L, Angeli P, Di Pascoli M. Prognostic value of procalcitonin in patients with cirrhosis hospitalized for acute infection. Dig Liver Dis 2024; 56:810-817. [PMID: 37845154 DOI: 10.1016/j.dld.2023.10.004] [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: 05/15/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND In patients with cirrhosis, infections significantly increase the risk of short and long-term mortality. During infection, the levels of procalcitonin increase, but it has not yet been clarified its prognostic value in subjects with cirrhosis. Therefore, the aim of this study was to evaluate the prognostic role of procalcitonin in patients with liver cirrhosis hospitalized for acute infection, and to compare it with other markers of infection. PATIENTS We included 279 patients hospitalized because of infection, 133 with liver cirrhosis. At admission the levels of the main biochemical parameters of infection, i.e. leukocytes, procalcitonin, C reactive protein and lactate, were considered. RESULTS The duration of hospitalization and antibiotic therapy were longer in patients with cirrhosis, while no difference was observed for mortality. In both groups, a correlation with the duration of hospitalization and antibiotic therapy was observed for high levels of procalcitonin. In the cirrhotic population, in particular, higher procalcitonin values were associated with an increase in the length of hospitalization and antibiotic therapy, suggesting an even greater predictive value for those patients. High levels of leucocytes and lactate were positively associated with the duration of hospitalization, but not with the duration of antibiotic therapy. For mortality, the strongest correlation was found for high serum lactate levels, regardless of the presence of cirrhosis. CONCLUSION In patients with cirrhosis and acute infection, the value of procalcitonin at admission is a good prognostic indicator for the course of hospitalization, and could be useful for guiding the management and treatment of hospitalized patients.
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Affiliation(s)
- Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari, University of Venice, Italy
| | - Raffaele Buono
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Camilla Bisazza
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Luisa Marchi
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Marco Di Pascoli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padova, Padova, Italy.
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Pizzi MA, Busl KM. Procalcitonin As Diagnostic Tool for CNS Infections-Overall, Not Good Enough (Yet?). Crit Care Med 2024; 52:163-165. [PMID: 38095527 DOI: 10.1097/ccm.0000000000006075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Michael A Pizzi
- Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL
- Department of Neurosurgery, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL
| | - Katharina M Busl
- Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL
- Department of Neurosurgery, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL
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Lu CY, Kao CL, Hung KC, Wu JY, Hsu HC, Yu CH, Chang WT, Feng PH, Chen IW. Diagnostic efficacy of serum presepsin for postoperative infectious complications: a meta-analysis. Front Immunol 2023; 14:1320683. [PMID: 38149257 PMCID: PMC10750271 DOI: 10.3389/fimmu.2023.1320683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023] Open
Abstract
Background Postoperative infectious complications (PICs) are major concerns. Early and accurate diagnosis is critical for timely treatment and improved outcomes. Presepsin is an emerging biomarker for bacterial infections. However, its diagnostic efficacy for PICs across surgical specialties remains unclear. Methods In this study, a systematic search on MEDLINE, Embase, Google Scholar, and Cochrane Library was performed on September 30, 2023, to identify studies that evaluated presepsin for diagnosing PICs. PIC is defined as the development of surgical site infection or remote infection. Pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were calculated. The primary outcome was the assessment of the efficacy of presepsin for PIC diagnosis, and the secondary outcome was the investigation of the reliability of procalcitonin or C-reactive protein (CRP) in the diagnosis of PICs. Results This meta-analysis included eight studies (n = 984) and revealed that the pooled sensitivity and specificity of presepsin for PIC diagnosis were 76% (95% confidence interval [CI] 68%-82%) and 83% (95% CI 75%-89%), respectively. The HSROC curve yielded an area under the curve (AUC) of 0.77 (95% CI 0.73-0.81). Analysis of six studies on procalcitonin showed a combined sensitivity of 78% and specificity of 77%, with an AUC of 0.83 derived from the HSROC. Meanwhile, data from five studies on CRP indicated pooled sensitivity of 84% and specificity of 79%, with the HSROC curve yielding an AUC of 0.89. Conclusion Presepsin exhibits moderate diagnostic accuracy for PIC across surgical disciplines. Based on the HSROC-derived AUC, CRP has the highest diagnostic efficacy for PICs, followed by procalcitonin and presepsin. Nonetheless, presepsin demonstrated greater specificity than the other biomarkers. Further study is warranted to validate the utility of and optimize the cutoff values for presepsin. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023468358.
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Affiliation(s)
- Chun-Ying Lu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Hui-Chen Hsu
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Ting Chang
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ping-Hsun Feng
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
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Sala G, Orsetti C, Meucci V, De Marchi L, Sgorbini M, Bonelli F. Case-Control Study: Endogenous Procalcitonin and Protein Carbonylated Content as a Potential Biomarker of Subclinical Mastitis in Dairy Cows. Vet Sci 2023; 10:670. [PMID: 38133221 PMCID: PMC10747190 DOI: 10.3390/vetsci10120670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Procalcitonin (PCT) and protein carbonylated content (PCC) are promising biomarkers for bacterial infection and inflammation in veterinary medicine. This study examined plasma PCT and PCC levels in healthy cows (H) and cows with subclinical mastitis (SCM). A total of 130 cows (65 H and 65 SCM) were included in this study. Blood samples were collected, and plasma was frozen at -80 °C. PCT levels were determined using a bovine procalcitonin ELISA kit, while PCC was measured following the methodology of Levine et al. Statistical analysis revealed a significant difference in PCT levels between H (75.4 pg/mL) and SCM (107.3 pg/mL) cows (p < 0.001) and significantly lower concentrations of PCC in the SCM group (H: 0.102 nmol/mL/mg, SCM: 0.046 nmol/mL/mg; p < 0.001). The PCT cut-off value for distinguishing healthy and subclinical mastitis animals was >89.8 pg/mL (AUC 0.695), with a sensitivity of 66.2% and specificity of 69.2%. PCT showed potential value as a diagnostic tool to help in decision making for subclinical mastitis cases, while PCC requires further studies to investigate the trend of this biomarker during localized pathology.
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Affiliation(s)
- Giulia Sala
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
| | - Chiara Orsetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
| | - Valentina Meucci
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
| | - Lucia De Marchi
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
| | - Micaela Sgorbini
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
| | - Francesca Bonelli
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
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Seppä AMJ, Skrifvars MB, Pekkarinen PT. Inflammatory response after out-of-hospital cardiac arrest-Impact on outcome and organ failure development. Acta Anaesthesiol Scand 2023; 67:1273-1287. [PMID: 37337696 DOI: 10.1111/aas.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Post-cardiac arrest syndrome that occurs in out-of-hospital cardiac arrest (OHCA) patients is characterized by inflammatory response. We conducted a scoping review of current evidence regarding several inflammatory markers' usefulness for assessment of patient outcome and illness severity. We also discuss the proposed underlying mechanisms leading to inflammatory response after OHCA. METHODS We searched the MEDLINE, PubMed Central, Cochrane CENTRAL and Web of Science Core Collection databases with the following search terms: ("inflammation" OR "cytokines") AND "out-of-hospital cardiac arrest." Each inflammatory marker found was combined with "out-of-hospital cardiac arrest" using "AND" to find further relevant studies. We included original studies measuring inflammatory markers in adult OHCA patients that assessed their prognostic capabilities for mortality, neurological outcome, or organ failure severity. RESULTS Fifty-nine studies met the inclusion criteria, covering in total 65 different markers. Interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were the most studied markers, and they were associated with poor outcomes in 13/15, 13/14 and 11/17 studies, respectively. Based on area under the receiver operating characteristic curve (AUC) value, the time point of best discriminatory capacity for poor outcome was ICU admission for IL-6 (median AUC 0.78, range 0.71-0.98) and day one after OHCA for PCT (median AUC 0.84, range 0.61-0.98). Seven studies reported AUCs for CRP (range 0.52-0.76) with no measurement time point being superior to others. The association of IL-6 and PCT with outcome appeared stronger in studies with more severely ill patients. Studies reported conflicting results regarding each marker's association with organ failure severity. CONCLUSION Inflammatory markers are potentially useful for early risk stratification after OHCA. PCT and IL-6 have moderate prognostic value during the first 24 h of the ICU stay. Predictive accuracy appears to be associated with the study overall event rate.
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Affiliation(s)
- Asser M J Seppä
- Division of Intensive Care, Department of Anaesthesiology and Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka T Pekkarinen
- Division of Intensive Care, Department of Anaesthesiology and Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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9
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Wang X, Wang W, Lin X, Chen X, Zhu M, Xu H, He K. Inflammatory Markers Showed Significant Incremental Value for Predicting Post-Hepatectomy Liver Failure in Hepatocellular Carcinoma Patients. Life (Basel) 2023; 13:1990. [PMID: 37895372 PMCID: PMC10607941 DOI: 10.3390/life13101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/11/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Post-hepatectomy liver failure (PHLF) remains a complication with the potential risk of mortality for hepatocellular carcinoma (HCC) patients. The systemic inflammatory response (SIR) has been demonstrated to be associated with a bad prognosis of liver cirrhosis and tumors. This study aims to evaluate the incremental prognostic value of inflammatory markers in predicting PHLF in patients with HCC. METHODS Clinical characteristics and variables were retrospectively collected in 2824 patients diagnosed with HCC who underwent radical hepatectomy from the First Medical Center of the General Hospital of the People's Liberation Army. A recently published prognostic model for PHLF was used as the reference model. The increase in AUC (ΔAUC), integrated discrimination improvement (IDI), and the continuous version of the net reclassification improvement (NRI) were applied for quantifying the incremental value of adding the inflammatory markers to the reference model. A p value < 0.05 was considered statistically significant. RESULTS The reference PHLF model showed acceptable prediction performance in the current cohort, with an AUC of 0.7492 (95%CI, 0.7191-0.7794). The calculated ΔAUC associated with procalcitonin (PCT) was the only one that was statistically significant (p < 0.05), with a value of 0.0044, and demonstrated the largest magnitude of the increase in AUC. The continuous NRI value associated with the systemic immune-inflammation index (SII) was 35.79%, second only to GPS (46.07%). However, the inflammatory markers of the new models with statistically significant IDI only included WBC count, lymphocyte count, and SII. IDI associated with SII, meanwhile, was the maximum (0.0076), which was consistent with the performance of using the ΔAUC (0.0044) to assess the incremental value of each inflammatory variable. CONCLUSIONS Among a wide range of inflammatory markers, only PCT and SII have potential incremental prognostic value for predicting PHLF in patients with radical resectable HCC.
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Affiliation(s)
- Xiao Wang
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China; (X.W.); (W.W.); (X.L.); (X.C.); (M.Z.); (H.X.)
- Medical School of Chinese PLA, Beijing 100853, China
- Department of Hepatobiliary Surgery, Chinese PLA 970th Hospital, Yantai 264001, China
| | - Wenjun Wang
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China; (X.W.); (W.W.); (X.L.); (X.C.); (M.Z.); (H.X.)
| | - Xixiang Lin
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China; (X.W.); (W.W.); (X.L.); (X.C.); (M.Z.); (H.X.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Xu Chen
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China; (X.W.); (W.W.); (X.L.); (X.C.); (M.Z.); (H.X.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Mingxiang Zhu
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China; (X.W.); (W.W.); (X.L.); (X.C.); (M.Z.); (H.X.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Hongli Xu
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China; (X.W.); (W.W.); (X.L.); (X.C.); (M.Z.); (H.X.)
| | - Kunlun He
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China; (X.W.); (W.W.); (X.L.); (X.C.); (M.Z.); (H.X.)
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10
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Yoon JH, Choi WS, Lim YS, Jang JH. Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome. J Clin Med 2023; 12:4568. [PMID: 37510683 PMCID: PMC10380844 DOI: 10.3390/jcm12144568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Post-cardiac arrest syndrome (PCAS) is a type of global ischemic reperfusion injury that occurs after the return of spontaneous circulation (ROSC). The procalcitonin to albumin ratio (PAR) has been studied as an independent prognostic factor of various diseases. There are no previous studies of PAR in patients with PCAS. We assessed if PAR is more effective than procalcitonin (PCT) in predicting prognosis for patients with PCAS. (2) Methods: This retrospective cohort study included a total of 187 patients with PCAS after non-traumatic out-of-hospital cardiac arrest (OHCA) between January 2016 and December 2020. Multivariate logistic regression analysis was conducted to assess the association between PAR and PCAS prognosis. The predictive performance of PAR was compared with PCT via the receiver-operating characteristic (ROC) analysis and DeLong test.; (3) Results: PAR at 24 and 48 h after hospital admission were independently associated with one-month neurological outcome (OR: 1.167, 95% CI: 1.023-1.330; OR: 1.077, 95% CI: 1.012-1.146, p < 0.05). By ROC analysis, PAR showed better performance over PCT at 48 h after admission in predicting one-month CPC (0.763 vs. 0.772, p = 0.010). (4) Conclusions: Our findings suggest that PAR at 48 h after admission is more effective in predicting a one-month neurological outcome than PCT at 48 h after admission in patients with PCAS after OHCA.
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Affiliation(s)
- Ju Hee Yoon
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Woo Sung Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Yong Su Lim
- Department of Emergency Medicine, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Jae Ho Jang
- Department of Emergency Medicine, Gachon University College of Medicine, Incheon 21565, Republic of Korea
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11
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Neumann S, Siegert S, Fischer A. Procalcitonin as an Endogenous Biomarker for Mastitis in Cows. Animals (Basel) 2023; 13:2204. [PMID: 37444002 DOI: 10.3390/ani13132204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Mastitis is one of the most common diseases of dairy cows. Procalcitonin (PCT) has been described as an endogenous inflammatory biomarker for bacterial infections. The aim of this study was to find possible correlations between PCT concentrations in the serum and milk of cows with mastitis and their clinical signs and disease progression. In total, 88 dairy cows were examined, of which 30 animals were diagnosed with clinical mastitis, 30 had subclinical mastitis, and 28 were designated as a healthy control group. The diseased animals were re-examined after 12 days. All PCT levels in this study were determined by a species-specific ELISA. All three groups could be differentiated from each other based on serum and milk PCT levels. The animals with clinical mastitis showed the highest mean concentrations of PCT (serum: 2641 pg/mL; milk: 1326 pg/mL), and the lowest PCT concentrations were found in the healthy control group (serum: 1166 pg/mL; milk: 176 pg/m). Over the course of the disease, results from the kinetics study showed that PCT levels remained high for the entire observation period. The results from this study showed that the PCT concentration could be used to differentiate between clinical mastitis, subclinical mastitis, and healthy cows.
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Affiliation(s)
- Stephan Neumann
- Institute of Veterinary Medicine, Georg-August University of Goettingen, D-37077 Goettingen, Germany
| | - Stephan Siegert
- Institute of Veterinary Medicine, Georg-August University of Goettingen, D-37077 Goettingen, Germany
| | - Anneke Fischer
- Institute of Veterinary Medicine, Georg-August University of Goettingen, D-37077 Goettingen, Germany
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12
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Masetto T, Matzenbach K, Reuschel T, Tölke SA, Schneider K, Esser LM, Reinhart M, Bindila L, Peter C, Grimmler M. Comprehensive Comparison of the Capacity of Functionalized Sepharose, Magnetic Core, and Polystyrene Nanoparticles to Immuno-Precipitate Procalcitonin from Human Material for the Subsequent Quantification by LC-MS/MS. Int J Mol Sci 2023; 24:10963. [PMID: 37446139 DOI: 10.3390/ijms241310963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The fast and accurate diagnosis of sepsis by procalcitonin (PCT) has emerged as an essential tool in clinical medicine. Although in use in the clinical laboratory for a long time, PCT quantification has not yet been standardized. The International Federation of Clinical Chemistry working group on the standardization of PCT (IFCC-WG PCT) aims to provide an LC-MS/MS-based reference method as well as the highest metrological order reference material to address this diagnostic need. Here, we present the systematic evaluation of the efficiency of an immuno-enrichment method, based on functionalized Sepharose, magnetic-core, or polystyrene (latex) nano-particles, to quantitatively precipitate PCT from different human sample materials. This method may be utilized for both mass spectrometric and proteomic purposes. In summary, only magnetic-core nano-particles functionalized by polyclonal PCT antibodies can fulfil the necessary requirements of the international standardization of PCT. An optimized method proved significant benefits in quantitative and specific precipitation as well as in the subsequent LC-MS/MS detection of PCT in human serum samples or HeLa cell extract. Based on this finding, further attempts of the PCT standardization process will utilize a magnetic core-derived immuno-enrichment step, combined with subsequent quantitative LC-MS/MS detection.
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Affiliation(s)
- Thomas Masetto
- Institute of Molecular Medicine I, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- DiaSys Diagnostic Systems GmbH, Alte Straße 9, 65558 Holzheim, Germany
| | - Kai Matzenbach
- Institute for Biomolecular Research, Hochschule Fresenius gGmbH, University of Applied Sciences, Limburger Straße 2, 65510 Idstein, Germany
| | - Thomas Reuschel
- Institute for Biomolecular Research, Hochschule Fresenius gGmbH, University of Applied Sciences, Limburger Straße 2, 65510 Idstein, Germany
| | - Sebastian-Alexander Tölke
- Institute for Biomolecular Research, Hochschule Fresenius gGmbH, University of Applied Sciences, Limburger Straße 2, 65510 Idstein, Germany
- Clinical Lipidomics Unit, Institute of Physiological Chemistry, University Medical Center, 55131 Mainz, Germany
| | - Klaus Schneider
- Institute for Biomolecular Research, Hochschule Fresenius gGmbH, University of Applied Sciences, Limburger Straße 2, 65510 Idstein, Germany
| | - Lea Marie Esser
- Institute of Molecular Medicine I, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | | | - Laura Bindila
- Clinical Lipidomics Unit, Institute of Physiological Chemistry, University Medical Center, 55131 Mainz, Germany
| | - Christoph Peter
- Institute of Molecular Medicine I, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Matthias Grimmler
- DiaSys Diagnostic Systems GmbH, Alte Straße 9, 65558 Holzheim, Germany
- Institute for Biomolecular Research, Hochschule Fresenius gGmbH, University of Applied Sciences, Limburger Straße 2, 65510 Idstein, Germany
- DiaServe Laboratories GmbH, Seeshaupter Straße 27, 82393 Iffeldorf, Germany
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13
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Wang R, Zhang J, He M, Chen H, Xu J. Procalcitonin as a biomarker of nosocomial pneumonia in aneurysmal subarachnoid hemorrhage patients treated in neuro-ICU. Clin Neurol Neurosurg 2023; 231:107870. [PMID: 37421741 DOI: 10.1016/j.clineuro.2023.107870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Nosocomial pneumonia commonly develops in aneurysmal subarachnoid hemorrhage (aSAH) patients and is associated with poor prognosis of these patients. This study is designed to verify the predictive value of procalcitonin (PCT) on nosocomial pneumonia in aSAH patients. METHODS 298 aSAH patients received treatments in the neuro-intensive care unit (NICU) of West China hospital were included. Logistic regression was conducted to verify the association between PCT level and nosocomial pneumonia and to construct a model for predicting pneumonia. Area under the receiver operating characteristic curve (AUC) were calculated to evaluate the accuracy of the single PCT and the constructed model. RESULTS 90 (30.2%) patients developed pneumonia during hospitalizations among included aSAH patients. Pneumonia group had higher procalcitonin level (p < 0.001) than non-pneumonia group. The mortality (p < 0.001), mRS (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (p < 0.001) were both higher or longer in pneumonia group. Multivariate logistic regression indicated WFNS (p = 0.001), acute hydrocephalus (p = 0.007), WBC (p = 0.021), PCT (p = 0.046) and C-reactive protein (CRP) (p = 0.031) were independently associated with the development of pneumonia in included patients. The AUC value of procalcitonin for predicting nosocomial pneumonia was 0.764. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, the predictive model for pneumonia has higher AUC of 0.811. CONCLUSIONS PCT is an available and effective predictive marker of nosocomial pneumonia in aSAH patients. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, our constructed predictive model is helpful for clinicians to evaluate the risk of nosocomial pneumonia and guide therapeutics in aSAH patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hongxu Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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14
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Chambliss AB, Patel K, Colón-Franco JM, Hayden J, Katz SE, Minejima E, Woodworth A. AACC Guidance Document on the Clinical Use of Procalcitonin. J Appl Lab Med 2023; 8:598-634. [PMID: 37140163 DOI: 10.1093/jalm/jfad007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Procalcitonin (PCT), a peptide precursor of the hormone calcitonin, is a biomarker whose serum concentrations are elevated in response to systemic inflammation caused by bacterial infection and sepsis. Clinical adoption of PCT in the United States has only recently gained traction with an increasing number of Food and Drug Administration-approved assays and expanded indications for use. There is interest in the use of PCT as an outcomes predictor as well as an antibiotic stewardship tool. However, PCT has limitations in specificity, and conclusions surrounding its utility have been mixed. Further, there is a lack of consensus regarding appropriate timing of measurements and interpretation of results. There is also a lack of method harmonization for PCT assays, and questions remain regarding whether the same clinical decision points may be used across different methods. CONTENT This guidance document aims to address key questions related to the use of PCT to manage adult, pediatric, and neonatal patients with suspected sepsis and/or bacterial infections, particularly respiratory infections. The document explores the evidence for PCT utility for antimicrobial therapy decisions and outcomes prediction. Additionally, the document discusses analytical and preanalytical considerations for PCT analysis and confounding factors that may affect the interpretation of PCT results. SUMMARY While PCT has been studied widely in various clinical settings, there is considerable variability in study designs and study populations. Evidence to support the use of PCT to guide antibiotic cessation is compelling in the critically ill and in some lower respiratory tract infections but is lacking in other clinical scenarios, and evidence is also limited in the pediatric and neonatal populations. Interpretation of PCT results requires guidance from multidisciplinary care teams of clinicians, pharmacists, and clinical laboratorians.
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Affiliation(s)
- Allison B Chambliss
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Khushbu Patel
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Joshua Hayden
- Department of Laboratories, Norton Healthcare, Louisville, KY, United States
| | - Sophie E Katz
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Emi Minejima
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles, CA, United States
| | - Alison Woodworth
- Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, KY, United States
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Evaluating the Benefits of TACE Combined with Lenvatinib Plus PD-1 Inhibitor for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. Adv Ther 2023; 40:1686-1704. [PMID: 36805422 DOI: 10.1007/s12325-023-02449-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION This study evaluated the efficacy and safety of transarterial chemoembolization (TACE) combined with lenvatinib plus programmed death (PD)-1 inhibitor (TACE-L-P) versus TACE combined with sorafenib plus PD-1 inhibitor (TACE-S-P) in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). METHODS The clinical data of patients with HCC and PVTT treated with TACE-L-P or TACE-S-P from January 2018 to March 2022 were collected. The Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and modified RECIST (mRECIST) standard were used to evaluate the therapeutic effect. The progression-free survival (PFS) and overall survival (OS) of the two groups were compared. Blood samples were collected before and after treatment to detect the changes of biochemical indicators, and the adverse events (AEs) related to treatment were recorded. RESULTS A total of 165 patients were included in the study, including 80 patients receiving TACE-L-P treatment and 85 patients receiving TACE-S-P. Patients in the TACE-L-P group had longer median OS (21.7 months vs. 15.6 months, P = 0.0027), longer median PFS (6.3 months vs. 3.2 months, P < 0.0001), higher objective response rate (41.25% vs. 30.59%, P = 0.008), and higher disease control rate (86.25% vs. 62.35%, P = 0.008) than those in the TACE-S-P group. Multivariate analysis of the TACE-L-P group showed that VP classification of PVTT, Child-Pugh grade, interleukin-17 (IL-17), vascular endothelial growth factor (VEGF), procalcitonin (PCT), and C-reactive protein (CRP) were independent factors significantly affecting patients' OS (P < 0.05). There was no significant difference in the incidence and severity of AEs between the two groups. CONCLUSION TACE-L-P treatment can improve the survival of patients with HCC and PVTT with an acceptable safety, but higher inflammatory indicators will affect the therapeutic effect.
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Cavallazzi R, Bradley J, Chandler T, Furmanek S, Ramirez JA. Severity of Illness Scores and Biomarkers for Prognosis of Patients with Coronavirus Disease 2019. Semin Respir Crit Care Med 2023; 44:75-90. [PMID: 36646087 DOI: 10.1055/s-0042-1759567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The spectrum of disease severity and the insidiousness of clinical presentation make it difficult to recognize patients with coronavirus disease 2019 (COVID-19) at higher risk of worse outcomes or death when they are seen in the early phases of the disease. There are now well-established risk factors for worse outcomes in patients with COVID-19. These should be factored in when assessing the prognosis of these patients. However, a more precise prognostic assessment in an individual patient may warrant the use of predictive tools. In this manuscript, we conduct a literature review on the severity of illness scores and biomarkers for the prognosis of patients with COVID-19. Several COVID-19-specific scores have been developed since the onset of the pandemic. Some of them are promising and can be integrated into the assessment of these patients. We also found that the well-known pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) are good predictors of mortality in hospitalized patients with COVID-19. While neither the PSI nor the CURB-65 should be used for the triage of outpatient versus inpatient treatment, they can be integrated by a clinician into the assessment of disease severity and can be used in epidemiological studies to determine the severity of illness in patient populations. Biomarkers also provide valuable prognostic information and, importantly, may depict the main physiological derangements in severe disease. We, however, do not advocate the isolated use of severity of illness scores or biomarkers for decision-making in an individual patient. Instead, we suggest the use of these tools on a case-by-case basis with the goal of enhancing clinician judgment.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - Thomas Chandler
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Stephen Furmanek
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
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17
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Chen Y, Qin T, Chen Y, Gao M. Case report: Ewing sarcoma with EWSR-ERG fusion elevates procalcitonin extremely in the long term without infection. Front Oncol 2023; 12:1047738. [PMID: 36713573 PMCID: PMC9880485 DOI: 10.3389/fonc.2022.1047738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Background Ewing sarcoma (ES) represents a rare, aggressive bone and soft-tissue cancer. Unlike breast, liver, pancreatic, and prostate cancers, Ewing sarcoma has had no representative tumor marker until now. The use of procalcitonin (PCT) as a tumor marker is also rarely reported. PCT is a clinically recognized and widely used inflammatory marker in recent years. In rare cases, PCT may also be falsely positive due to non-infectious factors. In the few previously reported papers regarding the correlation between tumors and PCT, we learned that abnormalities of PCT level can also be impacted by individual cancers. Case presentation Here, we first reported a case of Ewing sarcoma with markedly elevated PCT without infection and carried out some literature review. The patient was a middle-aged man with extraskeletal Ewing sarcoma whose lesion was located in the distal abdominal ileum. He had a sudden and unprovoked onset of high fever during chemotherapy before surgery. After multiple examinations, the patient's blood routine, C-reactive protein, blood culture, and CT examination showed no signs of infection, and even the culture from the end of the central venous catheter showed no pathogen growth. Only PCT increased dramatically to more than 200 ng/ml. PCT remained at this level for several months until a single abdominal lumpectomy was performed before it dropped to near-normal levels. Conclusion In our report, PCT is significantly elevated in Ewing sarcoma in the absence of infection. Not only that, but we particularly highlighted the precipitous drop in PCT following tumor resection.
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Affiliation(s)
- Ying Chen
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Qin
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Chen
- Department of Hematology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China,*Correspondence: Yan Chen, ; Ming Gao,
| | - Ming Gao
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,*Correspondence: Yan Chen, ; Ming Gao,
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18
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Development of conducting cellulose paper for electrochemical sensing of procalcitonin. Mikrochim Acta 2022; 190:32. [PMID: 36534199 DOI: 10.1007/s00604-022-05596-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
An electrochemical paper-based sensor was developed for the detection of bacterial infection (BI)-specific biomarker procalcitonin (PCT). Reduced graphene oxide-gold nanoparticles (rGO-AuNP) and poly(3,4-ethylene dioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) were synthesized and were fabricated to a disposable, portable, and inexpensive cellulose fiber paper (CFP) substrate. rGO-AuNP-PEDOT:PSS nanocomposite-modified conductive paper-based biosensing platform was efficaciously fabricated by a constant and simple coating procedure. rGO-AuNP-PEDOT:PSS nanocomposite-modified conductive paper electrode was found to provide a sensitive and conductive substrate for PCT detection. The presence of rGO-AuNP-PEDOT:PSS nanocomposite on CFP substate was investigated by Fourier transform infrared spectrometry, field emission scanning electron microscopy, ultraviolet-visible spectroscopy, and X-ray diffraction studies. The electrochemical behavior of rGO-AuNP-PEDOT:PSS @CFP surface was studied with impedance spectroscopy, cyclic voltammetry, and chronoamperometry techniques. This low-cost paper-based biosensor has a linear range for PCT of 1 × 103 to 6 × 107 fg mL-1. This developed sensor exhibited good reproducibility with a relative standard deviation (RSD) of about 3.7%. The proposed CFP-based biosensor has been proven as an accelerated simple point-of-care (POC) exploratory approach for early PCT diagnosis in inadequate areas with limited production facilities, computational techniques, and highly skilled experts.
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Matur E, Özcan M, Ergül Ekiz E, Ergen E, Erek M, Or E, Dokuzeylül B, Erhan S, Bilgiç B. Use of serum procalcitonin (PCT) level and PCT mRNA expression as a potential clinical biomarker in cats with bacterial and viral infections. J Feline Med Surg 2022; 24:e595-e602. [PMID: 36350675 PMCID: PMC10812354 DOI: 10.1177/1098612x221125570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the use of procalcitonin (PCT) as a biomarker in differentiating bacterial infections from viral infections in cats. In addition, the relationship between PCT and mortality rate was also examined. METHODS Forty-five cats were included in the study. The cats were categorised into two groups: bacterial (n = 20) and viral (n = 25) infection. Serum PCT level and PCT mRNA expression were analysed from blood samples collected before treatment. RESULTS Serum PCT level and PCT mRNA expression of the cats with presumed bacterial infection were higher than those with viral infection (P = 0.001 and P = 0.001, respectively). The receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve value of 0.888 for serum PCT and 0.850 for PCT mRNA expression. There was no statistically significant difference among respiratory, urinary and gastrointestinal tract infections regarding serum PCT level and PCT mRNA expression in the presumed bacterial infection group (P = 0.741 and P = 0.141, respectively). In the presumed bacterial infection group, serum PCT level and PCT mRNA expression in the non-surviving cats were higher than those of the surviving cats (P = 0.021 and P = 0.026, respectively). CONCLUSIONS AND RELEVANCE Serum PCT level and PCT mRNA expression were considered efficient biomarkers in cats to distinguish a bacterial infection from a viral infection. Moreover, ROC curve analysis was highly accurate in the discriminative capacity of these two parameters. PCT level and PCT mRNA expression offer substantial assistance in an efficient therapeutic approach and in avoiding unnecessary antibiotic use in feline clinical practice, particularly in emergency patients and those with non-specific clinical signs, decreasing the mortality rate. However, it should be noted that these data are only research data. More detailed future studies are needed.
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Affiliation(s)
- Erdal Matur
- Department of Physiology, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mukaddes Özcan
- Department of Physiology, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Elif Ergül Ekiz
- Department of Physiology, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ezgi Ergen
- Department of Physiology, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Erek
- Graduate Education Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Erman Or
- Department of Internal Disease, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Banu Dokuzeylül
- Department of Internal Disease, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Songül Erhan
- Graduate Education Institute, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bengü Bilgiç
- Department of Internal Disease, Faculty of Veterinary Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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20
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Higashikawa T, Ito T, Mizuno T, Ishigami K, Kuroki K, Maekawa N, Usuda D, Nakao S, Hamada K, Takagi S, Terada N, Takeshima K, Yamada S, Sangen R, Izumida T, Kiyosawa J, Saito A, Iguchi M, Wato H, Nakahashi T, Kasamaki Y, Fukuda A, Kanda T, Okuro M. A new predictive tool consolidating CURB-65 with procalcitonin and albumin to assess short-term mortality in hospitalized elderly patients with infectious disease: A retrospective study of a patient cohort. Medicine (Baltimore) 2022; 101:e31614. [PMID: 36401412 PMCID: PMC9678497 DOI: 10.1097/md.0000000000031614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Hospitalized elderly patients are often at risk of life-threatening infectious diseases such as pneumonia and urinary tract infection, thus diagnostic tools for bacterial infections are demanded. We developed a new predictive tool consolidating modified CURB-65, procalcitonin (PCT) and albumin (Alb). METHOD This is a retrospective study. Modified CURB-65 (mCURB-65) score, PCT, Alb, and various cardiovascular/respiratory/renal functions were measured. Survival analyses were conducted to assess 30-days mortality of elderly patients using mCURB-65 score, PCT and Alb. The consolidated scores were compared with the number of patients died. RESULTS There were 445 elderly patients included. Kaplan-Meier survival curves showed significant differences between the high and low groups of mCURB-65, PCT and Alb (log-rank test, P < .001). Cox proportional regression showed that the hazard ratios (95% confidence intervals) for high mCURB-65, high Alb, and high PCT were all significant, 1.95 (1.24-3.05), 0.50 (0.32-0.77), and 2.09 (1.32-3.31), respectively. The consolidated scores showed tendency of increase with proportion of the number of patients died. CONCLUSIONS The consolidated score consisted of mCURB-65, PCT and Alb can be a useful tool to predict short-term mortality of the hospitalized elderly patients with infectious disease.
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Affiliation(s)
- Toshihiro Higashikawa
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
- *Correspondence: Toshihiro Higashikawa, Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, 935-8531, Japan (e-mail: )
| | - Tomohiko Ito
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Takuro Mizuno
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Keiichirou Ishigami
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Kengo Kuroki
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Naoto Maekawa
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Takanodai, Nerima-ku, Tokyo, Japan
| | - Shinichiro Nakao
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Kazu Hamada
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
| | - Susumu Takagi
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Nao Terada
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Kento Takeshima
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Shinya Yamada
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Ryusho Sangen
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Toshihide Izumida
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Jun Kiyosawa
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Atsushi Saito
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Masaharu Iguchi
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Hiroyuki Wato
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Takeshi Nakahashi
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
| | - Yuji Kasamaki
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Akihiro Fukuda
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Tsugiyasu Kanda
- Kanazawa Medical University Himi Municipal Hospital, Kurakawa, Himi, Toyama, Japan
| | - Masashi Okuro
- Department of Geriatric Medicine, Kanazawa Medical University, Uchinada, Kahoku-gun, Ishikawa, Japan
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Xiang Z, Chen X, Zhou X, Qin Y, Zhao X, Wang Y, Li Q, Huang B. Development and application of a novel aldehyde nanoparticle-based amplified luminescent proximity homogeneous assay for rapid quantitation of pancreatic stone protein. Clin Chim Acta 2022; 535:120-130. [PMID: 36030885 DOI: 10.1016/j.cca.2022.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/04/2022] [Accepted: 08/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Timely diagnosis of bacterial infections is important to prevent sepsis. Classical infection biomarkers have some flaws, and common detection methods are time-consuming. Thus, we aimed to establish an efficient detection method that precisely detects pancreatic stone protein (PSP) in human plasma for the timely diagnosis of bacterial infections. METHODS Based on the novel amplified luminescent proximity homogeneous assay (AlphaLISA) method, donor and acceptor beads modified with aldehyde groups were directly coupled to the anti-PSP antibodies. PSP was quickly detected by a double-antibody sandwich method. Plasma samples from healthy individuals, bacterially infected patients, and acute-phase response patients were tested. RESULTS The detection time of the developed method is only 5 min. The results of PSP-AlphaLISA and time-resolved fluorescence were consistent (ρ = 0.9722). The plasma PSP levels of patients with bacterial infection were significantly higher than those of acute-phase response patients and healthy individuals (P < 0.05). PSP levels in patients with bacterial infection with sepsis were significantly higher than those in patients with bacterial infection without sepsis (P < 0.05). CONCLUSIONS The PSP-AlphaLISA exhibited excellent performance and may be applied to the differential diagnosis between bacterial infection and sepsis in patients without interference from patients with acute-phase response.
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Affiliation(s)
- Zhongyi Xiang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Xindong Chen
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Xiumei Zhou
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yuan Qin
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Xueqin Zhao
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yigang Wang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Qian Li
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
| | - Biao Huang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China.
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The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children. J Clin Med 2022; 11:jcm11195506. [PMID: 36233374 PMCID: PMC9571658 DOI: 10.3390/jcm11195506] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Community-acquired pneumonia (CAP) severely affects pediatric hospitalizations. This study assessed the contribution of CAP to hospitalizations, its etiology in relationship with age, and the inflammatory markers. Between 2013 and 2018, 1064 CAP patients were hospitalized and diagnosed with bacterial/possibly bacterial pneumonia (BP), viral/possibly viral pneumonia (VP) and atypical pneumonia (AP). The etiology was confirmed using blood/pleural fluid culture/polymerase chain reaction (PCR), rapid antigen test/PCR in nasopharyngeal swabs, or serological studies. CAP accounted for 9.9% of hospitalizations and 14.8% of patient days. BP was diagnosed in 825 (77.5%), VP in 190 (17.9%), and AP in 49 (4.6%) cases; the confirmed etiology (n = 209; 20%) included mostly influenza (39%; n = 82), respiratory syncytial virus (RSV, 35%; n = 72), and Mycoplasma pneumoniae (19%; n = 39). VP frequency decreased with age (41% in < 3 mo to 9% in ≥ 60 mo), in contrast to AP (13% in ≥ 60 mo). Among the analyzed parameters, the best differentiating potential was shown by: C-reactive protein (CRP, AUCBP-VP = 0.675; 95% CI: 0.634−0.715), procalcitonin (AUCBP-AP = 0.73; 95% CI: 0.67−0.794), and CRP/procalcitonin (AUCAP-VP = 0.752; 95% CI: 0.67−0.83); a good positive predictive value (88.8%, 98.3%, and 91.6%, respectively) but a low negative predictive value (29.5%, 13.1%, and 40.7%, respectively) was observed. CAP influences hospital patient days more than the crude number of patients would suggest. On a clinical basis, BP is mainly recognized, although viral pneumonia is confirmed most often. RSV and influenza are responsible for a huge percentage of hospitalized cases, as well as M. pneumoniae in children aged ≥ 5 years. Serum inflammatory markers may help differentiate etiological factors.
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Gürsoy C, Gürsoy G, Demirbilek SG. C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury. Acute Crit Care 2022; 37:462-467. [PMID: 35977896 PMCID: PMC9475143 DOI: 10.4266/acc.2022.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI. Methods Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively. Results The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR. Conclusions This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.
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Frick K, Beller EA, Kalisvaart M, Dutkowski P, Schüpbach RA, Klinzing S. Procalcitonin in early allograft dysfunction after orthotopic liver transplantation: a retrospective single centre study. BMC Gastroenterol 2022; 22:404. [PMID: 36045337 PMCID: PMC9429388 DOI: 10.1186/s12876-022-02486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022] Open
Abstract
Background Ischemia–reperfusion injury (IRI) is the pathophysiological hallmark of hepatic dysfunction after orthotopic liver transplantation (OLT). Related to IRI, early allograft dysfunction (EAD) after OLT affects short- and long-term outcome. During inflammatory states, the liver seems to be the main source of procalcitonin (PCT), which has been shown to increase independently of bacterial infection. This study investigates the association of PCT, IRI and EAD as well as the predictive value of PCT during the first postoperative week in terms of short- and long-term outcome after OLT. Methods Patients ≥ 18 years undergoing OLT between January 2016 and April 2020 at the University Hospital of Zurich were eligible for this retrospective study. Patients with incomplete PCT data on postoperative days (POD) 1 + 2 or combined liver-kidney transplantation were excluded. The PCT course during the first postoperative week, its association with EAD, defined by the criteria of Olthoff, and IRI, defined as aminotransferase level > 2000 IU/L within 2 PODs, were analysed. Finally, 90-day as well as 12-month graft and patient survival were assessed. Results Of 234 patients undergoing OLT, 110 patients were included. Overall, EAD and IRI patients had significantly higher median PCT values on POD 2 [31.3 (9.7–53.8) mcg/l vs. 11.1 (5.3–25.0) mcg/l; p < 0.001 and 27.7 (9.7–51.9) mcg/l vs. 11.5 (5.5–25.2) mcg/l; p < 0.001] and impaired 90-day graft survival (79.2% vs. 95.2%; p = 0.01 and 80.4% vs. 93.8%; p = 0.033). IRI patients with PCT < 15 mcg/l on POD 2 had reduced 90-day graft and patient survival (57.9% vs. 93.8%; p = 0.001 and 68.4% vs. 93.8%; p = 0.008) as well as impaired 12-month graft and patient survival (57.9% vs. 96.3%; p = 0.001 and 68.4% vs. 96.3%; p = 0.008), while the outcome of IRI patients with PCT > 15 mcg/l on POD 2 was comparable to that of patients without IRI/EAD. Conclusion Generally, PCT is increased in the early postoperative phase after OLT. Patients with EAD and IRI have a significantly increased PCT maximum on POD 2, and impaired 90-day graft survival. PCT measurement may have potential as an additional outcome predictor in the early phase after OLT, as in our subanalysis of IRI patients, PCT values < 15 mcg/l were associated with impaired outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02486-5.
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25
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Zheng X, Li Y, Cheng Q, Wang L. Predictive Value of Ionized Calcium for Prognosis of Sepsis in Very Low Birth Weight Infants. J Inflamm Res 2022; 15:3749-3760. [PMID: 35799618 PMCID: PMC9255904 DOI: 10.2147/jir.s369431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Previous studies have shown that ionized calcium (iCa) is strongly correlated with critical illnesses, including sepsis. However, there are few studies on the association of iCa levels and sepsis in very low birth weight infants (VLBWI). Therefore, the aim of this study was to investigate the role of iCa in assessing the severity of sepsis and in predicting the prognosis of sepsis in VLBWI. Patients and Methods 249 eligible VLBWI with sepsis were included in the present study and were divided into good and poor prognosis groups according to prognosis. We collected complete laboratory and clinical data. The lowest iCa measured during the first 24h from sepsis onset was recorded, and the Pediatric Risk of Mortality (PRISM III) score was calculated for each newborn. Results Neonatal mortality was higher in the hypocalcemia group (32.80% vs 12.80%, P < 0.001), and iCa levels were negatively correlated with PRISM III scores (r= −0.819, P < 0.001). The result of multiple logistic regression analysis showed that iCa was an independent predictor of poor prognosis (odds ratio [OR]= 0.558, 95% confidence interval [CI], 0.406–0.768, P < 0.001). Furthermore, our data demonstrated that iCa was also an independent predictor for the occurrence of death in VLBWI with sepsis who have a poor prognosis (OR= 0.659, 95% CI, 0.445–0.977, P =0.038). ROC curve analysis showed that iCa had good discriminatory power in predicting the poor prognosis (AUC=0.739, 95% CI, 0.664–0.813, P <0.001) in VLBWI with sepsis. Conclusion iCa levels correlate with the severity of sepsis and can be an independent predictor of poor prognosis in VLBWI with sepsis.
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Affiliation(s)
- Xuejie Zheng
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Yuanzhi Li
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Qiyuan Cheng
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Lili Wang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Correspondence: Lili Wang, Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Tel +86 13075578390, Email
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Hellenthal KEM, Brabenec L, Wagner NM. Regulation and Dysregulation of Endothelial Permeability during Systemic Inflammation. Cells 2022; 11:cells11121935. [PMID: 35741064 PMCID: PMC9221661 DOI: 10.3390/cells11121935] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Abstract
Systemic inflammation can be triggered by infection, surgery, trauma or burns. During systemic inflammation, an overshooting immune response induces tissue damage resulting in organ dysfunction and mortality. Endothelial cells make up the inner lining of all blood vessels and are critically involved in maintaining organ integrity by regulating tissue perfusion. Permeability of the endothelial monolayer is strictly controlled and highly organ-specific, forming continuous, fenestrated and discontinuous capillaries that orchestrate the extravasation of fluids, proteins and solutes to maintain organ homeostasis. In the physiological state, the endothelial barrier is maintained by the glycocalyx, extracellular matrix and intercellular junctions including adherens and tight junctions. As endothelial cells are constantly sensing and responding to the extracellular environment, their activation by inflammatory stimuli promotes a loss of endothelial barrier function, which has been identified as a hallmark of systemic inflammation, leading to tissue edema formation and hypotension and thus, is a key contributor to lethal outcomes. In this review, we provide a comprehensive summary of the major players, such as the angiopoietin-Tie2 signaling axis, adrenomedullin and vascular endothelial (VE-) cadherin, that substantially contribute to the regulation and dysregulation of endothelial permeability during systemic inflammation and elucidate treatment strategies targeting the preservation of vascular integrity.
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Tang YH, Jeng MJ, Wang HH, Tsao PC, Chen WY, Lee YS. Risk factors and predictive markers for early and late-onset neonatal bacteremic sepsis in preterm and term infants. J Chin Med Assoc 2022; 85:507-513. [PMID: 34966164 DOI: 10.1097/jcma.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The early detection and prediction of bacteremic sepsis in preterm and term neonates remains a challenging task because of their nonspecific clinical presentations. We aimed to investigate the risk factors associated with bacteremia and find the cutoff values of predictive markers to achieve accurate diagnosis of neonatal bacteremic sepsis. METHODS Not-doing-well preterm and term neonates with suspected sepsis were retrospectively enrolled between January 2015 and December 2017 in Taipei Veterans General Hospital. Blood culture, hemogram, serum procalcitonin (PCT), and C-reactive protein (CRP) were drawn at the onset of clinical signs and symptoms. All cases were divided to either early-onset or late-onset groups according to postpartum age. Nonparametric statistic, logistic regression, and receiver operating characteristic analysis were performed to evaluate the risk factors and cutoff values for predicting bacteremia. RESULTS A total of 169 suspected sepsis episodes were analyzed, 68.0% of which had cardiopulmonary dysfunction and 19.5% had perinatal stress. The early-onset group had 123 (72.8%) patients, 4 of which had bacteremia and 119 had nonbacteremia conditions. The late-onset group had 46 (27.2%) patients, 8 of which had bacteremia and 38 had nonbacteremia conditions. Gestational age, birth body weight, Apgar score at 5 minutes, serum PCT, CRP, and platelet (PLT) count in the early-onset group and white blood cell (WBC) count in the late-onset group were substantially different between the patients with bacteremia and nonbacteremia conditions. PCT greater than 27 µg/L (adjusted odd ratio [aOR], 21.6; 95% CI, 1.1-435.1) and thrombocytopenia less than 100 × 109/L (aOR, 38.6; 95% CI, 1.4-1030.3) were predictive markers for bacteremia in the early-onset group. CONCLUSION Early- and late-onset neonatal sepsis had different risk factors and predictive markers of bacteremia. PCT and PLT count in the early-onset group and WBC count in the late-onset group were accurate diagnostic serum markers for neonatal bacteremic sepsis.
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Affiliation(s)
- Yi-Hsuan Tang
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsin-Hui Wang
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Physiology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Yu Chen
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Sheng Lee
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Xu X, Lei X, Ye L, Song S, Liu L, Xu L, Xu C, Kuang H. Gold-based paper sensor for sensitive detection of procalcitonin in clinical samples. CHINESE JOURNAL OF ANALYTICAL CHEMISTRY 2022. [DOI: 10.1016/j.cjac.2022.100062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Li X, Liu C, Wang X, Mao Z, Yi H, Zhou F. Comparison of Two Predictive Models of Sepsis in Critically Ill Patients Based on the Combined Use of Inflammatory Markers. Int J Gen Med 2022; 15:1013-1022. [PMID: 35140504 PMCID: PMC8818968 DOI: 10.2147/ijgm.s348797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 01/08/2023] Open
Abstract
Background Sepsis is a systemic inflammatory response due to infection, resulting in organ dysfunction. Timely targeted interventions can improve prognosis. Inflammation plays a crucial role in the process of sepsis. To identify potential sepsis early, we developed and validated a nomogram model and a simple risk scoring model for predicting sepsis in critically ill patients. Methods The medical records of adult patients admitted to our intensive care unit (ICU) from August 2017 to December 2020 were analyzed. Patients were randomly divided into a training cohort (70%) and a validation cohort (30%). A nomogram model was developed through multivariate logistic regression analysis. The continuous variables included in nomogram model were transformed into dichotomous variables. Then, a multivariable logistic regression analysis was performed based on these dichotomous variables, and the odds ratio (OR) for each variable was used to construct a simple risk scoring model. The receiver operating characteristic curves (ROC) were constructed, and the area under the curve (AUC) was calculated. Results A total of 2074 patients were enrolled. Finally, white blood cell (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) were included in our models. The AUC of the nomogram model and the simple risk scoring model were 0.854 and 0.842, respectively. The prediction performance of the two models on sepsis is comparable (p = 0.1298). Conclusion This study combining five commonly available inflammatory markers (WBC, CRP, IL-6, PCT and NLR) developed a nomogram model and a simple risk scoring model to predict sepsis in critically ill patients. Although the prediction performance of the two models is comparable, the simple risk scoring model may be simpler and more practical for clinicians to identify potential sepsis in critically ill patients at an early stage and strategize treatments.
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Affiliation(s)
- Xiaoming Li
- Medical School of Chinese PLA, Beijing, People’s Republic of China
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Chao Liu
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xiaoli Wang
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Zhi Mao
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Hongyu Yi
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Correspondence: Feihu Zhou, Critical Care Medicine, The First Medical Centre, Chinese People’s Liberation Army General Hospital, 28 Fu-Xing Road, Beijing, 100853, People’s Republic of China, Tel +86-10-66938148, Fax +86-10-88219862, Email
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Farooqui R, Siddiqui QUA. Diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in preterm premature rupture of the membranes with respect of highvaginal swab as gold standard. Pak J Med Sci 2022; 38:310-314. [PMID: 35035445 PMCID: PMC8713219 DOI: 10.12669/pjms.38.1.4436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/31/2021] [Accepted: 08/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in Preterm premature rupture of the membranes (PPROM) with respect of high vaginal swab as gold standard Methods: A cross-sectional study was conducted at Liaquat National Hospital, Karachi, from February to August 2017. The blood sample of women with PPROM were collected to measure procalcitonin level. PCT1 and PCT2 were run along with the sample for the accuracy of the results. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of procalcitonin were calculated taking HVS C/S as gold standard. Results: Out of total 150 women, mean age was 28.78±4.79 years. Mean gestational age was 30.79±3.07 weeks. Mean procalcitonin level was 0.13±0.24 ng/ml. Intra-amniotic infection was diagnosed in 48.7% cases through procalcitonin levels and 51.3% through HVS culture and sensitivity. Sensitivity, Specificity, PPV (Positive predictive value), NPV (Negative predictive value) and accuracy were 87%, 91.8%, 91.78%, 87%, and 89.3% respectively. For females with gestational age ≤32 weeks, sensitivity, specificity, and diagnostic accuracy were 83.9%, 90.4%, and 87.03% respectively. For females with gestational age >32 weeks, sensitivity, specificity, and diagnostic accuracy were 95.2%, 92.5%, and 95.23% respectively. Conclusion: Diagnostic accuracy of maternal blood procalcitonin levels were found satisfactory in detection of early intra-amniotic infection in PPROM.
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Affiliation(s)
- Rabia Farooqui
- Dr. Rabia Farooqui, MBBS, FCPS. Senior Registrar, Department of Obstetrics & Gynaecology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Qurat-Ul-Aman Siddiqui
- Dr. Qurat-ul-Aman Siddiqui, MBBS, MCPS, FCPS. Associate Professor, Department of Obstetrics & Gynaecology, Australian Concept Infertility Medical Centre, Karachi, Pakistan. Liaquat National Hospital and Medical College, Karachi, Pakistan
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Neumann S, Steingräber L, Herold L. Investigation of procalcitonin and beta-defensin2 in the serum and feces of dogs with acute diarrhea. Vet Clin Pathol 2022; 50 Suppl 1:55-62. [PMID: 35040162 DOI: 10.1111/vcp.13099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Acute diarrhea is a common clinical condition where clinical parameters are used to assess disease severity, course, and prognosis. OBJECTIVES The aim of this study was to investigate procalcitonin (PCT) and beta-defensin2 (Bdef2) as biomarkers for disease severity, course, and prognosis of dogs with acute diarrhea. METHODS Dogs with acute diarrhea (enteritis group [EG], n = 35) were compared with 30 healthy controls. The dogs in the EG were scored using the Canine Acute Diarrhea Severity (CADS) index and grouped by bacterial fecal culture results. Procalcitonin and Bdef2 were analyzed in serum and feces. RESULTS Dogs with acute diarrhea showed higher serum PCT concentrations (P < 0.0001) and lower fecal Bdef2 concentrations (P = 0.0001) than unaffected dogs. Serum PCT was moderately and positively related to the extent of disease classified by the CADS score. Dogs with Clostridium perfringens or hemolyzing Escherichia coli as predominant pathogen had increased serum Bdef2 concentrations (P < 0.01). Differentiation between uncomplicated (≤3 days) and complicated (>3 days) disease courses, determined by receiver operating characteristic (ROC) curves, resulted in a sensitivity of 0.74 and a specificity of 0.69 for serum PCT at a cutoff of 3.9 ng/mL. The serum PCT and fecal Bdef2 quotient resulted in a sensitivity of 0.80 and a specificity of 0.92, with a cutoff of 80.5. CONCLUSIONS The results of the present study indicate that PCT and Bdef2 are potential biomarkers that can provide information on the severity, course, and prognosis of acute diarrhea in dogs.
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Affiliation(s)
- Stephan Neumann
- Institute of Veterinary Medicine, University of Göttingen, Göttingen, Germany
| | - Lilith Steingräber
- Institute of Veterinary Medicine, University of Göttingen, Göttingen, Germany
| | - Lisa Herold
- Institute of Veterinary Medicine, University of Göttingen, Göttingen, Germany
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Li YR, Meng XY, Zong RQ, Wu FX. Association Between Procalcitonin and Post-hepatectomy Liver Failure in Hepatocellular Carcinoma Patients. Front Pharmacol 2021; 12:791322. [PMID: 34867427 PMCID: PMC8637728 DOI: 10.3389/fphar.2021.791322] [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: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: Procalcitonin (PCT) has long been proved as an early diagnostic signal for postoperative outcomes. The purpose of this study is to explore the value of serum procalcitonin levels in predicting post-hepatectomy liver failure (PHLF), and further to declarethe relationship between postoperative PCT and short-term prognosis in patients after hepatectomy. Methods: Clinical data of patients with hepatocellular carcinoma (HCC) who underwent hepatectomy from June 1st, 2019 to September 31st, 2020 at Shanghai Eastern Hepatobiliary Surgery Hospital had been retrospectively analyzed. Logistic regression analysis was used to evaluate the risk factors related to PHLF. The Kaplan-Meier method was used to calculate the PHLF rate and 30-day survival after surgery. Results: A total of 885 patients with complete data were finally included in analysis, 311 of them with elevated serum PCT (≥1 ng/ml). Results of the logistic regression analysis suggested a significant association between PCT and PHLF [HR, 95%CI; 3.801 (1.825, 7.917), p < 0.001]. Other significant risk factors for PHLF included portal hypertension, portal blocking time (>30 min) and blood transfusion (>200 ml). Kaplan-Meier analysis also suggested a higher PHLF rate in elevated PCT patients [9.0% (95% CI, 7.3 to 12.8 VS. 1.9% (95% CI, 1.1–4.3)); p < 0.001]. For secondary outcomes, elevated PCT was also highly associated with postoperative sepsis, ICU admission, 30-day mortality and 3-month mortality. Conclusion: Elevated procalcitonin level in patients after hepatectomy is related to higher PHLF rate, with lower 30-day survival and poor short-term postoperative outcomes.
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Affiliation(s)
- Yi-Ran Li
- Department of Intensive Care Medicine, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiao-Yan Meng
- Department of Intensive Care Medicine, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Rui-Qing Zong
- Department of Intensive Care Medicine, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Fei-Xiang Wu
- Department of Intensive Care Medicine, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai, China
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Chen Y, Shen J, Yang H, Xu S, Ma Y, Pan F. Serum procalcitonin and C-reactive protein levels as diagnostic markers for distinguishing bacterial infections from lupus flares in systemic lupus erythematosus: A systematic review and meta‑analysis. Int Immunopharmacol 2021; 101:108304. [PMID: 34731783 DOI: 10.1016/j.intimp.2021.108304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To systematically evaluate the diagnostic performance of procalcitonin (PCT) and C-reactive protein (CRP) for distinguishing bacterial infections from lupus flares in systemic lupus erythematosus (SLE) via meta-analysis. METHODS Electronic databases were comprehensively searched. The pooled standard mean difference (SMD) and 95% confidence interval (CI) were calculated to estimate the differences of serum PCT and CRP levels between bacterial infections and flares in SLE. Sensitivity, specificity and summary receiver operating characteristics (SROC) curve were used to assess the diagnostic values of PCT and CRP. The use of fixed or random effects model depended on heterogeneity. RESULTS Fifteen studies were included in the analysis. Serum PCT and CRP levels were significantly higher in SLE patients with bacterial infections compared to SLE patients with flares (PCT: SMD = 1.035, 95 %CI = 0.708 to 1.362; CRP: SMD = 1.000, 95 %CI = 0.758 to 1.242). The overall sensitivity, specificity, area under the SROC curve, positive likelihood ratios (PLR) and negative likelihood ratios (NLR) of PCT were 0.62, 0.88, 0.862, 6.63 and 0.36, respectively, while the same indicators for CRP were 0.72, 0.70, 0.784, 2.45 and 0.38, respectively. CONCLUSION Serum PCT and CRP levels were significantly increased in SLE with bacterial infections. PCT had a better diagnostic performance than CRP. PCT had a high value of PLR and could serve as a rule-in marker, while CRP testing may result in a high false-positive rate due to low PLR; both markers had a suboptimal value of NLR and are not appropriate for ruling out bacterial infections.
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Affiliation(s)
- Yuting Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Jiran Shen
- Department of Internal Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China
| | - Hui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China.
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Chaftari P, Chaftari AM, Hachem R, Yeung SCJ, Dagher H, Jiang Y, Malek AE, Dailey Garnes N, Mulanovich VE, Raad I. The role of procalcitonin in identifying high-risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score. Cancer Med 2021; 10:8475-8482. [PMID: 34725958 PMCID: PMC8633259 DOI: 10.1002/cam4.4355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 10/03/2021] [Indexed: 12/18/2022] Open
Abstract
Background The Multinational Association for Supportive Care in Cancer (MASCC) risk index has been utilized to determine the risk for poor clinical outcomes in patients with febrile neutropenia (FN) in an emergency center (EC). However, this index comprises subjective elements and elaborated metrics limiting its use in ECs. We sought to determine whether procalcitonin (PCT) level (biomarker of bacterial infection) with or without lactate level (marker of inadequate tissue perfusion) offers a potential alternative to MASSC score in predicting the outcomes of patients with FN presenting to an EC. Methods We retrospectively identified 550 cancer patients with FN who presented to our EC between April 2018, and April 2019, and had serum PCT and lactate levels measured. Results Compared with patients with PCT levels <0.25 ng/ml, those with levels ≥0.25 ng/ml had a significantly higher 14‐day mortality rate (5.2% vs. 0.7%; p = 0.002), a higher bloodstream infection (BSI) rate, and a longer hospital length of stay (LOS). Logistic regression analysis showed that patients with PCT levels ≥0.25 ng/ml and lactate levels >2.2 mmol/L were more likely to be admitted and have an LOS >7 days, BSI, and 14‐day mortality than patients with lower levels. PCT level was a significantly better predictor of BSI than MASSC score (p = 0.003) or lactate level (p < 0.0001). Conclusions Procalcitonin level is superior to MASCC index in predicting BSI. The combination of PCT and lactate levels is a good predictor of BSI, hospital admission, and 14‐day mortality and could be useful in identifying high‐risk FN patients who require hospital admission.
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Affiliation(s)
- Patrick Chaftari
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hiba Dagher
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre E Malek
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Natalie Dailey Garnes
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Elevated Procalcitonin Is Positively Associated with the Severity of COVID-19: A Meta-Analysis Based on 10 Cohort Studies. ACTA ACUST UNITED AC 2021; 57:medicina57060594. [PMID: 34207689 PMCID: PMC8227321 DOI: 10.3390/medicina57060594] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Procalcitonin (PCT) is positively associated with the severity of COVID-19 (including severe, critical, or fatal outcomes), but some of the confounding factors are not considered. The aim of this meta-analysis was to estimate the adjusted relationship between elevated procalcitonin on admission and the severity of COVID-19. Materials and Methods: We searched 1805 articles from PubMed, Web of Science, and Embase databases up to 2 April 2021. The articles were selected which reported the adjusted relationship applying multivariate analysis between PCT and the severity of COVID-19. The pooled effect estimate was calculated by the random-effects model. Results: The meta-analysis included 10 cohort studies with a total of 7716 patients. Patients with elevated procalcitonin on admission were at a higher risk of severe and critical COVID-19 (pooled effect estimate: 1.77, 95% confidence interval (CI): 1.38–2.29; I2 = 85.6%, p < 0.001). Similar results were also observed in dead patients (pooled effect estimate: 1.77, 95% CI: 1.36–2.30). After adjusting for diabetes, the positive association between PCT and the severity of COVID-19 decreased. Subgroup analysis revealed heterogeneity between studies and sensitivity analysis showed that the results were robust. There was no evidence of publication bias by Egger’s test (p = 0.106). Conclusions: Higher procalcitonin is positively associated with the severity of COVID-19, which is a potential biomarker to evaluate the severity of COVID-19 and predict the prognosis.
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Joyce CM, Deasy S, Abu H, Lim YY, O'Shea PM, O'Donoghue K. Reference values for C-reactive protein and procalcitonin at term pregnancy and in the early postnatal period. Ann Clin Biochem 2021; 58:452-460. [PMID: 33730872 DOI: 10.1177/00045632211005807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early recognition of sepsis and prompt treatment improves patient outcome. C-reactive protein is a sensitive marker for tissue damage and inflammation, but procalcitonin has greater specificity for bacterial infection. Limited research exists regarding the use of C-reactive protein and procalcitonin at term pregnancy and the immediate postpartum period. AIM This study sought to define reference values for C-reactive protein and procalcitonin at term and the early postnatal period. METHODS A prospective cross-sectional study was performed in a university teaching hospital. Venous blood was collected from healthy women (n = 196), aged between 19 and 45 years with an uncomplicated singleton pregnancy, at term (37-40 weeks' gestation) and on day 1 and day 3 postpartum for the measurement of C-reactive protein and procalcitonin. RESULTS The reference population comprised of 189 participants: term pregnancy (n = 51), postpartum day 1 vaginal delivery (n = 70) and caesarean section (n = 38) and day 3 (caesarean section, n = 30). The maximum procalcitonin value at term pregnancy was 0.1 μg/L. On day 1 postpartum, 90% and 86.8% of procalcitonin results for vaginal delivery and caesarean section, respectively, were below the decision-threshold of 0.25 μg/L. The specificity of procalcitonin to rule out infection in the reference population was 91.5%. CONCLUSIONS Reference values for procalcitonin were established in a well-characterized population of healthy pregnant women at term and immediately postpartum. The variability of C-reactive protein limits its clinical utility in the assessment of systemic sepsis. Application of the procalcitonin cut-off of 0.25 μg/L in this population will be a valuable adjunct to clinicians ruling out infection in pregnancy and postpartum.
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Affiliation(s)
- Caroline M Joyce
- Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland.,Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Shane Deasy
- Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland
| | - Hala Abu
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Yoke Yin Lim
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Paula M O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.,The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
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Malik M, Sreekantan Nair A, Illango J, Siddiqui N, Gor R, Fernando RW, Hamid P. The Advancement in Detecting Sepsis and Its Outcome: Usefulness of Procalcitonin in Diagnosing Sepsis and Predicting Fatal Outcomes in Patients Admitted to Intensive Care Unit. Cureus 2021; 13:e14439. [PMID: 33996303 PMCID: PMC8114960 DOI: 10.7759/cureus.14439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Sepsis still remains a big challenge in patients admitted to intensive care units (ICUs) despite stellar advances made in the field of medicine. We can achieve better clinical outcomes in patients by diagnosing sepsis earlier. Procalcitonin (PCT), an inflammatory biomarker, has shown promising results in this regard. Therefore, this systematic review was done to assess the use of PCT in diagnosing and predicting severe outcomes in patients admitted to ICU and to assess if introducing PCT as a routine biochemical tool in hospitals would be helpful to achieve better clinical course in ICU patients. To identify relevant articles, we searched PubMed, Google Scholar, and references of included articles. Eligible studies were identified by two investigators independently and data were extracted. Original articles that evaluated the diagnostic and prognostic value of serum PCT levels in predicting sepsis, the severity of sepsis, and mortality among adult patients admitted to ICU were included in this study. A total of 2,063 citations were identified by the search, among which 10 studies (five prospective cohort, three retrospective cohort, one cross-sectional, and one case-control study) met the inclusion criteria. Most studies showed moderate-to-low risk of bias which was evaluated using the Quality in Prognosis Studies tool. All studies showed a positive correlation between initial PCT levels and detecting mortality resulting from sepsis, six studies found PCT helpful in detecting sepsis, and four studies evaluated the role of PCT in detecting severity in patients with sepsis. One study found area under the curve of serum PCT level for predicting 28-day mortality to be 0.82 (95% confidence interval [CI]: 0.70-0.94; p < 0.001) in adults and 0.83 (95% CI: 0.73-0.92; p < 0.001) in the elderly having an optimal cut-off level of serum PCT of 0.2 ng/mL in both the adult and elderly groups, with a sensitivity of 81 and 75% and specificity of 81.7 and 80.4%, respectively. PCT has shown promising results in detecting sepsis and its clinical course. For early diagnosis and management of sepsis, severe sepsis, and mortality in patients admitted to the ICU for a more favorable clinical outcome, PCT can be used.
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Affiliation(s)
- Mushrin Malik
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Janan Illango
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nabeel Siddiqui
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rajvi Gor
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ransirini W Fernando
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Trachtman R, Murray E, Wang CM, Szymonifka J, Toussi SS, Walters H, Nellis ME, Onel KB, Mandl LA. Procalcitonin Differs in Children With Infection and Children With Disease Flares in Juvenile Idiopathic Arthritis. J Clin Rheumatol 2021; 27:87-91. [PMID: 31693652 PMCID: PMC10364140 DOI: 10.1097/rhu.0000000000001170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with juvenile idiopathic arthritis (JIA) often present with signs and symptoms suggestive of serious bacterial infection (SBI). Procalcitonin (PCT) is a biomarker that is elevated in SBI. We conducted a comparative cohort study to test the hypothesis that PCT levels will differ between active JIA, quiescent JIA, and bacteremic patients and healthy controls. METHODS From October 2016 to May2018, consecutive children 6 months to 18 years of age with (a) active untreated JIA, (b) quiescent JIA, and (c) healthy elective presurgical candidates were recruited from clinics at a musculoskeletal specialty hospital. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Clinical data and serum samples meeting the same criteria were included from a prior study. Consecutive bacteremic patients were identified over the same period. Procalcitonin and other common measures of inflammation were measured. Descriptive statistics and univariate logistic analyses were performed. RESULTS Ninety-two study subjects were recruited. Erythrocyte sedimentation rate, C-reactive protein (CRP), and PCT levels were all elevated in bacteremic patients in comparison to the other groups. Erythrocyte sedimentation rate and CRP both had wide ranges that overlapped between groups; however, the PCT concentration was 0.15 μg/mL or greater in 1 of 59 patients with JIA, whereas it was 0.15 μg/mL or less in only 1 bacteremic patient. CONCLUSIONS Our study indicates that serum erythrocyte sedimentation rate, CRP, and PCT levels are all biomarkers that can be used to distinguish SBI versus active JIA at presentation. However, PCT is the most accurate, with the least overlap between patients with infection and noninfectious inflammatory arthritis. This finding can help clinicians direct therapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Karen B. Onel
- Hospital for Special Surgery
- Weill Cornell Medicine, New York
| | - Lisa A. Mandl
- Hospital for Special Surgery
- Northwell Health, Lake Success, NY
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Zhang P, Zou B, Liou YC, Huang C. The pathogenesis and diagnosis of sepsis post burn injury. BURNS & TRAUMA 2021; 9:tkaa047. [PMID: 33654698 PMCID: PMC7901709 DOI: 10.1093/burnst/tkaa047] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/20/2020] [Indexed: 02/05/2023]
Abstract
Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality. Although the survival rate after devastating burn injuries has continued to increase in previous decades due to medical advances in burn wound care, nutritional and fluid resuscitation and improved infection control practices, there are still large numbers of patients at a high risk of death. One of the most common complications of burn is sepsis, which is defined as “severe organ dysfunction attributed to host's disordered response to infection” and is the primary cause of death in burn patients. Indeed, burn injuries are accompanied by a series of events that lead to sepsis and multiple organ dysfunction syndrome, such as a hypovolaemic state, immune and inflammatory responses and metabolic changes. Therefore, clear diagnostic criteria and predictive biomarkers are especially important in the prevention and treatment of sepsis and septic shock. In this review, we focus on the pathogenesis of burn wound infection and the post-burn events leading to sepsis. Moreover, the clinical and promising biomarkers of burn sepsis will also be summarized.
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Affiliation(s)
- Pengju Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, No.17 People's South Road, Chengdu, 610041, China
| | - Bingwen Zou
- Department of Thoracic Oncology and Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Yih-Cherng Liou
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 14 Science Drive 4, 117543, Singapore
| | - Canhua Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, No.17 People's South Road, Chengdu, 610041, China
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Tsui TL, Huang YT, Kan WC, Huang MS, Lai MY, Ueng KC, Shiao CC. A novel procalcitonin-based score for detecting sepsis among critically ill patients. PLoS One 2021; 16:e0245748. [PMID: 33481913 PMCID: PMC7822524 DOI: 10.1371/journal.pone.0245748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. Methods We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. Results A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, “serum PCT level,” “albumin level” and “neutrophil-lymphocyte ratio” at ICU admission, along with “diabetes mellitus,” and “with vasopressor.” We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74–0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69–0.90; sensitivity 0.64; specificity 0.87). Conclusions We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.
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Affiliation(s)
- Tung-Lin Tsui
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Intensive Care Unit, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
| | - Ya-Ting Huang
- Department of Nursing, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
- Saint Mary’s Junior College of Medicine, Nursing and Management, Yilan, Taiwan
| | - Wei-Chih Kan
- Department of Nephrology, Department of Internal medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Mao-Sheng Huang
- Department of laboratory medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
| | - Min-Yu Lai
- Department of Nursing, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
| | - Kwo-Chang Ueng
- School of Medicine, Chung Shan Medical University, Taichung, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chih-Chung Shiao
- Saint Mary’s Junior College of Medicine, Nursing and Management, Yilan, Taiwan
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
- * E-mail:
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Naramura T, Imamura H, Yoshimatsu H, Hirashima K, Irie S, Inoue T, Tanaka K, Mitsubuchi H, Nakamura K, Iwai M. The Predictive Value of Procalcitonin and High-Sensitivity C-Reactive Protein for Early Bacterial Infections in Preterm Neonates. Neonatology 2021; 118:28-36. [PMID: 33326974 DOI: 10.1159/000512523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Evidence on the reliability of using procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) as diagnostic markers for early-onset neonatal bacterial infections is still insufficient because of their physiological elevation during the early neonatal period. This study aimed to assess the respiratory influence of serum PCT and hs-CRP levels and evaluate their predictive value for bacterial infections during the first 72 h of life in preterm neonates. METHODS The preterm neonates enrolled in this single-center retrospective cohort study were categorized into 3 groups: reference, infection-unlikely respiratory failure, and probable bacterial infection; their serum PCT and hs-CRP levels were assessed. Subsequently, age-specific 95th percentile curves were plotted and the median and cutoff PCT and hs-CRP levels for predicting bacterial infections at birth and 7-18, 19-36, and 37-72 h after birth were determined. Moreover, the analysis of PCT and hs-CRP with a neonatal sequential organ failure assessment (nSOFA) score was performed in very low birth weight neonates. RESULTS Serum PCT levels were influenced by respiratory failure. A significant difference was found in the median PCT and hs-CRP levels among the 3 groups at each time point. PCT sensitivities for predicting bacterial infection were slightly higher than those of hs-CRP in each time frame during the first 72 h of life. In both PCT and hs-CRP, there was no significant difference between infants with nSOFA scores of >4 and those with nSOFA scores of ≤4. DISCUSSION/CONCLUSION Age-specific evaluation showed that PCT has better predictive value than hs-CRP for early-onset bacterial infections in preterm neonates.
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Affiliation(s)
- Tetsuo Naramura
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hiroko Imamura
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hidetaka Yoshimatsu
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Kaname Hirashima
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Shinji Irie
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Takeshi Inoue
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tanaka
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Mitsubuchi
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan.,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Masanori Iwai
- Division of Neonatology, Perinatal Center, Kumamoto University Hospital, Kumamoto, Japan, .,Department of Pediatrics, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan,
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Liao M, Zheng J, Xu Y, Qiu Y, Xia C, Zhong Z, Liu L, Liu H, Liu R, Liang S. Development of magnetic particle-based chemiluminescence immunoassay for measurement of human procalcitonin in serum. J Immunol Methods 2020; 488:112913. [PMID: 33189726 DOI: 10.1016/j.jim.2020.112913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/01/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Serum procalcitonin (PCT) has been recognized as a primary biomarker in bacterial infections, and monitoring its concentration could help to evaluate the prognosis of sepsis and guide the antibiotic administration. We aimed to establish a fast and accurate immunoassay for PCT quantitation. METHODS Our newly developed monoclonal antibodies (mAbs) against human PCT were preliminarily evaluated by enzyme-linked immunosorbent assay and then used to develop a chemiluminescence enzyme immunoassay (CLEIA). The proposed CLEIA was assessed in analytical performance and applied to measurement of serum PCT. RESULTS mAb 2D3 and mAb 8F6 were selected as capture and detection antibody respectively, due to the highest sensitivity for PCT detection with no cross reaction to calcitonin gene-related peptides. The proposed CLEIA based on mAb pair of 2D3/8F6-AP was characterized for a working range from 0.03 to 100 μg/L. An excellent correlation was observed between our proposed assay and the VIDAS BRAHMS PCT assay (r: 0.9825). CONCLUSION Our newly developed mAbs and CLEIA can serve as important diagnostic tools for measurement of human PCT in serum.
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Affiliation(s)
- Minjing Liao
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China; Immunodiagnostic Reagents Engineering Research Center of Hunan Province, Hunan Normal University, Changsha 410013, China
| | - Jiao Zheng
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China; Immunodiagnostic Reagents Engineering Research Center of Hunan Province, Hunan Normal University, Changsha 410013, China
| | - Ye Xu
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China; Immunodiagnostic Reagents Engineering Research Center of Hunan Province, Hunan Normal University, Changsha 410013, China
| | - Yilan Qiu
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China
| | - Chuan Xia
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China; Immunodiagnostic Reagents Engineering Research Center of Hunan Province, Hunan Normal University, Changsha 410013, China
| | - Zhihong Zhong
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China; Immunodiagnostic Reagents Engineering Research Center of Hunan Province, Hunan Normal University, Changsha 410013, China
| | - Lihui Liu
- Department of Medical Laboratory, Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Hongrong Liu
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China
| | - Rushi Liu
- Department of Medical Laboratory, School of Medicine, Hunan Normal University, Changsha 410013, China; Immunodiagnostic Reagents Engineering Research Center of Hunan Province, Hunan Normal University, Changsha 410013, China; Changsha hospital affiliated to Hunan Normal University, Changsha 410081, China.
| | - Songyue Liang
- Hunan Maternal and Child Health Care Hospital, Changsha 410008, China.
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Algohar A, Alqerban A. Levels of procalcitonin in saliva and peri-implant crevicular fluid in patients with peri-implant diseases and health. Arch Oral Biol 2020; 120:104931. [PMID: 33113457 DOI: 10.1016/j.archoralbio.2020.104931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the levels of procalcitonin in saliva and peri-implant crevicular fluid (PICF) among healthy and peri-implant disease patients and correlate these levels with clinical and radiographic peri-implant parameters. DESIGN Three groups of 20 participants each [Group-1: healthy, Group-2: peri-implant mucositis, and Group-3: peri-implantitis] were selected. Peri-implant plaque index, bleeding on probing, probing depth and crestal bone loss was assessed. PICF and saliva samples were evaluated for procalcitonin levels and analyzed using enzyme-linked immunosorbent assay. Kruskal-Wallis test was performed for comparisons among the study groups. Multiple comparisons were considered for Post hoc two-group comparisons using Bonferroni-corrections. The Spearman rank correlation coefficient analysis was used to analyze the correlation between procalcitonin levels of both fluids and clinical peri-implant parameters. RESULTS Group-3 demonstrated significantly higher values for peri-implant plaque index, bleeding on probing, probing depth, and crestal bone loss as compared to Group-1 and Group-2. Participants of both Group-2 and Group-3 reported significantly increased procalcitonin levels in saliva and PICF in comparison to Group-1. Significant positive correlations were found between PICF procalcitonin levels and bleeding on probing, probing depth, and crestal bone loss in Group-3 and significant positive correlation was found between PICF and bleeding on probing in Group-2. For salivary procalcitonin levels, a significant positive correlation was observed between procalcitonin and bleeding on probing in Group-3. CONCLUSIONS The outcome of this study suggests that procalcitonin might play a role in peri-implant inflammation, and higher procalcitonin levels is suggestive of a probable surrogate biomarker for peri-implant diseases.
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Affiliation(s)
- Ahmed Algohar
- Department of Prosthodontics, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Ali Alqerban
- Department of Preventive Dental Science, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia; Department of Preventive Dental Science, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
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Wang W, Zhu Y, Yin L, Deng Y, Chu G, Liu S. Utilization of serum procalcitonin as a biomarker in the diagnosis and treatment of children with bacterial hospital-acquired pneumonia. Mol Cell Biochem 2020; 476:261-267. [PMID: 32990893 PMCID: PMC7522182 DOI: 10.1007/s11010-020-03902-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023]
Abstract
Hospital-acquired pneumonia (HAP) is one of the common infections in hospitalized patients. Early and prompt diagnosis of HAP is important because it aids in the appropriate selection of antibiotics and decreases the mortality and morbidity of patients. The investigation on serum procalcitonin (PCT) levels in pediatric patients is limited. Herein we aimed to evaluate the role of PCT in the early diagnosis of children with bacterial HAP. The study enrolled 264 children (< 14 years old) who were radiographically detected by pulmonary condensation chest X-rays. The HAP patients were stratified by patterns of microbiological detection of pathogens. Baseline white blood cell (WBC) count, neutrophil proportion, PCT, and C-reactive protein (CRP) were measured on admission. The laboratory findings and microbiological findings were analyzed and compared among groups. The median PCT concentration of patients with typical bacterial pathogens (3.95 ± 3.75 ng/mL) was significantly higher than the one of the patients with other pathogen types (median lower than 1.20 ng/mL). Correlation analysis indicated a significant correlation between PCT concentrations and the main inflammation makers including WBC count, neutrophil proportion, and CRP. PCT level was significantly decreased to 0.86 ± 1.46 ng/mL in post-treatment patients (p < 0.001). This cohort study with 264 pediatric HAP patients demonstrated the reliability of PCT level as a biomarker in patients with typical bacterial pathogens. Specifically, PCT cutoffs of 2 ng/mL accurately identified HAP children with typical bacterial pathogens. This finding suggested that PCT may serve as a reliable biomarker for the early diagnosis and treatment indicator of children with HAP.
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Affiliation(s)
- Wenlong Wang
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China.
| | - Yitang Zhu
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
| | - Linlin Yin
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
| | - Yaoyao Deng
- Clinical Laboratory, Mengcun Hui Autonomous County Hospital, Chaoyang Dajie, Mengcun Hui Autonomous County, Cangzhou, 061400, Hebei, China
| | - Guoxian Chu
- Clinical Laboratory, People's Hospital of Qingxian, Nanhuanxi Road, Qingxian, Cangzhou, 062650, Hebei, China
| | - Supin Liu
- Department of Blood Collection Center, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
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Kajbafzadeh AM, Ladi Seyedian SS, Kameli SM, Nabavizadeh B, Boroomand M, Moghtaderi M. Urinary carbohydrate antigen 19-9 level as a biomarker in children with acute pyelonephritis. Eur J Pediatr 2020; 179:1389-1394. [PMID: 32146571 DOI: 10.1007/s00431-020-03626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/21/2019] [Accepted: 02/27/2020] [Indexed: 01/25/2023]
Abstract
Early and prompt diagnosis of pyelonephritis is of great importance in children. The aim of this study is to evaluate the diagnostic accuracy of urinary carbohydrate antigen 19-9 (CA19-9) levels for predicting acute pyelonephritis (APN) in children with urinary tract infection (UTI). Patients were allocated into two groups of APN and acute cystitis according to their diagnosis. Urine samples of all patients were collected. Also, complete history was taken, and physical examination, kidney and bladder ultrasonography, 99mTc-dimercaptosuccinic acid renal cortical scintigraphy, and urine analysis and culture were performed. Urinary CA19-9 was measured by an electrochemiluminescence enzyme immunometric kit. In addition, CA19-9 levels were measured in the APN group 2 weeks and 3 months later. A total of 100 children were included in this study (mean age 46 ± 31 months, 16 males and 84 females). CA19-9 levels were significantly greater in the APN group than acute cystitis group (510 ± 328 vs. 18.7 ± 18.6 U/ml, P < 0.001). During follow-up periods of the APN group, CA19-9 levels decreased to 180 ± 124 U/ml after 2 weeks (P < 0.001) and 30 ± 23 U/ml after 3 months (P < 0.001). Urinary CA-19-9 had 95.3% sensitivity and 80% specificity for the diagnosis of APN. The area under the curve value of CA19-9 was 0.904 (95% CI 0.831-0.977).Conclusion: Urinary CA19-9 level can be used as a reliable biomarker for early detection of APN prior to urine culture confirmation in children with UTI. What is known: • Early and prompt diagnosis of pyelonephritis is necessary in children to prevent renal damage. • Acute pyelonephritis can present with vague and nonspecific symptoms in infants and children. What is new: • Urinary carbohydrate antigen 19-9 is a reliable biomarker for early detection of acute pyelonephritis prior to urine culture confirmation. • Urinary carbohydrate antigen 19-9 has 95.3% sensitivity and 80% specificity for diagnosis of acute pyelonephritis.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran.
| | - Seyedeh Sanam Ladi Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Seyedeh Maryam Kameli
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Iran
| | - Maryam Boroomand
- Pediatric Nephrology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mastaneh Moghtaderi
- Pediatric Nephrology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Effect of a novel extracorporeal cytokine apheresis method on endocan, copeptin And interleukin-6 levels in sepsis: An observational prospective study. Transfus Apher Sci 2020; 59:102919. [PMID: 32912735 DOI: 10.1016/j.transci.2020.102919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE There is still an evident need for useful biomarkers and effective therapeutic approaches regarding the challenging management of sepsis. The aim of the study is to evaluate the effect of each Cytosorb hemoadsorption therapy course on blood levels of inflammatory biomarkers of sepsis including endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein. METHODS There were a total of 178 samples belonging to 34 patients that were diagnosed with sepsis and undergone Cytosorb therapy during the study period. Patient demographics were recorded. Arterial blood samples were obtained both before and and after each Cytosorb course. Levels of copeptin, interleukin-6, procalcitonin, C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and creatinine were assessed both before and after each Cytosorb treatment. RESULTS Levels of endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein, and erythrocyte sedimentation rate were all significantly decreased after the Cytosorb course when compared with levels before therapy (p = 0.039, 0.001, 0.010, 0.001, 0.002 and 0.001, respectively). There was no significant difference between white blood cell count and creatinine levels before and after Cytosorb courses (p = 0.204 and 0.277). CONCLUSION Cytosorb courses achieved significant decreases in endocan, copeptin, interleukin-6, procalcitonin and C-reactive protein levels. Decreasing plasma levels of inflammatory cytokines may help alleviate the cytokine storm and may have a role in improve outcomes. Further prospective randomized controlled studies with larger sample size are needed concerning the long-term effects of this decrease in cytokine levels on outcome and mortality.
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Zincircioglu C, Yavuz T, Sarıtaş A, Çakmak M, Güldoğan IK, Uzun U, Şenoğlu N. Is Procalcitonin a Marker of Neurologic Outcome or Early Infection in Patients Treated with Targeted Temperature Management? Indian J Crit Care Med 2020; 24:327-331. [PMID: 32728323 PMCID: PMC7358853 DOI: 10.5005/jp-journals-10071-23418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Although high procalcitonin (PCT) levels are associated with poor neurological outcomes and increased mortality rates in patients treated with targeted temperature management (TTM) in the postcardiac arrest (CA) period, there are limited data about the correlation between PCT levels and infection. The aim of our study was to assess the relationship of PCT levels in the first 48 hours with early period infections, late period neurological prognosis, and mortality in patients treated with TTM after CA. Materials and methods Serum PCT was measured on admission days 1 and 2. The early onset infection diagnosis before the seventh day in the intensive care unit (ICU) was made according to the criteria of infection centers for disease control and prevention. Mortality and neurologic outcomes were assessed 90 days after CA according to cerebral performance category (CPC) score. Results There was no statistically significant correlation between early period infection diagnosis and PCT levels at the time of admission, 24th, and 48th hours. Patients with poor neurologic outcomes on the 90th day had significantly high PCT levels at 24 (p = 0.044) and 48 hours (p = 0.004). There was no statistically significant correlation between admission PCT levels and neurological prognosis. While the correlation between mortality and PCT levels at 24 (p = 0.049) and 48 (p = 0.004) hours was significantly high, no statistically significant correlation was found between admission PCT levels and mortality. Conclusion In patients treated with TTM after CA, increased PCT levels were significantly correlated with poor neurologic outcomes and mortality. However, the elevated PCT levels were not significantly correlated with early period infections. How to cite this article Zincircioglu C, Yavuz T, Sarıtaş A, Çakmak M, Güldoğan IK, Uzun U, et al. Is Procalcitonin a Marker of Neurologic Outcome or Early Infection in Patients Treated with Targeted Temperature Management? Indian J Crit Care Med 2020;24(5):327–331.
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Affiliation(s)
- Ciler Zincircioglu
- Department of Anaesthesiology and Reanimation, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tunzala Yavuz
- Department of Anesthesiology and Reanimation, Intensive Care Unit, Afyonkarahisar Health Sciences University, İzmir, Turkey
| | - Aykut Sarıtaş
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, Izmir, Turkey
| | - Meltem Çakmak
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, Izmir, Turkey
| | - Işıl Köse Güldoğan
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, Izmir, Turkey
| | - Uğur Uzun
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nimet Şenoğlu
- Department of Anesthesiology and Reanimation, Intensive Care Unit, SBU Tepecik Training and Research Hospital, Izmir, Turkey
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Riedel S. Predicting Bacterial Versus Viral Infection, or None of the Above: Current and Future Prospects of Biomarkers. Clin Lab Med 2020; 39:453-472. [PMID: 31383268 DOI: 10.1016/j.cll.2019.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sepsis and pneumonia cause significant morbidity and mortality worldwide. Despite improvements in diagnostic methodologies for organism identification, the early recognition and further risk stratification of these infections can be challenging. Although traditional clinical scoring systems are beneficial for the management of sepsis and pneumonia, biomarkers supporting the diagnosis and management of these infectious diseases are needed. Many biomarkers have been identified and there is no lack of studies and meta-analyses assessing the utility of biomarkers. Focusing primarily on sepsis and pneumonia, this article discusses the most commonly used biomarkers for which clinical laboratory testing methods are available.
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Affiliation(s)
- Stefan Riedel
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Yamins 309, Boston, MA 02215, USA.
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Tang J, Jiang Y, Ge Z, Wu H, Chen H, Dai J, Gu Y, Mao X, Lu J. Quantum Dots-Based Point-of-Care Measurement of Procalcitonin in Finger-Prick Blood and Venous Whole Blood Specimens. Lab Med 2020; 51:34-40. [PMID: 31245815 DOI: 10.1093/labmed/lmz025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To determine whether the performance of a new quantum dots-based point-of-care test (POCT) devices is qualified for procalcitonin testing. METHODS Finger-prick and venous blood specimens from 153 patients were measured with a quantum dots-based POCT device; the results were compared with those from the reference method. RESULTS The quantum dots-based POCT device correlated well with the reference method in measuring plasma, venous whole blood, and finger-prick blood. No significant bias was observed (-0.08 ng/mL). At 0.5 ng per mL cutoff value, the concordances were 96.6%, 94.6%, and 90.5% for plasma, venous whole blood, and finger-prick blood, respectively. And at 2 ng per mL cutoff value, the concordances were 98.0%, 96.6%, and 95.3%, respectively. CONCLUSIONS The quantum dots-based POCT device measured procalcitonin with multiple specimen types, high sensitivity, wide detection range, and short turnaround time. It would allow a more widespread use of procalcitonin and help lessen the burden of overcrowding in healthcare facilities in China.
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Affiliation(s)
- Junming Tang
- Department of Clinical Laboratory, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Yan Jiang
- Department of Critical Care Medicine, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Zhijun Ge
- Department of Critical Care Medicine, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Haifeng Wu
- Department of Critical Care Medicine, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Huajun Chen
- Department of Critical Care Medicine, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Ji Dai
- Department of Critical Care Medicine, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Yinjie Gu
- Department of Critical Care Medicine, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Xuhua Mao
- Department of Clinical Laboratory, Yixing People's Hospital, Affiliated Jiangsu University, China
| | - Junjie Lu
- Department of Critical Care Medicine, Yixing People's Hospital, Affiliated Jiangsu University, China
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The Diagnostic Values of Ischemia-Modified Albumin in Patients with Acute Abdominal Pain and Its Role in Differentiating Acute Abdomen. Emerg Med Int 2020; 2020:7925975. [PMID: 32509350 PMCID: PMC7244959 DOI: 10.1155/2020/7925975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 12/29/2022] Open
Abstract
Aim The aim of this study was to evaluate the diagnostic value of serum ischemia-modified albumin (IMA) levels in patients presenting to the emergency department with acute abdominal pain and its use in differentiating acute surgical abdomen. Methods This single-center prospective cross-sectional study included 334 adult patients who presented to the emergency department. These consisted of 194 patients (Group 1) with nontraumatic abdominal pain commencing in the preceding week, who were definitely diagnosed and either hospitalized in a specific department or planned for discharge, and a control group of 140 patients (Group 2). Results The mean IMA value of the patients diagnosed with acute appendicitis was statistically significantly higher than that of the control group. The mean IMA value of the patients diagnosed with acute appendicitis, ovarian pathologies, and gastritis-peptic ulcer was statistically significantly higher than that of the nonspecific abdominal pain group. Conclusion Serum IMA levels can be used as a diagnostic marker in patients with acute appendicitis. Furthermore, serum IMA levels in patients presenting to the emergency department with abdominal pain may be indicative of patients requiring surgery or of complicated cases, particularly in terms of acute appendicitis and ovarian pathologies.
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