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Ma Z, Jiang Z, Li H, Lu A, Wu S, Lu H, Wen W, Wang L, Yuan F. Prevalence, early predictors, and outcomes of sepsis in neurocritical illnesses: A prospective cohort study. Am J Infect Control 2024; 52:827-833. [PMID: 38281685 DOI: 10.1016/j.ajic.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patients with neurocritically illness are an under-recognized population at high risk of sepsis. We aimed to investigate the prevalence, early predictors, and outcomes of sepsis in neuro-ICU. METHODS Daily and accumulative incidences of sepsis in neuro-ICU were explored. Demographics, medical history, baseline disease severity scores, and baseline biomarkers regarding inflammation, immunology, organ function, and nutritional status were collected and analyzed as potential predictors of sepsis. Logistic regression analyses were used to determine the independent predictors, and a nomogram was used to estimate the individual probability of sepsis in neuro-ICU. RESULTS 153 patients were included in this study. Fifty-nine (38.6%) patients developed sepsis, and 21 (14%) patients developed septic shock. More than 86% of the septic cases occurred within the first week. Sequential organ failure assessment score ((relative risk) RR 1.334, P = .026), history of diabetes (RR 2.346, P = .049), and transferrin (RR 0.128, P = .042) on admission are independent predictors of sepsis. Septic patients had significantly higher mortality (P = .011), higher medical cost (P = .028), and a lower rate of functional independence (P = .010), compared to patients without sepsis. CONCLUSIONS Sepsis afflicted more than one-third of neurocritically-ill patients and occurred mostly in the first week of admission. History of diabetes, serum transferrin, and sequential organ failure assessment score on admission were early predictors. Sepsis led to significantly worse outcomes and higher medical costs.
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Affiliation(s)
- Zhaohui Ma
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeping Jiang
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Internal Medicine, Puning Hospital of Chinese Medicine, Puning, Guangdong, China
| | - Huiping Li
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Aili Lu
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shibiao Wu
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongji Lu
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wanxing Wen
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixin Wang
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China.
| | - Fang Yuan
- Department of Neurocritical Care, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China.
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Formenti P, Isidori L, Pastori S, Roccaforte V, Mantovani EA, Iezzi M, Menozzi A, Panella R, Galimberti A, Brenna G, Umbrello M, Pezzi A, Vetrone F, Sabbatini G, Gotti M. A Secondary Retrospective Analysis of the Predictive Value of Neutrophil-Reactive Intensity (NEUT-RI) in Septic and Non-Septic Patients in Intensive Care. Diagnostics (Basel) 2024; 14:821. [PMID: 38667467 PMCID: PMC11049356 DOI: 10.3390/diagnostics14080821] [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: 03/15/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Effective identification and management in the early stages of sepsis are critical for achieving positive outcomes. In this context, neutrophil-reactive intensity (NEUT-RI) emerges as a promising and easily interpretable parameter. This study aimed to assess the predictive value of NEUT-RI in diagnosing sepsis and to evaluate its prognostic significance in distinguishing 28-day mortality outcomes. MATERIALS This study is a secondary, retrospective, observational analysis. Clinical data upon ICU admission were collected. We enrolled septic patients and a control group of critically ill patients without sepsis criteria. The patients were divided into subgroups based on renal function for biomarker evaluation with 28-day outcomes reported for septic and non-septic patients. RESULTS A total of 200 patients were included in this study. A significant difference between the "septic" and "non-septic" groups was detected in the NEUT-RI plasma concentration (53.80 [49.65-59.05] vs. 48.00 [46.00-49.90] FI, p < 0.001, respectively). NEUT-RI and procalcitonin (PCT) distinguished between not complicated sepsis and septic shock (PCT 1.71 [0.42-12.09] vs. 32.59 [8.83-100.00], <0.001 and NEUT-RI 51.50 [47.80-56.30] vs. 56.20 [52.30-61.92], p = 0.005). NEUT-RI, PCT, and CRP values were significantly different in patients with "renal failure". NEUT-RI and PCT at admission in the ICU in the septic group were higher in patients who died (58.80 [53.85-73.10] vs. 53.05 [48.90-57.22], p = 0.005 and 39.56 [17.39-83.72] vs. 3.22 [0.59-32.32], p = 0.002, respectively). Both NEUT-RI and PCT showed a high negative predictive value and low positive predictive value. CONCLUSIONS The inflammatory biomarkers assessed in this study offer valuable support in the early diagnosis of sepsis and could have a possible role in anticipating the outcome. NEUT-RI elevation appears particularly promising for early sepsis detection and severity discrimination upon admission.
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Affiliation(s)
- Paolo Formenti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Letizia Isidori
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Stefano Pastori
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.)
| | - Vincenzo Roccaforte
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.)
| | - Elena Alessandra Mantovani
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Massimiliano Iezzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy (A.M.)
| | - Alessandro Menozzi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy (A.M.)
| | - Rossella Panella
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (S.P.)
| | - Andrea Galimberti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Giovanni Brenna
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Michele Umbrello
- Department of Intensive Care, New Hospital of Legnano (Ospedale Nuovo di Legnano), 20025 Legnano, Italy;
| | - Angelo Pezzi
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Francesco Vetrone
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Giovanni Sabbatini
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
| | - Miriam Gotti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy; (L.I.); (A.G.)
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Wityk P, Sokołowski P, Szczerska M, Cierpiak K, Krawczyk B, Markuszewski MJ. Optical method supported by machine learning for urinary tract infection detection and urosepsis risk assessment. JOURNAL OF BIOPHOTONICS 2023; 16:e202300095. [PMID: 37285226 DOI: 10.1002/jbio.202300095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
The study presents an optical method supported by machine learning for discriminating urinary tract infections from an infection capable of causing urosepsis. The method comprises spectra of spectroscopy measurement of artificial urine samples with bacteria from solid cultures of clinical E. coli strains. To provide a reliable classification of results assistance of 27 algorithms was tested. We proved that is possible to obtain up to 97% accuracy of the measurement method with the use of use of machine learning. The method was validated on urine samples from 241 patients. The advantages of the proposed solution are the simplicity of the sensor, mobility, versatility, and low cost of the test.
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Affiliation(s)
- Paweł Wityk
- Department of Biopharmaceutics and Pharmacodynamics, Faculty of Pharmacy, Medical University of Gdańsk, Gdańsk, Poland
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Patryk Sokołowski
- Department of Metrology and Optoelectronics, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland
| | - Małgorzata Szczerska
- Department of Biopharmaceutics and Pharmacodynamics, Faculty of Pharmacy, Medical University of Gdańsk, Gdańsk, Poland
- Department of Metrology and Optoelectronics, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland
| | - Kacper Cierpiak
- Department of Metrology and Optoelectronics, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland
| | - Beata Krawczyk
- Department of Biopharmaceutics and Pharmacodynamics, Faculty of Pharmacy, Medical University of Gdańsk, Gdańsk, Poland
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Michał J Markuszewski
- Department of Biopharmaceutics and Pharmacodynamics, Faculty of Pharmacy, Medical University of Gdańsk, Gdańsk, Poland
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Zakirov R, Petrichuk S, Yanyushkina O, Semikina E, Vershinina M, Karaseva O. Comprehensive Assessment of Mid-Regional Proadrenomedullin, Procalcitonin, Neuron-Specific Enolase and Protein S100 for Predicting Pediatric Severe Trauma Outcomes. Biomedicines 2023; 11:2306. [PMID: 37626802 PMCID: PMC10452732 DOI: 10.3390/biomedicines11082306] [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: 07/04/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The development of multiple organ failure and septic complications increases the cumulative risk of mortality in children with severe injury. Clinically available biochemical markers have shown promise in assessing the severity and predicting the development of complications and outcomes in such cases. This study aimed to determine informative criteria for assessing the severity and outcome prediction of severe injury in children based on levels of mid-regional proadrenomedullin (MR-proADM) procalcitonin (PCT), neuron-specific enolase (NSE), and protein S100. Biomarker levels were measured in 52 children with severe injury (ISS ≥ 16) on the 1st, 3rd, 7th, and 14th days after admission to the ICU. The children were divided into groups based on their favorable (n = 44) or unfavorable (n = 8) outcomes according to the Severe Injury Outcome Scale, as well as their favorable (n = 35) or unfavorable (n = 15) outcomes according to the Glasgow Coma Outcome Scale (GOS). The study also evaluated the significance of biomarker levels in predicting septic complications (with SC (n = 16) and without SC (n = 36)) and diagnosing and stratifying multiple organ failure (with MOF (n = 8) and without MOF (n = 44)). A comprehensive assessment of MR-proADM and PCT provided the highest diagnostic and prognostic efficacy for early diagnosis, risk stratification of multiple organ failure, and outcome prediction in severe injury cases involving children. Additionally, the inclusion of the S100 protein in the study allowed for further assessment of brain damage in cases of traumatic brain injury (TBI), contributing to the overall prognostic model.
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Affiliation(s)
- Rustam Zakirov
- National Medical Research Center for Children’s Health, 119296 Moscow, Russia
- Clinical and Research Institute of Emergency Pediatric Surgery and Traumatology, 119180 Moscow, Russia
| | - Svetlana Petrichuk
- National Medical Research Center for Children’s Health, 119296 Moscow, Russia
| | - Olga Yanyushkina
- Clinical and Research Institute of Emergency Pediatric Surgery and Traumatology, 119180 Moscow, Russia
| | - Elena Semikina
- National Medical Research Center for Children’s Health, 119296 Moscow, Russia
| | - Marina Vershinina
- National Medical Research Center for Children’s Health, 119296 Moscow, Russia
| | - Olga Karaseva
- National Medical Research Center for Children’s Health, 119296 Moscow, Russia
- Clinical and Research Institute of Emergency Pediatric Surgery and Traumatology, 119180 Moscow, Russia
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Mantovani EMA, Formenti P, Pastori S, Roccaforte V, Gotti M, Panella R, Galimberti A, Costagliola R, Vetrone F, Umbrello M, Pezzi A, Sabbatini G. The Potential Role of Neutrophil-Reactive Intensity (NEUT-RI) in the Diagnosis of Sepsis in Critically Ill Patients: A Retrospective Cohort Study. Diagnostics (Basel) 2023; 13:diagnostics13101781. [PMID: 37238265 DOI: 10.3390/diagnostics13101781] [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: 04/24/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
The diagnosis of sepsis is often difficult and belated, substantially increasing mortality in affected patients. Its early identification allows for us to choose the most appropriate therapies in the shortest time, improving patients' outcomes and eventually their survival. Since neutrophil activation is an indicator of an early innate immune response, the aim of the study was to evaluate the role of Neutrophil-Reactive Intensity (NEUT-RI), which is an indicator of their metabolic activity, in the diagnosis of sepsis. Data from 96 patients consecutively admitted to the Intensive Care Unit (ICU) were retrospectively analyzed (46 patients with and 50 without sepsis). Patients with sepsis were further divided between sepsis and septic shock according to the severity of the illness. Patients were subsequently classified according to renal function. For the diagnosis of sepsis, NEUT-RI showed an AUC of >0.80 and a better negative predictive value than Procalcitonin (PCT) and C-reactive protein (CRP) (87.4% vs. 83.9% and 86.6%, p = 0.038). Unlike PCT and CRP, NEUT-RI did not show a significant difference within the "septic" group between patients with normal renal function and those with renal failure (p = 0.739). Similar results were observed among the "non-septic" group (p = 0.182). The increase in NEUT-RI values could be useful in the early ruling-out of sepsis, and it does not appear to be influenced by renal failure. However, NEUT-RI has not proved to be efficient in discriminating the severity of sepsis at the time of admission. Larger, prospective studies are needed to confirm these results.
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Affiliation(s)
| | - Paolo Formenti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Stefano Pastori
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Vincenzo Roccaforte
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Miriam Gotti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Rossella Panella
- S.C. Analisi Chimico Cliniche e Microbiologiche, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Andrea Galimberti
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Roberto Costagliola
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Francesco Vetrone
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Michele Umbrello
- S.C. Anestesia e Rianimazione II, ASST Santi Paolo e Carlo, Ospedale San Carlo, 20148 Milan, Italy
| | - Angelo Pezzi
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
| | - Giovanni Sabbatini
- S.C. Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
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Wu Y, Wang Q, Li M, Lao J, Tang H, Ming S, Wu M, Gong S, Li L, Liu L, Huang X. SLAMF7 regulates the inflammatory response in macrophages during polymicrobial sepsis. J Clin Invest 2023; 133:150224. [PMID: 36749634 PMCID: PMC10014109 DOI: 10.1172/jci150224] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
Uncontrolled inflammation occurred in sepsis results in multiple organ injuries and shock, which contributes to the death of patients with sepsis. However, the regulatory mechanisms that restrict excessive inflammation are still elusive. Here, we identified an Ig-like receptor called signaling lymphocyte activation molecular family 7 (SLAMF7) as a key suppressor of inflammation during sepsis. We found that the expression of SLAMF7 on monocytes/macrophages was significantly elevated in patients with sepsis and in septic mice. SLAMF7 attenuated TLR-dependent MAPK and NF-κB signaling activation in macrophages by cooperating with Src homology 2-containing inositol-5'‑phosphatase 1 (SHIP1). Furthermore, SLAMF7 interacted with SHIP1 and TNF receptor-associated factor 6 (TRAF6) to inhibit K63 ubiquitination of TRAF6. In addition, we found that tyrosine phosphorylation sites within the intracellular domain of SLAMF7 and the phosphatase domain of SHIP1 were indispensable for the interaction between SLAMF7, SHIP1, and TRAF6 and SLAMF7-mediated modulation of cytokine production. Finally, we demonstrated that SLAMF7 protected against lethal sepsis and endotoxemia by downregulating macrophage proinflammatory cytokines and suppressing inflammation-induced organ damage. Taken together, our findings reveal a negative regulatory role of SLAMF7 in polymicrobial sepsis, thus providing sights into the treatment of sepsis.
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Affiliation(s)
- Yongjian Wu
- Center for Infection and Immunity and Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Qiaohua Wang
- Center for Infection and Immunity and Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Miao Li
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Juanfeng Lao
- Center for Infection and Immunity and Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Huishu Tang
- Center for Infection and Immunity and Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Siqi Ming
- National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital of the Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Minhao Wu
- Center for Infection and Immunity and Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China
| | - Sitang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Linhai Li
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong Province, China
| | - Lei Liu
- National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital of the Southern University of Science and Technology, Shenzhen, Guangdong Province, China
| | - Xi Huang
- Center for Infection and Immunity and Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China.,National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital of the Southern University of Science and Technology, Shenzhen, Guangdong Province, China.,The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, Guangdong Province, China
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7
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C-Reactive Protein and White Blood Cell Count in Cardiogenic Shock. J Clin Med 2023; 12:jcm12030965. [PMID: 36769613 PMCID: PMC9917886 DOI: 10.3390/jcm12030965] [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: 12/14/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
This study examines the prognostic impact of C-reactive protein (CRP) and white blood cell (WBC) counts in patients with cardiogenic shock (CS). Data regarding the prognostic impact of inflammatory biomarkers in CS are scarce. All consecutive patients with CS from 2019 to 2021 admitted to a cardiac intensive care unit (ICU) were included at one institution. Laboratory measurements were retrieved from the day of admission (i.e., day 1), as well as days 2, 3, 4, and 8. The primary endpoint was 30-day all-cause mortality. Statistical analyses included univariate t-tests, Spearman's correlations, C-statistics, Kaplan-Meier, and Cox regression analyses. From a total of 240 consecutive patients admitted with CS, 55% died within 30 days. CRP levels on days 3 to 8 were associated with reliable discrimination for 30-day all-cause mortality (area under the curve (AUC): 0.623-0.754), whereas CRP on day 1 was not (AUC = 0.514). In line, CRP > 100 mg/L on day 3 (56% vs. 37%; log-rank p = 0.023; HR = 1.702; 95% CI 1.060-2.735; p = 0.028) and especially a CRP increase of at least 200% from days 1 to day 3 (51% vs. 35%; log-rank p = 0.040; HR = 1.720; 95% CI 1.006-2.943; p = 0.048) were associated with an increased risk of all-cause mortality. Furthermore, WBC on day 1 discriminated 30-day all-cause mortality (AUC = 0.605; p = 0.005) with an increased risk of all-cause mortality in patients admitted with WBC > 10 × 106/mL (59% vs. 40%; log-rank p = 0.036; HR = 1.643; 95% CI 1.010-2.671; p = 0.045). In conclusion, WBC count on admission as well as CRP levels during the course of ICU treatment were associated with 30-day all-cause mortality. Specifically, an increase of CRP levels by at least 200% from day 1 to day 3 during the course of ICU treatment was associated with an increased risk of 30-day all-cause mortality. The present study is one of the first to describe the prognostic value of inflammatory biomarkers in consecutive all-comer CS patients treated at a cardiac ICU.
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8
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Wanrooij VHM, Cobussen M, Stoffers J, Buijs J, Bergmans DCJJ, Zelis N, Stassen PM. Sex differences in clinical presentation and mortality in emergency department patients with sepsis. Ann Med 2023; 55:2244873. [PMID: 37566727 PMCID: PMC10424597 DOI: 10.1080/07853890.2023.2244873] [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: 05/23/2023] [Revised: 07/20/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There is growing awareness that sex differences are associated with different patient outcomes in a variety of diseases. Studies investigating the effect of patient sex on sepsis-related mortality remain inconclusive and mainly focus on patients with severe sepsis and septic shock in the intensive care unit. We therefore investigated the association between patient sex and both clinical presentation and 30-day mortality in patients with the whole spectrum of sepsis severity presenting to the emergency department (ED) who were admitted to the hospital. MATERIALS AND METHODS In our multi-centre cohort study, we retrospectively investigated adult medical patients with sepsis in the ED. Multivariable analysis was used to evaluate the association between patient sex and all-cause 30-day mortality. RESULTS Of 2065 patients included, 47.6% were female. Female patients had significantly less comorbidities, lower Sequential Organ Failure Assessment score and abbreviated Mortality Emergency Department Sepsis score, and presented less frequently with thrombocytopenia and fever, compared to males. For both sexes, respiratory tract infections were predominant while female patients more often had urinary tract infections. Females showed lower 30-day mortality (10.1% vs. 13.6%; p = .016), and in-hospital mortality (8.0% vs. 11.1%; p = .02) compared to males. However, a multivariable logistic regression model showed that patient sex was not an independent predictor of 30-day mortality (OR 0.90; 95% CI 0.67-1.22; p = .51). CONCLUSIONS Females with sepsis presenting to the ED had fewer comorbidities, lower disease severity, less often thrombocytopenia and fever and were more likely to have a urinary tract infection. Females had a lower in-hospital and 30-day mortality compared to males, but sex was not an independent predictor of 30-day mortality. The lower mortality in female patients may be explained by differences in comorbidity and clinical presentation compared to male patients.KEY MESSAGESOnly limited data exist on sex differences in sepsis patients presenting to the emergency department with the whole spectrum of sepsis severity.Female sepsis patients had a lower incidence of comorbidities, less disease severity and a different source of infection, which explains the lower 30-day mortality we found in female patients compared to male patients.We found that sex was not an independent predictor of 30-day mortality; however, the study was probably underpowered to evaluate this outcome definitively.
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Affiliation(s)
- Vera H. M. Wanrooij
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maarten Cobussen
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- School of CARIM, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Judith Stoffers
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Dennis C. J. J. Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Noortje Zelis
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Patricia M. Stassen
- School of CARIM, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
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Nešković N, Drenjančević D, Kvolik S, Škiljić S, Budrovac D, Drenjančević IH. Predictive role of selected biomarkers in differentiating gram-positive from gram-negative sepsis in surgical patients: a retrospective study. Anaesthesiol Intensive Ther 2023; 55:319-325. [PMID: 38282497 PMCID: PMC10801538 DOI: 10.5114/ait.2023.134214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/09/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients. MATERIAL AND METHODS A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days. RESULTS Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes. CONCLUSIONS PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.
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Affiliation(s)
- Nenad Nešković
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Domagoj Drenjančević
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
- Department of Clinical Microbiology and Hospital Infections, Osijek University Hospital, Croatia
| | - Slavica Kvolik
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Sonja Škiljić
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Dino Budrovac
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Ivana Haršanji Drenjančević
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
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Optimal Predictors of Postoperative Complications After Gastrectomy: Results from the Procalcitonin and C-reactive Protein for the Early Diagnosis of Anastomotic Leakage in Esophagogastric Surgery (PEDALES) Study. J Gastrointest Surg 2022; 27:478-488. [PMID: 36509900 DOI: 10.1007/s11605-022-05547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to define whether procalcitonin (PCT) is an earlier and more accurate predictor than C-reactive protein (CRP) for anastomotic leakage (AL) and major infective complications (MICs). METHODS This was a prospective multicentric observational study conducted in three Italian centers, including all patients undergoing gastrectomy from May 2016 to April 2021. The endpoint was the assessment of the discrimination and accuracy achieved by the PCT and CRP values measured from POD1 to POD7 for predicting the occurrence of AL and MICs. Accuracy was assessed by calculating the area under the receiver operating curve (AUROC) values and Youden's statistics. Two charts were created for risk stratification during the postoperative course. RESULTS The rate of AL was 4.6%, with a median day of occurrence on POD5 (range 3-26). The overall rate of major infective complications was 19.9%, with a median day of occurrence on POD6 (range 2-30). PCT showed a significant association with AL on POD6 and POD7 and a significant association with MICs on POD2, while CRP values showed a significant association with AL on POD4 and a significant association with MICs on POD1. No difference in the prediction of AL was observed between PCT and CRP, while CRP was found to be a superior predictor of major infective complications on POD5 (p = 0.024) and POD7 (p = 0.035). CONCLUSIONS PCT was not superior to CRP as an early predictor of AL and major infective complications after gastrectomy. CRP should be used as the reference screening postoperative marker.
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11
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Anticoagulation Monitoring with Activated Partial ThromboPlastin Time and Anti-Xa Activity in Intensive Care Unit Patients: Interest of Thrombin Generation Assay. Int J Mol Sci 2022; 23:ijms231911219. [PMID: 36232517 PMCID: PMC9570449 DOI: 10.3390/ijms231911219] [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: 08/29/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
Current guidelines recommend monitoring the anticoagulant effect of unfractionated heparin (UFH) by measuring anti-Xa activity rather than activated partial thromboplastin time (aPTT) in intensive care unit (ICU) patients. The primary objective of this study was to evaluate the correlation of aPTT, anti-Xa activity, and thrombin generation in UFH-treated ICU patients. A prospective observational pilot study was conducted in adult surgical ICU patients treated with UFH. aPTT and anti-Xa activity were monitored daily. The therapeutic target was aPTT between 50 s and 84 s, and/or anti-Xa between 0.3 and 0.7 U/mL. Correlation among aPTT, anti-Xa activity, and thrombin generation was determined by measuring endogenous thrombin potential (ETP), with the inflammatory response evaluated. C-reactive protein (CRP) was used as a marker of inflammatory response. The plasma of 107 samples from 30 ICU patients was analyzed. The correlation between aPTT and anti-Xa activity was 0.66, CI95% [0.54;0.76] (p < 0.0001). Although thrombin generation, aPTT, and anti-Xa were correlated with inflammatory responses, the correlation was higher with thrombin generation and anti-Xa activity compared to aPTT. When aPTT was in a therapeutic range, a low thrombin generation was observed but was 50% inhibited when anti-Xa was in a therapeutic range. Coagulation testing with aPTT, anti-Xa correlated with thrombin generation. A 50% decrease in thrombin generation was observed when anti-Xa was within a therapeutic range. Further work is needed to evaluate coagulation biomarker responses and clinical outcomes in specific ICU populations.
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12
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Shan Y, Zhang X, Zhou G, Ji X, Gu Y. Increased progranulin as an independent predictive biomarker for poor prognosis in sepsis. Cytokine 2022; 155:155911. [PMID: 35597170 DOI: 10.1016/j.cyto.2022.155911] [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: 08/12/2021] [Revised: 03/20/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recently, many diagnostic biomarkers were reported, but each had its own limitation. However, there is a need for an effective sensitivity and specificity of biomarker in diagnosis and prognosis of sepsis. In this context, progranulin (PGRN), at elevated levels, has been associated with poor prognosis in infectious diseases. Moreover, increased PGRN levels were seen in septic mice. As the prognostic value of PGRN in humans is unclear, we aimed to identify the predictive value of serum PGRN for the prognosis of sepsis. METHODS A total of 128 participants with sepsis and 58 healthy controls were recruited in this study. The levels of serum PGRN were detected by enzyme-linked immunosorbent assay. According to the outcomes, patients were divided into survival and non-survival groups. RESULTS Serum PGRN levels had upregulated in patients with sepsis compared with those in healthy controls (P < 0.001) as well as in non‑survivors compared with those in survivors (P < 0.001). Furthermore, serum PGRN levels exhibited positive correlation with hypersensitive C-reactive protein, procalcitonin, sepsis‑related organ failure assessment (SOFA) scores, and acute physiology and chronic health evaluation II (APACHE II) scores. PGRN had a higher predictive effect, especially the 28-day in-hospital mortality (p < 0.001), when using it with SOFA or APACHE II scores. Cox proportional regression analysis showed that PGRN was an independent predictor for 28-day mortality risk in sepsis. CONCLUSIONS PGRN, as a biomarker of sepsis, could improve the prognostic power of traditional parameters. This study is the first to report the clinical significance of PGRN levels in terms of the severity and prognosis of sepsis.
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Affiliation(s)
- Yi Shan
- Department of Critical Care Medicine, Affiliated Yixing People's Hospital, Jiangsu University, Yixing, China
| | - Xiaoli Zhang
- Department of Clinical Laboratory, Affiliated Yixing People's Hospital, Jiangsu University, Yixing, China
| | - Guanghui Zhou
- Department of Pulmonary & Critical Care Medicine, Affiliated Yixing People's Hospital, Jiangsu University, Yixing, China
| | - XiuHai Ji
- Department of Oncology, Affiliated Taicang Hospital of Traditional Chinese Medicine, Taicang, China.
| | - Yinjie Gu
- Department of Critical Care Medicine, Affiliated Yixing People's Hospital, Jiangsu University, Yixing, China.
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13
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Perananthan V, Wijerathna T, Mohamed F, Gawarammana IB, Dawson AH, Buckley NA. Circulating intestinal fatty acid binding protein and intestinal toxicity in Russell's viper envenomation. Clin Toxicol (Phila) 2022; 60:311-318. [PMID: 34378471 DOI: 10.1080/15563650.2021.1965160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/24/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Abdominal pain is known to be an early clinical predictor of severe systemic Russell's viper (RV) envenomation and is often associated with the later development of coagulopathy and neurotoxicity. The mechanism of abdominal pain is unknown, but we postulated it might be due to intestinal microvascular endothelial gut damage. Gut-toxicity can be detected using the novel biomarker Intestinal Fatty Acid Binding Protein (IFABP). We also wanted to explore the mechanisms and consequences of this toxicity by measuring procalcitonin as a specific marker of sepsis triggered by bacterial endotoxin, and serum cystatin-C (CysC) as a measure of acute kidney injury. We hypothesised that severe gut-injury might lead to gut-barrier failure, translocation of gastrointestinal microorganisms, associated sepsis and systemic inflammatory response syndrome (SIRS), with a possible exacerbation of snake-bite severity, including acute kidney injury that was previously attributed to direct venom effects. METHODS Serial plasma samples previously collected from 16 RV envenomations with abdominal pain, 15 RV envenomations without abdominal pain and 25 healthy controls were assayed for IFABP. A subgroup of these RV envenomations were assayed for procalcitonin (n = 24) and serum CysC (n = 11). RESULTS The median peak IFABP for RV envenomations was much higher than healthy controls [3703.0 pg/mL (IQR 2250.1-13702.0 pg/mL) vs. 270.1 pg/mL (IQR 153.5-558.0 pg/mL) (p < 0.001)]. There was no difference in those with and without abdominal pain [3801.4 pg/mL (IQR 2080.5-22446.3 pg/mL) vs. 3696.6 pg/mL (IQR 2280.3-4664.7 pg/mL) (p = 1.0)]. Peak procalcitonin levels were elevated in envenomed patients 30.1 ng/ml (IQR: 13.1-59.7 ng/ml) with a level >2ng/mL indicative of severe sepsis] and also correlated with peak IFABP (r = 0.55, p = 0.006, n = 24). Peak serum CysC was also elevated and also correlated with IFABP (r = 0.71, p = 0.037, n = 9). CONCLUSION IFABP is significantly elevated indicating enterocyte damage occurs in RV envenomation. IFABP correlated with markers of sepsis (procalcitonin) and acute kidney injury (serum CysC) suggesting that enterocyte damage resulting in translocation of microbial associated molecular patterns (MAMPs) contributes to RV envenomation associated SIRS and sepsis.
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Affiliation(s)
- Varan Perananthan
- Edith Collins Research Institute, Royal Prince Alfred Hospital, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Thilini Wijerathna
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya
- Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, Australia
| | - Indika B Gawarammana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew H Dawson
- Edith Collins Research Institute, Royal Prince Alfred Hospital, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicholas A Buckley
- Edith Collins Research Institute, Royal Prince Alfred Hospital, Sydney, Australia
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Disciplines of Pharmacology/Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Li Y, Wang J, Wei B, Zhang X, Hu L, Ye X. Value of Neutrophil:Lymphocyte Ratio Combined with Sequential Organ Failure Assessment Score in Assessing the Prognosis of Sepsis Patients. Int J Gen Med 2022; 15:1901-1908. [PMID: 35228816 PMCID: PMC8881929 DOI: 10.2147/ijgm.s348200] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/01/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Yixuan Li
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Junyu Wang
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Junyu Wang; Bing Wei, Email ;
| | - Bing Wei
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiangqun Zhang
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Le Hu
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xinghua Ye
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
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15
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Wang JL, Xu CY, Geng CJ, Liu L, Zhang MZ, Wang H, Xiao RT, Liu L, Zhang G, Ni C, Guo XY. Anesthesia and perioperative management for giant adrenal Ewing’s sarcoma with inferior vena cava and right atrium tumor thrombus: A case report. World J Clin Cases 2022; 10:643-655. [PMID: 35097090 PMCID: PMC8771399 DOI: 10.12998/wjcc.v10.i2.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/01/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ewing’s sarcoma of the adrenal gland with inferior vena cava (IVC) and right atrium thrombus is extremely rare. Here, we report a case of giant adrenal Ewing’s sarcoma with IVC and right atrium tumor thrombus and summarize the anesthesia and perioperative management.
CASE SUMMARY A young female was admitted to the Department of Urology with intermittent pain under the right costal arch for four months. Enhanced abdominal computed tomography revealed a large retroperitoneal mass (22 cm in diameter), which may have originated from the right adrenal gland and was closely related to the liver. Transthoracic echocardiography showed a strong echogenic filling measuring 70 mm extended from the IVC into the right atrium and ventricle. After preoperative preparation with cardiopulmonary bypass, sufficient blood products, transesophageal echocardiography and multiple monitoring, tumor and thrombus resection by IVC exploration and right atriotomy were successfully performed by a multidisciplinary team. Intraoperative hemodynamic stability was the major concern of anesthesiologists and the status of tumor thrombus and pulmonary embolism were monitored continuously. During transfer of the patient to the intensive care unit (ICU), cardiac arrest occurred without external stimulus. Cardiopulmonary resuscitation was performed immediately and cardiac function was restored after 1 min. In the ICU, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were provided to maintain cardiac, liver and kidney function. Histopathologic examination confirmed the diagnosis of Ewing’s sarcoma. After postoperative treatments and rehabilitation, the patient was discharged from the urology ward.
CONCLUSION An adrenal Ewing’s sarcoma with IVC and right atrium thrombus is extremely rare, and its anesthesia and perioperative management have not been reported. Thus, this report provides significant insights in the perioperative management of patients with adrenal Ewing’s sarcoma and IVC tumor thrombus. Intraoperative circulation fluctuations and sudden cardiovascular events are the major challenges during surgery. In addition, postoperative treatments including ECMO and CRRT provide essential support in critically ill patients. Moreover, this case report also highlights the importance of multidisciplinary cooperation during treatment of the disease.
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Affiliation(s)
- Ji-Lian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Chuan-Ya Xu
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Chun-Jing Geng
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Ming-Zhu Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hua Wang
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Ruo-Tao Xiao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Lu Liu
- Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
| | - Geng Zhang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
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Lamot M, Miler M, Nikolac Gabaj N, Lamot L, Milošević M, Harjaček M, Abdović S. Serum Calprotectin Is a Valid Biomarker in Distinction of Bacterial Urinary Tract Infection From Viral Respiratory Illness in Children Under 3 Years of Age. Front Pediatr 2022; 10:768260. [PMID: 35359908 PMCID: PMC8964143 DOI: 10.3389/fped.2022.768260] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/31/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Febrile illnesses in young children can be a major diagnostic challenge, despite the routine use of various laboratory markers. Recent advancements in the understanding of inflammatory processes have highlighted the role of calprotectin, a heterodimer consisting of S100A8 and S100A9 proteins, with many studies suggesting its clinical value as a biomarker of inflammation. This research aimed to evaluate the usefulness of serum calprotectin (sCal) as a biomarker of urinary tract infection (UTI), which was due to its high pooled prevalence and feasibility of urine culture as a diagnostic reference standard selected for a model of bacterial infection in children. METHODS Febrile children aged 0-36 months with suspected UTI based on positive urinalysis or viral respiratory tract infection were included. Children with significant bacteriuria in urine culture were labeled as cases (n = 58), while those with confirmed viral infection (n = 51), as well as those with suspected UTI but sterile urine culture who went on to develop symptoms consistent with viral respiratory infection (n = 7), were labeled as controls. sCal levels were determined by a commercial immunoassay. Conventional inflammation markers (C-reactive protein, procalcitonin, white blood cell count, absolute neutrophil count, and neutrophil percentage) were measured on the day of the clinical examination. Differences in measured inflammatory markers between cases and controls were analyzed with Mann-Whitney U-test. ROC analysis reported cut-off values with the best sensitivity and specificity to distinguish bacterial UTI from viral respiratory infection. RESULTS All analyzed inflammatory biomarkers, including sCal, were significantly higher in cases than in controls. Median concentration of sCal was 4.97 μg/mL (IQR 3.43-6.42) and 2.45 μg/mL (IQR 1.63-3.85) for cases and controls, respectively (p < 0.001). For identifying bacterial UTI, sensitivity and specificity of sCal were 77.6 and 69.0%, respectively, at an adjusted cut-off point of >3.24 μg/mL (AUC 80.2%). CONCLUSION sCal could have substantial added value in the management of a child with fever and positive urinalysis and is a promising biomarker in distinction between bacterial UTI and viral respiratory causes of febrile illness in children under the age of 3 years.
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Affiliation(s)
- Mirta Lamot
- Division of Neonatology, Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marijana Miler
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Lovro Lamot
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Milan Milošević
- Andrija Ṡtampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Miroslav Harjaček
- Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Slaven Abdović
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital Zagreb, Zagreb, Croatia
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Polilli E, Frattari A, Esposito JE, Stanziale A, Giurdanella G, Di Iorio G, Carinci F, Parruti G. Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit. BMC Emerg Med 2021; 21:147. [PMID: 34809558 PMCID: PMC8607630 DOI: 10.1186/s12873-021-00521-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
Background Monocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin. This study explored the added value of MDW as an early predictor of ensuing sepsis in patients hospitalised in an Intensive Care Unit. Methods We performed an observational prospective monocentric study to estimate the analytical performance of MDW in detecting ensuing sepsis in a sample of consecutive patients assisted in an Intensive Care Unit for > 48 h for any reason. Demographic and clinical characteristics, past medical history and other laboratory measurements were included as potential predictors of confirmed sepsis in multivariate logistic regression. Results A total of 211 patients were observed, 129 of whom were included in the final sample due to the suspect of ensuing sepsis; of these, 74 (57%) had a confirmed diagnosis of sepsis, which was best predicted with the combination of MDW > 23.0 and PCT > 0.5 ng/mL (Positive Predictive Value, PPV: 92.6, 95% CI: 82.1–97.9). The best MDW cut-off to rule out sepsis was ≤20.0 (Negative Predictive Value, NPV: 86.4, 95% CI: 65.1–97.1). Multivariate analyses using both MDW and PCT found a significant association for MDW > 23 only (OR:17.64, 95% CI: 5.53–67.91). Conclusion We found that values of MDW > 23 were associated with a high PPV for sepsis, whereas values of MDW ≤ 20 were associated with a high NPV. Our findings suggest that MDW may help clinicians to monitor ICU patients at risk of sepsis, with minimal additional efforts over standard of care.
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Affiliation(s)
- Ennio Polilli
- Clinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | | | | | - Andrea Stanziale
- Postgraduate School of Clinical Pathology, University of Chieti, Chieti, Italy
| | | | | | - Fabrizio Carinci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy.
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Ashley BK, Hassan U. Point-of-critical-care diagnostics for sepsis enabled by multiplexed micro and nanosensing technologies. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2021; 13:e1701. [PMID: 33650293 PMCID: PMC8447248 DOI: 10.1002/wnan.1701] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 11/12/2022]
Abstract
Sepsis is responsible for the highest economic and mortality burden in critical care settings around the world, prompting the World Health Organization in 2018 to designate it as a global health priority. Despite its high universal prevalence and mortality rate, a disproportionately low amount of sponsored research funding is directed toward diagnosis and treatment of sepsis, when early treatment has been shown to significantly improve survival. Additionally, current technologies and methods are inadequate to provide an accurate and timely diagnosis of septic patients in multiple clinical environments. For improved patient outcomes, a comprehensive immunological evaluation is critical which is comprised of both traditional testing and quantifying recently proposed biomarkers for sepsis. There is an urgent need to develop novel point-of-care, low-cost systems which can accurately stratify patients. These point-of-critical-care sensors should adopt a multiplexed approach utilizing multimodal sensing for heterogenous biomarker detection. For effective multiplexing, the sensors must satisfy criteria including rapid sample to result delivery, low sample volumes for clinical sample sparring, and reduced costs per test. A compendium of currently developed multiplexed micro and nano (M/N)-based diagnostic technologies for potential applications toward sepsis are presented. We have also explored the various biomarkers targeted for sepsis including immune cell morphology changes, circulating proteins, small molecules, and presence of infectious pathogens. An overview of different M/N detection mechanisms are also provided, along with recent advances in related nanotechnologies which have shown improved patient outcomes and perspectives on what future successful technologies may encompass. This article is categorized under: Diagnostic Tools > Biosensing.
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Affiliation(s)
- Brandon K. Ashley
- Department of Biomedical Engineering, Rutgers, State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Umer Hassan
- Department of Biomedical Engineering, Rutgers, State University of New Jersey, Piscataway, NJ, 08854, USA
- Department of Electrical Engineering, Rutgers, State University of New Jersey, Piscataway, NJ, 08854, USA
- Global Health Institute, Rutgers, State University of New Jersey. Piscataway, NJ, 08854, USA
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Peroxidase-mimicking nanozyme with surface-dispersed Pt atoms for the colorimetric lateral flow immunoassay of C-reactive protein. Mikrochim Acta 2021; 188:309. [PMID: 34453188 DOI: 10.1007/s00604-021-04968-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023]
Abstract
Platinum-containing nanozymes with peroxidase-mimicking activity (PMA) have found a broad application in bioanalytical methods and are potentially able to compete with enzymes as the labels. However, traditionally used methods for the synthesis of nanozymes result in only a small fraction of surface-exposed Pt atoms, which participate in catalysis. To overcome this limitation, we propose a new approach for the synthesis of nanozymes with the efficient dispersion of Pt atoms on particles' surfaces. The synthesis of nanozymes includes three steps: the synthesis of gold nanoparticles (Au NPs), the overgrowth of a silver layer over Au NPs (Au@Ag NPs, 6 types of NPs with different thicknesses of Ag shell), and the galvanic replacement of silver with PtCl62- leading to the formation of trimetallic Au@Ag-Pt NPs with uniformly deposited catalytic sites and high Pt-utilization efficiency. Au@Ag-Pt NPs (23 types of NPs with different concentrations of Pt) with various sizes, morphology, optical properties, and PMA were synthesized and comparatively tested. Using energy-dispersive spectroscopy mapping, we confirm the formation of core@shell Au@Ag NPs and dispersion of surface-exposed Pt. The selected Au@Ag-Pt NPs were conjugated with monoclonal antibodies and used as the colorimetric and catalytic labels in lateral flow immunoassay of the inflammation biomarker: C-reactive protein (CRP). The colorimetric signal enhancement was achieved by the oxidation of 3,3'-diaminobenzidine by H2O2 catalyzed by Au@Ag-Pt NPs directly on the test strip. The use of Au@Ag-Pt NPs as the catalytic label produces a 65-fold lower limit of CRP detection in serum (15 pg mL-1) compared with Au NPs and ensures the lowest limit of detection for equipment-free lateral flow immunoassays. The assay shows a high correlation with data of enzyme-linked immunosorbent assay (R2 = 0.986) and high recovery (83.7-116.2%) in serum and plasma. The assay retains all the benefits of lateral flow immunoassay as a point-of-care method.
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20
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Nešković N, Marczi S, Mandić D, Mraovic B, Škiljić S, Kristek G, Vinković H, Kvolik S. ANALGESIC EFFECT OF TRAMADOL IS NOT ALTERED BY POSTOPERATIVE SYSTEMIC INFLAMMATION AFTER MAJOR ABDOMINAL SURGERY. Acta Clin Croat 2021; 60:268-275. [PMID: 34744277 PMCID: PMC8564835 DOI: 10.20471/acc.2021.60.02.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/29/2020] [Indexed: 12/04/2022] Open
Abstract
Tramadol is a commonly used analgesic in intensive care units (ICUs) for acute postoperative pain. Conversion of tramadol into active metabolites may be impaired in inflammatory states. Catechol-O-methyltransferase may influence pain. The aim of the study was to examine differences in the analgesic effect of tramadol between ICU patients with and without signs of systemic inflammation. Forty-three patients were admitted to ICU after a major abdominal surgery. The patients received a dose of 100 mg of tramadol intravenously every 6 hours during the first 24 hours after surgical procedure. Pain scores were measured by the Numeric Rating Scale before and 30 minutes after tramadol administration in awake patients. Systemic inflammation was considered when at least two of the following postoperative parameters were present in the first 24 hours of ICU admission: fever or hypothermia, tachycardia, pCO2 <4.3 kPa, white blood cells >12000/mm3 or <4000/mm3, or preoperative value of C-reactive protein (CRP) >50 mg/L or/and procalcitonin (PCT) >0.5 mg/L. Catechol-O-methyltransferase was analyzed postoperatively. Fifteen (34.8%) patients met the criteria for systemic inflammation. Tramadol was proven to be an effective analgesic for the treatment of postoperative pain regardless of the presence of systemic inflammation (p<0.05). Lower perception of pain before tramadol application was observed in patients with systemic inflammation, but the difference was not significant. A negative correlation was observed between the preoperative values of CRP and PCT and the analgesic effect of tramadol assessed at the second measurement point (r=-0.358, p=0.03, and r=-0.364, p=0.02, respectively). Catechol-O-methyltransferase variants were not in correlation with pain and opioid consumption. Based on our findings, tramadol is effective in lowering pain scores after major abdominal surgery irrespective of the presence of systemic inflammation.
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Affiliation(s)
| | - Saška Marczi
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Dario Mandić
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Boris Mraovic
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Sonja Škiljić
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Gordana Kristek
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Hrvoje Vinković
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
| | - Slavica Kvolik
- 1Osijek University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia; 2Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Osijek University Hospital Centre, Department of Transfusion Medicine, Laboratory of Molecular and HLA Diagnostics, Osijek, Croatia; 4Osijek University Hospital Centre, Department of Clinical and Laboratory Diagnostics, Osijek, Croatia; 5University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, USA
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21
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Cong S, Ma T, Di X, Tian C, Zhao M, Wang K. Diagnostic value of neutrophil CD64, procalcitonin, and interleukin-6 in sepsis: a meta-analysis. BMC Infect Dis 2021; 21:384. [PMID: 33902476 PMCID: PMC8072745 DOI: 10.1186/s12879-021-06064-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 04/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background The aim of the study was to conduct a meta-analysis to evaluate the accuracy of neutrophil CD64, procalcitonin (PCT), and interleukin-6 (IL-6) as markers for the diagnosis of sepsis in adult patients. Methods Various databases were searched to collect published studies on the diagnosis of sepsis in adult patients using neutrophil CD64, PCT, and IL-6 levels. Utilizing the Stata SE 15.0 software, forest plots and the area under the summary receiver operating characteristic curves were drawn. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC) were calculated. Results Fifty-four articles were included in the study. The pooled sensitivity, specificity, and AUC of neutrophil CD64 for the diagnosis of sepsis were 0.88 (95% confidence interval [CI], 0.81–0.92), 0.88 (95% CI, 0.83–0.91), and 0.94 (95% CI, 0.91–0.96), respectively. The pooled sensitivity, specificity, and AUC of PCT for the diagnosis of sepsis were 0.82 (95% CI, 0.78–0.85), 0.78 (95% CI, 0.74–0.82), and 0.87 (95% CI, 0.83–0.89), respectively. Subgroup analysis showed that the AUC for PCT diagnosis of intensive care unit (ICU) sepsis was 0.86 (95% CI, 0.83–0.89) and the AUC for PCT diagnosis of non-ICU sepsis was 0.82 (95% CI, 0.78–0.85). The pooled sensitivity, specificity, and AUC of IL-6 for the diagnosis of sepsis were 0.72 (95% CI, 0.65–0.78), 0.70 (95% CI, 0.62–0.76), and 0.77 (95% CI, 0.73–0.80), respectively. Conclusions Of the three biomarkers studied, neutrophil CD64 showed the highest diagnostic value for sepsis, followed by PCT, and IL-6. On the other hand, PCT showed a better diagnostic potential for the diagnosis of sepsis in patients with severe conditions compared with that in patients with non-severe conditions.
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Affiliation(s)
- Shan Cong
- Department of Respiratory Medicine, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China
| | - Tiangang Ma
- Department of Respiratory Medicine, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China
| | - Xin Di
- Department of Respiratory Medicine, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China
| | - Chang Tian
- Department of Respiratory Medicine, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China
| | - Min Zhao
- Department of Respiratory Medicine, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China
| | - Ke Wang
- Department of Respiratory Medicine, The Second Hospital of Jilin University, 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin Province, China.
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22
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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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23
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Neskovic N, Mandic D, Marczi S, Skiljic S, Kristek G, Vinkovic H, Mraovic B, Debeljak Z, Kvolik S. Different Pharmacokinetics of Tramadol, O-Demethyltramadol and N-Demethyltramadol in Postoperative Surgical Patients From Those Observed in Medical Patients. Front Pharmacol 2021; 12:656748. [PMID: 33935773 PMCID: PMC8082457 DOI: 10.3389/fphar.2021.656748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Most studies examining tramadol metabolism have been carried out in non-surgical patients and with oral tramadol. The aim of this study was 1) to measure concentrations of tramadol, O-demethyltramadol (ODT), and N-demethyltramadol (NDT) in the surgical patients admitted to the intensive care unit (ICU) within the first 24 postoperative hours after intravenous application of tramadol, and 2) to examine the effect of systemic inflammation on tramadol metabolism and postoperative pain. Methods: A prospective observational study was carried out in the surgical ICU in the tertiary hospital. In the group of 47 subsequent patients undergoing major abdominal surgery, pre-operative blood samples were taken for CYP2D6 polymorphism analysis. Systemic inflammation was assessed based on laboratory and clinical indicators. All patients received 100 mg of tramadol intravenously every 6 h during the first postoperative day. Postoperative pain was assessed before and 30 min after tramadol injections. Tramadol, ODT, and NDT concentrations were determined by high-performance liquid chromatography. Results: CYP2D6 analysis revealed 2 poor (PM), 22 intermediate (IM), 22 extensive (EM), and 1 ultrafast metabolizer. After a dose of 100 mg of tramadol, t1/2 of 4.8 (3.2-7.6) h was observed. There were no differences in tramadol concentration among metabolic phenotypes. The area under the concentration-time curve at the first dose interval (AUC1-6) of tramadol was 1,200 (917.9-1944.4) μg ×h ×L-1. NDT concentrations in UM were below the limit of quantification until the second dose of tramadol was administrated, while PM had higher NDT concentrations compared to EM and IM. ODT concentrations were higher in EM, compared to IM and PM. ODT AUC1-6 was 229.6 (137.7-326.2) μg ×h ×L-1 and 95.5 (49.1-204.3) μg ×h ×L-1 in EM and IM, respectively (p = 0.004). Preoperative cholinesterase activity (ChE) of ≤4244 U L-1 was a cut-off value for a prediction of systemic inflammation in an early postoperative period. NDT AUC1-6 were significantly higher in patients with low ChE compared with normal ChE patients (p = 0.006). Pain measurements have confirmed that sufficient pain control was achieved in all patients after the second tramadol dose, except in the PM. Conclusions: CYP2D6 polymorphism is a major factor in O-demethylation, while systemic inflammation accompanied by low ChE has an important role in the N-demethylation of tramadol in postoperative patients. Concentrations of tramadol, ODT, and NDT are lower in surgical patients than previously reported in non-surgical patients. Clinical Trial Registration: ClinicalTrials.gov, NCT04004481.
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Affiliation(s)
- Nenad Neskovic
- Department of Anesthesiology, Resuscitation and ICU, Osijek University Hospital, Osijek, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
| | - Dario Mandic
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
- Department of Clinical and Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia
| | - Saska Marczi
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
- Laboratory for Molecular and HLA Diagnostic, Department of Transfusion Medicine, Osijek University Hospital, Osijek, Croatia
| | - Sonja Skiljic
- Department of Anesthesiology, Resuscitation and ICU, Osijek University Hospital, Osijek, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
| | - Gordana Kristek
- Department of Anesthesiology, Resuscitation and ICU, Osijek University Hospital, Osijek, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
| | - Hrvoje Vinkovic
- Department of Anesthesiology, Resuscitation and ICU, Osijek University Hospital, Osijek, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
| | - Boris Mraovic
- University of Missouri, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Columbia, MO, United States
| | - Zeljko Debeljak
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
- Department of Clinical and Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia
| | - Slavica Kvolik
- Department of Anesthesiology, Resuscitation and ICU, Osijek University Hospital, Osijek, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer, Osijek, Croatia
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24
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Farooq N, Chuan B, Mahmud H, El Khoudary SR, Nouraie SM, Evankovich J, Yang L, Dunlap D, Bain W, Kitsios G, Zhang Y, O’Donnell CP, McVerry BJ, Shah FA. Association of the systemic host immune response with acute hyperglycemia in mechanically ventilated septic patients. PLoS One 2021; 16:e0248853. [PMID: 33755703 PMCID: PMC7987165 DOI: 10.1371/journal.pone.0248853] [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: 01/01/2021] [Accepted: 03/07/2021] [Indexed: 12/13/2022] Open
Abstract
Hyperglycemia during sepsis is associated with increased organ dysfunction and higher mortality. The role of the host immune response in development of hyperglycemia during sepsis remains unclear. We performed a retrospective analysis of critically ill adult septic patients requiring mechanical ventilation (n = 153) to study the relationship between hyperglycemia and ten markers of the host injury and immune response measured on the first day of ICU admission (baseline). We determined associations between each biomarker and: (1) glucose, insulin, and c-peptide levels at the time of biomarker collection by Pearson correlation; (2) average glucose and glycemic variability in the first two days of ICU admission by linear regression; and (3) occurrence of hyperglycemia (blood glucose>180mg/dL) by logistic regression. Results were adjusted for age, pre-existing diabetes mellitus, severity of illness, and total insulin and glucocorticoid dose. Baseline plasma levels of ST2 and procalcitonin were positively correlated with average blood glucose and glycemic variability in the first two days of ICU admission in unadjusted and adjusted analyses. Additionally, higher baseline ST2, IL-1ra, procalcitonin, and pentraxin-3 levels were associated with increased risk of hyperglycemia. Our results suggest associations between the host immune response and hyperglycemia in critically ill septic patients particularly implicating the interleukin-1 axis (IL-1ra), the interleukin-33 axis (ST2), and the host response to bacterial infections (procalcitonin, pentraxin-3).
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Affiliation(s)
- Nauman Farooq
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Byron Chuan
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Hussain Mahmud
- Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Samar R. El Khoudary
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Seyed Mehdi Nouraie
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - John Evankovich
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Libing Yang
- School of Medicine, Tsinghua University, Haidian District, Beijing, China
| | - Daniel Dunlap
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - William Bain
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
| | - Georgios Kitsios
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Christopher P. O’Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Bryan J. McVerry
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Faraaz Ali Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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25
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Wang Y, Gloss B, Tang B, Dervish S, Santner-Nanan B, Whitehead C, Masters K, Skarratt K, Teoh S, Schibeci S, Fewings N, Brignone C, Triebel F, Booth D, McLean A, Nalos M. Immunophenotyping of Peripheral Blood Mononuclear Cells in Septic Shock Patients With High-Dimensional Flow Cytometry Analysis Reveals Two Subgroups With Differential Responses to Immunostimulant Drugs. Front Immunol 2021; 12:634127. [PMID: 33828550 PMCID: PMC8019919 DOI: 10.3389/fimmu.2021.634127] [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: 11/27/2020] [Accepted: 02/22/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis is associated with a dysregulated inflammatory response to infection. Despite the activation of inflammation, an immune suppression is often observed, predisposing patients to secondary infections. Therapies directed at restoration of immunity may be considered but should be guided by the immune status of the patients. In this paper, we described the use of a high-dimensional flow cytometry (HDCyto) panel to assess the immunophenotype of patients with sepsis. We then isolated peripheral blood mononuclear cells (PBMCs) from patients with septic shock and mimicked a secondary infection by stimulating PBMCs for 4 h in vitro with lipopolysaccharide (LPS) with or without prior exposure to either IFN-γ, or LAG-3Ig. We evaluated the response by means of flow cytometry and high-resolution clustering cum differential analysis and compared the results to PBMCs from healthy donors. We observed a heterogeneous immune response in septic patients and identified two major subgroups: one characterized by hypo-responsiveness (Hypo) and another one by hyper-responsiveness (Hyper). Hypo and Hyper groups showed significant differences in the production of cytokines/chemokine and surface human leukocyte antigen-DR (HLA-DR) expression in response to LPS stimulation, which were observed across all cell types. When pre-treated with either interferon gamma (IFN-γ) or lymphocyte-activation gene 3 (LAG)-3 recombinant fusion protein (LAG-3Ig) prior to LPS stimulation, cells from the Hypo group were shown to be more responsive to both immunostimulants than cells from the Hyper group. Our results demonstrate the importance of patient stratification based on their immune status prior to any immune therapies. Once sufficiently scaled, this approach may be useful for prescribing the right immune therapy for the right patient at the right time, the key to the success of any therapy.
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Affiliation(s)
- Ya Wang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia.,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Brian Gloss
- Westmead Research Hub, Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia.,Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Suat Dervish
- Westmead Cytometry, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Brigitte Santner-Nanan
- Charles Perkins Centre Nepean, Sydney Medical School Nepean, The University of Sydney, Kingswood, NSW, Australia
| | - Christina Whitehead
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Kristy Masters
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Kristen Skarratt
- Department of Medicine, Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Kingswood, NSW, Australia
| | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Stephen Schibeci
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Nicole Fewings
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | | | | | - David Booth
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia
| | - Marek Nalos
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, NSW, Australia.,1st Department of Medicine, Medical Faculty in Plzen, Charles University, Prague, Czechia
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26
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Cioni G, Canini J, Pieralli F. Procalcitonin in clinical practice: from diagnosis of sepsis to antibiotic therapy. ITALIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4081/itjm.2021.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A diagnostic algorithm that allows for the rapid identification of sepsis and possibly guides the appropriate antimicrobial therapy application is the cornerstone to obtaining effective treatment and better results. The use of emerging surrogate markers could significantly improve clinical practice, but the validity and clinical utility have been proved only for very few of them, and their availability in clinical routine is limited. For this purpose, numerous scientific evidence has indicated procalcitonin as a marker linked to sepsis and its evolution. This review aims to retrace the main evidence relating to the use of procalcitonin in sepsis. We analyzed the primary studies in the literature and the existing meta-analysis evaluating the behavior of procalcitonin as a marker of bacterial sepsis, its prognostic power, and its ability to influence antibiotic therapy. Recent evidence has suggested that procalcitonin could be an efficient marker for diagnosing sepsis and its therapeutic management in many types of patients. The choice of the appropriate timing to initiate and suspend antibiotic therapy, with obvious clinical advantages, the favorable effects could also include reducing health costs, both avoiding the administration of inappropriate antibiotic therapies, and reducing the duration of hospitalization. Moreover, limited studies reported high procalcitonin levels in coronavirus disease 2019 patients with a worse prognosis. Despite the considerable evidence in favor of the potential of procalcitonin as an index for managing septic patients, there are conflicting data that deserve specific and detailed studies.
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Nikzad M, Banafshe HR, Momen-Heravi M, Haddad Kashani H, Shiehmorteza M. The effect of vitamin C on procalcitonin biomarker in community-acquired pneumonia. Clin Mol Allergy 2021; 19:1. [PMID: 33658036 PMCID: PMC7927370 DOI: 10.1186/s12948-021-00140-1] [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: 10/13/2020] [Accepted: 02/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Community acquired pneumonia (CAP) is a prevalent low respiratory infection. Diagnosis is based on clinical symptoms, radiologic evidence and culture. Biomarkers such as IL6, CRP and procalcitonin are helpful in diagnosis. Procalcitonin is a soluble biomarker in serum that increase in systemic inflammation and bacterial infections. People with normal procalcitonin have low risk to infect pneumonia. Patient with CAP have more oxidative stress than normal people. Studies show that receiving vitamin C can reduce incidence of pneumonia. The present study was designed to evaluate the effect of vitamin C supplement on procalcitonin biomarker in patient with CAP. Methods
Patients with CAP who passed inclusion and exclusion criteria after obtaining informed consent, were assigned randomly in two groups of drug and placebo. The drug group received vitamin C (1000 mg/d) daily and medications that physician prescribed for treating CAP for 10 days and placebo group received placebo and medications that physician prescribed. The serum level of procalcitonin was measured at the beginning of the study and after 10 days of intervention. Results 35 patients finished the study. Serum level of procalcitonin on the first and tenth day did not show any significant difference between drug and placebo groups. Conclusions To clarify the relationship between the effects of vitamin C on procalcitonin in CAP, a larger sample size is required.
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Affiliation(s)
- Mahsa Nikzad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Hamid Reza Banafshe
- Department of Pharmacology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Hamed Haddad Kashani
- Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Shiehmorteza
- Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran.
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Liu Z, Wu D, Han X, Jiang W, Qiu L, Tang R, Yu X. Different characteristics of critical COVID-19 and thinking of treatment strategies in non-elderly and elderly severe adult patients. Int Immunopharmacol 2021; 92:107343. [PMID: 33450596 PMCID: PMC7833421 DOI: 10.1016/j.intimp.2020.107343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The differences in the characteristics and main causes of critical COVID-19 infection in non-elderly and elderly severe patients remain unknown. METHODS We included 273 adult patients with confirmed severe COVID-19 from Tongji Hospital, Wuhan, China from February 10 to March 8, 2020. Clinical characteristics and risk factors for outcomes were compared between the young and middle-aged and the elderly severe patients. RESULTS Hemoglobin, neutrophil percentage, inflammatory markers, hepatic, renal, and cardiovascularparameters differed between the non-elderly and elderly severe patients. In young and middle-aged patients, critical patients showed higher high-sensitivity C-reactive protein (hsCRP) during hospitalization than severe patients. However, in the elderly patients, critical patients showed decreased hsCRP during hospitalization and higher proBNP values. The hsCRP fluctuation and proBNP were independent risk factors for intensive care unit (ICU) admission in young and middle-aged severe patients (OR=1.068) and elderly severe patients (OR=1.026), respectively. CONCLUSION The study revealed different potential causes of disease and predictive factors for non-elderly and elderly critical patients and treatment recommendations. Deterioration of inflammatory state was the main cause of ICU admission in young and middle-aged severe COVID-19 patients, while a decline in hsCRP was not associated with better outcomes in elderly severe patients, indicating the need for different treatments for non-elderly and elderly severe patients. Anti-inflammatory therapy with corticosteroids should be considered in the early disease stage among non-elderly severe patients, but cardiovascular protection plays a more important role in elderly severe patients.
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Affiliation(s)
- Zhelong Liu
- Department of Endocrinology, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danning Wu
- Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xia Han
- Department of Endocrinology, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wangyan Jiang
- Department of Endocrinology, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Qiu
- Department of Pharmacy, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Tang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Corresponding authors at: Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China (R. Tang). Department of Endocrinology, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China (X. Yu)
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Corresponding authors at: Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China (R. Tang). Department of Endocrinology, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China (X. Yu)
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Tian Y, Qu S, Alam HB, Williams AM, Wu Z, Deng Q, Pan B, Zhou J, Liu B, Duan X, Ma J, Mondal S, Thompson PR, Stringer KA, Standiford TJ, Li Y. Peptidylarginine deiminase 2 has potential as both a biomarker and therapeutic target of sepsis. JCI Insight 2020; 5:138873. [PMID: 33055424 PMCID: PMC7605547 DOI: 10.1172/jci.insight.138873] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022] Open
Abstract
Peptidylarginine deiminases (PADs) are a family of calcium-dependent enzymes that are involved in a variety of human disorders, including cancer and autoimmune diseases. Although targeting PAD4 has shown no benefit in sepsis, the role of PAD2 remains unknown. Here, we report that PAD2 is engaged in sepsis and sepsis-induced acute lung injury in both human patients and mice. Pad2–/– or selective inhibition of PAD2 by a small molecule inhibitor increased survival and improved overall outcomes in mouse models of sepsis. Pad2 deficiency decreased neutrophil extracellular trap (NET) formation. Importantly, Pad2 deficiency inhibited Caspase-11–dependent pyroptosis in vivo and in vitro. Suppression of PAD2 expression reduced inflammation and increased macrophage bactericidal activity. In contrast to Pad2–/–, Pad4 deficiency enhanced activation of Caspase-11–dependent pyroptosis in BM-derived macrophages and displayed no survival improvement in a mouse sepsis model. Collectively, our findings highlight the potential of PAD2 as an indicative marker and therapeutic target for sepsis. Peptidylarginine deiminases 2 (PAD2) regulates neutrophil extracellular trap (NET) formation in sepsis and sepsis-induced acute lung injury.
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Affiliation(s)
- Yuzi Tian
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Shibin Qu
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.,Department of Hepatobiliary Surgery, Xijing Hospital, Xian, Shanxi, China
| | - Hasan B Alam
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Aaron M Williams
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Zhenyu Wu
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.,Department of Infectious Disease, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiufang Deng
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Baihong Pan
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Jing Zhou
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA.,Trauma Center, Department of Orthopedic and Traumatology, Peking University People's Hospital, Beijing, China
| | - Baoling Liu
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Xiuzhen Duan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jianjie Ma
- Department of Surgery, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Santanu Mondal
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Paul R Thompson
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kathleen A Stringer
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Theodore J Standiford
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Yongqing Li
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Murakami H, Naraba H, Gondo T, Mochizuki M, Nakano H, Takahashi Y, Sonoo T, Hashimoto H, Nakamura K. Diagnostic Value of Serum Procalcitonin in Patients with Convulsion in Emergency Department, an Observational Study. Antibiotics (Basel) 2020; 9:antibiotics9100683. [PMID: 33050085 PMCID: PMC7599961 DOI: 10.3390/antibiotics9100683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/01/2023] Open
Abstract
Procalcitonin (PCT), a widely used biomarker for bacterial infections, is sometimes measured in convulsion patients to distinguish bacterial infections including bacterial meningitis. However, serum PCT elevation is reported in several other conditions. This study assessed the diagnostic value of serum PCT concentrations in convulsion patients. This study examined a convulsion group: patients admitted to our critical care center during April 2018 through September 2019 via the emergency department presenting with convulsions. Randomly sampled patients admitted without convulsions were categorized as a non-convulsion group. Serum PCT analysis was performed with consideration of whether or not the patient had an infection. Diagnostic values of serum PCT for bacterial infection were evaluated for convulsion and non-convulsion patients using the positive likelihood ratio of PCT. This study found 84 patients as eligible for the convulsion group; 1:2 matched 168 control patients were selected as non-convulsion group members. The positive likelihood ratio for bacterial infection was found to be significantly lower in the convulsion group than in the control group (1.94 vs. 2.65) when setting the positive cut-off for PCT as 0.5 ng/mL. Convulsion patients had a higher PCT value. The positive likelihood ratio for patients without bacterial infection was lower.
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Affiliation(s)
- Hisashi Murakami
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
- Correspondence: ; Tel.: +81-294-23-1111; Fax: +81-294-23-8317
| | - Hiromu Naraba
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
| | - Takashi Gondo
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
| | - Masaki Mochizuki
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
| | - Hidehiko Nakano
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
| | - Yuji Takahashi
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
| | - Tomohiro Sonoo
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
- TXP Medical Co., Ltd, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8485, Japan
| | - Hideki Hashimoto
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan; (H.N.); (T.G.); (M.M.); (H.N.); (Y.T.); (T.S.); (H.H.); (K.N.)
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Niederwanger C, Varga T, Hell T, Stuerzel D, Prem J, Gassner M, Rickmann F, Schoner C, Hainz D, Cortina G, Hetzer B, Treml B, Bachler M. Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis. PeerJ 2020; 8:e9993. [PMID: 33083117 PMCID: PMC7543722 DOI: 10.7717/peerj.9993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Abstract
Background Scores can assess the severity and course of disease and predict outcome in an objective manner. This information is needed for proper risk assessment and stratification. Furthermore, scoring systems support optimal patient care, resource management and are gaining in importance in terms of artificial intelligence. Objective This study evaluated and compared the prognostic ability of various common pediatric scoring systems (PRISM, PRISM III, PRISM IV, PIM, PIM2, PIM3, PELOD, PELOD 2) in order to determine which is the most applicable score for pediatric sepsis patients in terms of timing of disease survey and insensitivity to missing data. Methods We retrospectively examined data from 398 patients under 18 years of age, who were diagnosed with sepsis. Scores were assessed at ICU admission and re-evaluated on the day of peak C-reactive protein. The scores were compared for their ability to predict mortality in this specific patient population and for their impairment due to missing data. Results PIM (AUC 0.76 (0.68-0.76)), PIM2 (AUC 0.78 (0.72-0.78)) and PIM3 (AUC 0.76 (0.68-0.76)) scores together with PRSIM III (AUC 0.75 (0.68-0.75)) and PELOD 2 (AUC 0.75 (0.66-0.75)) are the most suitable scores for determining patient prognosis at ICU admission. Once sepsis is pronounced, PELOD 2 (AUC 0.84 (0.77-0.91)) and PRISM IV (AUC 0.8 (0.72-0.88)) become significantly better in their performance and count among the best prognostic scores for use at this time together with PRISM III (AUC 0.81 (0.73-0.89)). PELOD 2 is good for monitoring and, like the PIM scores, is also largely insensitive to missing values. Conclusion Overall, PIM scores show comparatively good performance, are stable as far as timing of the disease survey is concerned, and they are also relatively stable in terms of missing parameters. PELOD 2 is best suitable for monitoring clinical course.
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Affiliation(s)
- Christian Niederwanger
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Varga
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Tobias Hell
- Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Innsbruck, Austria
| | - Daniel Stuerzel
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Jennifer Prem
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Magdalena Gassner
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Rickmann
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Schoner
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Hainz
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerard Cortina
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Hetzer
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Benedikt Treml
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Mirjam Bachler
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.,Department of Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP. PLoS One 2020; 15:e0238587. [PMID: 32881963 PMCID: PMC7470390 DOI: 10.1371/journal.pone.0238587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the effects of combining the Simplified-Acute-Physiology-Score (SAPS) 2 or the SAPS 3 with Interleukin-6 (IL-6) or Procalcitonin (PCT) or C-Reactive Protein (CRP) concentrations for predicting in-hospital mortality. MATERIAL AND METHODS This retrospective study was conducted in an interdisciplinary 22-bed intensive care unit (ICU) at a German university hospital. Within an 18-month period, SAPS 2 and SAPS 3 were calculated for 514 critically ill patients that were admitted to the internal medicine department. To evaluate discrimination performance, the area under the receiver operating characteristic curves (AUROCs) and the 95% confidence intervals (95% CIs) were calculated for each score, exclusively or in combination with IL-6 or PCT or CRP. DeLong test was used to compare different AUROCs. RESULTS The SAPS 2 exhibited a better discrimination performance than SAPS 3 with AUROCs of 0.81 (95% CI, 0.76-0.86) and 0.72 (95% CI, 0.66-0.78), respectively. Overall, combination of the SAPS 2 with IL-6 showed the best discrimination performance (AUROC 0.82; 95% CI, 0.77-0.87), albeit not significantly different from SAPS2. IL-6 performed better than PCT and CRP with AUROCs of 0.75 (95% CI, 0.69-0.81), 0.72 (95% CI, 0.66-0.77) and 0.65 (95% CI, 0.59-0.72), respectively. Performance of the SAPS 3 improved significantly when combined with IL-6 (AUROC 0.76; 95% CI, 0.69-0.81) or PCT (AUROC 0.73; 95% CI, 0.67-0.78). CONCLUSIONS Our analysis provided evidence that the risk stratification performance of the SAPS 3 and, to a lesser degree, also of the SAPS 2 can increase when combined with IL-6. A more accurate detection of aberrant or dysregulated systemic immunological responses (by IL-6) may explain the higher performance achieved by SAPS 3 + IL-6 vs. SAPS 3. Thus, implementation of IL-6 in critical care scores can improve prediction outcomes, especially in patients experiencing acute inflammatory conditions; however, statistical results may vary across hospital types and/or patient populations with different case mix.
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Bock C, Vogt B, Mattecka S, Yapici G, Brunner P, Fimpel S, Unger JK, Sheriff A. C-Reactive Protein Causes Blood Pressure Drop in Rabbits and Induces Intracellular Calcium Signaling. Front Immunol 2020; 11:1978. [PMID: 32983135 PMCID: PMC7483553 DOI: 10.3389/fimmu.2020.01978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/22/2020] [Indexed: 01/02/2023] Open
Abstract
Systemic diseases characterized by elevated levels of C-reactive protein (CRP), such as sepsis or systemic inflammatory response syndrome, are usually associated with hardly controllable haemodynamic instability. We therefore investigated whether CRP itself influences blood pressure and heart rate. Immediately after intravenous injection of purified human CRP (3.5 mg CRP/kg body weight) into anesthetized rabbits, blood pressure dropped critically in all animals, while control animals injected with bovine serum albumin showed no response. Heart rate did not change in either group. Approaching this impact on a cellular level, we investigated the effect of CRP in cell lines expressing adrenoceptors (CHO-α1A and DU-145). CRP caused a Ca2+ signaling being dependent on the CRP dose. After complete activation of the adrenoceptors by agonists, CRP caused additional intracellular Ca2+ mobilization. We assume that CRP interacts with hitherto unknown structures on the surface of vital cells and thus interferes with the desensitization of adrenoceptors.
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Affiliation(s)
- Christopher Bock
- Division of Nephrology and Internal Intensive Care Medicine, Medical Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Vogt
- Division of Nephrology and Internal Intensive Care Medicine, Medical Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Mattecka
- Division of Nephrology and Internal Intensive Care Medicine, Medical Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gülcan Yapici
- Division of Nephrology and Internal Intensive Care Medicine, Medical Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Juliane K Unger
- Department of Experimental Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ahmed Sheriff
- Division of Nephrology and Internal Intensive Care Medicine, Medical Department, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Division of Gastroenterology, Infectiology and Rheumatology, Medical Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Hussein EA. Idiopathic TTP in the Middle East: Epidemiology and clinical outcomes in infection associated episodes. Transfus Apher Sci 2020; 59:102916. [PMID: 32878734 DOI: 10.1016/j.transci.2020.102916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/18/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Literature on epidemiology of thrombotic thrombocytopenic purpura (TTP) in the Middle East is scarce. MATERIALS AND METHODS We prospectively examined the association between infection and clinical outcomes in 44 patients with idiopathic TTP, with severely deficient ADAMTS13. We also investigated seasonality of the disease, hoping to better understand the epidemiology of idiopathic TTP. RESULTS Summer demonstrated significantly lower incidence for idiopathic TTP, compared with other seasons P = 0.0003. Fourteen patients had 15 episodes with a suspected concomitant infection. Five initial episodes were triggered by an infection (33.3 %), all presenting in winter, six episodes were associated with an exacerbation (40 %) and infection triggered a relapse in the other four episodes (26.7 %), with 2 episodes presenting in winter. TTP associated infections included: central line infection, urinary tract infection and post-operative infection. One patient had respiratory tract infection, on both his initial and relapsing episodes. Refractoriness to treatment was demonstrated in 4 patients (28.6 %) and it was associated with dental abscess (one patient), septic shock (one patient) and Mycoplasma pneumonia (2 patients). All 4 patients had markedly elevated CRP values with a median of 335 mg/L. CONCLUSION Most of the infection associated episodes developed in winter (77.8 %). In patients with idiopathic TTP refractory to conventional treatment, infection should be seriously considered as an additional contributing factor for their initial and /or recurrent episodes, particularly when CRP is markedly elevated.
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Affiliation(s)
- Eiman A Hussein
- Department of Clinical Pathology, Division of Transfusion Medicine and Blood Banking, Cairo University, Cairo, Egypt.
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Gautam S, Cohen AJ, Stahl Y, Valda Toro P, Young GM, Datta R, Yan X, Ristic NT, Bermejo SD, Sharma L, Restrepo MI, Dela Cruz CS. Severe respiratory viral infection induces procalcitonin in the absence of bacterial pneumonia. Thorax 2020; 75:974-981. [PMID: 32826284 DOI: 10.1136/thoraxjnl-2020-214896] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Procalcitonin expression is thought to be stimulated by bacteria and suppressed by viruses via interferon signalling. Consequently, during respiratory viral illness, clinicians often interpret elevated procalcitonin as evidence of bacterial coinfection, prompting antibiotic administration. We sought to evaluate the validity of this practice and the underlying assumption that viral infection inhibits procalcitonin synthesis. METHODS We conducted a retrospective cohort study of patients hospitalised with pure viral infection (n=2075) versus bacterial coinfection (n=179). The ability of procalcitonin to distinguish these groups was assessed. In addition, procalcitonin and interferon gene expression were evaluated in murine and cellular models of influenza infection. RESULTS Patients with bacterial coinfection had higher procalcitonin than those with pure viral infection, but also more severe disease and higher mortality (p<0.001). After matching for severity, the specificity of procalcitonin for bacterial coinfection dropped substantially, from 72% to 61%. In fact, receiver operating characteristic curve analysis showed that procalcitonin was a better indicator of multiple indices of severity (eg, organ failures and mortality) than of coinfection. Accordingly, patients with severe viral infection had elevated procalcitonin. In murine and cellular models of influenza infection, procalcitonin was also elevated despite bacteriologic sterility and correlated with markers of severity. Interferon signalling did not abrogate procalcitonin synthesis. DISCUSSION These studies reveal that procalcitonin rises during pure viral infection in proportion to disease severity and is not suppressed by interferon signalling, in contrast to prior models of procalcitonin regulation. Applied clinically, our data suggest that procalcitonin represents a better indicator of disease severity than bacterial coinfection during viral respiratory infection.
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Affiliation(s)
- Samir Gautam
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Avi J Cohen
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Yannick Stahl
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Patricia Valda Toro
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grant M Young
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rupak Datta
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xiting Yan
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nicholas T Ristic
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Santos D Bermejo
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lokesh Sharma
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marcos I Restrepo
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health, San Antonio, Texas, USA.,Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Charles S Dela Cruz
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Durrance RJ, Ullah T, Patel H, Martinez G, Cervellione K, Zafonte VB, Gafoor K, Bagheri F. Marked Elevation in Serum Procalcitonin Levels Do Not Correlate With Severity of Disease or Mortality in Hospitalized Patients: A Retrospective Study. Biomark Insights 2020; 15:1177271920917941. [PMID: 32476970 PMCID: PMC7232048 DOI: 10.1177/1177271920917941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/16/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Bacteremia and sepsis are significant contributors to the morbidity,
mortality, and economic burden of health care systems worldwide.
Procalcitonin has been identified as a potentially useful marker of disease
and severity in sepsis. However, the assumption that greater procalcitonin
levels correlate with greater burden of disease has not been adequately
studied. Methods: A retrospective chart review of adult patients admitted to an urban teaching
hospital with suspected sepsis was undertaken to test the association of
elevated procalcitonin (>30 ng/mL) with other markers of sepsis (lactic
acid, white blood cell count, percent bands), severity of disease
(Sequential Organ Failure Assessment [SOFA] and Acute Physiology and Chronic
Health Evaluation–II [APACHE II] scores), and mortality. Results: In total, 168 patients were identified over 18 months (42% ward, 11%
Stepdown, 44% medical intensive care unit [MICU], 2% surgical intensive care
unit (STICU), 1% gynecology [GYN]). The Spearman correlation analysis showed
that serum procalcitonin level did not correlate with SOFA
(P = .238) or APACHE II (P = .918)
scores on admission, and did not correlate with survival (Kruskal-Wallis
test, P = .937). However, higher serum procalcitonin levels
were associated with patients who had positive blood cultures
(Kruskal-Wallis test, P = .0016 for Gram-positive and
P = .0007 for Gram-negative bacteria). Lactic acid
levels on admission strongly correlated with SOFA APACHE II (the Spearman
correlation, P < .0001 for both) and mortality
(P = .0001 for both). Conclusions: Higher serum procalcitonin levels above 30 ng/mL failed to correlate with
indicators of sepsis, severity of disease (SOFA and APACHE II scores), and
mortality but were associated with positive blood cultures. Lactic acid
levels did show correlation to both severity of disease and mortality. Serum
procalcitonin levels >30 ng/mL do not appear to correlate with the
severity of disease in a sample of patients with markedly elevated initial
procalcitonin levels.
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Affiliation(s)
- Richard J Durrance
- Division of Pulmonary and Critical Care, Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, Elmhurst, NY, USA.,Department of Clinical Research, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Tofura Ullah
- Department of Clinical Research, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Harsh Patel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Grace Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Kelly Cervellione
- Department of Clinical Research, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Veronica B Zafonte
- Department of Pharmacy, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Khalid Gafoor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
| | - Farshad Bagheri
- Division of Infectious Disease, Department of Medicine, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
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38
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Rodríguez RX, Villarroel LA, Meza RA, Peña JI, Musalem C, Kattan J, Urzúa S. Infection profile in neonatal patients during extracorporeal membrane oxygenation. Int J Artif Organs 2020; 43:391398820911379. [PMID: 32195608 DOI: 10.1177/0391398820911379] [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: 12/16/2022]
Abstract
OBJECTIVES To describe risk factors for acquired infection during neonatal extracorporeal membrane oxygenation and to examine the predictive value of inflammatory markers in the diagnosis of infection. METHODS A retrospective study was conducted with data for patients under 30 days supported with extracorporeal membrane oxygenation from 2003 to April 2016, in a neonatal intensive care unit. RESULTS Our study included 160 neonatal patients, the average age of connection was 8.5 days and the duration of extracorporeal membrane oxygenation support was 9.7 days. The incidence of confirmed infection was 23%. Patients with confirmed infection present more frequently: vaginal delivery, lower birth weight, female sex, diagnosis of congenital diaphragmatic hernia, and longer duration of extracorporeal membrane oxygenation. When comparing the group of patients with confirmed infection and suspicion of infection, there were no significant differences in the inflammatory markers. When calculating the slope for each one, the difference in white blood cell count slope 72 h before the infection is significant; in patients with confirmed infection, the count of white blood cell increases (slope: 0.25), versus the group of patients with suspected infection in whom the count decreases (slope: -0.39). No differences were found in other variables. CONCLUSION Our study describes that the factors that increase the risk of infection are lower birth weight, vaginal birth, duration of extracorporeal membrane oxygenation, and a positive trend of white blood cell 72 h prior to infection/suspicion. Further studies are necessary to include or definitively rule out the use of these factors and the biomarkers as predictors of infection in neonatal patients supported with extracorporeal membrane oxygenation.
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Affiliation(s)
| | - Luis A Villarroel
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo A Meza
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier I Peña
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Musalem
- Department of Statistics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Kattan
- Department of Neonatology, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Soledad Urzúa
- Department of Neonatology, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
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Cinel I, Kasapoglu US, Gul F, Dellinger RP. The initial resuscitation of septic shock. J Crit Care 2020; 57:108-117. [PMID: 32135409 DOI: 10.1016/j.jcrc.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 01/28/2020] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
Septic shock is the most severe form of sepsis, characterized by (a) persistent hypotension despite fluid resuscitation and (b) the presence of tissue hypoperfusion. Delays in the diagnosis and initiation of treatment of septic shock is associated with increasing risk for mortality. Early and effective fluid resuscitation and vasopressor administration play a crucial role in maintaining tissue perfusion in septic shock patients. A low diastolic arterial pressure (DAP) correlates with severity of arteriolar vasodilation, compromises left ventricle oxygen supply and can be used for identifying septic shock patients that would potentially benefit from earlier vasopressor therapy. Controversy currently exists as to the balance of fluids and vasopressors to maintain target mean arterial pressure. The aim of this article is to review the rationale for fluid resuscitation and vasopressor therapy and the importance of both mean and diastolic blood pressure during the initial resuscitation of the septic shock. We relate our personal prescription of balancing fluids and vasopressors in the resuscitation of septic shock.
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Affiliation(s)
- Ismail Cinel
- Department of Critical Care Medicine, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Umut S Kasapoglu
- Department of Critical Care Medicine, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Fethi Gul
- Department of Critical Care Medicine, Marmara University School of Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - R Phillip Dellinger
- Division of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA.
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40
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Meng F, Du C, Zhang Y, Wang S, Zhou Q, Wu L, Wang Y, Yang X. Protective effect of rhubarb combined with ulinastatin for patients with sepsis. Medicine (Baltimore) 2020; 99:e18895. [PMID: 32049789 PMCID: PMC7035124 DOI: 10.1097/md.0000000000018895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Sepsis is the leading cause of death in critically ill patients. Ulinastatin (UTI), a protease inhibitor, and rhubarb, used as a traditional Chinese medication, are proved to be effective in treating sepsis, but the effect of the combination therapy of these two drugs on sepsis remains unclear. This study aimed to investigate the effect of the combination treatment of UTI and rhubarb on sepsis patients. METHODS A total of 75 septic patients were randomly divided into control group, UTI group, Rhubarb group, and UTI plus Rhubarb group. Clinical data and score of Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected; lymphocyte subtypes in the peripheral blood were analyzed before and after the 5-day treatment in the Intensive Care Unit. RESULTS All the therapeutic interventions (UTI alone, rhubarb alone, or UTI plus rhubarb) significantly reduced the levels of C-Reactive protein, white blood cell density, lactic acid, and APACH II scores, and elevated the levels of CD4/CD8, but only UTI plus rhubarb treatment obviously decreased the level of procalcitonin. CONCLUSION This study suggested that the combination of UTI and rhubarb may be a promising therapeutic scheme to ameliorate sepsis.
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Affiliation(s)
| | | | | | | | | | | | - Yanli Wang
- Department of Mental Health, First Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
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41
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Binnie A, Lage J, Dos Santos CC. How can biomarkers be used to differentiate between infection and non-infectious causes of inflammation? EVIDENCE-BASED PRACTICE OF CRITICAL CARE 2020. [PMCID: PMC7152028 DOI: 10.1016/b978-0-323-64068-8.00055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosis of sepsis is based on recognition of systemic inflammation and organ failure in the context of an inciting infection. Since none of the diagnostic criteria are specific to sepsis, it is easy to confound sepsis with noninfectious causes of systemic inflammation, including pancreatitis, cardiac ischemia, bowel perforation, vasculitis, and pulmonary embolism amongst others. Two widely used biomarkers, C-reactive protein and procalcitonin, have proven promising in sepsis diagnosis. Each has found varying success in the clinical context, with some centers relying heavily on these markers and others eschewing their use almost entirely. In this chapter, we present the evidence for their use in the diagnosis of sepsis and management of antibiotic therapy in the intensive care unit context.
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42
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AlRawahi AN, AlHinai FA, Doig CJ, Ball CG, Dixon E, Xiao Z, Kirkpatrick AW. The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:390. [PMID: 31796098 PMCID: PMC6892215 DOI: 10.1186/s13054-019-2669-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022]
Abstract
Background Major trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD), which markedly influence the outcome of injured patients. Early identification of patients at risk of developing posttraumatic complications is crucial to provide early treatment and improve outcomes. We sought to evaluate the prognostic value of serum procalcitonin (PCT) levels after trauma as related to severity of injury, sepsis, organ dysfunction, and mortality. Methods We searched PubMed, MEDLINE, EMBASE, the Cochrane Database, and references of included articles. Two investigators independently identified eligible studies and extracted data. We included original studies that assessed the prognostic value of serum PCT levels in predicting severity of injury, sepsis, organ dysfunction, and mortality among critically injured adult patients. Results Among 2015 citations, 19 studies (17 prospective; 2 retrospective) met inclusion criteria. Methodological quality of included studies was moderate. All studies showed a strong correlation between initial PCT levels and Injury Severity Score (ISS). Twelve out of 16 studies demonstrated significant elevation of initial PCT levels in patients who later developed sepsis after trauma. PCT level appeared a strong predictor of MOD in seven out of nine studies. While two studies did not show association between PCT levels and mortality, four studies demonstrated significant elevation of PCT levels in non-survivors versus survivors. One study reported that the PCT level of ≥ 5 ng/mL was associated with significantly increased mortality (OR 3.65; 95% CI 1.03–12.9; p = 0.04). Conclusion PCT appears promising as a surrogate biomarker for trauma. Initial peak PCT level may be used as an early predictor of sepsis, MOD, and mortality in trauma population.
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Affiliation(s)
- Aziza N AlRawahi
- Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Fatma A AlHinai
- Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, University of Calgary, Ground Floor McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Chad G Ball
- Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada.,Regional Trauma Program, University of Calgary and the Foothills Medical Centre, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada
| | - Elijah Dixon
- Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada
| | - Zhengwen Xiao
- Regional Trauma Program, University of Calgary and the Foothills Medical Centre, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada
| | - Andrew W Kirkpatrick
- Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada.,Department of Critical Care Medicine, University of Calgary, Ground Floor McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Regional Trauma Program, University of Calgary and the Foothills Medical Centre, 1403-29th St. NW, Calgary, Alberta, T2N 2T9, Canada
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43
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Effect of l-arginine supplementation on C-reactive protein and other inflammatory biomarkers: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2019; 47:102226. [DOI: 10.1016/j.ctim.2019.102226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022] Open
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44
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Kwan K, Arapi O, Wagner KE, Schneider J, Sy HL, Ward MF, Sison CP, Li C, Eisenberg MB, Chalif D, Narayan RK, Miller EJ, Ledoux D. Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg 2019; 133:1786-1791. [PMID: 31585427 DOI: 10.3171/2019.6.jns19613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In patients with aneurysmal subarachnoid hemorrhage (aSAH), poor outcomes have been shown to be correlated with subsequent cerebral vasospasm (CV) and delayed cerebral ischemia (DCI). The identification of novel biomarkers may aid in the prediction of which patients are vulnerable to developing vasospasm, cerebral ischemia, and neurological deterioration. METHODS In this prospective clinical study at North Shore University Hospital, patients with aSAH or normal pressure hydrocephalus (NPH) with external ventricular drains were enrolled. The concentration of macrophage migration inhibitory factor (MIF) in CSF was assessed for correlation with CV or DCI, the primary outcome measures. RESULTS Twenty-five patients were enrolled in the aSAH group and 9 were enrolled in the NPH group. There was a significant increase in aggregate CSF MIF concentration in patients with aSAH versus those with NPH (24.4 ± 19.2 vs 2.3 ± 1.1 ng/ml, p < 0.0002). Incidence of the day of peak MIF concentration significantly correlated with the onset of clinical vasospasm (rho = 0.778, p < 0.0010). MIF concentrations were significantly elevated in patients with versus those without evidence of DCI (18.7 ± 4.93 vs 8.86 ± 1.28 ng/ml, respectively, p < 0.0025). There was a significant difference in MIF concentrations between patients with infection versus those without infection (16.43 ± 4.21 vs 8.5 ± 1.22 ng/ml, respectively, p < 0.0119). CONCLUSIONS Preliminary evidence from this study suggests that CSF concentrations of MIF are correlated with CV and DCI. These results, however, could be confounded in the presence of clinical infection. A study with a larger patient sample size is necessary to corroborate these findings.
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Affiliation(s)
- Kevin Kwan
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Orseola Arapi
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Katherine E Wagner
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Julia Schneider
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Heustein L Sy
- 2Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York
| | - Mary Frances Ward
- 3Department of Neurology, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens
| | - Cristina P Sison
- 4Biostatistics Unit, The Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
- 5Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset; and
| | - Chunyan Li
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Mark B Eisenberg
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - David Chalif
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Raj K Narayan
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
| | - Edmund J Miller
- 5Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset; and
- 6Heart and Lung Research Unit, The Feinstein Institute for Medical Research, Manhasset, New York
| | - David Ledoux
- 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
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45
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Wolf TA, Wimalawansa SJ, Razzaque MS. Procalcitonin as a biomarker for critically ill patients with sepsis: Effects of vitamin D supplementation. J Steroid Biochem Mol Biol 2019; 193:105428. [PMID: 31323346 DOI: 10.1016/j.jsbmb.2019.105428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/22/2019] [Accepted: 07/15/2019] [Indexed: 01/24/2023]
Abstract
Early diagnosis of sepsis is often difficult in clinical practice, whilst it can be vital for positive patient outcomes in sepsis management. Any delay in diagnosis and treatment may lead to significant organ failure and can be associated with elevated mortality rates. Early diagnosis and effective management of sepsis can allow for prompt antibiotic therapy and a potential reduction in mortality; it can also minimize the unnecessary use of antibiotics. Furthermore, vitamin D supplementation, which is commonly used in the intensive care units to reduce mortality, may interfere with the ability to use procalcitonin (PCT) as a means of assessing clinical progression. This paper aims to explore the diagnostic and prognostic value of serum levels of PCT as an early marker of sepsis and to assess whether it can be used as a guide for using antibiotic therapy. Several serum-based biomarkers such as C-reactive protein, lactate, presepsin, and cytokines, such as interleukin-1 (IL-1), and IL-6 have been evaluated as early indicators of sepsis but none have been proven sensitive and/or specific enough to make a definitive diagnosis. Finally the potential benefits and disadvantages of using serum levels of PCT to diagnose and monitor patients with sepsis and septic shock will be briefly discussed.
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Affiliation(s)
- Thijs A Wolf
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | - Mohammed S Razzaque
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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46
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Park SJ, Park J, Lee MJ, Seo JS, Ahn JY, Cho JW. Time series analysis of delta neutrophil index as the predictor of sepsis in patients with acute poisoning. Hum Exp Toxicol 2019; 39:86-94. [PMID: 31558056 DOI: 10.1177/0960327119878244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Delta neutrophil index (DNI), which reflects the fraction of immature granulocytes, is used to detect infection and sepsis from noninfectious conditions, but few studies have evaluated in the early stage of acute poisoning. This retrospective observational study was performed on acute poisoning patients who visited to the emergency department (ED) and were consecutively admitted in intensive care units over 18-month period. The serial DNI, conventional inflammatory biomarkers, and culture results were obtained in the ED and after admission. The outcomes were the identification of sepsis, bacteremia, and 30-day mortality. Of 166 patients (mean age, 56.0 years) in this cohort, 59 (35.5%) had sepsis and 29 (17.5%) had bacteremia. Initial and peak DNI fractions 24 h after ED admission were strong independent predictors of sepsis development. Analysis of the area under the curve according to multiple receiver operating characteristics showed that DNI had a higher capability to predict sepsis than other parameters (0.815 for DNI, 0.700 for procalcitonin, 0.681 for C-reactive protein, and 0.741 for white blood cell). Using multivariable logistic regression analysis, it was found that DNI was an independent predictor of sepsis (95% confidence interval (CI) of odds: 1.03-1.18) and bacteremia (95% CI: 1.01-1.14). Therefore, initial and serial measurement of DNI may serve as useful risk predictor for development of sepsis or bacteremia in acute poisoning.
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Affiliation(s)
- S J Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - M J Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J S Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, Republic of Korea
| | - J Y Ahn
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - J W Cho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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47
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Miyoshi M, Inoue Y, Nishioka M, Ikegame A, Nakao T, Kishi S, Doi T, Nagai K. Clinical evaluation of presepsin considering renal function. PLoS One 2019; 14:e0215791. [PMID: 31490935 PMCID: PMC6730850 DOI: 10.1371/journal.pone.0215791] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Presepsin, a glycoprotein produced during bacterial phagocytosis, is used as a sepsis marker for bacterial infections. However, presepsin levels are affected by renal function, and the evaluation criteria according to kidney function or in chronic kidney diseases remain controversial. Furthermore, presepsin may be increased by sample stirring, but no studies have evaluated this effect.In this study, we excluded the effect of stirring by standardizing the blood collection conditions, analyzed the influence of kidney function on presepsin concentrations, and recalculated the reference range based on the findings. EDTA-whole blood from 47 healthy subjects and 85 patients with chronic kidney disease was collected to measure presepsin by PATHFAST. Presepsin was found to be significantly correlated with the levels of creatinine (r = 0.834), eGFRcreat (r = 0.837), cystatin-C (r = 0.845), and eGFRcys (r = 0.879). Furthermore, in patients with CKD, presepsin levels stratified by eGFRcys showed a significant increase in the CKD G2 patient group and with advancing glomerular filtration rate stage. The following values were obtained: Normal: 97.6 ± 27.4 pg/mL, CKD G1: 100.2 ± 27.6 pg/mL, CKD G2: 129.7 ± 40.7 pg/mL, CKD G3: 208.1 ± 70.2 pg/mL, CKD G4: 320.2 ± 170.1 pg/mL, CKD G5: 712.8 ± 336.3 pg/mL. The reference range, calculated by a nonparametric method using 67 cases of healthy volunteers and patients with chronic kidney disease G1, was found to be 59-153 pg/mL, which was notably lower than the standard reference range currently used. Presepsin concentrations were positively correlated with a few biomarkers of renal function, indicating the necessity to consider the effect of renal function in patients with renal impairment. Using the recalculated reference range considering kidney function may improve the accuracy of evaluating presepsin for diagnosis of sepsis compared to the standard reference currently in use.
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Affiliation(s)
- Masashi Miyoshi
- Department of Medical Technology, Tokushima University Hospital, Tokushima, Japan
| | - Yusuke Inoue
- Department of Medical Technology, Tokushima University Hospital, Tokushima, Japan
| | - Mai Nishioka
- Department of Medical Technology, Tokushima University Hospital, Tokushima, Japan
| | - Akishige Ikegame
- Department of Medical Technology, Tokushima University Hospital, Tokushima, Japan
| | - Takayuki Nakao
- Department of Medical Technology, Tokushima University Hospital, Tokushima, Japan
| | - Seiji Kishi
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Toshio Doi
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
| | - Kojiro Nagai
- Department of Nephrology, Tokushima University Hospital, Tokushima, Japan
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Jonsson N, Gille-Johnson P, Martling CR, Xu S, Venge P, Mårtensson J. Performance of plasma measurement of neutrophil gelatinase-associated lipocalin as a biomarker of bacterial infections in the intensive care unit. J Crit Care 2019; 53:264-270. [PMID: 31301642 DOI: 10.1016/j.jcrc.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/10/2019] [Accepted: 07/01/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess the value of dimeric neutrophil-gelatinase associated lipocalin (NGAL) as an early marker of bacterial infection and its response to antibiotic therapy in intensive care unit (ICU) patients. MATERIALS & METHODS We measured daily plasma dNGAL in 198 patients admitted to a mixed ICU. Likelihood of infection was determined with International Sepsis Forum criteria. We measured dNGAL in 145 healthy controls to establish normal values. RESULTS ICU patients had higher dNGAL than healthy controls. A suspected or confirmed infection was independently associated with 90% (95% CI 15-215%) higher dNGAL than absence of infection. We observed no association between acute kidney injury and dNGAL. Diagnostic accuracy at antibiotic treatment initiation, assessed with area under the receiver-operating characteristics curve (AUC-ROC), for dNGAL was 0.70 (95% CI 0.60-0.79). AUC-ROC for dNGAL 24 h before antibiotic treatment initiation was 0.54 (95% CI 0.41-0.66). The mean (95% CI) change of dNGAL in the first 2 days after appropriate antibiotic therapy initiation was -31 (-49,-13)%. CONCLUSIONS In our cohort of ICU patients, plasma dNGAL was associated with presence of bacterial infections independent of AKI but it performed poor as a predictor of infections. Following antibiotic therapy, dNGAL markedly decreased-supporting further exploration of dNGAL-guided antibiotic de-escalation.
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Affiliation(s)
- Niklas Jonsson
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | | | - Claes-Roland Martling
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Shengyuan Xu
- Departments of Medical Sciences and Clinical Chemistry, Uppsala University, 751 05 Uppsala, Sweden
| | - Per Venge
- Departments of Medical Sciences and Clinical Chemistry, Uppsala University, 751 05 Uppsala, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden
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Shim BS, Yoon YH, Kim JY, Cho YD, Park SJ, Lee ES, Choi SH. Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection. J Clin Med 2019; 8:jcm8060833. [PMID: 31212806 PMCID: PMC6617302 DOI: 10.3390/jcm8060833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/21/2019] [Accepted: 06/05/2019] [Indexed: 01/10/2023] Open
Abstract
We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups—those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.
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Affiliation(s)
- Bo-Sun Shim
- Department of Emergency Medicine, Korea University College of Medicine, 08308 Seoul, Korea.
| | - Young-Hoon Yoon
- Department of Emergency Medicine, Korea University College of Medicine, 08308 Seoul, Korea.
| | - Jung-Youn Kim
- Department of Emergency Medicine, Korea University College of Medicine, 08308 Seoul, Korea.
| | - Young-Duck Cho
- Department of Emergency Medicine, Korea University College of Medicine, 08308 Seoul, Korea.
| | - Sung-Jun Park
- Department of Emergency Medicine, Korea University College of Medicine, 08308 Seoul, Korea.
| | - Eu-Sun Lee
- Department of Emergency Medicine, Korea University College of Medicine, 08308 Seoul, Korea.
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, Korea University College of Medicine, 08308 Seoul, Korea.
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Wang X, Sun Y, Shao X. Predictive value of procalcitonin for infection of patients with type-2 diabetes mellitus. Exp Ther Med 2019; 18:722-728. [PMID: 31258707 DOI: 10.3892/etm.2019.7611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/26/2019] [Indexed: 12/11/2022] Open
Abstract
The aim of the present study was to investigate the predictive value of procalcitonin (PCT) for infection in patients with type 2 diabetes mellitus (T2DM). A retrospective analysis of 178 patients with T2DM who were divided into non-infection, local infection and sepsis groups was conducted; in conjunction with 33 healthy control patients. Clinicopathological characteristics and inflammatory indicators were compared between the four groups. Patients in the non-infection group exhibited significantly higher PCT levels compared with healthy controls (P=0.002). In addition, PCT, C-reactive protein (CRP), white blood cell count and neutrophil percent were significantly different amongst patients with T2MD across different infection groups (all P<0.001) with the following rank order: Sepsis group > local infection group > non-infection group (all P<0.05). In addition, the following observations were made: i) PCT and CRP demonstrated larger areas under the curve (AUC) for predicting local infection (0.804 and 0.741, respectively); ii) PCT displayed lower sensitivity of only 21.8% at its classical cutoff value (0.500 ng/ml) whereas CRP exhibited higher sensitivity and specificity at 64.1 and 76.1%, respectively, at its classical cutoff value (10.0 mg/l); and iii) PCT exhibited the largest AUC (0.914) for predicting sepsis with high sensitivity and specificity (86.4 and 84.5%, respectively) at its cutoff value (0.990 ng/ml). Patients with T2DM without infection demonstrated higher baseline PCT levels. The present study clarified the value of PCT in predicting infection of T2DM patients. The application of PCT to predict local infection in patients with T2DM was identified to be inferior to CRP, but its ability to predict sepsis was concluded to be the best when compared with CRP, white blood cell count and neutrophil percent.
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Affiliation(s)
- Xinshui Wang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Yanbei Sun
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213003, P.R. China
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