[Blood concentrations of lactate, C-reactive protein, and creatinine as early indicators of severity and outcome of sepsis]

Combining CD64 and CD123 Biomarkers for Sepsis Early Diagnosis and Severity Assessment via PD-L1 Antibody Affinity Microfluidic (PAAM) Chip in Trace Clinical Samples

Sepsis, a lethal organ dysfunction caused by a dysregulated host response to infection, is the leading cause of worldwide in-hospital mortality. However, the early diagnostic methods for sepsis are still urgent for guiding accurate antibiotic usage and improving the survival rate of the patients. Herein, we constructed a PD-L1 antibody affinity microfluidic (PAAM) chip for early sepsis diagnosis and severity assessment. The chip was used to capture PD-L1-expressing leukocytes from whole blood samples obtained from healthy control (HC) volunteers (n = 15) and sepsis patients on day 1 (D1) and day 7 (D7) (n = 20), and there was a statistically significant difference between HC and sepsis patients (p < 0.0001), and the AUC was 0.96. However, there was no significant difference in the number of cells captured on-chip between sepsis patients on D1 and D7 (p = 0.16). Therefore, we performed immunofluorescence staining of PD-L1, CD64, and CD123 on the chip. The results showed that the combination of PD-L1, CD64, and CD123 for sepsis diagnosis had an AUC of 0.98, and there was a significant difference in PD-L1+/CD64+/CD123+ leukocytes between sepsis patients on D1 and on D7 (p < 0.0001). In conclusion, we found that the combination of multiple biomarkers was more precise and dependable for sepsis diagnosis and severity assessment.

Evaluation of the modified quick sequential organ failure assessment scoring system for triage and prognostic assessment in canine emergency and critically ill patients: a retrospective study

BACKGROUND

In veterinary medicine, the qSOFA model has been studied in patients with conditions such as peritonitis or pyometra, and among the modified qSOFA models, only the qSOFA-lactate model has been researched. Thus, this study aimed to evaluate the effectiveness of q-SOFA-C-reactive protein (CRP), qSOFA-lactate, and quick systemic inflammatory response syndrome (qSIRS) models for triaging emergency and critically ill patients. These models were juxtaposed with conventional systems (SIRS, qSOFA, and acute patient physiology and laboratory evaluation [APPLE] fast) to ascertain their efficacy in patient triage and prognostication. In this retrospective cohort study, data from 166 dogs admitted to the Department of Emergency and Critical care at Konkuk Veterinary Medical Teaching Hospital between February 2021 and May 2023 were analyzed. Scoring systems were computed based on initial admission physical examinations (respiratory rate, heart rate, temperature, mentation, and systolic blood pressure) and laboratory results (white blood cell and platelet count and albumin, glucose, lactate, and CRP levels). Because no prior veterinary studies on the qSOFA-CRP model were available, optimal cutoff values were established using receiver operating characteristic (ROC) curves and the Youden index. Conventional scoring systems were compared with the modified qSOFA within the survivor and non-survivor groups. The most effective system was determined through ROC curve analysis.

RESULTS

For the qSOFA-CRP model, we identified an optimal cutoff value for CRP at > 1.55 mg/dL. All modified qSOFA scoring systems showed significant differences between survivors and non-survivors, in contrast to the conventional scoring systems. Notably, the qSOFA-CRP model demonstrated the highest area under the ROC curve value (0.761, 95% CI 0.68-0.83) and odds ratio (13.373, p < 0.001) when evaluating mortality at 28 days.

CONCLUSIONS

The qSOFA-CRP model, when employing a CRP threshold of 1.55 mg/dL, demonstrated promising potential as a novel criterion for triaging emergency and critically ill patients. However, further assessment is required in a larger population of patients at the precise early stage of sepsis.

Relationship of Serum Procalcitonin, C-reactive Protein, and Lactic Acid to Organ Failure and Outcome in Critically Ill Pediatric Population

Objective:

To evaluate the clinical and prognostic utility of procalcitonin (PCT), C-reactive protein (CRP), and lactic acid in children admitted to the Pediatric Intensive Care Unit (PICU) of a university teaching hospital.

Materials and Methods:

Medical records of children (1 month–16 years) tested for serum PCT at the time of admission in the PICU of our hospital from July 1, 2013, to January 15, 2015, were reviewed. Within 24 h of admission, the Pediatric Risk of Mortality Score, blood cultures, white blood cell count, neutrophil counts, serum CRP, plasma lactic acid, and PCT were noted. Patient outcome was assessed at hospital discharge, and the patients were divided into nonsurvivors and survivors.

Results:

A total of 167 children being admitted to the PICU were enrolled. The median age of the study population was 3 years (0–16 years), with 58.6% being males. Nonsurvivors had significantly higher lactic acid (4.7 mmol/L [2.07–7.6]; P < 0.05) than that of the survivors (2 mmol/L [1.3–3]; P < 0.05). In addition, nonsurvivors (94.4%; P < 0.05) had greater incidence of multiple organ dysfunction syndrome (MODS) than that of the survivors (38.05%; P < 0.05). Binary logistic regression showed age, MODS, and lactic acid to be associated with mortality.

Conclusions:

This study found that in comparison to PCT and CRP, high plasma lactic acid levels are associated with the development of all-cause MODS and worse outcome in critically ill children admitted in PICU. Prediction of prognosis based on the lactic acid alone may contribute to improve patient management, but further studies are required to endorse our findings.