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Bacârea A, Coman O, Bacârea VC, Văsieşiu AM, Săplăcan I, Fodor RŚ, Grigorescu BL. Immune profile of patients‑a new approach in management of sepsis and septic shock? Exp Ther Med 2024; 27:203. [PMID: 38590571 PMCID: PMC11000046 DOI: 10.3892/etm.2024.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/29/2024] [Indexed: 04/10/2024] Open
Abstract
The present study was a prospective observational single center study, enrolling 102 patients with sepsis, admitted in the Intensive Care Unit of the County Emergency Clinical Hospital in Târgu Mureș (Mureș, Romania). The main goal of the present study was to compare the changes of the following parameters on day 1 compared with day 5, in sepsis compared with septic shock, as well as in survivors compared with non-survivors: Cell blood count parameters, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic inflammation index, C reactive protein (CRP), ferritin, procalcitonin (PCT), CD 3+ T cells, CD4+ T cells, CD8+ T cells, CD16+CD56+/CD3-NK cells and CD19+ B cells. The relationship between the subcategories of lymphocytes with the inflammatory markers was evaluated. The serum concentration of CRP and PCT was significantly lower on day 5 compared with day 1 and serum ferritin was significantly higher in patients with septic shock. The percentage of cytotoxic T lymphocytes was significantly decreased and the percentage of NK lymphocytes was significantly increased in patients who developed septic shock. The results indicated a negative significant correlation between the proportion of T lymphocytes and PCT concentration and a positive significant correlation between the proportion of B lymphocytes and PCT concentration.
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Affiliation(s)
- Anca Bacârea
- Department of Pathophysiology, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, Târgu Mureș, Mureș 540142, Romania
| | - Oana Coman
- Department of Simulation Applied in Medicine, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, Târgu Mureș, Mureș 540142, Romania
| | - Vladimir Constantin Bacârea
- Department of Scientific Research Methodology, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, Târgu Mureș, Mureș 540142, Romania
| | - Anca Meda Văsieşiu
- Department of Infectious Disease, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, Târgu Mureș, Mureș 540142, Romania
| | - Irina Săplăcan
- Clinic of Anesthesiology and Intensive Care, Emergency County Hospital, Târgu Mureș, Mureș 540136, Romania
| | - Raluca Śtefania Fodor
- Department of Anesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, Târgu Mureș, Mureș 540142, Romania
| | - Bianca Liana Grigorescu
- Department of Anesthesiology and Intensive Therapy, University of Medicine, Pharmacy, Science and Technology ‘George Emil Palade’, Târgu Mureș, Mureș 540142, Romania
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Hue-Bigé A, François-Garret B, Casagrande F, Oertel J, Mayerus M, Eleni Dit Trolli S. Early procalcitonin assays may reduce antibiotic exposure in premature newborn infants. Acta Paediatr 2024; 113:939-946. [PMID: 38314886 DOI: 10.1111/apa.17137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
AIM The diagnosis of early-onset neonatal sepsis (EOS) remains difficult. The main aim was to study the effect of a new algorithm for EOS, which includes the level of procalcitonin in umbilical cord blood, on the exposure to antibiotic therapy of premature newborn infants. METHODS This was a monocentric, observational and retrospective study with before-and-after design. The duration and dose of antibiotic therapy provided as well as the morbidity and mortality were compared in two groups, one included 01 May 2015-30 November 2015 when procalcitonin was not used, and one after the change 01 November 2016-30 May 2017 when procalcitonin was used in a hospital setting in Nice, France. RESULTS Sixty newborn infants were included in the before group and 54 in the after group. Antibiotic therapy was stopped after 24 h for 18 newborn infants in the after group and four in the before group, and after 48 h for 26 newborn infants in the after group and 10 in the before group. CONCLUSION The implementation of a new decision-making algorithm including early procalcitonin assay of premature newborn infants significantly reduced exposure to antibiotics without modifying mortality or morbidity.
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Affiliation(s)
- Amandine Hue-Bigé
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
| | | | | | - Julie Oertel
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
| | - Mathilde Mayerus
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
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Sakunchotpanit G, Rohan TZ, Milosavljevic S, Patil MK, Braun N, Nambudiri VE, Iriarte C. Procalcitonin: A potentially useful serum test in patients with dermatologic disease. J Am Acad Dermatol 2024; 90:1090-1091. [PMID: 38224914 DOI: 10.1016/j.jaad.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Goranit Sakunchotpanit
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Thomas Z Rohan
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sofia Milosavljevic
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Mihir K Patil
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Carle Illinois College of Medicine, Urbana, Illinois
| | - Natalie Braun
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Christopher Iriarte
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Parrey AH, Koka M, Kasana B, Ismail M. Procalcitonin and qSOFA as a Marker of Mortality in Sepsis. Rev Recent Clin Trials 2024; 19:RRCT-EPUB-139527. [PMID: 38644718 DOI: 10.2174/0115748871288534240322083746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The qSOFA and procalcitonin are currently used for both diagnostic as well as prognostic purposes. OBJECTIVE To explore the combined use of day one procalcitonin level and qSOFA scores for prognostication of sepsis-related mortality Design: This was a prospective observational study. PARTICIPANTS All patients who fulfilled the inclusion criteria for sepsis with an age of more than 16 years were enrolled in the study Results: In this study of 211 patients, 15 patients died (7.1%) during hospital stay. Among the 15 patients who died, the highest mortality of 29.4% qSOFA of "2" had a mortality of 12.8%),qSOFA of "1" had a mortality of 1% and qSOFA of "0" had zero mortality. In this study, procalcitonin had a statistically significant positive correlation/association with both qSOFA and mortality. CONCLUSION The qSOFA and procalcitonin at presentation to the emergency department in septic patients have a significant correlation with mortality in patients hospitalized with sepsis. Obtaining these two parameters at presentation will help in managing aggressively these patients who at presentation have higher qSOFA and procalcitonin levels.
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Affiliation(s)
| | - Manzoor Koka
- Internal Medicine Government Medical College, Srinagar, India
| | - Basharat Kasana
- Internal Medicine Government Medical College, Srinagar, India
| | - Mohd Ismail
- Internal Medicine Government Medical College, Srinagar, India
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Sun X, Li Y, Lv Y, Liu Y, Lai Z, Zeng Y, Zhang H. Diagnostic value of procalcitonin in patients with periprosthetic joint infection: a diagnostic meta-analysis. Front Surg 2024; 11:1211325. [PMID: 38660585 PMCID: PMC11039863 DOI: 10.3389/fsurg.2024.1211325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Background The success rate of periprosthetic joint infection (PJI) treatment is still low. Early diagnosis is the key to successful treatment. Therefore, it is necessary to find a biomarker with high sensitivity and specificity. The diagnostic value of serum procalcitonin (PCT) for PJI was systematically evaluated to provide the theoretical basis for clinical diagnosis and treatment in this study. Methods We searched the Web of Science, Embase, Cochrane Library, and PubMed for studies that evaluated the diagnostic value of serum PCT for PJI (from the inception of each database until September 2020). Two authors independently screened the literature according to the inclusion and exclusion criteria. The quality of each selected literature was evaluated by using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) tool. RevMan 5.3 software was used for the quality evaluation. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were merged by using Meta-DiSc 1.4 software. The area under the curve (AUC) and Q index were calculated after the summary receiver operating characteristic (SROC) was generated. We also performed subgroup analysis. Results A total of 621 patients were enrolled in the nine studies. The pooled sensitivity of serum PCT for PJI diagnosis was 0.441 [95% confidence interval (CI), 0.384-0.500], the pooled specificity was 0.852 (95% CI, 0.811-0.888), the pooled PLR was 2.271 (95% CI, 1.808-2.853), the pooled NLR was 0.713 (95% CI, 0.646-0.786), and the pooled DOR was 5.756 (95% CI, 3.673-9.026). The area under SROC (the pooled AUC) was 0.76 (0.72-0.79). Q index was 0.6948. Conclusion This study showed that PCT detection of PJI had poor diagnostic accuracy. Hence, the serum PCT is not suitable as a serum marker for PJI diagnosis.
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Affiliation(s)
- Xiaobo Sun
- Department of Orthopaedics, Ganzhou Hospital of Traditional Chinese Medicine, Ganzhou, Jiangxi, China
| | - Yijin Li
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yan Lv
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuting Liu
- Academic Affairs Office, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Zhiwei Lai
- Department of Orthopaedics, Ganzhou Hospital of Traditional Chinese Medicine, Ganzhou, Jiangxi, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Haitao Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Liu S, Zhao H, Li X. Serum Biochemical Markers for Medullary Thyroid Carcinoma: An Update. Cancer Manag Res 2024; 16:299-310. [PMID: 38617188 PMCID: PMC11011642 DOI: 10.2147/cmar.s440477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Medullary thyroid carcinoma (MTC), a rare malignancy, requires early diagnosis for optimal patient outcomes. An important aspect of MTC diagnosis is the assessment of serum biomarkers. This review aimed to evaluate the use of serum biomarkers in the diagnosis, prognosis, and follow-up of MTC. Methods A thorough search of PubMed covering 1975 to 2022 was conducted to identify English-language articles on MTC serum biomarkers. Results The review revealed that calcitonin (Ctn) and carcinoembryonic antigen (CEA) remain the most important serum biomarkers for MTC diagnosis and management. Despite limited studies on procalcitonin (PCT), its stability and ability to exclude interference from inflammation make it a valuable potential marker of MTC. Although the positive rate of serum CA19-9 levels in MTC patients was not high, it can be used as an indicator of poor prognosis in advanced MTC. Other serum markers, including chromogranin A, gastrin-releasing peptide precursor, and neurospecific enolase, did not show any unique value in MTC diagnosis and management. Conclusion Taken together, this review emphasized the importance of serum biomarkers, particularly Ctn and CEA, in the diagnosis and management of MTC. PCT shows promise as a valuable potential marker, whereas CA19-9 can be used as a prognostic indicator of advanced MTC. Further research is needed to validate the significance of these serum biomarkers in MTC and determine the effects of confounding factors on their levels. Clinicians should consider using these markers in MTC diagnosis, prognosis, and follow-up, particularly for patients with advanced disease.
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Affiliation(s)
- Shuzhou Liu
- Department of Head & Neck Surgery, Hainan General Hospital, Haikou, 570311, People’s Republic of China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100010, People’s Republic of China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100010, People’s Republic of China
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Long Z, Li X, Li Z, Hu J, Qiu Y, Li S, Zhan Y, Ye F, Wang Y. Improved diagnostic markers for invasive pulmonary aspergillosis in COPD patients. Front Cell Infect Microbiol 2024; 14:1294971. [PMID: 38633749 PMCID: PMC11021593 DOI: 10.3389/fcimb.2024.1294971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
Background The prevalence of invasive pulmonary aspergillosis (IPA) among patients with chronic obstructive pulmonary disease (COPD) is steadily increasing, leading to high mortality. Although early diagnosis can significantly reduce mortality, the efficacy of current diagnostic methods is limited. Consequently, there is a need for novel approaches for early IPA detection. Methods This retrospective study involved 383 hospitalized COPD patients with GOLD stages III and IV. The IPA group (67 patients) and non-IPA group (316 patients) were identified at the First Affiliated Hospital of Guangzhou Medical University between January 2016 and February 2022. We analyzed common serological indicators in our hospital to identify predictive indicators for the early diagnosis of IPA in COPD patients. Results The sensitivity and specificity of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), lactate dehydrogenase (LDH), and ceruloplasmin (CER) for diagnosing IPA in COPD patients were as follows: CRP (91.2%, 57.7%), ESR (77.5%, 73.0%), PCT (60.5%, 71.4%), LDH (50.0%, 88.8%), and CER (60.7%, 74.3%). Combinations of biomarkers, such as CRP-ESR, CRP-LDH, ESR-LDH, ESR-CER, and LDH-CER, showed promising diagnostic potential, with larger area under the curve (AUC) values for IPA diagnosis in COPD patients. However, no statistically significant difference was observed between the diagnostic efficacy of single biomarkers and combined biomarkers. Notably, compared to those in the unassisted ventilation group, the patients in the assisted ventilation group (including noninvasive ventilation and tracheal intubation/incision-assisted ventilation group) exhibited significantly greater PCT and LDH levels, while the CER significantly decreased (p=0.021). There were no significant differences in biomarker levels between the ICU group and the non-ICU group. CRP (p<0.01), ESR (p=0.028), PCT (p<0.01), and CER (p<0.01) were positively correlated with hospitalization duration, whereas LDH was not correlated with hospitalization duration. Conclusion Our study highlights the diagnostic potential of CRP, ESR, PCT, LDH, and CER for IPA in COPD patients. CRP and LDH can also initially predict the need for assisted ventilation, while CRP can initially estimate the length of hospitalization. This study represents the first report of the potential of CER for diagnosing IPA, suggesting its significance for further research.
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Affiliation(s)
| | | | | | | | | | | | | | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, China
| | - Yan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, China
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Ince FM, Alkan Bilik O, Ince H. Evaluating Mortality Predictors in COVID-19 Intensive Care Unit Patients: Insights into Age, Procalcitonin, Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Ferritin Lactate Index. Diagnostics (Basel) 2024; 14:684. [PMID: 38611597 PMCID: PMC11011413 DOI: 10.3390/diagnostics14070684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Numerous studies suggest that alterations in blood parameters, such as changes in platelet, lymphocyte, hemoglobin, eosinophil, and basophil counts; increased neutrophil counts; and elevated neutrophil/lymphocyte and platelet/lymphocyte ratios, signal COVID-19 infection and predict worse outcomes. Leveraging these insights, our study seeks to create a predictive mortality model by assessing age and crucial laboratory markers. MATERIALS AND METHODS Patients were categorized into two groups based on their hospital outcomes: 130 survivors who recovered from their Intensive Care Unit (ICU) stay (Group 1) and 74 who died (Group 2). We then developed a predictive mortality model using patients' age, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), procalcitonin levels, and ferritin lactate (FL) index results. RESULTS A total of 204 patients were included. Patients in Group 2 had a notably higher mean age compared to those in Group 1 (76 ± 11 vs. 66 ± 15 years) (p < 0.001). Using specific cut-off values, our analysis revealed varying effectiveness in predicting COVID-19 mortality: Those aged over 73 years showed 74% sensitivity and 60% specificity, with an area under the curve (AUC) of 0.701. Procalcitonin levels above 0.35 ng/mL balanced true-positive and -negative identifications well, achieving an AUC of 0.752. The FL index, with a threshold of 1228 mg/dL, had 68% sensitivity and 65% specificity with an AUC of 0.707. A PLR higher than 212 resulted in 48% sensitivity and 69% specificity, with an AUC of 0.582. An NLR higher than 5.8 resulted in 55% sensitivity and 63% specificity, with an AUC of 0.640, showcasing diverse predictive accuracies across parameters. The statistical analysis evaluated the effects of age (>73), procalcitonin levels (>0.35), FL > 1228, PLR > 212, and NLR > 5.8 on mortality variables using logistic regression. Ages over 73 significantly increased event odds by 2.1 times (p = 0.05), procalcitonin levels above 0.35 nearly quintupled the odds (OR = 5.6, p < 0.001), high FL index levels more than tripled the odds (OR = 3.5, p = 0.003), a PLR > 212 significantly increased event odds by 3.5 (p = 0.030), and an NLR > 5.8 significantly increased event odds by 1.6 (p = 0.043). CONCLUSIONS Our study highlights significant predictors of mortality in COVID-19 ICU patients, including advanced age, elevated procalcitonin, FL index levels, the PLR, and the NLR.
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Affiliation(s)
- Fatma Meral Ince
- Infectious Diseases and Clinical Microbiology, Selahaddin Eyyubi State Hospital, 21100 Diyarbakir, Turkey
| | - Ozge Alkan Bilik
- Medical Microbiology, Selahaddin Eyyubi State Hospital, 21100 Diyarbakir, Turkey
| | - Hasan Ince
- Internal Medicine, Selahaddin Eyyubi State Hospital, 21100 Diyarbakir, Turkey;
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Meng W, Wang Q, Xu Q, Gao H, Zhou Y, Shao W. Biomarkers in the Severity of Necrotizing Enterocolitis in Preterm Infants: A Pilot Study. Int J Gen Med 2024; 17:1017-1023. [PMID: 38505145 PMCID: PMC10950000 DOI: 10.2147/ijgm.s446378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Background The occurrence of necrotizing enterocolitis (NEC) is a common and severe disease of the digestive system in neonates. This study aims to assess the value of the intestinal tissue oxygen saturation (rintSO2) combined with the levels of procalcitonin (PCT) and mean platelet volume (MPV) in predicting the severity of NEC in preterm infants. Methods This experiment was a retrospective cohort study conducted in the Department of Pediatrics, Hongqi Hospital Affiliated to Mudanjiang Medical University between January 2017 and July 2022. Premature neonates with NEC were enrolled and divided into mild-moderate NEC group and severe NEC group according to Bell's stage. The general information data, rintSO2 and blood parameters such as the white blood cell (WBC) count, platelet count (PLT), PCT, MPV, red blood cell distribution width (RDW), hemoglobin (Hb), C-reactive protein (CRP) were compared between the two groups. Results A total of 122 patients were enrolled, including 79 mild-moderate NEC and 43 severe NEC. The rintSO2 was lower in severe group than in mild-moderate group (P = 0.042), the PCT and MPV were both higher in severe group than in mild-moderate group (P = 0.048, P = 0.049). The results of logistic regression suggested that the rintSO2 (OR = 1.491, P = 0.003), PCT (OR = 3.071, P = 0.001) and MPV (OR = 4.027, P = 0.015) were independent predictive factors for severity of NEC. The area under the curve (AUC) of the rintSO2 combined with PCT and MPV showed good diagnostic ability in the severity of NEC. Conclusion The rintSO2 combined with PCT and MPV may be considered as the early biomarkers in the severity of NEC and could help us to diagnose the case early with early treatment with better prognosis.
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Affiliation(s)
- Wei Meng
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Qing Wang
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Qingyu Xu
- Department of Pediatrics Surgery, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People's Republic China
| | - Hongli Gao
- Department of Digestive Endoscopy Center, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Yunjun Zhou
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
| | - Wei Shao
- Department of Pediatric Internal Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, People’s Republic of China
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Yin S, Lin Y, Wang B, Peng Y, Wang Z, Zhu X, Liang H, Li X, Wang M. Reliability of Droplet Digital PCR Alone and in Combination with Interleukin-6 and Procalcitonin for Prognosis of Bloodstream Infection. Infect Drug Resist 2024; 17:1051-1071. [PMID: 38505247 PMCID: PMC10950090 DOI: 10.2147/idr.s439683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose Bloodstream infection(BSI) is linked with high mortality, underscoring the significance of prompt etiological diagnosis for timely and precise treatment. This study aims to investigate the diagnostic value of droplet digital polymerase chain reaction(ddPCR) in combination with conventional inflammatory markers [interleukin-6(IL-6) and procalcitonin(PCT)] concerning disease progression and treatment prognosis in BSI patients. Furthermore, the study aims to explore a more efficient clinical application strategy. Patients and Methods This prospective case seried study centers on 176 patients suspected of or confirmed with BSI. Blood samples were collected to extract nucleic acids for identifying pathogens (bacteria, fungi, and viruses) and determining copy loads via ddPCR. Results The sensitivity of ddPCR was markedly higher compared to the culture method (74.71% vs 31.03%). A positive correlation existed between bacterial load and levels of inflammatory markers [IL-6 (P=0.0182), PCT (P=0.0029), and CRP (P=0.0005)]. In suspected BSI cases, the combination of ddPCR and inflammatory markers could predict sepsis risk [ROC: Area under the curve(AUC)=0.6071, P=0.0383]. Within confirmed BSI patients, the ddPCR bacterial load of those with SOFA<7 was lower than that of the SOFA≥7 (P=0.0334). ddPCR (OR: 1.789, P=0.035) monitoring combined with PCT (OR: 1.787, P=0.035) holded predictive value for SOFA progression (AUC=0.7913, P=0.0003). Similarly, BSI survivors displayed a lower burden than non-survivors (P=0.0170). Additionally, ddPCR combinated with IL-6 provided a more accurate and expedited insight into clinical outcomes prediction for BSI confirmed patients (AUC=0.7352, P=0.0030). Serial monitoring of bacterial load by ddPCR effectively mirrored the clinical course of BSI in patients. Notably, patients with positive ddPCR virus infection exhibited significantly reduced lymphocyte counts (P=0.0003). Conclusion In a clinical context, qualitative ddPCR results and quantitative continuous monitoring can more precisely assess sepsis progression and treatment prognosis in BSI patients. Furthermore, ddPCR results offer quicker and more accurate reference points for clinical antibacterial and antiviral interventions.
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Affiliation(s)
- Sheng Yin
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - YingRui Lin
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Bingqi Wang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Yizhi Peng
- Department of Laboratory Medicine, Hunan Cancer Hospital, Central South University, Changsha, Hunan, 410031, People’s Republic of China
| | - Zeyou Wang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Xiaolin Zhu
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Hao Liang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Xianping Li
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Min Wang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
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Sinha M, Banerjee A, Kumar S, Mahto M, Kumari B, Ranjan A, Bansal A. Development of Predictive Models Based on Biochemical Parameters to Triage COVID-19 Patients: A Study Conducted in a Tertiary Care Hospital. Cureus 2024; 16:e56197. [PMID: 38618472 PMCID: PMC11016157 DOI: 10.7759/cureus.56197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
Background The COVID-19 disease continues to cause severe mortality and morbidity. Biochemical parameters are being used to predict the severity of the infection. This study aims to predict disease severity and mortality to help reduce mortality through timely intervention in a cost-effective way. Methods A total of 324 COVID-19 cases admitted at our hospital (All India Institute of Medical Sciences, Patna, BR, India) between June 2020 to December 2020 (phase 1: 190 patients) and April 2021 to May 2021 (phase 2: 134 patients) were recruited for this study. Statistical analysis was done using SPSS Statistics version 23 (IBM Corp., Armonk, NY, USA) and model prediction using Python (The Python Software Foundation, Wilmington, DE, USA). Results There were significant differences in biochemical parameters at the time of admission among COVID-19 patients between phases 1 and 2, ICU and non-ICU admissions, and expired and discharged patients. The receiver operating characteristic (ROC) curves predicted mortality solely based on biochemical parameters. Using multiple logistic regression in Python, a total of four models (two each) were developed to predict ICU admission and mortality. A total of 92 out of 96 patients were placed into the correct management category by our model. This model would have allowed us to preserve 17 of the 21 patients we lost. Conclusions We developed predictive models for admission (ICU or non-ICU) and mortality based on biochemical parameters at the time of admission. A predictive model with a significant predictive capability for IL-6 and procalcitonin values using normal biochemical parameters was proposed. Both can be used as machine learning tools to prognosticate the severity of COVID-19 infections. This study is probably the first of its kind to propose triage for admission in the ICU or non-ICU at the medical emergency department during the first presentation for the necessary optimal treatment of COVID-19 based on a predictive model.
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Affiliation(s)
- Mainak Sinha
- General Surgery, All India Institute of Medical Sciences, Patna, IND
| | - Ayan Banerjee
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Sushil Kumar
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Mala Mahto
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Bandana Kumari
- Biochemistry, All India Institute of Medical Sciences, Patna, IND
| | - Alok Ranjan
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Akash Bansal
- Biochemistry, All India Institute of Medical Sciences, Gorakhpur, IND
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12
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Gómez NFP, Del Pilar Sanz Martín M, Chong MAS, Cruz NDZ, Hernández RM, Molina IG, Sanz IG, Tejerina AF, Rueda FR. Usefulness of Procalcitonin Levels for Predicting the Microbiological Orientation in Patients with Sepsis. J Pers Med 2024; 14:208. [PMID: 38392641 PMCID: PMC10890570 DOI: 10.3390/jpm14020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024] Open
Abstract
The main objective of the study was to verify whether levels of procalcitonin (PCT) could guide us toward determining the type of bacteria causing the sepsis and to identify the discriminatory cut-off point in the first urgent laboratory test. This study is a single center retrospective analysis that includes 371 patients with a mean age of 71.7 ± 15.6 years who were diagnosed with sepsis or septic shock. The yield of blood cultures in demonstrating the causative microbiological agent was 24.3% (90), and it was 57, 1% (212) when evaluating all types of cultures. Statistically significant positive differences were observed in the mean value of the PCT between the group that obtained positive cultures and the group that did not (p < 0.0001). The AUC-ROC of PCT values as a guide to the causal bacteria type was 0.68 (95%CI: 0.57-0.78, p < 0.0021). The PCT value that showed the best diagnostic characteristics for identifying Gram-negative rods (GNR) as the causative agent in blood cultures was 2.1 ng/mL. The positive predictive value (PPV) was 78, 9% (66.3-88.1%). The AUC-ROC of the PCT values for sepsis diagnosis, with any positive culture that could be assessed, was 0.67 (95%CI: 0.63-0.73, p < 0.0001). The PCT value that showed the best diagnostic characteristic for predicting sepsis was 3.6 ng/mL.
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Affiliation(s)
- Natalia Fernanda Pascual Gómez
- Department of Clinical Analysis, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain
- Physiology and Pathophysiology Teaching Unit, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
| | | | | | | | - Rosa Méndez Hernández
- Department of Anesthesiology and Surgical Intensive Care, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain
| | - Iñigo Guerra Molina
- Department of Emergency, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain
| | - Iñigo García Sanz
- Department of Digestive and General Surgical, La Princesa University Hospital, Autónoma University of Madrid, Diego de León 62, 28006 Madrid, Spain
| | - Angels Figuerola Tejerina
- Department of Preventive Medicine and Public Health, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain
| | - Fernando Ramasco Rueda
- Department of Anesthesiology and Surgical Intensive Care, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain
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13
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Tao LC, Shu H, Wang Y, Hou Q, Li JJ, Huang XL, Hua F. Inflammatory biomarkers predict higher risk of hyperglycemic crises but not outcomes in diabetic patients with COVID-19. Front Endocrinol (Lausanne) 2024; 15:1287795. [PMID: 38455656 PMCID: PMC10919215 DOI: 10.3389/fendo.2024.1287795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
Background Inflammation is a predictor of severe complications in patients with COVID-19 infection under a variety of clinical settings. A few studies suggested that COVID-19 infection was a trigger of hyperglycemic crises including diabetic ketoacidosis (DKA) and/or hyperglycemic hyperosmolar state (HHS). However, the association between inflammation and hyperglycemic crises in diabetic patients with COVID-19 infection is unclear. Methods One hundred and twenty-four patients with type 2 diabetes mellitus (T2DM) and COVID-19 infection from January 2023 to March 2023 were retrospectively analyzed. Demographic, clinical, and laboratory data, especially inflammatory markers including white blood cell (WBC), neutrophils, neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP) and procalcitonin (PCT) were collected and compared between patients with or without DKA and/or HHS. Multivariable logistic regression analysis was conducted to explore the association between inflammatory biomarkers and the prevalence of hyperglycemic crises. Patients were followed up 6 months for outcomes. Results Among 124 diabetic patients with COVID-19, 9 were diagnosed with DKA or HHS. Comparing COVID-19 without acute diabetic complications (ADC), patients with DKA or HHS showed elevated levels of c-reactive protein (CRP, P=0.0312) and procalcitonin (PCT, P=0.0270). The power of CRP and PCT to discriminate DKA or HHS with the area under the receiver operating characteristics curve (AUROC) were 0.723 and 0.794, respectively. Multivariate logistic regression indicated 1.95-fold and 1.97-fold increased risk of DKA or HHS with 1-unit increment of CRP and PCT, respectively. However, neither CRP nor PCT could predict poor outcomes in diabetic patients with COVID-19. Conclusion In this small sample size study, we firstly found that elevated serum CRP and PCT levels increased the risk of hyperglycemic crises in T2DM patients with COVID-19 infection. More study is needed to confirm our findings.
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Affiliation(s)
- Li-Chan Tao
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hong Shu
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ying Wang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Qian Hou
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Lin Huang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fei Hua
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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14
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Dräger S, Ewoldt TMJ, Abdulla A, Rietdijk WJR, Verkaik N, Ramakers C, de Jong E, Osthoff M, Koch BCP, Endeman H. Exploring the Impact of Model-Informed Precision Dosing on Procalcitonin Concentrations in Critically Ill Patients: A Secondary Analysis of the DOLPHIN Trial. Pharmaceutics 2024; 16:270. [PMID: 38399324 PMCID: PMC10891837 DOI: 10.3390/pharmaceutics16020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Model-informed precision dosing (MIPD) might be used to optimize antibiotic treatment. Procalcitonin (PCT) is a biomarker for severity of infection and response to antibiotic treatment. The aim of this study was to assess the impact of MIPD on the course of PCT and to investigate the association of PCT with pharmacodynamic target (PDT) attainment in critically ill patients. This is a secondary analysis of the DOLPHIN trial, a multicentre, open-label, randomised controlled trial. Patients with a PCT value available at day 1 (T1), day 3 (T3), or day 5 (T5) after randomisation were included. The primary outcome was the absolute difference in PCT concentration at T1, T3, and T5 between the MIPD and the standard dosing group. In total, 662 PCT concentrations from 351 critically ill patients were analysed. There was no statistically significant difference in PCT concentration between the trial arms at T1, T3, or T5. The median PCT concentration was highest in patients who exceeded 10× PDT at T1 [13.15 ng/mL (IQR 5.43-22.75)]. In 28-day non-survivors and in patients that exceeded PDT at T1, PCT decreased significantly between T1 and T3, but plateaued between T3 and T5. PCT concentrations were not significantly different between patients receiving antibiotic treatment with or without MIPD guidance. The potential of PCT to guide antibiotic dosing merits further investigation.
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Affiliation(s)
- Sarah Dräger
- Department of Hospital Pharmacy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, 3015 GD Rotterdam, The Netherlands
- Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Tim M. J. Ewoldt
- Department of Hospital Pharmacy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, 3015 GD Rotterdam, The Netherlands
- Department of Intensive Care Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Alan Abdulla
- Department of Hospital Pharmacy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, 3015 GD Rotterdam, The Netherlands
| | - Wim J. R. Rietdijk
- Department of Hospital Pharmacy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Institutional Affairs, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Nelianne Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Evelien de Jong
- Department of Intensive Care, Rode Kruis Ziekenhuis, 1942 LE Beverwijk, The Netherlands
| | - Michael Osthoff
- Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Birgit C. P. Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Rotterdam Clinical Pharmacometrics Group, 3015 GD Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
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15
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Mesolella M, Allosso S, Petruzzi G, Evangelista A, Motta G, Motta G. Procalcitonin for Early Detection of Pharyngocutaneous Fistula after Total Laryngectomy: A Pilot Study. Cancers (Basel) 2024; 16:768. [PMID: 38398159 PMCID: PMC10886710 DOI: 10.3390/cancers16040768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The aim of this prospective study was to investigate the role of procalcitonin as an early diagnostic marker of pharyngocutaneous fistula (PCF) in a cohort of head and neck patients treated with total laryngectomy for squamous cell carcinoma. METHODS This prospective study was conducted on a sample of patients enrolled from January 2019 to March 2022. All patients were subjected to a "protocol" of blood chemistry investigations, scheduled as follows: complete blood count with formula, ESR dosage, CPR, and PCT. PCT was also dosed by salivary sampling and a pharyngo-cutaneous swab in patients who presented with PCF. The dosage scheme was systematically repeated: the day before the intervention (t0); the 5th day postoperative (t1); the 20th day postoperative (t2); and at time X, the day of the eventual appearance of the pharyngocutaneous fistula. RESULTS A total of 36 patients met the inclusion criteria. The patients enrolled in the study were subsequently divided into two groups: 27 patients underwent total laryngectomy (TL) for laryngeal cancer without postoperative complications, and 9 patients were undergoing TL with postoperative PCF. Using the Cochran's Q test, statistical significance was found for PCT among T0, T1, Tx, and T2 (p-value < 0.001) between the PCF and non-PCF groups. The Z test demonstrated that there is a difference in PCT levels at T1 and T2 and that this difference is statistically significant (p < 0.001). CONCLUSIONS PCT could be considered an early marker of complications in open laryngeal surgery. According to our results, it could be useful in the precocious detection of pharyngocutaneous fistulas and in the management of antibiotic therapy.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, 80131 Naples, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology—Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Giovanni Motta
- Unit of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, University Luigi Vanvitelli, 80131 Naples, Italy; (G.M.); (G.M.)
| | - Gaetano Motta
- Unit of Otorhinolaryngology, Department of Mental and Physical Health and Preventive Medicine, University Luigi Vanvitelli, 80131 Naples, Italy; (G.M.); (G.M.)
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16
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Mann BK, Bhandohal JS, Kalha I, Fox K, Jean B. Relevance of Procalcitonin Levels as a Marker of Severity and Predictor of Mortality, Initiation and Duration of Antibiotics in Patients Admitted with Acute Pancreatitis: A Retrospective Cohort Study. Clin Exp Gastroenterol 2024; 17:31-39. [PMID: 38352170 PMCID: PMC10863456 DOI: 10.2147/ceg.s453345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Procalcitonin levels have been studied to predict the benefit of adding antibiotics in a patient with acute pancreatitis. Through this study, we are searching for any possible correlation between serum procalcitonin levels and the severity of acute pancreatitis (included acute on chronic cases) to determine whether procalcitonin levels can predict a benefit from antibiotic therapy in acute pancreatitis. Methods This is a retrospective cohort study involving patients with acute pancreatitis and acute on chronic pancreatitis. We included all hospitalized patients admitted to Kern Medical from January 2020 to October 2022 with a diagnosis of acute pancreatitis in a consecutive manner. The primary outcome studied was mortality related to the pancreatitis episode. Logistic regression was used to control numerous confounders. Results Based on univariate analysis of procalcitonin, we found starting antibiotics on the day of admission statistically significant. We also found the median differences in mortality to be mildly significant (difference = 0.79, p = 0.0640) based on procalcitonin values. In a multivariate analysis of ln(procalcitonin), we found lipase (p = 0.0249), duration of antibiotics (p = 0.0009), multi-organ failure (p = 0.0045) to be statistically significant, and lactate being mildly significant in the multivariate model (p = 0.0643). Conclusion The procalcitonin level can predict the initiation of antibiotics, duration of antibiotics, multi-organ failure, and mortality in patients with acute pancreatitis.
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Affiliation(s)
- Baldeep Kaur Mann
- Division of Hospital Medicine, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Janpreet Singh Bhandohal
- Division of Hospital Medicine, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Ishaan Kalha
- Division of Gastroenterology, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Kasey Fox
- Division of Hospital Medicine, Department of Medicine, Kern Medical Center, Bakersfield, CA, USA
| | - Brian Jean
- Biostatistician, Professor Emeritus, Kern Medical Center, Bakersfield, CA, USA
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17
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Shan D, Wang Q, Heng X, Wu X. Clinical Application of Serum Interleukin-6 Combined with Inflammatory Cytokines in the Dynamic Monitoring of Patients with Acute Cholecystitis. Int J Gen Med 2024; 17:503-508. [PMID: 38348126 PMCID: PMC10860495 DOI: 10.2147/ijgm.s444839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/14/2024] [Indexed: 02/15/2024] Open
Abstract
Objective To investigate the dynamic fluctuations of serum interleukin-6 (IL-6), procalcitonin (PCT), and neutrophil counts in individuals diagnosed with acute cholecystitis. Additionally, the research seeks to investigate the potential clinical significance of these biomarkers in the early stages of acute cholecystitis. Methods This retrospective cohort study included one hundred patients with acute cholecystitis (60 with mild acute cholecystitis and 40 with severe cholecystitis) admitted to our hospital between January 2022 and December 2022 were included. The levels of various cytokines, PCT and neutrophils in serum on days 1, 3, 5, and 7 were dynamically detected. The difference in each indicator between the two groups was analysed, and the diagnostic value of each indicator for acute cholecystitis was evaluated using a receiver operating characteristic (ROC) curve. Results IL-6 and PCT levels and neutrophil counts were significantly higher in patients with moderate and severe cholecystitis than those in those with mild cholecystitis (P <0.01). The AUC values for the three indicators were all greater than 60%, and the AUC value for the joint diagnosis of the three indicators reached 90%. Conclusion Serum interleukin-6 combined with PCT and neutrophil count is helpful to determine the degree of disease development in patients with acute cholecystitis. The advantage of dynamic monitoring of the three indicators is that the detection is simple and worthy of clinical promotion.
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Affiliation(s)
- Danping Shan
- Department of Clinical Laboratory, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, People’s Republic of China
| | - Qiyao Wang
- Department of Clinical Laboratory, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, People’s Republic of China
| | - Xiang Heng
- Department of Clinical Laboratory, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, People’s Republic of China
| | - Xiaoyan Wu
- Department of Clinical Laboratory, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, People’s Republic of China
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Genc S, Taghizadehghalehjoughi A, Naldan ME, Gülcü O, Caglayan C, Spanakis M, Nikolouzakis TK, Alegakis A, Docea AO, Drocas AI, Mitrut R, Hatzidaki E, Spandidos DA, Tsatsakis A. Evaluation of various blood biomarkers associated with the outcomes of patients with COVID‑19 treated in intensive care units. Exp Ther Med 2024; 27:82. [PMID: 38274343 PMCID: PMC10809360 DOI: 10.3892/etm.2024.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/10/2023] [Indexed: 01/27/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (COVID-19) represented a global public health crisis and the most significant pandemic in modern times. Transmission characteristics, and the lack of effective antiviral treatment protocol and protective vaccines, pushed healthcare systems, particularly intensive care units (ICUs), to their limits and led to extreme quarantine measures to control the pandemic. It was evident from an early stage that patient stratification approaches needed to be developed to better predict disease progression. In the present study, the predictive value of clinical and blood biomarkers for the outcomes of patients with COVID-19 hospitalized in the ICU were investigated, taking age and sex into consideration. The present study analyzed blood samples from 3,050 patients with COVID-19 hospitalized in the ICU. The analysis revealed that the levels of procalcitonin, N-terminal pro-B-type natriuretic peptide, D-dimer, ferritin, liver enzymes, C-reactive protein and lactate dehydrogenase were increased and were associated with disease progression, resulting in a prolonged hospitalization period and severe COVID-19 related complications. Additionally, significant age and sex disparities among these biomarkers were documented and discussed in specific cases. On the whole, the results of the present study suggest a potential association of the demographic characteristics and blood biomarkers with prolonged hospitalization in the ICU and the mortality of patients with COVID-19.
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Affiliation(s)
- Sidika Genc
- Department of Medical Pharmacology, Faculty of Medicine, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
| | - Ali Taghizadehghalehjoughi
- Department of Medical Pharmacology, Faculty of Medicine, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
| | - Muhammet E. Naldan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
| | - Oktay Gülcü
- Department of Cardiology, Educational and Research Hospital, Faculty of Medicine, Health Science University, Erzurum 25240, Turkey
| | - Cüneyt Caglayan
- Department of Biochemistry, Faculty of Medicine, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
| | - Marios Spanakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | | | - Athanasios Alegakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Andrei Ioan Drocas
- Department of Urology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Radu Mitrut
- Department of Cardiology, University and Emergency Hospital, Bucharest 050098, Romania
| | - Eleftheria Hatzidaki
- Department of Neonatology, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
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19
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Kayani M, Fatima N, Yarra PC, Almansouri NE, K D, Balasubramanian A, Parvathaneni N, Mowo-Wale AG, Valdez JA, Nazir Z. Novel Biomarkers in Early Detection of Heart Failure: A Narrative Review. Cureus 2024; 16:e53445. [PMID: 38435138 PMCID: PMC10909379 DOI: 10.7759/cureus.53445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
Heart failure (HF) represents a significant global health challenge, characterized by a variety of symptoms resulting from cardiac dysfunction. This dysfunction often leads to systemic and pulmonary congestion. The pathophysiology of HF is complex, involving stimulation of the sympathetic nervous system, which is insufficiently balanced by the release of natriuretic peptide. This imbalance leads to progressive hypertrophy and dilatation of the heart's chambers, impairing its pumping efficiency and increasing the risk of arrhythmias and conduction disorders. The prevalence of HF is exceptionally high in industrialized nations and is expected to increase owing to an aging population and advancements in diagnostic methods. This study emphasizes the critical role of early diagnosis in reducing morbidity and mortality associated with HF, focusing specifically on the evolving importance of biomarkers in managing this condition. Biomarkers have played a key role in transforming the diagnosis and treatment of HF. Traditional biomarkers such as b-type natriuretic peptide and N-terminal pro-b-type natriuretic peptide have been widely adopted for their cost-effectiveness and ease of access. However, the rise of novel biomarkers such as growth differentiation factor 15 and adrenomedullin has shown promising results, offering superior sensitivity and specificity. These new biomarkers enhance diagnostic accuracy, risk stratification, and prognostic evaluation in HF patients. Despite these advancements, challenges remain, such as limited availability, high costs, and the need for further validation in diverse patient populations. Through a comprehensive literature review across databases such as PubMed, Google Scholar, and the Cochrane Library, this study compiles and analyzes data from 18 relevant studies, offering a detailed understanding of the current state of HF biomarkers. The study examines both traditional and emerging biomarkers such as galectin-3 and soluble suppression of tumorigenicity 2 in HF, exploring their clinical roles and impact on patient outcomes.
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Affiliation(s)
- Maryam Kayani
- Cardiology, Shifa Tameer-e-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Neha Fatima
- Internal Medicine, Lisie Hospital, Kochi, IND
| | | | - Naiela E Almansouri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, University of Tripoli, Tripoli, LBY
| | - Deepshikha K
- Cardiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
| | | | | | | | - Josue A Valdez
- General Practice, Universidad Autónoma de Durango, Los Mochis, MEX
| | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
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20
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Mobed A, Darvishi M, Tahavvori A, Alipourfard I, Kohansal F, Ghazi F, Alivirdiloo V. Nanobiosensors for procalcitonin (PCT) analysis. J Clin Lab Anal 2024; 38:e25006. [PMID: 38268233 PMCID: PMC10873684 DOI: 10.1002/jcla.25006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Procalcitonin (PCT) is a critical biomarker that is released in response to bacterial infections and can be used to differentiate the pathogenesis of the infectious process. OBJECTIVE In this article, we provide an overview of recent advances in PCT biosensors, highlighting different approaches for biosensor construction, different immobilization methods, advantages and roles of different matrices used, analytical performance, and PCT biosensor construction. Also, we will explain PCT biosensors sensible limits of detection (LOD), linearity, and other analytical characteristics. Future prospects for the development of better PCT biosensor systems are also discussed. METHODS Traditional methods such as capillary electrophoresis, high-performance liquid chromatography, and mass spectrometry are effective in analyzing PCT in the medical field, but they are complicated, time-consuming sample preparation, and require expensive equipment and skilled personnel. RESULTS In the past decades, PCT biosensors have emerged as simple, fast, and sensitive tools for PCT analysis in various fields, especially medical fields. CONCLUSION These biosensors have the potential to accompany or replace traditional analytical methods by simplifying or reducing sample preparation and making field testing easier and faster, while significantly reducing the cost per analysis.
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Affiliation(s)
- Ahmad Mobed
- Infectious and Tropical Diseases Research Center, Clinical Research InstituteTabriz University of Medical SciencesTabrizIran
| | - Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic MedicineAJA University of Medical SciencesTehranIran
| | - Amir Tahavvori
- Internal Department, Medical FacultyUrmia University of Medical SciencesUrmiaIran
| | - Iraj Alipourfard
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural SciencesTehran University of Medical SciencesTehranIran
| | - Fereshteh Kohansal
- Infectious and Tropical Diseases Research Center, Clinical Research InstituteTabriz University of Medical SciencesTabrizIran
- Stem Cell Research CenterTabriz University of Medical SciencesTabrizIran
| | - Farhood Ghazi
- Ramsar CampusMazandaran University of Medical SciencesRamsarIran
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Di Deo P, Vantaggiato C, Di Modugno A, Licari D, Savina PF, Zagliani A, Viganò C, Grimaldi G, Frassanito A, Lettera T, De Corato P, Ammirabile M, Ferraris Fusarini C, De Liso F, Maregnani A, Silvani I, Taverriti TPS, Ceriotti F, Vidali M. Extensive analytical evaluation of the performances of the new DiaSys PCT assay and comparison with Elecsys B·R·A·H·M·S PCT test on Roche Cobas and B·R·A·H·M·S PCT-sensitive Kryptor. Clin Chem Lab Med 2024; 62:e44-e47. [PMID: 37531078 DOI: 10.1515/cclm-2023-0776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Priscilla Di Deo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Chiara Vantaggiato
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Adriana Di Modugno
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Debora Licari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Pier Francesco Savina
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Arianna Zagliani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Cristina Viganò
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Gabriella Grimaldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Antonio Frassanito
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Tommaso Lettera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Paola De Corato
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Massimiliano Ammirabile
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | | | - Federica De Liso
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Alessio Maregnani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Iris Silvani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | | | - Ferruccio Ceriotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
| | - Matteo Vidali
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Patologia Clinica, Milan, Italy
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Masetto T, Grimmler M. Comment to: Extensive analytical evaluation of the performances of the new DiaSys PCT assay and comparison with Elecsys B·R·A·H·M·S PCT test on Roche Cobas and B·R·A·H·M·S PCT-sensitive Kryptor. Clin Chem Lab Med 2024; 62:e48-e50. [PMID: 37746855 DOI: 10.1515/cclm-2023-0997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Thomas Masetto
- DiaSys Diagnostic Systems GmbH, Holzheim, Germany
- Institute of Molecular Medicine I, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Matthias Grimmler
- DiaSys Diagnostic Systems GmbH, Holzheim, Germany
- Institute for Biomolecular Research, Hochschule Fresenius gGmbH, University of Applied Sciences, Idstein, Germany
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23
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Miron M, Blaj M, Ristescu AI, Iosep G, Avădanei AN, Iosep DG, Crișan-Dabija R, Ciocan A, Perțea M, Manciuc CD, Luca Ș, Grigorescu C, Luca MC. Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review. Microorganisms 2024; 12:213. [PMID: 38276198 PMCID: PMC10820465 DOI: 10.3390/microorganisms12010213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Hospital-acquired pneumonia (HAP) and its subtype, ventilator-associated pneumonia (VAP), remain two significant causes of morbidity and mortality worldwide, despite the better understanding of pathophysiological mechanisms, etiology, risk factors, preventive methods (bundle of care principles) and supportive care. Prior detection of the risk factors combined with a clear clinical judgement based on clinical scores and dosage of different inflammatory biomarkers (procalcitonin, soluble triggering receptor expressed on myelloid cells type 1, C-reactive protein, mid-regional pro-adrenomedullin, mid-regional pro-atrial natriuretic peptide) represent the cornerstones of a well-established management plan by improving patient's outcome. This review article provides an overview of the newly approved terminology considering nosocomial pneumonia, as well as the risk factors, biomarkers, diagnostic methods and new treatment options that can guide the management of this spectrum of infections.
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Affiliation(s)
- Mihnea Miron
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Mihaela Blaj
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Anesthesiology and Intensive Care Unit, “Sf. Spiridon” Hospital, 700111 Iasi, Romania
| | - Anca Irina Ristescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Anesthesiology and Intensive Care Unit, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Gabriel Iosep
- Anesthesiology and Intensive Care Unit, Clinical Hospital of Pneumology, 700182 Iasi, Romania;
| | - Andrei-Nicolae Avădanei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Diana-Gabriela Iosep
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Radu Crișan-Dabija
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Pulmonology Department, Clinical Hospital of Pneumology, 700182 Iasi, Romania
| | | | - Mihaela Perțea
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Department of Surgery 1, “Sf. Spiridon” Hospital, 700111 Iasi, Romania
| | - Carmen Doina Manciuc
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Ștefana Luca
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
| | - Cristina Grigorescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Thoracic Surgery Department, Clinical Hospital of Pneumology, 700182 Iasi, Romania
| | - Mihaela Cătălina Luca
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iași, 700115 Iasi, Romania; (M.B.); (A.I.R.); (A.-N.A.); (D.-G.I.); (R.C.-D.); (M.P.); (C.D.M.); (Ș.L.); (C.G.); (M.C.L.)
- Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
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Hincu MA, Zonda GI, Vicoveanu P, Harabor V, Harabor A, Carauleanu A, Melinte-Popescu AS, Melinte-Popescu M, Mihalceanu E, Stuparu-Cretu M, Vasilache IA, Nemescu D, Paduraru L. Investigating the Association between Serum and Hematological Biomarkers and Neonatal Sepsis in Newborns with Premature Rupture of Membranes: A Retrospective Study. Children (Basel) 2024; 11:124. [PMID: 38255436 PMCID: PMC10814729 DOI: 10.3390/children11010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
(1) Background: Neonatal early-onset sepsis (EOS) is associated with important mortality and morbidity. The aims of this study were to evaluate the association between serum and hematological biomarkers with early onset neonatal sepsis in a cohort of patients with prolonged rupture of membranes (PROM) and to calculate their diagnostic accuracy. (2) Methods: A retrospective cohort study was conducted on 1355 newborns with PROM admitted between January 2017 and March 2020, who were divided into two groups: group A, with PROM ≥ 18 h, and group B, with ROM < 18 h. Both groups were further split into subgroups: proven sepsis, presumed sepsis, and no sepsis. Descriptive statistics, analysis of variance (ANOVA) and a Random Effects Generalized Least Squares (GLS) regression were used to evaluate the data. (3) Results: The statistically significant predictors of neonatal sepsis were the high white blood cell count from the first (p = 0.005) and third day (p = 0.028), and high C-reactive protein (CRP) values from the first day (p = 0.004). Procalcitonin (area under the curve-AUC = 0.78) and CRP (AUC = 0.76) measured on the first day had the best predictive performance for early-onset neonatal sepsis. (4) Conclusions: Our results outline the feasibility of using procalcitonin and CRP measured on the first day taken individually in order to increase the detection rate of early-onset neonatal sepsis, in the absence of positive blood culture.
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Affiliation(s)
- Maura-Adelina Hincu
- Division of Neonatology, Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (A.C.); (D.N.)
| | - Gabriela-Ildiko Zonda
- Division of Neonatology, Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (A.C.); (D.N.)
| | - Petronela Vicoveanu
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Valeriu Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (V.H.); (A.H.); (M.S.-C.)
| | - Anamaria Harabor
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (V.H.); (A.H.); (M.S.-C.)
| | - Alexandru Carauleanu
- Division of Neonatology, Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (A.C.); (D.N.)
| | - Alina-Sînziana Melinte-Popescu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania
| | - Marian Melinte-Popescu
- Department of Internal Medicine, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania
| | - Elena Mihalceanu
- Division of Neonatology, Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (A.C.); (D.N.)
| | - Mariana Stuparu-Cretu
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (V.H.); (A.H.); (M.S.-C.)
| | - Ingrid-Andrada Vasilache
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (V.H.); (A.H.); (M.S.-C.)
| | - Dragos Nemescu
- Division of Neonatology, Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (A.C.); (D.N.)
| | - Luminita Paduraru
- Division of Neonatology, Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania (A.C.); (D.N.)
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Bernardi L, Bossù G, Dal Canto G, Giannì G, Esposito S. Biomarkers for Serious Bacterial Infections in Febrile Children. Biomolecules 2024; 14:97. [PMID: 38254697 PMCID: PMC10813546 DOI: 10.3390/biom14010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Febrile infections in children are a common cause of presentation to the emergency department (ED). While viral infections are usually self-limiting, sometimes bacterial illnesses may lead to sepsis and severe complications. Inflammatory biomarkers such as C reactive protein (CRP) and procalcitonin are usually the first blood exams performed in the ED to differentiate bacterial and viral infections; nowadays, a better understanding of immunochemical pathways has led to the discovery of new and more specific biomarkers that could play a role in the emergency setting. The aim of this narrative review is to provide the most recent evidence on biomarkers and predictor models, combining them for serious bacterial infection (SBI) diagnosis in febrile children. Literature analysis shows that inflammatory response is a complex mechanism in which many biochemical and immunological factors contribute to the host response in SBI. CRP and procalcitonin still represent the most used biomarkers in the pediatric ED for the diagnosis of SBI. Their sensibility and sensitivity increase when combined, and for this reason, it is reasonable to take them both into consideration in the evaluation of febrile children. The potential of machine learning tools, which represent a real novelty in medical practice, in conjunction with routine clinical and biological information, may improve the accuracy of diagnosis and target therapeutic options in SBI. However, studies on this matter are not yet validated in younger populations, making their relevance in pediatric precision medicine still uncertain. More data from further research are needed to improve clinical practice and decision making using these new technologies.
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Affiliation(s)
| | | | | | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (L.B.); (G.B.); (G.D.C.); (G.G.)
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Mester P, Räth U, Schmid S, Amend P, Keller D, Krautbauer S, Bondarenko S, Müller M, Buechler C, Pavel V. Serum Insulin-like Growth Factor-Binding Protein-2 as a Prognostic Factor for COVID-19 Severity. Biomedicines 2024; 12:125. [PMID: 38255230 PMCID: PMC10813598 DOI: 10.3390/biomedicines12010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Insulin-like growth factor-binding protein (IGFBP)-2 is a regulator of anabolic pathways, which become inactivated in severe illness. Here, we measured the serum IGFBP-2 levels of COVID-19 patients with moderate and severe disease as well as healthy controls to identify the associations of serum IGFBP-2 levels with disease severity. Patients with severe COVID-19 had higher serum IGFBP-2 levels than those with moderate disease and healthy controls, who had similar levels. Non-survivors of COVID-19 tended to have elevated serum IGFBP-2 levels compared to survivors. Increased serum IGFBP-2 levels were observed in patients requiring dialysis and vasopressor therapy. Serum IGFBP-2 was positively correlated with procalcitonin in both patient groups. Bacterial co-infection in severe COVID-19 patients did not influence serum IGFBP-2 levels. Patients with liver cirrhosis and obesity, showing increased and decreased serum IGFBP-2 levels, respectively, were excluded from the study. The present analysis showed that higher serum IGFBP-2 levels are associated with increased disease severity in COVID-19 patients. The similarity in serum IGFBP-2 levels between patients with moderate COVID-19 and healthy controls suggests that elevated IGFBP-2 is associated with critical illness rather than SARS-CoV-2 infection itself.
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Affiliation(s)
- Patricia Mester
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
| | - Ulrich Räth
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
| | - Stephan Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
| | - Pablo Amend
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
| | - Dennis Keller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
| | - Sabrina Krautbauer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (S.K.); (S.B.)
| | - Sofiia Bondarenko
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany; (S.K.); (S.B.)
| | - Martina Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
| | - Christa Buechler
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
| | - Vlad Pavel
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany; (P.M.); (U.R.); (S.S.); (P.A.); (D.K.); (M.M.); (V.P.)
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Kwa ALH, Aninda Sidharta BR, Son DN, Zirpe K, Periyasamy P, Plongla R, Swaminathan S, Loho T, Van Giap V, Apisarnthanarak A. Clinical utility of procalcitonin in implementation of procalcitonin-guided antibiotic stewardship in the South-East Asia and India: evidence and consensus-based recommendations. Expert Rev Anti Infect Ther 2024; 22:45-58. [PMID: 38112181 DOI: 10.1080/14787210.2023.2296066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The South-East Asian (SEA) region and India are highly susceptible to antibiotic resistance, which is caused due to lack of antimicrobial stewardship (AMS) knowledge, uncontrolled use of antibiotics, and poor infection control. Nonadherence to national/local guidelines, developed to combat antimicrobial resistance, is a major concern. A virtual advisory board was conducted to understand the current AMS standards and challenges in its implementation in these regions. AREAS COVERED Procalcitonin (PCT)-guided antibiotic use was discussed in various clinical conditions across initiation, management, and discontinuation stages. Most experts strongly recommended using PCT-driven antibiotic therapy among patients with lower respiratory tract infections, sepsis, and COVID-19. However, additional research is required to understand the optimal use of PCT in patients with organ transplantation and cancer patients with febrile neutropenia. Implementation of the solutions discussed in this review can help improve PCT utilization in guiding AMS in these regions and reducing challenges. EXPERT OPINION Experts strongly support the inclusion of PCT in AMS. They believe that PCT in combination with other clinical data to guide antibiotic therapy may result in more personalized and precise targeted antibiotic treatment. The future of PCT in antibiotic treatment is promising and may result in effective utilization of this biomarker.
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Affiliation(s)
- Andrea Lay-Hoon Kwa
- Department of Pharmacy, Singapore General Hospital; Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | | | - Do Ngoc Son
- Center for Critical Care Medicine, Bach Mai Hospital; Hanoi Medical University; School of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
| | - Kapil Zirpe
- Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India
| | - Petrick Periyasamy
- Infectious Diseases Unit, Medical Department, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Rongpong Plongla
- Division of Infectious Diseases, Department of Medicine and Center of Excellence in Antimicrobial Resistance and Stewardship; Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Tonny Loho
- Department of Clinical Pathology, Medistra Hospital; Medicine and Health Sciences, Universitas Kristen Krida Wacana, Jakarta, Indonesia
| | - Vu Van Giap
- Training and Direction of Healthcare Activities Center; Internal Medicine Department, Hanoi Medical University; Vietnam Respiratory Society; Vietnam Society of Sleep Medicine; Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
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Cander B, Visneci EF, Karaoglan O, Cakmak F, Tuncar A, Taslidere B. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis. Open Med (Wars) 2023; 18:20230865. [PMID: 38223899 PMCID: PMC10787304 DOI: 10.1515/med-2023-0865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. There is a need for biomarkers that can be used for the diagnosis of sepsis and the early identification of patients at high risk of death. In this study, we aimed to investigate the relationship between Mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT), and copeptin in sepsis. A total of 28 sepsis, 32 septic shock, and 30 control patients were included in our prospective study. Patients' MR-proADM, PCT, and copeptin levels were recorded. Sequential organ failure assessment scores, length of hospital stay, and 30-day mortality were also recorded. These values were compared between the sepsis, septic shock, and control groups. The mean age of all participants was 64.04 ± 15.83 years. In the study, 37 (61.6%) patients were female and 23 (39.3%) were male. There was no statistically significant difference in gender/age between all patient groups and the control group (for all, p > 0.05). We found a significant difference between the survivors and nonsurvivors in terms of MR-proADM, PCT, and copeptin levels. There was a significant difference between the sepsis and septic shock groups in terms of MR-proADM and PCT. A significant correlation was found between the length of hospital stay and MR-proADM and copeptin. MR-proADM, PCT, and copeptin may be useful in the prognosis of sepsis and to predict the length of stay in hospital and mortality.
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Affiliation(s)
- Basar Cander
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Osman Karaoglan
- Department of Emergency Medicine, Konya Numune Hospital, Konya, Turkey
| | - Fatma Cakmak
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum, Türkiye
| | - Alpay Tuncar
- Department of Emergency Medicine, Konya City Hospital, Konya, Türkiye
| | - Bahadir Taslidere
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Chen T, Liu Y, Tang Y, Xu Y, Kuang P, Cai L. Use of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 as prognostic indicators in patients with sepsis. Medicine (Baltimore) 2023; 102:e36724. [PMID: 38206695 PMCID: PMC10754579 DOI: 10.1097/md.0000000000036724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024] Open
Abstract
Sepsis is a heterogeneous syndrome caused by the immune response to severe infection. This study aimed to investigate the value of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels for predicting death in patients with sepsis. Patients with sepsis who were hospitalized in the Department of Critical Care Medicine at our hospital between June 2017 and October 2022 were included in this retrospective study and divided into a survival group and a death group according to their survival status after 28 days. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, and levels of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 were measured. A total of 516 patients were included in the analysis. Multivariable analysis showed that the APACHE II score (P < .001), SOFA score (P < .001), and cardiac troponin I (P < .001), lactic acid (P = .002), procalcitonin (P < .001), and serum complement C3 (P = .01) levels were independent predictors of sepsis death. The area under the receiver operating characteristic curve (AUC) was 0.882 (95% CI: 0.794-0.941) in patients with sepsis predicted using a combination of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels, which was better than the predictive value of cardiac troponin I (AUC: 0.734, 95% CI: 0.628-0.824), lactic acid (AUC: 0.686, 95% CI: 0.576-0.781), procalcitonin (AUC: 0.727, 95% CI: 0.620-0.817), or serum complement C3 (AUC: 0.684, 95% CI: 0.575-0.780) alone. Cardiac troponin I, lactic acid, and procalcitonin levels are independent predictors of death, whereas serum complement C3 protects against death in patients with sepsis. The combination of cardiac troponin I, lactic acid, procalcitonin, and serum complement C3 levels has a better predictive value for death than any single measure alone in patients with sepsis.
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Affiliation(s)
- Tao Chen
- Department of Critical Medicine, Yichun People’s Hospital, Yichun, China
| | - Yijun Liu
- Department of Critical Medicine, Yichun People’s Hospital, Yichun, China
| | - Yi Tang
- Department of Critical Medicine, Yichun People’s Hospital, Yichun, China
| | - Ye Xu
- Department of Clinical Laboratory, Yichun People’s Hospital, Yichun, China
| | - Pengcheng Kuang
- Department of Critical Medicine, Yichun People’s Hospital, Yichun, China
| | - Long Cai
- Department of Critical Medicine, Yichun People’s Hospital, Yichun, China
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Senoner T, Treml B, Breitkopf R, Oezpeker UC, Innerhofer N, Eckhardt C, Spurnic AR, Rajsic S. ECMO in Myocardial Infarction-Associated Cardiogenic Shock: Blood Biomarkers as Predictors of Mortality. Diagnostics (Basel) 2023; 13:3683. [PMID: 38132267 PMCID: PMC10742636 DOI: 10.3390/diagnostics13243683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Veno-arterial extracorporeal membrane oxygenation (va-ECMO) can provide circulatory and respiratory support in patients with cardiogenic shock. The main aim of this work was to investigate the association of blood biomarkers with mortality in patients with myocardial infarction needing va-ECMO support. METHODS We retrospectively analyzed electronic medical charts from patients receiving va-ECMO support in the period from 2008 to 2021 at the Medical University Innsbruck, Department of Anesthesiology and Intensive Care Medicine. RESULTS Of 188 patients, 57% (108/188) survived to discharge, with hemorrhage (46%) and thrombosis (27%) as the most frequent adverse events. Procalcitonin levels were markedly higher in non-survivors compared with survivors during the observation period. The multivariable model identified higher blood levels of procalcitonin (HR 1.01, p = 0.002) as a laboratory parameter associated with a higher risk of mortality. CONCLUSIONS In our study population of patients with myocardial infarction-associated cardiogenic shock, deceased patients had increased levels of inflammatory blood biomarkers throughout the whole study period. Increased procalcitonin levels have been associated with a higher risk of mortality. Future studies are needed to show the role of procalcitonin in patients receiving ECMO support.
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Affiliation(s)
- Thomas Senoner
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (T.S.); (R.B.); (N.I.); (C.E.)
| | - Benedikt Treml
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (T.S.); (R.B.); (N.I.); (C.E.)
| | - Robert Breitkopf
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (T.S.); (R.B.); (N.I.); (C.E.)
| | - Ulvi Cenk Oezpeker
- Department of Cardiac Surgery, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Nicole Innerhofer
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (T.S.); (R.B.); (N.I.); (C.E.)
| | - Christine Eckhardt
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (T.S.); (R.B.); (N.I.); (C.E.)
| | | | - Sasa Rajsic
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (T.S.); (R.B.); (N.I.); (C.E.)
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Lu CY, Kao CL, Hung KC, Wu JY, Hsu HC, Yu CH, Chang WT, Feng PH, Chen IW. Diagnostic efficacy of serum presepsin for postoperative infectious complications: a meta-analysis. Front Immunol 2023; 14:1320683. [PMID: 38149257 PMCID: PMC10750271 DOI: 10.3389/fimmu.2023.1320683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023] Open
Abstract
Background Postoperative infectious complications (PICs) are major concerns. Early and accurate diagnosis is critical for timely treatment and improved outcomes. Presepsin is an emerging biomarker for bacterial infections. However, its diagnostic efficacy for PICs across surgical specialties remains unclear. Methods In this study, a systematic search on MEDLINE, Embase, Google Scholar, and Cochrane Library was performed on September 30, 2023, to identify studies that evaluated presepsin for diagnosing PICs. PIC is defined as the development of surgical site infection or remote infection. Pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were calculated. The primary outcome was the assessment of the efficacy of presepsin for PIC diagnosis, and the secondary outcome was the investigation of the reliability of procalcitonin or C-reactive protein (CRP) in the diagnosis of PICs. Results This meta-analysis included eight studies (n = 984) and revealed that the pooled sensitivity and specificity of presepsin for PIC diagnosis were 76% (95% confidence interval [CI] 68%-82%) and 83% (95% CI 75%-89%), respectively. The HSROC curve yielded an area under the curve (AUC) of 0.77 (95% CI 0.73-0.81). Analysis of six studies on procalcitonin showed a combined sensitivity of 78% and specificity of 77%, with an AUC of 0.83 derived from the HSROC. Meanwhile, data from five studies on CRP indicated pooled sensitivity of 84% and specificity of 79%, with the HSROC curve yielding an AUC of 0.89. Conclusion Presepsin exhibits moderate diagnostic accuracy for PIC across surgical disciplines. Based on the HSROC-derived AUC, CRP has the highest diagnostic efficacy for PICs, followed by procalcitonin and presepsin. Nonetheless, presepsin demonstrated greater specificity than the other biomarkers. Further study is warranted to validate the utility of and optimize the cutoff values for presepsin. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023468358.
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Affiliation(s)
- Chun-Ying Lu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Hui-Chen Hsu
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Ting Chang
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ping-Hsun Feng
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
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Mester P, Räth U, Popp L, Schmid S, Müller M, Buechler C, Pavel V. Plasma Insulin-like Growth Factor-Binding Protein-2 of Critically Ill Patients Is Related to Disease Severity and Survival. Biomedicines 2023; 11:3285. [PMID: 38137505 PMCID: PMC10740865 DOI: 10.3390/biomedicines11123285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Insulin-like growth factor-binding protein (IGFBP)-2 regulates the bioactivity of the anabolic hormone's insulin-like growth factors, which are decreased in sepsis and contribute to the catabolic status of severely ill patients. The circulating levels of IGFBP-2 in critical illness have been rarely studied; therefore, we evaluated IGFBP-2 plasma levels in patients with systemic inflammatory response syndrome (SIRS) or sepsis as well as healthy controls. Our analysis of 157 SIRS/sepsis patients revealed higher plasma IGFBP-2 levels compared to 22 healthy controls. Plasma IGFBP-2 levels correlated positively with procalcitonin but not with C-reactive protein, interleukin-6, or the leukocyte count. Septic shock patients exhibited higher IGFBP-2 levels than those with SIRS. Bacterial or SARS-CoV-2 infection did not influence plasma IGFBP-2 levels. There was no difference in the IGFBP-2 levels between ventilated and non-ventilated SIRS/sepsis patients, and vasopressor therapy did not alter these levels. Dialysis patients had elevated plasma IGFBP-2 levels. Survivors had lower plasma IGFBP-2 levels than non-survivors. In conclusion, our study indicates that plasma IGFBP-2 levels are associated with disease severity, renal failure, and mortality in SIRS/sepsis patients.
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Colak M, Arda Kilinc M, Güven R, Onur Kutlu N. Procalcitonin and blood lactate level as predictive biomarkers in pediatric multiple trauma patients' pediatric intensive care outcomes: A retrospective observational study. Medicine (Baltimore) 2023; 102:e36289. [PMID: 38065907 PMCID: PMC10713149 DOI: 10.1097/md.0000000000036289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
Pediatric trauma represents a significant source of morbidity and mortality in children, encompassing a broad spectrum of injuries. Despite advancements in the treatment and prevention of injuries, the risk of trauma in children remains a persistent concern. Severe trauma cases often necessitate admission to a pediatric intensive care unit (PICU). Procalcitonin, an essential biomarker that elevates bacterial infections and trauma, and elevated lactate levels can signal adverse outcomes in critically ill patients. This study retrospectively examined pediatric patients with multiple trauma treated at the Başakşehir Çam and Sakura City Hospital PICU between 2021 and 2023. The analysis sought to evaluate the relationship between initial procalcitonin and lactate levels with the duration of stay in the PICU, the length of invasive mechanical ventilation (IMV), and the duration of inotropic support. Furthermore, a comparison was made between procalcitonin and lactate levels in survivors and non-survivors, analyzing their potential influence on PICU outcomes and mortality. For pediatric multi-trauma patients, the median duration of stay in the PICU was found to be 3 days. Among these patients, 32% necessitated IMV support and utilized it for a median of 5 days. Additionally, 36% of these patients were provided inotropic drug support for a median time of 6 days. The observed mortality rate was 11%. Procalcitonin and blood lactate levels were found to have significant predictive power for mortality with odds ratios of 1.05 (P = .04) and 1.87 (P = .02), respectively. Both blood lactate and procalcitonin levels were significantly associated with the duration of IMV support, the period of inotropic drug administration, and the length of PICU stay (P < .01; P < .01; P < .01, respectively). this research underscores the prognostic value of initial procalcitonin and lactate levels about the intensive care trajectory of pediatric trauma patients. The findings suggest that both procalcitonin and lactate levels may play pivotal roles as potential biomarkers in predicting and managing clinical outcomes in this population.
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Affiliation(s)
- Mustafa Colak
- Department of Paediatric Intensive Care Unit, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Arda Kilinc
- Department of Paediatric Intensive Care Unit, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ramazan Güven
- Department of Emergency Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Nurettin Onur Kutlu
- Department of Paediatric Intensive Care Unit, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Ayrancı MK, Küçükceran K, Koçak S, Girişgin AS, Dündar ZD. The Role of Procalcitonin/Albumin Ratio and CRP/Albumin Ratio in Predicting In-hospital Mortality in COVID-19 Patients. J Acute Med 2023; 13:150-158. [PMID: 38099207 PMCID: PMC10720914 DOI: 10.6705/j.jacme.202312_13(4).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/19/2023] [Accepted: 02/16/2023] [Indexed: 12/17/2023]
Abstract
Background Hospitalized coronavirus disease 2019 (COVID-19) patients have higher mortality rates. Parameters to predict mortality are needed. Therefore, we investigated the power of procalcitonin/albumin ratio (PAR) and C-reactive protein/albumin ratio (CAR) to predict in-hospital mortality in hospitalized COVID-19 patients. Methods In this study, 855 patients were included. Patients' PAR and CAR values were recorded from the hospital information management system. The patients were evaluated in two groups according to their in-hospital mortality status. Results In-hospital mortality was observed in 163 patients (19.1%). The median PAR and CAR values of patients in the non-survivor group were statistically significantly higher than those of patients in the survivor group, PAR (median: 0.07, interquartile range [IQR]: 0.03-0.33 vs. median: 0.02, IQR: 0.01-0.04, respectively; p < 0.001); CAR (median: 27.60, IQR: 12.49-44.91 vs. median: 7.47, IQR: 2.66-18.93, respectively; p < 0.001). The area under the curve (AUC) and odds ratio (OR) values obtained by PAR to predict in-hospital mortality were higher than the values obtained by procalcitonin, CAR, albumin, and CRP (AUCs of PAR, procalcitonin, CAR, albumin, and CRP: 0.804, 0.792, 0.762, 0.755, and 0.748, respectively; OR: PAR > 0.04, procalcitonin > 0.14, CAR > 20.59, albumin < 4.02, and CRP > 63; 8.215, 7.134, 5.842, 6.073, and 5.07, respectively). Patients with concurrent PAR > 0.04 and CAR > 20.59 had an OR of 15.681 compared to patients with concurrent PAR < 0.04 and CAR < 20.59. Conclusions In this study, PAR was found to be more valuable for predicting in-hospital COVID-19 mortality than all other parameters. In addition, concurrent high levels of PAR and CAR were found to be more valuable than a high level of PAR or CAR alone.
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Affiliation(s)
- Mustafa Kürşat Ayrancı
- Emergency Department, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Kadir Küçükceran
- Emergency Department, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Sedat Koçak
- Emergency Department, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | | | - Zerrin Defne Dündar
- Emergency Department, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
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Fisler G, Brandt T, Ostovar GA, Taylor MD, Shah S. Procalcitonin Levels in Identifying Bacterial Infections in Children with and without COVID-19. Infect Dis Clin Microbiol 2023; 5:287-291. [PMID: 38633859 PMCID: PMC10986730 DOI: 10.36519/idcm.2023.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/13/2023] [Indexed: 04/19/2024]
Abstract
Objective Elevated procalcitonin levels have been associated with bacterial infection in children. Observational studies reported high procalcitonin values in COVID-19. Data on bacterial coinfections in pediatric COVID-19 is sparse; small studies suggest a low coinfection rate. In this study, we aimed to quantify the positive predictive value (PPV) of procalcitonin in identifying bacterial infection in children with and without COVID-19. Materials and Methods A retrospective chart review was performed for 215 children <21 years admitted to our tertiary children's hospital between February 1, 2013, and July 15, 2020, who had procalcitonin levels measured within 48 hours of admission. Confirmed bacterial infection was defined as positive blood, urine, or cerebrospinal fluid (CSF) culture, positive endotracheal culture with evidence of leukocytosis on Gram stain, or pneumonia by chest radiograph. Suspected bacterial infection was defined as confirmed bacterial infection or administration of antibiotics for >48 hours. Results Of the 215 patients, 73 were admitted for COVID-19 (66% multisystem inflammatory syndrome in children [MIS-C], 34% acute COVID-19). The PPV of an elevated procalcitonin level >1.0 ng/mL in identifying suspected bacterial infections for those with MIS-C was 6.3% (95% CI=0-15), in acute COVID-19 was 29% (95% CI=0-62%), and in the non-COVID-19 cohort was 75% (95% CI=62-88%). For identification of confirmed bacterial infection, PPV of an elevated procalcitonin level was 0% in MIS-C, 14% (95% CI=0-40%) in acute COVID-19, and 55% (95% CI=40-69%) in the non-COVID-19 cohort. Conclusion We found a low PPV of elevated procalcitonin level above 1 ng/mL in identifying either culture-confirmed or presumed bacterial infection in children hospitalized with COVID-19-related illness.
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Affiliation(s)
- Grace Fisler
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Donald and Barbara Zucker School of Medicine, New York, USA
| | - Timothy Brandt
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, The Children's Hospital at Montefiore, New York, USA
| | - G. Amin Ostovar
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Donald and Barbara Zucker School of Medicine, New York, USA
| | - Matthew D. Taylor
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Donald and Barbara Zucker School of Medicine, New York, USA
| | - Sareen Shah
- Division of Pediatric Critical Care Medicine, Department of Pediatrics Cedars-Sinai Medical Center, Los Angeles, USA
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Borra SD, Morkar DN. Study of Phospholipase A2 Levels and Its Comparison With Procalcitonin Levels in Patients With Sepsis Admitted in a Tertiary Care Hospital, Karnataka, India. Cureus 2023; 15:e50890. [PMID: 38249263 PMCID: PMC10799635 DOI: 10.7759/cureus.50890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Sepsis is a complicated host response to infection involving organ failure which ultimately causes death of the host. Procalcitonin (PCT) is an effective marker used to diagnose sepsis but until now, there has been no ideal marker for sepsis. Phospholipase A2 (PLA2) also increases infections; however, only a few studies have assessed its capacity as a biomarker to diagnose sepsis. Thus, we aimed to examine PLA2 and compare its diagnostic capacity and accuracy with PCT as a biomarker of sepsis. MATERIAL AND METHODS Our study was a hospital-oriented cross-sectional study. Our study group included 80 patients of both sexes older than 18 years, meeting the quick sequential organ failure assessment (qSOFA) or systemic inflammatory response syndrome (SIRS) criteria of ≥2, hospitalized in a tertiary care hospital in Karnataka, India from January 2021 to December 2021. Out of them, 59 were found to have sepsis. Samples of all the patients were evaluated for relevant parameters, and data were statistically analyzed using SPSS v21 running on Windows 10. The statistical significance was set at p-value <0.05. RESULTS The mean PCT and PLA2 were significantly raised in sepsis patients compared to non-sepsis patients. Out of 59 septic patients, 45.76% had positive blood cultures, and 16.95% had positive urine culture reports. In blood cultures, the most common Gram-positive organism found was Staphylococcus, and the most common Gram-negative organism was Enterobacter. In urine cultures, Escherichia coli was the most common species. PLA2 was significantly higher in patients with bacterial etiology and Gram-positive cultures. The diagnostic capability, sensitivity, specificity, and accuracy of PLA2 were demonstrably higher than those of PCT. CONCLUSION Our study proves that PLA2 is a much better and more efficient biomarker in sepsis than PCT. The diagnostic capacity and accuracy of PLA2 clearly surpass PCT, so using PLA2 in sepsis as a biomarker can help clinicians in deciding on timely and appropriate management to speed the recovery of patients.
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Affiliation(s)
- Suma D Borra
- Internal Medicine, Jawaharlal Nehru Medical College and Hospital, Belagavi, IND
| | - Dnyanesh N Morkar
- Internal Medicine, Jawaharlal Nehru Medical College and Hospital, Belagavi, IND
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Lee T, Lee J, Shin DH, Lee H, Kim SK. Prognostic and Diagnostic Power of Delta Neutrophil Index and Mean Platelet Component in Febrile Patients with Suspected Sepsis. Biomedicines 2023; 11:3190. [PMID: 38137411 PMCID: PMC10740452 DOI: 10.3390/biomedicines11123190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The delta neutrophil index (DNI), a prognostic and diagnostic marker for sepsis, is based on the leukocyte count. Platelet activation, similar to leukocyte activation, plays a crucial role in host defense against pathogens and may serve as a predictor of sepsis outcome. However, the combined evaluation of mean platelet component (MPC) and DNI has rarely been used to assess sepsis. METHODS To assess the prognostic and diagnostic validity of the simultaneous evaluation of DNI and MPC in cases of human febrile sepsis, we conducted measurements of cellular indices, including DNI and MPC, as well as molecular biomarkers, including procalcitonin (PCT) and C-reactive protein (CRP). This study was carried out in patients admitted to the emergency department with suspected sepsis. RESULTS Using a cutoff value of 2.65%, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the DNI in sepsis were found to be 69%, 73.9%, 77.9%, and 64.1%, respectively. Furthermore, significant differences in DNI and MPC levels were observed between the sepsis and non-sepsis groups (6.7 ± 7.8% versus 2.1 ± 2.2% (p = 0.000) and 26.0 ± 1.9 g/dL versus 26.8 ± 1.4 g/dL (p = 0.002), respectively). Notably, there was a negative correlation between DNI and MPC, with the strength of the correlation varying based on the cause of sepsis. By setting the cutoff value of the DNI to 6.2%, its sensitivity, specificity, and NPV improved to 100%, 80.3%, and 100%, respectively, although the PPV remained at 10.6%. CONCLUSIONS In our study, the DNI demonstrates superior effectiveness compared with other molecular biomarkers, such as CRP and procalcitonin, in distinguishing septic febrile patients from non-septic febrile patients. Additionally, a negative correlation exists between MPC and DNI, making MPC a valuable marker for differentiating the etiology of sepsis. These findings hold significant clinical implications, as DNI/MPC evaluation is a cost-effective and readily applicable approach in various impending sepsis scenarios. Notably, this study represents the first examination of the prognostic and diagnostic validity of employing the simultaneous evaluation of DNI and MPC in human cases of febrile sepsis.
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Affiliation(s)
- Taehun Lee
- Department of Emergency Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Republic of Korea;
| | - Jongwook Lee
- Department of Laboratory Medicine, Konyang University Hospital, Daejeon 35465, Republic of Korea;
| | - Dong Hoon Shin
- Department of Laboratory Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Republic of Korea;
| | - Hyungdon Lee
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Republic of Korea
| | - Soo-Ki Kim
- Department of Microbiology, Wonju College of Medicine, Research Institute of Metabolism and Inflammation Research, Yonsei University, Wonju 26426, Republic of Korea
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Giacobbe DR, Marelli C, Mora S, Guastavino S, Russo C, Brucci G, Limongelli A, Vena A, Mikulska M, Tayefi M, Peluso S, Signori A, Di Biagio A, Marchese A, Campi C, Giacomini M, Bassetti M. Early diagnosis of candidemia with explainable machine learning on automatically extracted laboratory and microbiological data: results of the AUTO-CAND project. Ann Med 2023; 55:2285454. [PMID: 38010342 PMCID: PMC10836245 DOI: 10.1080/07853890.2023.2285454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Candidemia is associated with a heavy burden of morbidity and mortality in hospitalized patients. The availability of blood culture results could require up to 48-72 h after blood draw; thus, early treatment decisions are made in the absence of a definite diagnosis. METHODS In this retrospective study, we assessed the performance of different supervised machine learning algorithms for the early differential diagnosis of candidemia and bacteremia in adult patients on a large dataset automatically extracted within the AUTO-CAND project. RESULTS Overall, 12,483 episodes of candidemia (1275; 10%) or bacteremia (11,208; 90%) were included in the analysis. A random forest classifier achieved the best diagnostic performance for candidemia, with sensitivity 0.98 and specificity 0.65 on the training set (true skill statistic [TSS] = 0.63) and sensitivity 0.74 and specificity 0.57 on the test set (TSS = 0.31). Then, the random classifier was trained in the subgroup of patients with available serum β-D-glucan (BDG) and procalcitonin (PCT) values by exploiting the feature ranking learned in the entire dataset. Although no statistically significant differences were observed from the performance measures obtained by employing BDG and PCT alone, the performance measures of the classifier that included the features selected in the entire dataset, plus BDG and PCT, were the highest in most cases. CONCLUSIONS Random forest classifiers trained on large datasets of automatically extracted data have the potential to improve current diagnostic algorithms for candidemia. However, further development through implementation of automatically extracted clinical features may be necessary to achieve crucial improvements.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | | | - Chiara Russo
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Brucci
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Limongelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maryam Tayefi
- Norwegian Centre for E-Health Research, Tromsø, Norway
| | - Stefano Peluso
- Department of Statistics and Quantitative Methods, University of Milan - Bicocca, Milan, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Microbiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Campi
- Department of Mathematics (DIMA), University of Genoa, Genoa, Italy
- Life Science Computational Laboratory (LISCOMP), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Sala G, Orsetti C, Meucci V, De Marchi L, Sgorbini M, Bonelli F. Case-Control Study: Endogenous Procalcitonin and Protein Carbonylated Content as a Potential Biomarker of Subclinical Mastitis in Dairy Cows. Vet Sci 2023; 10:670. [PMID: 38133221 PMCID: PMC10747190 DOI: 10.3390/vetsci10120670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Procalcitonin (PCT) and protein carbonylated content (PCC) are promising biomarkers for bacterial infection and inflammation in veterinary medicine. This study examined plasma PCT and PCC levels in healthy cows (H) and cows with subclinical mastitis (SCM). A total of 130 cows (65 H and 65 SCM) were included in this study. Blood samples were collected, and plasma was frozen at -80 °C. PCT levels were determined using a bovine procalcitonin ELISA kit, while PCC was measured following the methodology of Levine et al. Statistical analysis revealed a significant difference in PCT levels between H (75.4 pg/mL) and SCM (107.3 pg/mL) cows (p < 0.001) and significantly lower concentrations of PCC in the SCM group (H: 0.102 nmol/mL/mg, SCM: 0.046 nmol/mL/mg; p < 0.001). The PCT cut-off value for distinguishing healthy and subclinical mastitis animals was >89.8 pg/mL (AUC 0.695), with a sensitivity of 66.2% and specificity of 69.2%. PCT showed potential value as a diagnostic tool to help in decision making for subclinical mastitis cases, while PCC requires further studies to investigate the trend of this biomarker during localized pathology.
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Affiliation(s)
- Giulia Sala
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
| | - Chiara Orsetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
| | - Valentina Meucci
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
| | - Lucia De Marchi
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
| | - Micaela Sgorbini
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
| | - Francesca Bonelli
- Department of Veterinary Sciences, University of Pisa, Via Livornese s.n.c., San Piero a Grado, 56122 Pisa, Italy; (C.O.); (V.M.); (L.D.M.); (M.S.); (F.B.)
- Centro di Ricerche Agro-Ambientali “E. Avanzi”, University of Pisa, San Piero a Grado (PI), 56122 Pisa, Italy
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Prabhu M, Wilkie G, MacEachern M, LaBuda D, Purtell J, Rao K, Riley LE, Fuller M, Rosser M, Habib AS, Bauer ME. Procalcitonin levels in pregnancy: A systematic review and meta-analysis of observational studies. Int J Gynaecol Obstet 2023; 163:484-494. [PMID: 37118923 DOI: 10.1002/ijgo.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The utility of procalcitonin to identify obstetric sepsis is unknown. OBJECTIVE To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prelabor rupture of membranes (PPROM) without clinical chorioamnionitis (group 3). SEARCH STRATEGY NLM PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials from inception to February 21, 2022. SELECTION CRITERIA Ten or more pregnant women with procalcitonin reported at more than 20 weeks of pregnancy, with information on labor, PPROM, and infection. Exclusions were major medical comorbidities. DATA COLLECTION AND ANALYSIS Each abstract and full-text review was independently reviewed by the same two authors. Quality was reviewed using the Newcastle-Ottawa Scale. A meta-analysis was performed using a random effects model. MAIN RESULTS The systematic review included 25 studies: 10 (40%) of good quality and 15 (60%) of poor quality. The meta-analysis included 21 studies. Mean procalcitonin in group 1 was 0.092 ng/mL (range 0.036-0.049 ng/mL), in group 2 it was 0.130 ng/mL (range 0.049-0.259 ng/mL), and in group 3 it was 0.345 ng/mL (range 0.005-1.292 ng/mL). CONCLUSIONS Among healthy pregnant women not in labor, procalcitonin levels are comparable to those in non-pregnant adults and may be useful in identifying infection. Procalcitonin levels in other groups overlap abnormal values of procalcitonin in non-pregnant adults, and may not discriminate infection among women in labor or with obstetric comorbidities. PROSPERO CRD42020157376, registered 4/28/2020.
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Affiliation(s)
- Malavika Prabhu
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Gianna Wilkie
- Department of Obstetrics & Gynecology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | | | - Dana LaBuda
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Krishna Rao
- Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura E Riley
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Fuller
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Morgan Rosser
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - Melissa E Bauer
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Kunigami C, Imai T, Yamashita K, Takagi T, Okawa M, Honda A, Okada Y, Maeda M, Kamiya T. Relationship between the diagnosis of food protein-induced enterocolitis syndrome and postemetic procalcitonin levels. J Allergy Clin Immunol Glob 2023; 2:100156. [PMID: 37781652 PMCID: PMC10510010 DOI: 10.1016/j.jacig.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023]
Abstract
Background There are no reports on the relationship between food protein-induced enterocolitis syndrome (FPIES) diagnosis and procalcitonin levels. Objective Our study sought to demonstrate a correlation between the presence or absence and severity of FPIES symptoms and postemetic procalcitonin levels. Methods The subjects were 53 patients with FPIES (44 with hen's egg allergy, 4 with milk allergy, 4 with wheat allergy, and 3 with soy allergy), who collectively underwent a total of 75 oral food challenges (OFCs). Procalcitonin levels at 5 hours after antigen ingestion were compared between patients with a positive OFC result and those with a negative OFC result and between patients who experienced mild or moderate events and those who experienced severe events. Results At 5 hours after ingestion of the causative food, the median procalcitonin levels in patients with a negative OFC result, patients who experienced a mild or moderate event, and patients who experienced a severe event were 0.02, 0.03, and 0.16 ng/mL, respectively. The procalcitonin level was significantly higher in the groups with a positive OFC result than in the groups with a negative OFC result (P < .001), and it was significantly higher in those who experienced severe events than in those who experienced mild or moderate events (P = .012). Conclusion Measurement of procalcitonin levels has the potential to provide a quantitative and objective assessment of FPIES diagnosis and severity.
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Affiliation(s)
- Chihiro Kunigami
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Takanori Imai
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Kosei Yamashita
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Toshiyuki Takagi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Megumi Okawa
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Aiko Honda
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Yuki Okada
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mayu Maeda
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Taro Kamiya
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
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Tang X, Qiu L, Wang F, Liu S, Lü X, Chen X. Diagnostic value of procalcitonin and red blood cell distribution width at admission on the prognosis of patients with severe burns: A retrospective analysis. Int Wound J 2023; 20:3708-3716. [PMID: 37381890 PMCID: PMC10588303 DOI: 10.1111/iwj.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/20/2023] [Indexed: 06/30/2023] Open
Abstract
The plasma procalcitonin (PCT) concentration and red blood cell distribution (RDW) value after severe burns can be used as prognostic indicators, but at present, it is difficult to give consideration to sensitivity and specificity in diagnosing the prognosis of severe burns with a single indicator. This study analysed the diagnostic value of plasma PCT concentration and RDW value at admission on the prognosis of severe burn patients to improve its sensitivity and specificity. A total of 205 patients with severe burns who were treated in the First Affiliated Hospital of Anhui Medical University from November 2017 to November 2022 were retrospectively analysed. The optimal cut-off values of plasma PCT concentration and RDW were analysed and counted through the subject curve (ROC curve). According to the cut-off value, patients were divided into high PCT group and low PCT group, high RDW group and low RDW group. The independent risk factors of severe burns were analysed by single-factor and multiple-factor COX regression. Kaplan-Meier survival was used to analyse the mortality of high PCT group and low PCT group, high RDW group and low RDW group. The area under the curve of plasma PCT concentration and RDW value at admission was 0.761 (95% CI, 0.662-0.860, P < .001), 0.687 (95% CI, 0.554-0.820, P = .003) respectively, and the optimal cut-off values of serum PCT concentration and RDW were 2.775 ng/mL and 14.55% respectively. Cox regression analysis found that age, TBSA, and RDW were independent risk factors for mortality within 90 days after severe burns. Kaplan-Meier survival analysis showed that there was a significant difference in the 90-day mortality rate of severe burns between the PCT ≥ 2.775 ng/mL group and the PCT < 2.775 ng/mL group (log-rank: 24.162; P < .001), with the mortality rate of 36.84% versus 5.49%, respectively. The 90-day mortality rate of severe burns was significantly different between the RDW ≥ 14.55% group and the RDW < 14.55% group (log-rank: 14.404; P < .001), with the mortality rate of 44% versus 12.2% respectively. The plasma PCT concentration and RDW value at admission are both of diagnostic value for the 90-day mortality of severe burns, but the plasma PCT concentration has higher sensitivity and the RDW value has higher specificity. Age, TBSA, and RDW were independent risk factors for severe burns, and then plasma PCT concentration was not independent risk factors.
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Affiliation(s)
- Xu‐Dong Tang
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Le Qiu
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Fei Wang
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Sheng Liu
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Xiong‐Wen Lü
- School of PharmacyAnhui Medical UniversityHefeiAnhui ProvinceChina
- Institute for Liver Disease of Anhui Medical UniversityAnhui Medical UniversityHefeiAnhui ProvinceChina
| | - Xu‐Lin Chen
- Department of BurnsThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
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Yankov YG, Bocheva Y. Comparative Characterization of Procalcitonin (Sensitivity, Specificity, Predictability, and Cut-Off Reference Values) as a Marker of Inflammation in Odontogenic Abscesses of the Head and Neck in the Female Population. Cureus 2023; 15:e48207. [PMID: 38050495 PMCID: PMC10693721 DOI: 10.7759/cureus.48207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Introduction Odontogenic abscesses of the head and neck can lead to serious complications and even end in death. This requires healthcare professionals to have a good knowledge of all the markers of inflammation that can be used in their diagnosis and treatment. Such markers that we use in our daily medical practice are leukocytes (WBC), neutrophils (Neu), and C-reactive protein (CRP). Somehow, in the background is procalcitonin (PCT), which has not been studied in detail in this type of purulent infection. The aim of the present study is to investigate and analyze PCT in odontogenic purulent infections of the head and neck in the female population and to compare it with already proven markers of inflammation such as CRP, WBC, and Neu. For the first time in the literature, as per our knowledge, the sensitivity, specificity, and predictability of PCT were determined when using it as an independent indicator of inflammation, and its cut-off reference values were determined in women with odontogenic abscesses of the head and neck. Materials and methods This is a prospective study, in which the CRP, WBC, Neu, and PCT of 30 women with odontogenic abscesses of the head and neck with a mean age of 47 (18-81) years were examined and analyzed. As a control group, we included 30 healthy women with a mean age of 48 (18-80) years, in whom there was no anamnestic and physical evidence of the presence of any infection in the last three months. The four markers were measured for the control group too. Results In the clinical group of women with odontogenic abscesses of the head and neck, the average values of CRP, WBC, Neu, and PCT were significantly higher (p<0.0001) compared to the same in the control group of healthy women; CRP: 95.46±76.41 mg/l vs. 0.63±0.37 mg/l, WBC: 10.44±2.97x103/L vs. 6.5±1.49x103/L, Neu: 7.92±2.93x103/L vs. 4.03±1.07x103/L, PCT: 0.74±0.69 ng/ml vs. 0.14±0.08 ng/ml. Discussion PCT, as well as CRP, WBC, and Neu, increases its plasma concentration in women with odontogenic abscesses of the head and neck and is extremely well positively correlated with them, with a high correlation with CRP and a significant correlation with WBC and Neu. In addition, PCT has a number of advantages over the other markers; it begins to increase its plasma concentration faster, reaches its maximum plasma concentration faster, normalizes its concentration faster after the infection subsides, and increases its blood level only in bacterial infection genesis. Conclusions PCT as a marker of inflammation not only positively correlates well with CRP, WBC, and Neu but also, with its advantages over them, it appears to be the most accurate indicator in the diagnosis, treatment, and follow-up of odontogenic head and neck abscesses in the near future; not only in women but also in the male and children's population. Its sensitivity, specificity, and predictability as an independent indicator of inflammation are 80%, 76.7%, and 83%, respectively, and its cut-off value of 0.225 ng/ml is lower than the generally accepted 0.5 ng/ml.
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Affiliation(s)
- Yanko G Yankov
- Maxillofacial Surgery, University Hospital St. Marina, Varna, BGR
- General and Operative Surgery, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
| | - Yana Bocheva
- Cinical Laboratory, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
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Dark P, Perkins GD, McMullan R, McAuley D, Gordon AC, Clayton J, Mistry D, Young K, Regan S, McGowan N, Stevenson M, Gates S, Carlson GL, Walsh T, Lone NI, Mouncey PR, Singer M, Wilson P, Felton T, Marshall K, Hossain AM, Lall R. biomArker-guided Duration of Antibiotic treatment in hospitalised Patients with suspecTed Sepsis (ADAPT-Sepsis): A protocol for a multicentre randomised controlled trial. J Intensive Care Soc 2023; 24:427-434. [PMID: 37841304 PMCID: PMC10572477 DOI: 10.1177/17511437231169193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Aim To describe the protocol for a multi-centre randomised controlled trial to determine whether treatment protocols monitoring daily CRP (C-reactive protein) or PCT (procalcitonin) safely allow a reduction in duration of antibiotic therapy in hospitalised adult patients with sepsis. Design Multicentre three-arm randomised controlled trial. Setting UK NHS hospitals. Target population Hospitalised critically ill adults who have been commenced on intravenous antibiotics for sepsis. Health technology Three protocols for guiding antibiotic discontinuation will be compared: (a) standard care; (b) standard care + daily CRP monitoring; (c) standard care + daily PCT monitoring. Standard care will be based on routine sepsis management and antibiotic stewardship. Measurement of outcomes and costs. Outcomes will be assessed to 28 days. The primary outcomes are total duration of antibiotics and safety outcome of all-cause mortality. Secondary outcomes include: escalation of care/re-admission; infection re-lapse/recurrence; antibiotic dose; length and level of critical care stay and length of hospital stay. Ninety-day all-cause mortality rates will also be collected. An assessment of cost effectiveness will be performed. Conclusion In the setting of routine NHS care, if this trial finds that a treatment protocol based on monitoring CRP or PCT safely allows a reduction in duration of antibiotic therapy, and is cost effective, then this has the potential to change clinical practice for critically ill patients with sepsis. Moreover, if a biomarker-guided protocol is not found to be effective, then it will be important to avoid its use in sepsis and prevent ineffective technology becoming widely adopted in clinical practice.
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Affiliation(s)
- Paul Dark
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Critical Care Unit, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Greater Manchester, UK
| | - Gavin D Perkins
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Ronan McMullan
- Wellcome Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Danny McAuley
- Wellcome Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Anthony C Gordon
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Jonathan Clayton
- Clinical Biochemistry Department, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston Lancashire, UK
| | - Dipesh Mistry
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Keith Young
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Scott Regan
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Nicola McGowan
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Matt Stevenson
- School of Health and Related Research, The University of Sheffield Western Bank, Sheffield, UK
| | - Simon Gates
- Cancer Research Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Gordon L Carlson
- National Intestinal Failure Centre, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Greater Manchester, UK
| | - Tim Walsh
- Anaesthesia, Critical Care and Pain Medicine, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Nazir I Lone
- Anaesthesia, Critical Care and Pain Medicine, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, Napier House, London, UK
| | - Mervyn Singer
- Centre for Intensive Care Medicine, Experimental and Translational Medicine, Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
| | - Peter Wilson
- Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Felton
- Respiratory Academic Group, Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Wythenshawe Hospital, Manchester, UK
| | - Kay Marshall
- Pharmacy and Pharmaceutical Sciences, School of Health Sciences, University of Manchester, Manchester, UK
| | - Anower M. Hossain
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
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Zhang L, Lan Y, Qi B, Shuai P, Hou Q, Liu W, Wang Q. RDW-SD and PCT Are Potential Prognostic Factors for In-hospital Death in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Allergy Asthma Immunol Res 2023; 15:812-824. [PMID: 37957797 PMCID: PMC10643861 DOI: 10.4168/aair.2023.15.6.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/12/2023] [Accepted: 06/13/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Our study aimed to explore potential prognostic factors in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) patients from easily accessible laboratory data and to investigate whether the combination of these indicators with a score for toxic epidermal necrolysis (SCORTEN) can improve the predictive value. METHODS Data from 85 SJS/TEN patients hospitalized from 2010 to 2021 were retrospectively analyzed. The primary outcome was in-hospital mortality. Univariate analysis was used to screen for laboratory indexes associated with death. Logistic regression was used to analyze significant risk factors for death. The differentiation and calibration of SCORTEN and modified score were assessed using receiver operating characteristic (ROC) curves and Hosmer-Lemeshow goodness-of-fit test. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate the incremental prognostic value. RESULTS Among the 85 patients (37 males, 48 females) aged 14-88 years, the mortality rate was 11.8% (n = 10). SCORTEN had good discrimination and calibration to predict mortality in this cohort of patients (area under the ROC curve [AUC] of 0.874, 95% confidence interval [CI], 0.758-0.990; Hosmer-Lemeshow goodness-of-fit test P = 0.994). Red cell distribution width-standard deviation index (RDW-SD) > 47.9 fL and procalcitonin (PCT) > 0.67 ng/mL were significant risk factors for death. When adding the 2 factors to SCORTEN, AUC was 0.915 (95% CI, 0.833-0.997), but not statistically different compared to SCORTEN alone (P = 0.091). The NRI was 1.2 (95% CI, 0.672-1.728; P < 0.001) and the IDI was 0.09 (95% CI, 0.011-0.173; P = 0.026), still suggesting that the modified score had better discriminatory and predictive power than SCORTEN alone. The modified score also showed good calibration (Hosmer-Lemeshow goodness-of-fit test, P = 0.915). CONCLUSIONS SCORTEN is a good predictor of mortality in SJS/TEN patients in southwest China. Combining RDW-SD > 47.9 fL and PCT > 0.67 ng/mL with SCORTEN may enhance the ability to predict prognosis.
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Affiliation(s)
- Lixia Zhang
- The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunping Lan
- Department of Intensive Care Unit, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Qi
- Department of Intensive Care Unit, 903 Hospital, Mianyang, China
| | - Ping Shuai
- Department of Health Management & Institute of Health Management, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinchuan Hou
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Wei Liu
- The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Qian Wang
- The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Heren JE, Lund BC, Alexander B, Livorsi DJ. Procalcitonin Monitoring and Antibiotic Duration in Presumed Lower Respiratory Tract Infections: A Propensity Score-Matched Cohort Across the Veterans Health Administration. Open Forum Infect Dis 2023; 10:ofad520. [PMID: 37942465 PMCID: PMC10629903 DOI: 10.1093/ofid/ofad520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
Background Randomized controlled trials have shown that procalcitonin-guided algorithms can reduce antibiotic duration for lower respiratory tract infections (LRTIs). The goal of this study was to compare antibiotic duration for LRTIs with and without procalcitonin testing in real-life practice. Methods This retrospective cohort study included all acute care hospital admissions for presumed LRTIs between 1/2018 and 12/2021 at 81 Veterans Affairs facilities with on-site procalcitonin testing. The exposure was procalcitonin testing; the primary outcome was antibiotic duration. We used 1:1 nearest-neighbor propensity score matching to estimate the difference in outcome between procalcitonin-tested and nontested patients. Results A total of 35 610 patients with LRTIs were included (6015 [16.9%] with procalcitonin testing; 29 595 [83.1%] without testing). In tested patients, the median number of procalcitonin levels checked (interquartile range) was 2 (1-3). The mean antibiotic duration was 10.0 days in the procalcitonin group compared with 8.3 days in nontested patients (unadjusted difference, 1.7 days; P < .0001). After propensity score matching with 3903 pairs, antibiotic duration remained greater in the procalcitonin group (9.6 days vs 9.2 days; P < .0001). In a subgroup analysis of 2241 tested patients with a procalcitonin value at the standard threshold for antibiotic discontinuation, antibiotic duration was shorter in tested vs nontested patients, with a mean difference of 0.1 days (P < .01). Conclusions In this retrospective propensity-matched cohort of patients with presumed LRTIs across a geographically diverse group of hospitals, patients who underwent procalcitonin testing did not have a meaningful reduction in antibiotic duration compared with those who were not tested. Poor implementation of procalcitonin testing may have undermined its effectiveness.
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Affiliation(s)
- Jamie E Heren
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Brian C Lund
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Bruce Alexander
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - Daniel J Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
- Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Taraș R, Mahler B, Bălgrădean M, Derewicz D, Lazăr MI, Vidlescu R, Berghea F. The Role of Mannose-Binding Lectin and Inflammatory Markers in Establishing the Course and Prognosis of Community-Acquired Pneumonia in Children. Children (Basel) 2023; 10:1744. [PMID: 38002835 PMCID: PMC10670250 DOI: 10.3390/children10111744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most significant childhood diseases worldwide and a leading infectious cause of death in children. This study aimed to evaluate the prognostic value of the inflammatory markers-C-reactive protein (CRP) and procalcitonin (PCT)-and the polymorphic glycoprotein mannose-binding lectin (MBL), deficiency of which is associated with severe infections, in the determination of the optimal type and timing of therapeutic intervention for CAP in childhood. METHODS Retrospective evaluation was conducted on a cohort of 204 children aged 4 months-17 years hospitalized with CAP. Their levels of CRP, PCT, and MBL were assessed for their association with a variety of outcomes, including the incidence of local and systemic complications, admission to the ICU, duration of antibiotic treatment and hospital stay, and death. RESULTS CRP and PCT proved to be better predictors of complications of CAP than MBL. The area under the curve (AUC) value was highest for PCT as a predictor of systemic complications (AUC = 0.931, 95%CI 0.895-0.967), while CRP (AUC = 0.674, 95%CI 0.586-0.761) performed best as a predictor of local complications (AUC = 0.674, 95%CI 0.586-0.761). Regarding admission to the ICU, CRP was the weakest predictor (AUC = 0.741), while PCT performed the best (AUC = 0.833), followed by MBL (AUC = 0.797). Sensitivity and specificity were calculated for the optimal threshold generated by receiver operating characteristic (ROC) curves, rendering sensitivity of 90% and specificity of 87% for PCT in assessing the risk of systemic complications, compared to sensitivity of 83% and specificity of 90% for CRP. MBL showed relatively high sensitivity (96%) but low specificity (25%) for predicting the need for ICU admission. CONCLUSIONS Early measurement of CRP, PCT, and MBL provides clinicians with important information regarding the course and prognosis of children diagnosed with CAP, thus ensuring prompt, optimal therapeutic management.
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Affiliation(s)
- Roxana Taraș
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Beatrice Mahler
- Department of Pneumophthisiology II, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
- “Marius Nasta” Institute of Pneumophthisiology, 050159 Bucharest, Romania
| | - Mihaela Bălgrădean
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Diana Derewicz
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Miruna Ioana Lazăr
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Ruxandra Vidlescu
- Department of Paediatrics, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.T.); (M.B.); (D.D.)
- Emergency Clinical Hospital for Children “Maria S. Curie”, 077120 Bucharest, Romania;
| | - Florian Berghea
- Department of Internal Medicine and Rheumatology, “Dr. Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Sfânta Maria” Clinical Hospital, 011172 Bucharest, Romania
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Liu Q, Fan X, Cui W, Wang X, Zhang Z, Wang N, Qiao L. Serum Cholinesterase, C-reactive Protein, Interleukin 6, and Procalcitonin Levels as Predictors of Mortality in Patients in the Intensive Care Unit. Turk J Anaesthesiol Reanim 2023; 51:408-413. [PMID: 37876167 PMCID: PMC10606736 DOI: 10.4274/tjar.2023.231349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/24/2023] [Indexed: 10/26/2023] Open
Abstract
Objective The prognostic utility of inflammatory markers in survival has been suggested in patients with cancer; however, evidence on their prognostic value in severely ill patients is very limited. We aimed to explore the prognostic value of cholinesterase (ChE), C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) in predicting mortality in patients from the intensive care unit (ICU). Methods Serum levels of ChE, CRP, IL-6 and PCT were measured in ICU patients from December 13th, 2019 to June 28th, 2022. We assessed the predictive power of ChE, CRP, IL-6, and PCT using the receiver operating characteristic (ROC) curves. Furthermore, we evaluated their diagnostic accuracy by comparing the areas under the ROC curve (AUCs) along with their corresponding 95% confidence intervals (CIs). The cut-off values were determined to dichotomise these biomarkers, which were then included in multivariable logistic regression models to examine their relationship with ICU mortality. Results Among 253 ICU patients included in the study, 66 (26%) died during the ICU stay. The AUCs to predict ICU mortality were 0.643 (95% CI, 0.566-0.719), 0.648 (95% CI, 0.633-0.735), 0.643 (95% CI, 0.563-0.723) and 0.735 (95% CI, 0.664-0.807) for ChE, CRP, IL-6 and PCT, respectively. After adjusting for age, sex and disease severity, lower ChE level (<3.668 × 103 U L-1) and higher levels of CRP (>10.546 mg dL-1), IL-6 (>986.245 pg mL-1) and PCT (>0.505 μg L-1) were associated with higher mortality risk, with odd ratios of 2.70 (95% CI, 1.32-5.54), 4.99 (95% CI, 2.41-10.38), 3.24 (95% CI, 1.54-6.78) and 3.67 (95% CI, 1.45-9.95), respectively. Conclusion ChE, CRP, IL-6 and PCT were independent ICU mortality risk factors in severely ill patients. Elevated PCT levels exhibited better predictive value than the other three biomarkers that were evaluated.
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Affiliation(s)
- Qin Liu
- Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
- The authors share first authorship
| | - Xiaoguang Fan
- Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
- The authors share first authorship
| | - Wenjuan Cui
- Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Xincheng Wang
- Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Zhaolong Zhang
- Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Naizhi Wang
- Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital, Dongying, China
| | - Lujun Qiao
- Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
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Campani S, Talamonti M, Dall’Ara L, Coloretti I, Gatto I, Biagioni E, Tosi M, Meschiari M, Tonelli R, Clini E, Cossarizza A, Guaraldi G, Mussini C, Sarti M, Trenti T, Girardis M. The Association of Procalcitonin and C-Reactive Protein with Bacterial Infections Acquired during Intensive Care Unit Stay in COVID-19 Critically Ill Patients. Antibiotics (Basel) 2023; 12:1536. [PMID: 37887237 PMCID: PMC10604665 DOI: 10.3390/antibiotics12101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
In COVID-19 patients, procalcitonin (PCT) and C-reactive protein (CRP) performance in identifying bacterial infections remains unclear. Our study aimed to evaluate the association of PCT and CRP with secondary infections acquired during ICU stay in critically ill COVID-19 patients. This observational study included adult patients admitted to three COVID-19 intensive care units (ICUs) from February 2020 to May 2022 with respiratory failure caused by SARS-CoV-2 infection and ICU stay ≥ 11 days. The values of PCT and CRP collected on the day of infection diagnosis were compared to those collected on day 11 after ICU admission, the median time for infection occurrence, in patients without secondary infection. The receiver operating characteristic curve (ROC) and multivariate logistic model were used to assess PCT and CRP association with secondary infections. Two hundred and seventy-nine patients were included, of whom 169 (60.6%) developed secondary infection after ICU admission. The PCT and CRP values observed on the day of the infection diagnosis were larger (p < 0.001) than those observed on day 11 after ICU admission in patients without secondary infections. The ROC analysis calculated an AUC of 0.744 (95%CI 0.685-0.803) and 0.754 (95%CI 0.695-0.812) for PCT and CRP, respectively. Multivariate logistic models showed that PCT ≥ 0.16 ng/mL and CRP ≥ 1.35 mg/dL were associated (p < 0.001) with infections acquired during ICU stay. Our results indicated that in COVID-19 patients, PCT and CRP values were associated with infections acquired during the ICU stay and can be used to support, together with clinical signs, rather than predict or rule out, the diagnosis of these infections.
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Affiliation(s)
- Simone Campani
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Marta Talamonti
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Lorenzo Dall’Ara
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Irene Coloretti
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Ilenia Gatto
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Emanuela Biagioni
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Martina Tosi
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
| | - Marianna Meschiari
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Roberto Tonelli
- Respiratory Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (R.T.); (E.C.)
| | - Enrico Clini
- Respiratory Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (R.T.); (E.C.)
| | - Andrea Cossarizza
- Immunology Laboratory, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Giovanni Guaraldi
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Cristina Mussini
- Infectious Disease Unit, University Hospital of Modena, 41125 Modena, Italy; (M.M.); (G.G.); (C.M.)
| | - Mario Sarti
- Clinical Microbiology Laboratory, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Tommaso Trenti
- Diagnostic Hematology and Clinical Genomics Laboratory, Department of Laboratory Medicine and Pathology, Local Health Service and University Hospital of Modena, 41124 Modena, Italy;
| | - Massimo Girardis
- Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy; (S.C.); (M.T.); (L.D.); (I.C.); (I.G.); (E.B.); (M.T.)
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Timbrook TT, Garner CD, Hueth KD, Capraro GA, Zimmer L, Dwivedi HP. Procalcitonin and Risk Prediction for Diagnosing Bacteremia in Hospitalized Patients: A Retrospective, National Observational Study. Diagnostics (Basel) 2023; 13:3174. [PMID: 37891995 PMCID: PMC10605738 DOI: 10.3390/diagnostics13203174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Bacteremia is associated with significant morbidity and mortality. Timely, appropriate therapy may improve clinical outcomes, and therefore, determining which patients benefit from more comprehensive diagnostic strategies (i.e., direct specimen testing) could be of value. We performed an assessment of procalcitonin (PCT) and clinical characteristics in the discrimination of bacteremic hospitalizations. We analyzed 71,105 encounters and 14,846 visits of patients with bacteremia alongside 56,259 without an admission. The area under the receiver-operating characteristic (AUROC) curve for the prediction of bacteremia via procalcitonin was 0.782 (95% CI 0.779-0.787). The prediction modeling of clinical factors with or without PCT resulted in a similar performance to PCT alone. However, the clinically predicted risk of bacteremia stratified by PCT thresholds allowed the targeting of high-incidence bacteremia groups (e.g., ≥50% positivity). The combined use of PCT and clinical characteristics could be useful in diagnostic stewardship by targeting further advanced diagnostic testing in patients with a high predicted probability of bacteremia.
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Affiliation(s)
- Tristan T. Timbrook
- BioMérieux, Salt Lake City, UT 84104, USA; (C.D.G.); (K.D.H.); (G.A.C.); (L.Z.); (H.P.D.)
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT 84112, USA
| | - Cherilyn D. Garner
- BioMérieux, Salt Lake City, UT 84104, USA; (C.D.G.); (K.D.H.); (G.A.C.); (L.Z.); (H.P.D.)
| | - Kyle D. Hueth
- BioMérieux, Salt Lake City, UT 84104, USA; (C.D.G.); (K.D.H.); (G.A.C.); (L.Z.); (H.P.D.)
| | - Gerald A. Capraro
- BioMérieux, Salt Lake City, UT 84104, USA; (C.D.G.); (K.D.H.); (G.A.C.); (L.Z.); (H.P.D.)
| | - Louise Zimmer
- BioMérieux, Salt Lake City, UT 84104, USA; (C.D.G.); (K.D.H.); (G.A.C.); (L.Z.); (H.P.D.)
| | - Hari P. Dwivedi
- BioMérieux, Salt Lake City, UT 84104, USA; (C.D.G.); (K.D.H.); (G.A.C.); (L.Z.); (H.P.D.)
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