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Biscardi E, Carpinteri G, Castellino P, Malatino L. Use of CytoSorb in the emergency department-high dependency unit: A case report and a mini review. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Circulating inflammatory mediators and cytokines play a pivotal role in the progression of sepsis, leading in turn to septic shock, organ failure and resistance to standard therapy. Blood purification therapies may be adjuvant treatment for severe sepsis, but results have been shown to be so far controversial. Recently, CytoSorb has achieved promising outcomes on reduction of cytokine blood levels, improvement of clinical parameters and mortality in sepsis, as well as in other acute conditions. It is mostly used in Intensive Care Unit (ICU), in isolated hemoperfusion, or inserted in other circuits in addition to Continuous Renal Replacement Therapy (CRRT), heart-lung machines and extracorporeal membrane oxygenation. We report a case of septic shock occurred in our Emergency Department-High Dependency Unit (ED-HDU), resistant to standard therapy and improved after CytoSorb, so avoiding ICU hospitalization.
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Bou Chebl R, Geha M, Assaf M, Kattouf N, Haidar S, Abdeldaem K, Halawi N, Khamis M, Makki M, Tamim H, Abou Dagher G. The prognostic value of the lactate/albumin ratio for predicting mortality in septic patients presenting to the emergency department: a prospective study. Ann Med 2021; 53:2268-2277. [PMID: 34854770 PMCID: PMC8648034 DOI: 10.1080/07853890.2021.2009125] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Lactate/albumin (L/A) ratio is a biomarker in sepsis that has been shown to outperform lactate. This prospective study aims to validate the superior prognostic value of the L/A ratio to lactate in sepsis and septic shock. METHODS Prospective cohort conducted from September 2018 till February 2021 on adult patients presenting to the Emergency Department (ED) at a tertiary care centre with sepsis or septic shock. The primary outcome was the prognostic value of the L/A ratio compared to lactate with regards to mortality. RESULTS A total of 939 septic patients were included throughout the study period. A total of 236 patients developed septic shock. The AUC value of the L/A ratio in septic patients was 0.65 (95% CI 0.61-0.70) and was higher than that of lactate alone 0.60 (95% CI 0.55-0.64) with a p < .0001. The optimal L/A ratio cut-off threshold that separated survivors from non-survivors was found to be 0.115 for all septic patients. The AUC of the L/A ratio was significantly higher for patients with a lactate ≥2 mmol/L: 0.69 (95% CI 0.64-0.74) versus 0.60 (95% CI 0.54-0.66) with a p < .0001 as well as for patients with an albumin level less than 30 g/L (AUC = 0.69 95% CI= 0.62-0.75 vs AUC= 0.66 95% CI= 0.59-0.73, p = .04). Among septic shock patients there was no statically significant difference in the AUC value of the L/A ratio compared to lactate (0.53 95% CI 0.45-0.61 vs 0.50 95% CI 0.43-0.58 respectively with a p-value = .11). CONCLUSIONS The L/A ratio is a better predictor of in-patient mortality than lactate in sepsis patients. This superiority was not found in the septic shock subgroup. Our results encourage the use of the ratio early in the ED as a superior prognostic tool in sepsis patients.Key messagesWe aimed to assess the prognostic usefulness of the Lactate/Albumin ratio compared to lactate alone in septic and septic shock patients.The L/A ratio proved to be a better predictor of in-patient mortality than lactate alone in sepsis patients. This pattern also applies across various subgroups in our study (malignancy, diabetics, age above 65, lactate level less than 2 mmol/L, albumin less than 30 g/L). Our results favour the use of the L/A ratio over lactate alone in patients with sepsis and the previously mentioned subgroups.Our results do not favour the use of the ratio instead of lactate in septic shock patients as there was no statistically significant difference between the AUCs of the ratio and lactate alone.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mirabelle Geha
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Assaf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadim Kattouf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Saadeddine Haidar
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Karim Abdeldaem
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Nour Halawi
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamed Khamis
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
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Choo SH, Lim YS, Cho JS, Jang JH, Choi JY, Choi WS, Yang HJ. Usefulness of ischemia-modified albumin in the diagnosis of sepsis/septic shock in the emergency department. Clin Exp Emerg Med 2020; 7:161-169. [PMID: 33028058 PMCID: PMC7550814 DOI: 10.15441/ceem.19.075] [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: 09/02/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022] Open
Abstract
Objective No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED. Methods This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance. Results This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667–0.791] vs. 0.681 [0.613–0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613–0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762–0.867) and 0.806 (0.754–0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00–1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02–1.11; P=0.002). Conclusion Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/ septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.
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Affiliation(s)
- Seung Hwa Choo
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yong Su Lim
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jin Seong Cho
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jae Ho Jang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Woo Sung Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyuk Jun Yang
- Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea
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Lippi G, Salvagno GL, Gelati M, Pucci M, Lo Cascio C, Demonte D, Faggian D, Plebani M. Two-center comparison of 10 fully-automated commercial procalcitonin (PCT) immunoassays. Clin Chem Lab Med 2020; 58:77-84. [PMID: 31539351 DOI: 10.1515/cclm-2019-0888] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/30/2019] [Indexed: 01/08/2023]
Abstract
Background This two-center study was designed to verify comparability of procalcitonin (PCT) values among 10 different commercial immunoassays. Methods A total number of 176 routine lithium-heparin plasma samples were divided in identical aliquots and simultaneously analyzed with 10 different PCT immunoassays, including Kryptor BRAHMS PCT sensitive, Abbott Architect BRAHMS PCT, Beckman Coulter Access PCT (on Access and DXI), BioMérieux Vidas BRAHMS PCT, Diasorin Liaison BRAHMS PCT, Fujirebio Lumipulse G BRAHMS PCT, Roche BRAHMS PCT (on Cobas E801), Diazyme PCT (on Roche Cobas C702) and SNIBE Maglumi PCT. Results Highly significant correlation was always found across multiple comparisons, with correlation coefficients comprised between 0.918 and 0.997 (all p < 0.001). Bland and Altman plots analysis revealed highly variable bias among immunoassays, ranging between ±0.2% and ±38.6%. Diazyme PCT on Roche Cobas C702 and SNIBE Maglumi PCT displayed the larger overestimation, whilst PCT values were underestimated by Cobas BRAHAMS PCT. The agreement was always >80% (all p < 0.001), but varied largely across multiple comparisons, ranging between 90%-99% at 0.1 μg/L, 81%-99% at 0.25 μg/L, 83%-100% at 0.5 μg/L, 94%-100% at 2.0 μg/L and 90%-99% at 10 μg/L, respectively. The larger disagreement was observed comparing Diazyme PCT and Maglumi PCT with the other methods. Conclusions Although we found acceptable correlation among 10 commercial PCT immunoassays, the limited agreement at clinical decision thresholds remains a major issue, especially at lower end of PCT concentration, thus potentially contributing to jeopardize the clinical value of this biomarker.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Matteo Gelati
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Mairi Pucci
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Claudia Lo Cascio
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Davide Demonte
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Diego Faggian
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
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Lippi G, Salvagno GL, Gelati M, Pucci M, Demonte D, Faggian D, Plebani M. Analytical Evaluation of the New Beckman Coulter Access Procalcitonin (PCT) Chemiluminescent Immunoassay. Diagnostics (Basel) 2020; 10:diagnostics10030128. [PMID: 32111028 PMCID: PMC7151122 DOI: 10.3390/diagnostics10030128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/01/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022] Open
Abstract
This study was designed to evaluate the analytical performance of the recently commercialized Beckman Coulter Access procalcitonin (PCT) chemiluminescent test on the Access immunoassay system. The analytical assessment encompassed the estimation of limit of blank (LoB), limit of detection (LoD), functional sensitivity (i.e., PCT value with ≤10% imprecision), linearity, imprecision and comparability of values with BRAHMS PCT-sensitive Kryptor. LoB, LoD and functional sensitivity were 0.002 μg/L, 0.003 μg/L and 0.003 μg/L, respectively. Intra-assay, inter-assay and total imprecision for plasma pools with low, medium and high PCT values were 1.8–2.1%, 2.4–3.7% and 3.1–4.3%, respectively. The assay exhibited excellent linearity between 0.02 and 84.0 μg/L. Excellent correlation (r = 0.999; p < 0.001) and negligible bias (3.2%) were found by comparing values obtained in paired plasma samples with BRAHMS PCT-sensitive Kryptor. Diagnostic agreement at 0.5, 2.0 and 10 μg/L PCT values ranged between 98%-100%. The results of this study confirm that Access PCT displays excellent analytical performance and high comparability with BRAHMS PCT-sensitive Kryptor.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy; (G.L.); (M.G.); (M.P.); (D.D.)
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy; (G.L.); (M.G.); (M.P.); (D.D.)
- Correspondence:
| | - Matteo Gelati
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy; (G.L.); (M.G.); (M.P.); (D.D.)
| | - Mairi Pucci
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy; (G.L.); (M.G.); (M.P.); (D.D.)
| | - Davide Demonte
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy; (G.L.); (M.G.); (M.P.); (D.D.)
| | - Diego Faggian
- Department of Laboratory Medicine, University Hospital of Padova, 35128 Padova, Italy; (D.F.); (M.P.)
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, 35128 Padova, Italy; (D.F.); (M.P.)
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Cabral L, Afreixo V, Meireles R, Vaz M, Marques M, Tourais I, Chaves C, Almeida L, Paiva JA. Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients - a retrospective observational study. BMC Anesthesiol 2018; 18:122. [PMID: 30185148 PMCID: PMC6123981 DOI: 10.1186/s12871-018-0585-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/24/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Early sepsis diagnosis is crucial for the correct management of burn patients, and it clearly influences outcomes. The systemic inflammatory response triggered by burns mimics sepsis presentation and complicates early sepsis diagnosis. Biomarkers were advocated to aid the diagnosis of early sepsis. Serum procalcitonin (PCT) exhibits fair accuracy and good correlation with sepsis severity, being used in diverse clinical settings. However, few studies have evaluated perioperative changes in PCT levels in burn patients. The present study evaluated PCT kinetics during the first days after burn injury and subsequent surgical interventions to assess PCT utility in distinguishing septic from non-septic inflammatory responses. METHODS This study was a retrospective observational study of all burn patients admitted to the Coimbra Burns Unit (Portugal) between January 2011 and December 2014 who presented with a total burn surface area ≥ 15% and who underwent subsequent surgery. PCT kinetics were investigated a) during the first five days after burn injury and b) preoperatively during the five days after surgery in three subsets of patients, including those with no preoperative and no postoperative sepsis (NN), no preoperative but postoperative sepsis (NS), and preoperative and postoperative sepsis (SS). A total of 145 patients met the selection criteria and were included in the analysis. RESULTS PCT levels in the first five days after burn injury were significantly higher in patients who developed at least one sepsis episode (n = 85) compared with patients who did not develop sepsis (n = 60). PCT values > 1.00 ng/mL were clearly associated with sepsis. Study participants (n = 145) underwent a total of 283 surgical interventions. Their distribution by preoperative/postoperative sepsis status was 142 (50.2%) in NN; 62 (21.9%) in NS; and 79 (27.9%) in SS. PCT values exhibited a parallel course in the three groups that peaked on the second postoperative day and returned to preoperative levels on the third day or later. The lowest PCT values were found in NN, and the highest values were observed in SS; the NS values were intermediate. CONCLUSIONS PCT kinetics coupled with a clinical examination may be helpful for sepsis diagnosis during the first days after burn injury and burn surgery.
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Affiliation(s)
- Luís Cabral
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
- Autonomous Section of Health Sciences (SACS), University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- CIDMA-Center for Research and Development in Mathematics and Applications; iBiMED-Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Rita Meireles
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Miguel Vaz
- Department of Plastic Surgery and Burns Unit, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Margarida Marques
- Department of Anesthesiology, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Isabel Tourais
- Department of Anesthesiology, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Catarina Chaves
- Department of Clinical Pathology, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Luís Almeida
- MedinUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Artur Paiva
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto; Grupo de Infecção e Sépsis, Porto, Portugal
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