51
|
Gille J, Schmidt J, Kremer T, Sablotzki A. Evaluation of MR-proANP and copeptin for sepsis diagnosis after burn injury. J Crit Care 2019; 52:149-155. [DOI: 10.1016/j.jcrc.2019.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/11/2019] [Accepted: 04/29/2019] [Indexed: 01/02/2023]
|
52
|
Mangogna A, Agostinis C, Ricci G, Romano F, Bulla R. Overview of procalcitonin in pregnancy and in pre-eclampsia. Clin Exp Immunol 2019; 198:37-46. [PMID: 31081935 DOI: 10.1111/cei.13311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 12/19/2022] Open
Abstract
Procalcitonin (PCT), a precursor for calcitonin, is a prohormone involved in the inflammatory processes, which has been poorly studied in the context of pregnancy. During severe inflammation, PCT derives from almost all cell types, including monocytes and parenchymal tissues, making it a good predictive and diagnostic marker of an inflammatory state with rapidly increased serum levels in inflammation or sepsis. In normal pregnancy, PCT is basally expressed at very low level by decidual cells, even if decidual macrophages, which in normal pregnancy are skewed to M2 macrophages, are resistant to lipopolysaccharide (LPS)-induced production of PCT. As PCT increase is associated with an inflammatory state, several research groups investigated whether PCT can be considered a marker of pre-eclampsia, a pregnancy disease characterized by systemic inflammation. The first aim of this review is to summarize what is already known about the tissues synthesizing PCT, about the stimuli that cause the increase of circulating PCT levels and how PCT acts as a proinflammatory stimulus by itself. Secondly, we will describe the role of this prohormone in normal pregnancy and in pregnancies complicated by pre-eclampsia, highlighting the involvement of the decidual macrophages and the proinflammatory cytokine tumor necrosis factor-α in the modulation of PCT expression in the decidual microenvironment.
Collapse
Affiliation(s)
- A Mangogna
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - C Agostinis
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - G Ricci
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy.,Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - F Romano
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - R Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
53
|
Predictive value of preprocedural procalcitonin for short- and long-term mortality after transfemoral transcatheter aortic valve implantation. Heart Vessels 2019; 34:1993-2001. [DOI: 10.1007/s00380-019-01448-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/31/2019] [Indexed: 12/24/2022]
|
54
|
Positive Role of Procalcitonin Level in the Diagnosis of Infectious Diseases After Liver Transplantation. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.85668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
55
|
Park SY. Procalcitonin to Guide Antibiotic Therapy for Critically Ill Patients in Korea. J Korean Med Sci 2019; 34:e122. [PMID: 30977318 PMCID: PMC6460105 DOI: 10.3346/jkms.2019.34.e122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/04/2022] Open
Affiliation(s)
- Seong Yeon Park
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, Goyang, Korea.
| |
Collapse
|
56
|
Dong R, Wan B, Lin S, Wang M, Huang J, Wu Y, Wu Y, Zhang N, Zhu Y. Procalcitonin and Liver Disease: A Literature Review. J Clin Transl Hepatol 2019; 7:51-55. [PMID: 30944820 PMCID: PMC6441648 DOI: 10.14218/jcth.2018.00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/02/2018] [Accepted: 10/23/2018] [Indexed: 12/23/2022] Open
Abstract
Procalcitonin (PCT) is a widely used biomarker for the diagnosis of bacterial infections. It is produced by various organs and the liver is considered to be the most important site of production. Severe liver dysfunction has been shown to influence PCT levels. Patients with no sources of infection who have liver disease are observed to have increased serum levels of PCT, thereby reducing the diagnostic utility and value within this particular patient subset. Here, we have summarized the relationship between PCT and liver disease, including liver cirrhosis, liver failure, and liver transplantation.
Collapse
Affiliation(s)
- Ruolin Dong
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bo Wan
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Su Lin
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mingfang Wang
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiaofeng Huang
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yinlian Wu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yilong Wu
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Nanwen Zhang
- Department of Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Yueyong Zhu
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence to: Yueyong Zhu, Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China. Tel: +86-591-87981660, Fax: +86-591-83356180, E-mail:
| |
Collapse
|
57
|
Chun K, Chung W, Kim AJ, Kim H, Ro H, Chang JH, Lee HH, Jung JY. Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients. Sci Rep 2019; 9:4777. [PMID: 30886220 PMCID: PMC6423019 DOI: 10.1038/s41598-019-41291-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
Procalcitonin (PCT) is a useful marker for the diagnosis of systemic inflammatory response syndrome. In addition, PCT is affected by renal function. However, few studies have investigated the relationship between PCT and the development of acute kidney injury (AKI). Hence, we investigated whether serum PCT levels at the time of admission were associated with the development of AKI and clinical outcomes. A total of 790 patients in whom PCT was measured on admission to the intensive care unit (ICU) were analyzed retrospectively. We attempted to investigate whether serum PCT levels measured at the time of admission could be used as a risk factor for the development of AKI in septic and nonseptic patients or as a risk factor for all-cause mortality, and diagnostic usefulness of PCT was further assessed. Serum PCT levels were significantly higher in patients with AKI than in those without AKI (P < 0.001). After multivariable adjustment for clinical factors, laboratory findings, and comorbidities, PCT as a continuous variable showed a significant association with AKI (OR 1.006, 95% CI [1.000–1.011]; P = 0.035). However, PCT was not effective in predicting mortality. The cut-off value of PCT for the prediction of AKI incidence was calculated to be 0.315 ng/ml, with sensitivity and specificity of 60.9% and 56.9%, respectively. The odds ratios (ORs) from an equation adjusted for optimum thresholds of PCT levels for developing AKI with and without sepsis were 2.422 (1.222–4.802, P = 0.011) and 1.798 (1.101–2.937, P = 0.019), respectively. However, there were no absolute differences between the pre- and posttest probabilities after including the PCT value for AKI development. This study suggests that the PCT value was higher in AKI patients than in non-AKI patients, but PCT measurement at the time of admission did not improve the prediction model for AKI.
Collapse
Affiliation(s)
- Kayeong Chun
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wookyung Chung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Ae Jin Kim
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Hyunsook Kim
- Gachon Medical Research Institute, Incheon, Korea
| | - Han Ro
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Jae Hyun Chang
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Hyun Hee Lee
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University College of Medicine, Incheon, Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea. .,Gachon University College of Medicine, Incheon, Korea. .,Gachon Medical Research Institute, Incheon, Korea.
| |
Collapse
|
58
|
de Carvalho FT, Rabello Filho R, Bulgarelli L, Serpa Neto A, Deliberato RO. Procalcitonin as a Diagnostic, Therapeutic, and Prognostic Tool: a Critical Review. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-0178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
59
|
Li D, Sha M, Chen L, Xiao Y, Lu J, Shao Y. A preliminary study: the role of preoperative procalcitonin in predicting postoperative fever after mini-percutaneous nephrolithotomy in patients with a negative baseline urine culture. Urolithiasis 2019; 47:455-460. [PMID: 30747240 DOI: 10.1007/s00240-019-01115-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/07/2019] [Indexed: 01/19/2023]
Abstract
To evaluate the role of preoperative procalcitonin (PCT) levels in predicting postoperative fever after mini-percutaneous nephrolithotomy (mini-PCNL) in patients with a negative baseline urine culture. Between January 2014 and October 2017, 329 patients with a negative baseline urine culture and who underwent mini-PCNL were enrolled in this study. Patients were stratified into the control or febrile group based on a body temperature either less than or greater than 38 °C, respectively. Demographic and perioperative data were compared between the groups, and variables found to be statistically significant were included in a binary logistic regression analysis. A total of 68 (20.6%) patients experienced postoperative fever. The univariate analysis revealed a statistically significant difference between groups in preoperative fever (p = 0.032), stone burden (p < 0.001), C-reactive protein (p = 0.011), PCT (p < 0.001) and interleukin-6 (p = 0.035) levels. Binary logistic regression analysis indicated that stone burden > 353 mm3 (p = 0.003) and PCT > 0.05 ng/mL (p < 0.001) are independent risk factors for postoperative fever in mini-PCNL-treated patients with a negative baseline urine culture. We concluded that patients with stone burden > 353 mm3 or PCT > 0.05 ng/mL were more likely to develop postoperative fever after mini-PCNL, though with a negative baseline urine culture.
Collapse
Affiliation(s)
- Deng Li
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, People's Republic of China
| | - Minglei Sha
- Department of Gerontology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, People's Republic of China
| | - Lei Chen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, People's Republic of China
| | - Yinglong Xiao
- Department of Urology, Shanghai General Hospital, Nanjing Medical University, No. 100, Haining Road, Hongkou District, Shanghai, People's Republic of China
| | - Jun Lu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, People's Republic of China
| | - Yi Shao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, People's Republic of China.
| |
Collapse
|
60
|
Predictive value of the kinetics of procalcitonin and C-reactive protein for early clinical stability in patients with bloodstream infections due to Gram-negative bacteria. Diagn Microbiol Infect Dis 2019; 93:63-68. [DOI: 10.1016/j.diagmicrobio.2018.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/07/2018] [Accepted: 07/31/2018] [Indexed: 12/19/2022]
|
61
|
Kee Z, Kodji X, Brain SD. The Role of Calcitonin Gene Related Peptide (CGRP) in Neurogenic Vasodilation and Its Cardioprotective Effects. Front Physiol 2018; 9:1249. [PMID: 30283343 PMCID: PMC6156372 DOI: 10.3389/fphys.2018.01249] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/17/2018] [Indexed: 12/05/2022] Open
Abstract
Calcitonin gene-related peptide (CGRP) is a highly potent vasoactive peptide released from sensory nerves, which is now proposed to have protective effects in several cardiovascular diseases. The major α-form is produced from alternate splicing and processing of the calcitonin gene. The CGRP receptor is a complex composed of calcitonin like receptor (CLR) and a single transmembrane protein, RAMP1. CGRP is a potent vasodilator and proposed to have protective effects in several cardiovascular diseases. CGRP has a proven role in migraine and selective antagonists and antibodies are now reaching the clinic for treatment of migraine. These clinical trials with antagonists and antibodies indicate that CGRP does not play an obvious role in the physiological control of human blood pressure. This review discusses the vasodilator and hypotensive effects of CGRP and the role of CGRP in mediating cardioprotective effects in various cardiovascular models and disorders. In models of hypertension, CGRP protects against the onset and progression of hypertensive states by potentially counteracting against the pro-hypertensive systems such as the renin-angiotensin-aldosterone system (RAAS) and the sympathetic system. With regards to its cardioprotective effects in conditions such as heart failure and ischaemia, CGRP-containing nerves innervate throughout cardiac tissue and the vasculature, where evidence shows this peptide alleviates various aspects of their pathophysiology, including cardiac hypertrophy, reperfusion injury, cardiac inflammation, and apoptosis. Hence, CGRP has been suggested as a cardioprotective, endogenous mediator released under stress to help preserve cardiovascular function. With the recent developments of various CGRP-targeted pharmacotherapies, in the form of CGRP antibodies/antagonists as well as a CGRP analog, this review provides a summary and a discussion of the most recent basic science and clinical findings, initiating a discussion on the future of CGRP as a novel target in various cardiovascular diseases.
Collapse
Affiliation(s)
- Zizheng Kee
- Section of Vascular Biology & Inflammation, BHF Centre for Cardiovascular Research, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Xenia Kodji
- Section of Vascular Biology & Inflammation, BHF Centre for Cardiovascular Research, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Susan D Brain
- Section of Vascular Biology & Inflammation, BHF Centre for Cardiovascular Research, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| |
Collapse
|
62
|
El Kassas GM, Shehata MA, El Wakeel MA, Amer AF, Elzaree FA, Darwish MK, Amer MF. Role of Procalcitonin As an Inflammatory Marker in a Sample of Egyptian Children with Simple Obesity. Open Access Maced J Med Sci 2018; 6:1349-1353. [PMID: 30159055 PMCID: PMC6108804 DOI: 10.3889/oamjms.2018.323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND: Obesity is a multifactorial disease, associated with metabolic disorders and chronic low-grade inflammation. Procalcitonin (PCT) is well known as a biomarker of infection, and systemic inflammation. Recently, it has potential as a marker for chronic low-grade inflammation. AIM: This study aims to evaluate the role of serum PCT as an inflammatory biomarker in the diagnosis of obesity-related low-grade inflammation. METHOD: In this case-control study, 50 obese and 35 normal weight children and adolescents aged 5–15 years were enrolled. Anthropometric parameters were measured in all subjects. Blood samples were collected for measurement of lipid profile, blood glucose, insulin, high sensitivity-CRP (Hs-CRP) and serum procalcitonin. Serum (PCT) levels were assessed using enzyme-linked immunosorbent assay. RESULTS: Obese participants had higher concentrations of serum PCT, total cholesterol, triglycerides, LDL-c, glucose and Hs-CRP than control group. On correlation analysis, procalcitonin had significant positive correlation with (BMI) z-score (P = 0.02), insulin (P = 0.00), insulin resistance (HOMA-IR) (P = 0.006), Hs-CRP (P = 0.02), total cholesterol (P = 0.04) and triglycerides (P = 0.00) in obese group. CONCLUSION: The increased serum procalcitonin concentrations were closely related to measures of adiposity, Hs-CRP and insulin resistance, suggesting that PCT may be an excellent biomarker for obesity-related chronic low-grade inflammation in children and adolescents.
Collapse
Affiliation(s)
| | - Manal A Shehata
- Department of Child Health, National Research Centre, Cairo, Egypt
| | | | - Ahmed F Amer
- Department of Child Health, National Research Centre, Cairo, Egypt
| | - Fatma A Elzaree
- Department of Child Health, National Research Centre, Cairo, Egypt
| | - Marwa K Darwish
- Biochemistry Department, Faculty of Science, Suez University, Egypt
| | - Marwa F Amer
- Department of Medical Biochemistry, Cairo University, Cairo, Egypt
| |
Collapse
|
63
|
Le Y, Chen T, Xun K, Ding T. Expression of the Long Intergenic Non-Coding RNA (lincRNA) of the NED25 Gene Modulates the microRNA-125b, STAT3, Nitric Oxide, and Procalcitonin Signaling Pathways in Patients with Sepsis. Med Sci Monit 2018; 24:4555-4566. [PMID: 29962507 PMCID: PMC6060691 DOI: 10.12659/msm.907496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The aim of this study was to investigate the long intergenic non-coding RNA (lincRNA) of the NED25 gene, and the microRNA (miR)-125b, STAT3, nitric oxide (NO), and procalcitonin (PCT) pathway in sepsis. Material/Methods Seventy-five age-matched and sex-matched patients were divided into three groups: 25 patients with sepsis only; 25 patients with septic shock; and 25 healthy control subjects. Computational analysis and a luciferase assay confirmed that the STAT3 and PCT genes were target genes of miR-125b, whereas the lincRNA of the NED25 gene was validated as an endogenous lincRNA competing with miR-125b for binding to STAT3 and PCT. Real-time polymerase chain reaction (PCR) and Western blot measured the expression of miR-125b, STAT3, and PCT in peripheral blood monocytes (PBM) transfected with miR-125b mimics, miR-125b inhibitors, or small interfering (siRNA). Results The expression of miR-125b, the PCT position ratio, the expression of PCT mRNA and protein were increased when compared with healthy individuals. When compared with the siRNA negative control, miR-125b and the lincRNA of the NED25 gene mimics, as well as STAT3 siRNA significantly downregulated the mRNA and protein expression of STAT3 and PCT; mRNA and protein expression of STAT3 and PCT in cells transfected with miR-125b inhibitors were significantly increased. Intracellular nitric oxide (NO) production was upregulated by miR-125b inhibitors and downregulated by miR-125b mimics or siRNA. Conclusions Downregulation of the lincRNA of the NED25 gene was associated with sepsis in patients by modulating the signaling pathways downstream of miR-125b/STAT3/PCT/NO signaling pathway.
Collapse
Affiliation(s)
- Yuanjie Le
- Department of Emergency, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China (mainland)
| | - Tongen Chen
- Department of Emergency, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China (mainland)
| | - Kai Xun
- Department of Emergency, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China (mainland)
| | - Tao Ding
- Department of Emergency, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China (mainland)
| |
Collapse
|
64
|
Goggs R, Milloway M, Troia R, Giunti M. Plasma procalcitonin concentrations are increased in dogs with sepsis. Vet Rec Open 2018; 5:e000255. [PMID: 29682292 PMCID: PMC5905832 DOI: 10.1136/vetreco-2017-000255] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/23/2018] [Accepted: 03/08/2018] [Indexed: 11/03/2022] Open
Abstract
Sepsis, the life-threatening organ dysfunction caused by a dysregulated host response to infection, is difficult to identify and to prognosticate for. In people with sepsis, procalcitonin (PCT) measurement aids diagnosis, enables therapeutic monitoring and improves prognostic accuracy. This study used a commercial canine PCT assay to measure plasma PCT concentrations in dogs with gastric dilatation volvulus (GDV) syndrome and in dogs with sepsis. It was hypothesised that dogs with GDV syndrome and with sepsis have greater plasma PCT concentrations than healthy dogs and that dogs with sepsis have greater PCT concentrations than dogs with GDV syndrome. Before analysing canine plasma samples, the ability of the assay to identify canine PCT, in addition to assay imprecision and the lower limit of detection were established. The assay had low imprecision with coefficients of variation ≤4.5 per cent. The lower limit of detection was 3.4 pg/ml. Plasma PCT concentrations were measured in 20 dogs with sepsis, in 32 dogs with GDV syndrome and in 52 healthy dogs. Median (IQR) PCT concentration in dogs with sepsis 78.7 pg/ml (39.1-164.7) was significantly greater than in healthy dogs 49.8 pg/ml (36.2-63.7) (P=0.019), but there were no significant differences between PCT concentrations in dogs with GDV syndrome and controls (P=0.072) or between dogs with sepsis and GDV syndrome (P=1.000). Dogs with sepsis have significantly increased plasma PCT concentrations compared with healthy dogs, although considerable overlap between these populations was identified. Future investigations should confirm this finding in other populations and evaluate the diagnostic and prognostic value of PCT in dogs with sepsis.
Collapse
Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York City, USA
| | - Matthew Milloway
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York City, USA
| | - Roberta Troia
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Massimo Giunti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| |
Collapse
|
65
|
Cabral L, Afreixo V, Meireles R, Vaz M, Chaves C, Caetano M, Almeida L, Paiva JA. Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients. BURNS & TRAUMA 2018; 6:10. [PMID: 29610766 PMCID: PMC5878422 DOI: 10.1186/s41038-018-0112-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
Background Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients' survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality. The aim of this work is to check the suitability of procalcitonin (PCT) to fulfill these goals in a large sample of septic burn patients. Methods One hundred and one patients, with 15% or more of total body surface area (TBSA) burned, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), in Portugal were included in the sample. All patients had a diagnosis of sepsis, according to the American Burn Association (ABA) criteria. The sample was factored by survival (68 survivors and 33 non-survivors). The maximum value of PCT in each day was used for statistical analysis. Data were summarized by location measures (mean, median, minimum, maximum, quartiles) and dispersion measures (standard error and range measures). Statistical analysis was performed with SPSS© 23.0 IBM© for Windows©. Results There were statistically significant differences between PCT levels of patients from the survivor and non-survivor groups during the first and the last weeks of hospitalization as well as during the first week after sepsis suspicion, being slightly higher during this period. During the first 7 days of antimicrobial therapy, PCT was always higher in the non-survivor, still without reaching statistical significance, but when the analysis was extended till the 15th day, PCT increased significantly, rapidly, and steadily, denouncing therapy failure. Conclusion Despite being not an ideal biomarker, PCT proved to have good prognostic power in septic burn patients, paralleling the evolution of the infectious process and reflecting the efficacy of antimicrobial therapy, and the inclusion of its serial dosing may be advised to reinforce antimicrobial stewardship programs at burn units; meanwhile, more accurate approaches are not available.
Collapse
Affiliation(s)
- Luís Cabral
- 1Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal.,2Autonomous Section of Health Sciences (SACS), University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- 3CIDMA - Center for Research and Development in Mathematics and Applications, iBiMED, Institute for Biomedicine, University of Aveiro, Aveiro, Portugal
| | - Rita Meireles
- 1Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Miguel Vaz
- 1Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC), Av. Bissaya Barreto s/n, 3000-075 Coimbra, Portugal
| | - Catarina Chaves
- 4Clinical Pathology Department, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Marisa Caetano
- 5Pharmacy Department, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Luís Almeida
- 6MedinUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Artur Paiva
- 7Department of Emergency and Intensive Care Medicine, Centro Hospitalar São João, Porto, Portugal.,8Faculty of Medicine, University of Porto, Grupo de Infecção e Sépsis, Porto, Portugal
| |
Collapse
|
66
|
Agostinis C, Rami D, Zacchi P, Bossi F, Stampalija T, Mangogna A, Amadio L, Vidergar R, Vecchi Brumatti L, Ricci G, Celeghini C, Radillo O, Sargent I, Bulla R. Pre-eclampsia affects procalcitonin production in placental tissue. Am J Reprod Immunol 2018; 79:e12823. [PMID: 29427369 DOI: 10.1111/aji.12823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/16/2018] [Indexed: 01/05/2023] Open
Abstract
PROBLEM Procalcitonin (PCT) is the prohormone of calcitonin which is usually released from neuroendocrine cells of the thyroid gland (parafollicular) and the lungs (K cells). PCT is synthesized by almost all cell types and tissues, including monocytes and parenchymal tissue, upon LPS stimulation. To date, there is no evidence for PCT expression in the placenta both in physiological and pathological conditions. METHOD Circulating and placental PCT levels were analysed in pre-eclamptic (PE) and control patients. Placental cells and macrophages (PBDM), stimulated with PE sera, were analysed for PCT expression. The effect of anti-TNF-α antibody was analysed. RESULTS Higher PCT levels were detected in PE sera and in PE placentae compared to healthy women. PE trophoblasts showed increased PCT expression compared to those isolated from healthy placentae. PE sera induced an upregulation of PCT production in macrophages and placental cells. The treatment of PBDM with PE sera in the presence of anti-TNF-α completely abrogated the effect induced by pathologic sera. CONCLUSION Trophoblast cells are the main producer of PCT in PE placentae. TNF-α, in association with other circulating factors present in PE sera, upregulates PCT production in macrophages and normal placental cells, thus contributing to the observed increased in circulating PCT in PE sera.
Collapse
Affiliation(s)
- Chiara Agostinis
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Damiano Rami
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Paola Zacchi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Fleur Bossi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Stampalija
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Leonardo Amadio
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Romana Vidergar
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Oriano Radillo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Ian Sargent
- Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
| |
Collapse
|
67
|
Stover KR, Kenney RM, King ST, Gross AE. Evaluation of the Use of Novel Biomarkers to Augment Antimicrobial Stewardship Program Activities. Pharmacotherapy 2018; 38:271-283. [PMID: 29245184 DOI: 10.1002/phar.2069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
As antimicrobial stewardship increasingly receives worldwide attention for improving patient care by optimizing antimicrobial therapy, programs are evaluating new tools that may augment antimicrobial stewardship activities. Biomarkers are objective, accurate, and reproducible measures that provide information about medical conditions. A systematic literature search using PubMed/MEDLINE databases was performed to evaluate the use of novel biomarkers as additions to the antimicrobial stewardship armamentarium. Procalcitonin may help clinicians discriminate between bacterial and viral infections, help with antimicrobial discontinuation decisions, and predict mortality. β-d-glucan, Candida albicans germ tube antibody, and galactomannan are useful in suspected fungal infections and may reduce inappropriate antifungal use. Adrenomedullin and soluble triggering receptor on myeloid cells-1 may be useful for mortality prediction and the determination of a need for empiric antibacterials. Although studies evaluating these biomarkers are promising, these biomarkers are not without limitations and should be used in combination with clinical signs, symptoms, or other biomarkers. For successful implementation of biomarker use, stewardship programs should consider the populations most likely to benefit, without using them indiscriminately in all patients. Antimicrobial stewardship programs should facilitate education of clinicians through institutional guidelines to ensure the appropriate use and interpretation of these biomarkers.
Collapse
Affiliation(s)
- Kayla R Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi.,Department of Medicine-Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Rachel M Kenney
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan
| | - Samuel Travis King
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi.,Department of Medicine-Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Alan E Gross
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, Illinois.,Department of Pharmacy, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| |
Collapse
|
68
|
De Logu F, Nassini R, Landini L, Geppetti P. Pathways of CGRP Release from Primary Sensory Neurons. Handb Exp Pharmacol 2018; 255:65-84. [PMID: 29980913 DOI: 10.1007/164_2018_145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The benefit reported in a variety of clinical trials by a series of small molecule antagonists for the calcitonin gene-related peptide (CGRP) receptor, or four monoclonal antibodies against the neuropeptide or its receptor, has underscored the release of CGRP from terminals of primary sensory neurons, including trigeminal neurons, as one of the major mechanisms of migraine headaches. A large variety of excitatory ion channels and receptors have been reported to elicit CGRP release, thus proposing these agonists as migraine-provoking agents. On the other side, activators of inhibitory channels and receptors may be regarded as potential antimigraine agents. The knowledge of the intracellular pathways underlying the exocytotic process that results in CGRP secretion or its inhibition is, therefore, of importance for understanding how migraine pain originates and how to treat the disease.
Collapse
Affiliation(s)
- Francesco De Logu
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, Headache Center, University of Florence, Florence, Italy
| | - Romina Nassini
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, Headache Center, University of Florence, Florence, Italy
| | - Lorenzo Landini
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, Headache Center, University of Florence, Florence, Italy
| | - Pierangelo Geppetti
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, Headache Center, University of Florence, Florence, Italy.
| |
Collapse
|
69
|
Ghareghani M, Scavo L, Arnoult D, Zibara K, Farhadi N. Melatonin therapy reduces the risk of osteoporosis and normalizes bone formation in multiple sclerosis. Fundam Clin Pharmacol 2017; 32:181-187. [DOI: 10.1111/fcp.12337] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Majid Ghareghani
- Cellular and Molecular Research Center; Faculty of Medicine; Yasuj University of Medical Sciences; Yasuj Iran
| | - Linda Scavo
- ER045, PRASE; Laboratory of stem cells, Biology department; Faculty of Sciences; Lebanese University; Beirut Lebanon
- INSERM U 1197; Laboratory of stem cells, transplantation and immunoregulation; Villejuif France
| | - Damien Arnoult
- INSERM U 1197; Laboratory of stem cells, transplantation and immunoregulation; Villejuif France
| | - Kazem Zibara
- ER045, PRASE; Laboratory of stem cells, Biology department; Faculty of Sciences; Lebanese University; Beirut Lebanon
| | - Naser Farhadi
- Cellular and Molecular Research Center; Faculty of Medicine; Yasuj University of Medical Sciences; Yasuj Iran
| |
Collapse
|
70
|
Hackner K, Riegler W, Handzhiev S, Bauer R, Veres J, Speiser M, Meisinger K, Errhalt P. Fever after bronchoscopy: serum procalcitonin enables early diagnosis of post-interventional bacterial infection. BMC Pulm Med 2017; 17:156. [PMID: 29179755 PMCID: PMC5704393 DOI: 10.1186/s12890-017-0508-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/17/2017] [Indexed: 01/14/2023] Open
Abstract
Background The aim of this study was to differentiate unspecific and self-limiting fever after bronchoscopy from fever due to infection by using serum procalcitonin, C-reactive protein and neutrophil count. Furthermore, frequency of fever after bronchoscopy and procedures as possible risk factors were evaluated. Methods Three hundred and fourteen consecutive patients were included. All bronchoscopies were performed using jet-ventilation and general anesthesia. Patients were analyzed according to interventions performed during bronchoscopy and laboratory results. Microbiological assessment was done in patients who developed fever to prove or rule out a bacterial infection. Results Forty-four patients showed fever within 24 h following bronchoscopy (14%). A bacterial infection was proven in 11 patients with fever (3.5%). Procalcitonin, neutrophil count and C-reactive protein were significantly higher in patients with fever after bronchoscopy compared to non-fever patients. To predict bacterial infection in the receiver operating analysis, procalcitonin had the highest area under the curve (0.942; 95% confidence interval [CI], 0.768 to 1.000; p = <0.001), followed by neutrophil count (AUC, 0.804; 95% CI, 0.606 to 0.946; p = 0.005), whereas CRP levels where not statistically significant. Endoscopic airway recanalization was the only intervention that induced fever more frequently than all other interventions (OR 13.629). Conclusions Fever is frequently seen after bronchoscopy and in some cases caused by bacterial infection. Procalcitonin might be useful to distinguish a bacterial infection from unspecific self-limiting fever. Airway recanalization is a procedure that seems to induce fever significantly more often than other bronchoscopic interventions.
Collapse
Affiliation(s)
- Klaus Hackner
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria. .,Karl Landsteiner University of Health Science, Krems, Austria.
| | - Waltraud Riegler
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Sabin Handzhiev
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Rosemarie Bauer
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Jan Veres
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Manuela Speiser
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Karin Meisinger
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| | - Peter Errhalt
- Department of Pneumonology, Krems University Hospital, Mitterweg 10, Krems, Austria.,Karl Landsteiner University of Health Science, Krems, Austria
| |
Collapse
|
71
|
Choi JJ, McCarthy MW. Novel applications for serum procalcitonin testing in clinical practice. Expert Rev Mol Diagn 2017; 18:27-34. [PMID: 29148856 DOI: 10.1080/14737159.2018.1407244] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Procalcitonin has emerged as a reliable marker of acute bacterial infection in hospitalized patients and the assay has recently been incorporated into several clinical algorithms to reduce antimicrobial overuse, but its use in patients with end-organ dysfunction is controversial. Areas covered: In this review, the authors examine what is known about procalcitonin testing in patients with organ dysfunction, including those with end-stage renal disease, congestive heart failure, chronic obstructive pulmonary disease, and cirrhosis, and explore how the assay is now being used in the management of non-infectious diseases. Expert commentary: Procalcitonin holds tremendous promise to identify a diverse set of medical conditions beyond those associated with acute bacterial infection, including post-surgical anastomotic leaks, acute kidney injury, and complications after intracerebral hemorrhage. The authors review recent studies examining procalcitonin in these areas and explore how the assay might be used to guide diagnosis and prognosis of non-infectious diseases in the near future.
Collapse
Affiliation(s)
- Justin J Choi
- a Division of General Internal Medicine , Weill Cornell Medical College, New York-Presbyterian Hospital , New York , NY , USA
| | - Matthew W McCarthy
- a Division of General Internal Medicine , Weill Cornell Medical College, New York-Presbyterian Hospital , New York , NY , USA
| |
Collapse
|
72
|
Zhang Y, Chen Z, Tang Y, Shan W, Wang L, Shi J, Luo Q, Duan J, Xu G. Association between procalcitonin levels and carotid atherosclerosis in acute ischemic stroke patients. Int J Neurosci 2017; 128:237-242. [PMID: 29096569 DOI: 10.1080/00207454.2017.1387114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSES Procalcitonin has been suggested as a new risk factor in atherosclerotic disease. However, whether procalcitonin levels are associated with the risk of carotid atherosclerosis remains unclear. This study aimed to investigate the relationship between procalcitonin levels and carotid atherosclerosis among patients with first-ever acute ischemic stroke. METHODS Two hundred and thirty consecutive patients were prospectively enrolled in this study. Serum procalcitonin concentrations were measured at admission for all patients. We also performed ultrasound examination to detect the mean carotid intima-media thickness, presence of carotid-wall thickening, plaque and significant stenosis. Multiple regression analysis was used to estimate the association between procalcitonin levels and carotid atherosclerosis. RESULTS The median procalcitonin concentration was 0.051 µg/L (interquartile range, 0.036-0.080 µg/L). Of the 230 patients, 102 (44.3%) had carotid-wall thickening, 113 (49.1%) had plaque and 77 (33.5%) had significant stenosis. After adjusting for all potential confounders by multiple logistic regression analysis, patients with procalcitonin levels in the fourth quartile, compared with the first quartile, were more likely to have carotid-wall thickening [odds ratio 2.288, 95% confidence intervals 1.042-5.021, P = 0.039] and significant stenosis [odds ratio 3.871, 95% confidence intervals 1.690-8.867, P = 0.003]. Furthermore, the linear regression analysis revealed a significant positive correlation between procalcitonin levels and the mean carotid intima-media thickness (β = 0.162, P = 0.012). CONCLUSIONS Higher procalcitonin concentrations at admission might be associated with carotid-wall thickening and significant stenosis in ischemic stroke patients.
Collapse
Affiliation(s)
- Yun Zhang
- a Department of Neurology, Jinling Hospital , Southern Medical University , Nanjing , China.,b Department of Neurology , Mianyang Central Hospital , Mianyang , China
| | - Zhonglun Chen
- a Department of Neurology, Jinling Hospital , Southern Medical University , Nanjing , China.,b Department of Neurology , Mianyang Central Hospital , Mianyang , China
| | - Yufeng Tang
- b Department of Neurology , Mianyang Central Hospital , Mianyang , China
| | - Wanying Shan
- a Department of Neurology, Jinling Hospital , Southern Medical University , Nanjing , China
| | - Ling Wang
- a Department of Neurology, Jinling Hospital , Southern Medical University , Nanjing , China
| | - Jian Shi
- b Department of Neurology , Mianyang Central Hospital , Mianyang , China
| | - Qian Luo
- b Department of Neurology , Mianyang Central Hospital , Mianyang , China
| | - Jinfeng Duan
- b Department of Neurology , Mianyang Central Hospital , Mianyang , China
| | - Gelin Xu
- a Department of Neurology, Jinling Hospital , Southern Medical University , Nanjing , China
| |
Collapse
|
73
|
Li G, Zhu C, Li J, Wang X, Zhang Q, Zheng H, Zhan C. Increased level of procalcitonin is associated with total MRI burden of cerebral small vessel disease in patients with ischemic stroke. Neurosci Lett 2017; 662:242-246. [PMID: 29061396 DOI: 10.1016/j.neulet.2017.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Procalcitonin (PCT) has been found to be associated with subclinical cerebrovascular damage. The relationship between PCT levels and cerebral small vessel disease (cSVD), especially cSVD burden, has not been fully understood. This study aimed to investigate the association between PCT levels and cSVD in patients with first-ever acute ischemic stroke or transient ischemic attack (TIA). METHODS Two hundred and seventy-eight consecutive patients were prospectively recruited during Jan 2016 to Jun 2017. Serum PCT concentrations measurement was performed after admission. The presence and burden of cSVD was determined by magnetic resonance imaging (MRI). Multivariable logistic regression was used to assess whether serum PCT levels were associated with cSVD. RESULTS The median PCT level was 0.042μg/L (interquartile range, 0.025-0.065μg/L). Univariable logistic regression analysis indicated that patients with PCT level in the top quartile, compared with the lowest quartile, were more likely to have silent lacunar infarctions [odds ratio (OR), 2.266; 95% confidence interval (CI) 1.131-4.538, P=0.021], white matter lesions (OR, 1.793; 95% CI 1.029-3.574, P=0.047), high-grade enlarged perivascular spaces (OR, 8.061; 95% CI 3.599-14.055, P=0.001) and increased total MRI cSVD burden (OR, 3.743; 95% CI 1.998-7.008, P=0.002). These results persisted even after adjusting for potential confounders. CONCLUSIONS This study demonstrated that elevated PCT levels might be associated with total MRI cSVD burden in patients with ischemic stroke or TIA.
Collapse
Affiliation(s)
- Guangzong Li
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Chen Zhu
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Jing Li
- Department of Clinical Laboratory, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Xiangming Wang
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Qingbin Zhang
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Hongjia Zheng
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Cheng Zhan
- Department of Neurology, Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China.
| |
Collapse
|
74
|
Suthahar N, Meijers WC, Brouwers FP, Heerspink HJL, Gansevoort RT, van der Harst P, Bakker SJL, de Boer RA. Heart failure and inflammation-related biomarkers as predictors of new-onset diabetes in the general population. Int J Cardiol 2017; 250:188-194. [PMID: 29074040 DOI: 10.1016/j.ijcard.2017.10.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/15/2017] [Accepted: 10/09/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is a strong reciprocal relationship between heart failure (HF) and diabetes mellitus (DM). Shared pathophysiological mechanisms might be a possible explanation. Therefore, we hypothesised that biomarkers linked to HF would also predict new-onset type 2 DM in the general population. METHODS AND RESULTS We utilized the Prevention of Vascular and Renal End-stage Disease (PREVEND) cohort (mean age 48.9years, 51% female) to study the relationship between HF and DM in 7953 participants free of baseline HF and DM. Multiple HF-related, inflammation-related and renal function-related biomarkers were evaluated regarding their predictive utility in new-onset DM. Incidence of DM in participants who developed HF was 11.8%, versus 5.4% in those who had not developed HF (p<0.001). Incidence of HF in participants who developed DM was 8.5%, versus 3.8% in those who had not developed DM (p<0.001). Classical HF biomarkers, NT-proBNP and hs-TnT were not associated with an increased risk for new-onset DM. However, inflammatory biomarkers hs-CRP [hazard ratio (HR) 1.16, (95% CI 1.05 to 1.29), p=0.005], procalcitonin [HR 1.34, (95% CI 1.07 to 1.69), p=0.012] and PAI-1 [HR 1.55, (95% CI 1.37 to 1.75), p<0.001] remained significantly associated with new-onset DM, even after multivariable adjustment for established predictors of DM. CONCLUSIONS Although HF and DM have a strong correlation with each other, systemic biomarkers that predict HF do not have a predictive value in new-onset DM. This suggests that other, indirect, pathophysiological mechanisms related to inflammation may explain their strong relation.
Collapse
Affiliation(s)
- Navin Suthahar
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Wouter C Meijers
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Frank P Brouwers
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| |
Collapse
|
75
|
Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bucher HC, Annane D, Reinhart K, Falsey AR, Branche A, Damas P, Nijsten M, de Lange DW, Deliberato RO, Oliveira CF, Maravić-Stojković V, Verduri A, Beghé B, Cao B, Shehabi Y, Jensen JUS, Corti C, van Oers JAH, Beishuizen A, Girbes ARJ, de Jong E, Briel M, Mueller B. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. THE LANCET. INFECTIOUS DISEASES 2017; 18:95-107. [PMID: 29037960 DOI: 10.1016/s1473-3099(17)30592-3] [Citation(s) in RCA: 286] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. METHODS Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on procalcitonin concentrations (procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. FINDINGS We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 procalcitonin-guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (pinteractions>0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI -2·71 to -2·15], p<0·0001) and a reduction in antibiotic-related side-effects (16% vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p<0·0001). INTERPRETATION Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. FUNDING National Institute for Health Research.
Collapse
Affiliation(s)
- Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Yannick Wirz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Ramon Sager
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Faculty of Medicine, University of Basel, Basel, Switzerland; Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
| | - Daiana Stolz
- Faculty of Medicine, University of Basel, Basel, Switzerland; Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Faculty of Medicine, University of Basel, Basel, Switzerland; Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Lila Bouadma
- Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Charles E Luyt
- Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France
| | - Michel Wolff
- Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean Chastre
- Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France
| | - Florence Tubach
- Département de Biostatistique, Santé publique et Information médicale, AP-HP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | | | - Olaf Burkhardt
- Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Member of the German Center of Lung Research, Hannover, Germany
| | - Tobias Welte
- Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Member of the German Center of Lung Research, Hannover, Germany
| | - Stefan Schroeder
- Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Dueren, Dueren, Germany
| | - Vandack Nobre
- Department of Intensive Care, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Long Wei
- Department of Internal and Geriatric Medicine, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Heiner C Bucher
- Faculty of Medicine, University of Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Djillali Annane
- Critical Care Department, Hôpital Raymond Poincaré, AP-HP, Faculty of Health Science Simone Veil, UVSQ-University Paris Saclay, Garches, France
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Ann R Falsey
- Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Angela Branche
- Department of Medicine, University of Rochester, Rochester, NY, USA
| | - Pierre Damas
- Department of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Liège, Liège, Belgium
| | - Maarten Nijsten
- University Medical Centre, University of Groningen, Groningen, Netherlands
| | - Dylan W de Lange
- University Medical Center Utrecht and University of Utrecht, Utrecht, Netherlands
| | | | - Carolina F Oliveira
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Alessia Verduri
- Section of Respiratory Medicine, Department of Medical and Surgical Sciences, University Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bianca Beghé
- Section of Respiratory Medicine, Department of Medical and Surgical Sciences, University Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bin Cao
- Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yahya Shehabi
- Critical Care and Peri-operative Medicine, Monash Health, Melbourne, VIC, Australia; School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jens-Ulrik S Jensen
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Caspar Corti
- Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | | | | | | | | | - Matthias Briel
- Faculty of Medicine, University of Basel, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
76
|
Cvetinovic N, Isakovic AM, Lainscak M, Dungen HD, Nikolic NM, Loncar G. Procalcitonin in heart failure: hic et nunc. Biomark Med 2017; 11:893-903. [PMID: 28976777 DOI: 10.2217/bmm-2017-0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although procalcitonin (PCT) was evaluated for the first time in the setting of heart failure (HF) in 1999, its utility in HF patients is still under examination. Patients with HF have significantly higher plasma PCT concentrations than healthy subjects and PCT levels are associated with severity of HF. It has been confirmed that higher levels of PCT are associated with worse outcomes, such as increased mortality and higher rate of rehospitalization, in HF patients with no evidence of infection. Furthermore, it has been approved that PCT-guided antibiotic treatment in HF patients reduces duration of antibiotic therapy and improves outcomes. This review summarizes current evidence from the published literature of the usefulness and limitations of PCT as a biomarker in HF.
Collapse
Affiliation(s)
- Natasa Cvetinovic
- Department of Cardiology, Zvezdara University Medical Center, Belgrade, Serbia
| | | | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Hans-Durk Dungen
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Natasa Markovic Nikolic
- Department of Cardiology, Zvezdara University Medical Center, Belgrade, Serbia.,School of Medicine, University of Belgrade, Serbia
| | - Goran Loncar
- Department of Cardiology, Zvezdara University Medical Center, Belgrade, Serbia.,School of Medicine, University of Belgrade, Serbia
| |
Collapse
|
77
|
Salmabadi Z, Mohseni Kouchesfahani H, Parivar K, Karimzadeh L. Effect of Grape Seed Extract on Lipid Profile and Expression of Interleukin-6 in Polycystic Ovarian Syndrome Wistar Rat Model. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:176-183. [PMID: 28868839 PMCID: PMC5582145 DOI: 10.22074/ijfs.2017.5007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/03/2016] [Indexed: 01/08/2023]
Abstract
Background Polycystic ovary syndrome (PCOS) is a common but complex endocrine
disorder and is the major cause of anovulation and consequent subfertility. In this study
the effect of grape seed extract (GSE) on triglyceride (TG), total cholesterol (TC), highdensity lipoprotein-cholestrol (HDL-C), low-density lipoprotein-cholestrol (LDL-C) and
interleukin-6 (IL-6) in PCOS Wistar rats were assessed. Materials and Methods In this experimental study, 84 adult female Wistar rats were
divided into 7 groups (n=12) including control (intact), Sham (estradiol valerate solvent
injection), control PCOS and 4 experimental PCOS groups. To induce the syndrome, a
single subcutaneous injection of 2 mg estradiol valerate was applied. In experimental
groups, PCOS rats were treated with different doses of 50, 75, 100 and 200 mg/kg body
weight (BW) GSE by intraperitoneal injection for 10 consecutive days. After harvesting blood serum, TG was measured by Glycerol-3-phosphate Oxidase-Peoxidase (GPO-
PAP), TC by Cholesterol Oxidase-Peroxidase (CHOD-PAP), and HDL-C by sedimentation method, LDL-C by Friedwald calculation and IL-6 by ELISA method. The serum
values of each parameter were analyzed using one-way ANOVA at P≤0.05. Results In all experimental groups significant decrease of visceral fat was obvious as
compared with control PCOS group. LDL-C, TC and IL-6 levels in experimental groups,
particularly at dose of 50 mg/kg of GSE, were significantly decreased as compared with
PCOS group. However, HDL-C levels were not significantly changed. Conclusion : According to the findings of this study, it can be concluded that GSE with
its effects on serum TC, LDL-C and IL-6 could reduce the effects of dyslipidemia and
inflammation in PCOS rats and improve systemic symptoms of PCOS.
Collapse
Affiliation(s)
- Zohreh Salmabadi
- Department of Animal Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | | | - Kazem Parivar
- Department of Animal Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Latifeh Karimzadeh
- Animal Center Laboratories and Cellular and Molecular Research Laboratory, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| |
Collapse
|
78
|
Schuetz P, Mueller B. Procalcitonin-guided antibiotic stewardship from newborns to centennials. Lancet 2017; 390:826-829. [PMID: 28711319 DOI: 10.1016/s0140-6736(17)31628-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022]
Affiliation(s)
- Philipp Schuetz
- Medical University Clinic, Kantonsspital Aarau & Medical Faculty of the University of Basel, Aarau, CH -5001, Switzerland
| | - Beat Mueller
- Medical University Clinic, Kantonsspital Aarau & Medical Faculty of the University of Basel, Aarau, CH -5001, Switzerland.
| |
Collapse
|
79
|
Serum Procalcitonin Levels are Associated with Clinical Outcome in Intracerebral Hemorrhage. Cell Mol Neurobiol 2017; 38:727-733. [PMID: 28825209 DOI: 10.1007/s10571-017-0538-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/14/2017] [Indexed: 01/13/2023]
Abstract
Procalcitonin (PCT) has emerged as a new prognostic inflammatory marker in a variety of diseases. This study aimed to evaluate whether PCT is associated with increased risk of unfavorable outcome in intracerebral hemorrhage (ICH) patients. During January 2015-December 2016, we conducted a prospective cohort investigation involved 251 primary ICH patients who were admitted within 24 h after the onset of symptoms. We assessed serum PCT levels for all patients at admission. The functional outcome after 3 months was evaluated by modified Rankin Scale (mRS) and dichotomized as favorable (mRS 0-2) and unfavorable (mRS 3-6). The independent risk factors for unfavorable outcome and mortality after 3 months were examined by binary logistic regression. Of 251 ICH patients, the median PCT concentration was 0.053 µg/L (interquartile range 0.035-0.078 µg/L). Unfavorable outcome and mortality at 3 months were observed in 161 (64.1%) and 51 (20.3%) patients, respectively. After adjusting for potential confounders, patients with PCT levels in the top quartile (>0.078 ug/L), compared with the lowest quartile (<0.035 μg/L) were more likely to have a higher risk of poor functional outcome [odds ratio (OR) 7.341; 95% confidence interval (CI) 2.770-21.114; P = 0.001] and mortality (OR 7.483; 95% CI 1.871-24.458, P = 0.006). Furthermore, the area under the receiver operating characteristic curve of PCT showed 0.701 (95% CI 0.635-0.767) for worse functional prognosis, and 0.652 (95% CI 0.569-0.735) for mortality. This study demonstrated that elevated PCT levels at admission were independently associated with unfavorable clinical outcome in ICH patients.
Collapse
|
80
|
Pieralli F, Corbo L, Torrigiani A, Mannini D, Antonielli E, Mancini A, Corradi F, Arena F, Moggi Pignone A, Morettini A, Nozzoli C, Rossolini GM. Usefulness of procalcitonin in differentiating Candida and bacterial blood stream infections in critically ill septic patients outside the intensive care unit. Intern Emerg Med 2017; 12:629-635. [PMID: 28161884 DOI: 10.1007/s11739-017-1627-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/30/2017] [Indexed: 12/12/2022]
Abstract
We aimed to explore the role of procalcitonin (PCT) for the diagnosis of Candida spp. bloodstream infections in a population of critically ill septic patients admitted to internal medicine units. This is a retrospective case-control study considering all cases of candidemia identified in three internal medicine units, from January 1st 2012 to May 31st 2016. For each case of candidemia, two patients with bacteremic sepsis were included in the study as control cases. The end point of the study was to evaluate the diagnostic performance of PCT for the diagnosis of Candida spp. blood stream infections in patients with objectively documented sepsis. Sixty-four patients with candidemia and 128 controls with bacteremia were enrolled. Median and interquartile range (IQR) PCT values are significantly lower in patients with candidemia (0.73; IQR 0.26-1.85 ng/mL) than in those with bacteremia (4.48; IQR 1.10-18.26 ng/mL). At ROC curve analysis, values of PCT greater than 2.5 ng/mL had a negative predictive value (NPV) of 98.3% with an AUC of 0.76 (0.68-0.84 95% CI) for the identification of Candida spp. from blood cultures. At multivariate analysis, a PCT value <2.5 ng/mL showed an odds ratio of 8.57 (95% CI 3.09-23.70; p < 0.0001) for candidemia. In septic patients at risk of Candida infection, a PCT value lower than 2.5 ng/mL should raise the suspicion of candidemia, adding value for considering prompt initiation of antifungal therapy.
Collapse
Affiliation(s)
- Filippo Pieralli
- Internal Medicine Unit 1, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Lorenzo Corbo
- Internal Medicine Unit 1, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | | | - Dario Mannini
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Elisa Antonielli
- Internal Medicine Unit 1, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Antonio Mancini
- Internal Medicine Unit 1, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Corradi
- Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy
| | - Fabio Arena
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | | | - Carlo Nozzoli
- Internal Medicine Unit 1, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Gian Maria Rossolini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation, Florence, Italy
| |
Collapse
|
81
|
Wagner NM, Van Aken C, Butschkau A, Bierhansl L, Kellner P, Schleusener V, Seggewiss J, Vollmar B, Nöldge-Schomburg G, Roesner JP. Procalcitonin Impairs Endothelial Cell Function and Viability. Anesth Analg 2017; 124:836-845. [PMID: 27655274 DOI: 10.1213/ane.0000000000001574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Procalcitonin is used as a diagnostic tool for the identification and risk stratification of septic patients. Procalcitonin plasma concentrations tightly correlate with the severity of the ongoing inflammatory reaction and can rise up to 10,000-fold. Impairment of endothelial cell function plays an important role in the pathogenesis of hypotension and disturbed organ perfusion during sepsis. We investigated the possible effects of procalcitonin itself on endothelial cell function and viability. METHODS Human endothelial cells were exposed to 0.01 to 100 ng/mL procalcitonin and investigated for endothelial permeability using transwells, migration in a scratch wound assay and new capillary formation on extracellular matrix in vitro. Tumor necrosis factor-α and vascular endothelial growth factor served as positive controls. Procalcitonin's impact on the response of endothelial cells toward ischemia was investigated in vivo in the murine model of unilateral femoral artery ligation. Procalcitonin-exposed endothelial cells were subjected to immunoblot for the investigation of vascular endothelial-cadherin expression and angiogenic signaling pathways. Flow cytometry was used for the detection of inflammatory activation and viability, and genomic analysis was performed. Data are presented as difference in means and 95% confidence intervals; statistical analyses were performed using analysis of variance/Bonferroni, and P values are reported as adjusted for multiple comparisons (Padjust). RESULTS Tumor necrosis factor-α and 0.1 ng/mL procalcitonin induced endothelial barrier disruption after incubation of endothelial monolayers for 6 hours (-2.53 [-4.16 to -0.89], P = .0008 and -2.09 [-3.73 to -0.45], Padjust = .0064 compared with vehicle-treated control, respectively). Procalcitonin beginning at concentrations of 0.02 ng/mL reduced endothelial cell migration (0.26 [0.06 to 0.47], Padjust = .0069) and new capillary formation in vitro (0.47 [0.28 to 0.66], Padjust < .0001) contrasting the proangiogenic action of vascular endothelial growth factor. Left ventricular injection of procalcitonin in mice on postoperative day 1, 3, and 5 after induction of ischemia impaired new capillary formation and recovery of hindlimb perfusion in vivo (number of capillaries/mm in the ischemic leg of vehicle-treated versus procalcitonin-treated mice, 852.6 [383.4-1322], Padjust = .0002). Twenty-four-hour incubation with procalcitonin reduced the expression of vascular endothelial-cadherin at 100 ng/mL (0.39 [0.06-0.71], Padjust = .0167) and induced endothelial cell death (apoptosis, -5.4 [-10.67 to -0.13], Padjust = .0431). No alteration in the expression of intercellular adhesion molecule-1, vascular cell adhesion molecule-1 or extracellular signal-regulated kinase 1/2, and AKT signaling pathways was observed. Genomic analysis revealed regulation of a variety of genes involved in inflammation, angiogenesis, and cell growth. CONCLUSIONS This study found that procalcitonin itself impaired several aspects of endothelial cell function. Procalcitonin-induced loss of endothelial barrier function may contribute to capillary leakage and therapy-refractory hypotension during sepsis. Anti-angiogenic properties of procalcitonin at low concentrations could also identify procalcitonin as a mediator of vascular disease associated with the metabolic syndrome. Future studies are needed to further test procalcitonin as a potential therapeutic target for preserving vascular dysfunction during acute and chronic inflammatory disorders.
Collapse
Affiliation(s)
- Nana-Maria Wagner
- From the *Department of Anesthesiology and Critical Care Medicine and †Institute for Experimental Surgery, University Hospital Rostock, Rostock, Germany; ‡Department of Anesthesiology and Intensive Care, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck, Germany; §Molecular and Experimental Mycobacteriology, Research Center Borstel, Germany; and ‖Institute of Human Genetics, University Hospital Muenster, Muenster, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
82
|
Maiese A, Del Nonno F, Dell'Aquila M, Moauro M, Baiocchini A, Mastracchio A, Bolino G. Postmortem diagnosis of sepsis: A preliminary immunohistochemical study with an anti-procalcitonin antibody. Leg Med (Tokyo) 2017; 28:1-5. [PMID: 28728072 DOI: 10.1016/j.legalmed.2017.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Aniello Maiese
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy.
| | - Franca Del Nonno
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Marco Dell'Aquila
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy
| | - Mario Moauro
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Andrea Baiocchini
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Antonio Mastracchio
- Medical UOC Pathology Local Health Agency Rome/6, University of Rome "Tor Vergata", 00149 Rome, Italy
| | - Giorgio Bolino
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy
| |
Collapse
|
83
|
Elevated procalcitonin is associated with bacterial infection during acute liver failure only when unrelated to acetaminophen intoxication. Eur J Gastroenterol Hepatol 2017; 29:811-816. [PMID: 28272093 DOI: 10.1097/meg.0000000000000862] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM The aim of this study was to evaluate the accuracy of procalcitonin (PCT) in predicting bacterial infection and survival without transplantation upon admission in the ICU for acute liver failure (ALF). PATIENTS AND METHODS From January 2009 until October 2015, all cases of ALF patients admitted in our ICU were retrospectively reviewed and included in the study if the PCT level upon admission was available. Patients with pre-existing liver pathology or ALF in a context of already advanced multiorgan failure were excluded. The main clinical and biological characteristics of patients were recorded, as well as the etiology of ALF, diagnosis of bacterial infection (bacteriologically documented or suspected), and outcome. RESULTS 35 patients were included: 46% men, mean age 42 years, initial prothrombin ratio 31%, PCT 9.8 mg/l (0.7-49), and PCT more than 2 mg/l in 54% of cases. Etiology was acetaminophen intoxication in 18/35 (51%) cases. Sepsis was diagnosed in 9/35 (26%) cases, most frequently pneumonia with 4/9 cases. Survival without liver transplantation (LT) was observed in 28 (80%) cases. The median PCT was not different in patients with or without bacterial infection [6.3 mg/l (0.6-16) vs. 1.2 mg/l (0.8-9.7), P=0.8]. The median PCT was not different in patients who survived without LT [7.1 mg/l (0.9-16.1) vs. 0.75 mg/l (7.7-11.5), P=0.06]. In patients with ALF unrelated to acetaminophen intoxication, the median PCT was higher in patients with bacterial infection [1.1 mg/l (0.9-4) vs. 0.5 mg/l (0.3-0.8), P=0.01], but was similar in patients who did not survive without LT [0.7 mg/l (0.4-1.1) vs. 0.8 mg/l (0.4-2.2), P=0.6]. In the overall cohort, the median C-reactive protein (CRP) and leukocyte count were higher in patients who developed bacterial infection [40 mg/l (19-60) vs. 16 mg/l (6-34), P=0.04; 11.9 G/l (8.3-19) vs. 7.9 G/l (6-12.6), P=0.05]. The median CRP and leukocyte count were not significantly different in survivors versus nonsurvivors without LT. CONCLUSION PCT was an accurate predictor for the diagnosis of bacterial infection only in patients with ALF unrelated to acetaminophen intoxication. CRP was higher in patients who developed infection and could also be an interesting tool in ALF patients.
Collapse
|
84
|
Hill DM, Sinclair SE, Hickerson WL. Rational Selection and Use of Antimicrobials in Patients with Burn Injuries. Clin Plast Surg 2017; 44:521-534. [DOI: 10.1016/j.cps.2017.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
85
|
Kurtul A, Elcik D. Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease. Int J Cardiol 2017; 236:61-64. [DOI: 10.1016/j.ijcard.2017.02.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/11/2017] [Accepted: 02/19/2017] [Indexed: 12/18/2022]
|
86
|
Park JH, Suh DH, Kim HJ, Lee YI, Kwak IH, Choi GW. Role of procalcitonin in infected diabetic foot ulcer. Diabetes Res Clin Pract 2017; 128:51-57. [PMID: 28448892 DOI: 10.1016/j.diabres.2017.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 03/16/2017] [Accepted: 04/07/2017] [Indexed: 02/01/2023]
Abstract
AIMS Procalcitonin (PCT) has been recently accepted as a marker for diagnosing infection. The aim of the present study was to determine whether PCT levels are associated with infection severity of diabetic foot ulcers and whether PCT levels would be helpful to differentiate infected diabetic foot ulcer (IDFU) from IDFU associated with other infectious diseases (IDFU+O). METHODS We prospectively included 123 diabetic patients hospitalized for IDFU. Infection severity of diabetic foot ulcers was graded according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot clinical classification of diabetic foot infection. Chest radiograph, urinalysis, urine microscopy, urine culture, and blood cultures (if fever was present) were performed for all patients to diagnose other infectious diseases. Laboratory parameters were measured from blood venous samples. RESULTS PCT (Spearman's ρ=0.338, P<0.001) and C-reactive protein (Spearman's ρ=0.477, P<0.001) levels were significantly associated with infection severity of diabetic foot ulcers. However, only PCT levels could differentiate patients with associated infectious diseases from patients with no concomitant infection (area under the receiver-operator characteristic curve 0.869, P<0.0001; cut-off value 0.59; sensitivity 94.7; specificity 88.5). CONCLUSION PCT and CRP levels positively correlated with infection severity of diabetic foot ulcers and PCT levels>0.59ng/mL in patients with IDFU may be associated with other systemic bacterial infection.
Collapse
Affiliation(s)
- Jung Ho Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do 15355, South Korea
| | - Dong Hun Suh
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do 15355, South Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Yong In Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 61, Jinhwangdoro-gil, Gangdong-gu, Seoul 05368, South Korea
| | - Il Hoon Kwak
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do 15355, South Korea
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeonggi-do 15355, South Korea.
| |
Collapse
|
87
|
Schuetz P, Bretscher C, Bernasconi L, Mueller B. Overview of procalcitonin assays and procalcitonin-guided protocols for the management of patients with infections and sepsis. Expert Rev Mol Diagn 2017; 17:593-601. [DOI: 10.1080/14737159.2017.1324299] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
88
|
Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA, Runyon MS, Self WH, Courtney DM, Nowak RM, Gaieski DF, Ebmeyer S, Johannes S, Wiemer JC, Schwabe A, Shapiro NI. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med 2017; 45:781-789. [PMID: 28257335 PMCID: PMC5389588 DOI: 10.1097/ccm.0000000000002321] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. DESIGN Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-approved protocol. SETTING Thirteen U.S.-based emergency departments and ICUs. PATIENTS Consecutive patients meeting criteria for severe sepsis or septic shock who were admitted to the ICU from the emergency department, other wards, or directly from out of hospital were included. INTERVENTIONS Procalcitonin was measured daily over the first 5 days. MEASUREMENTS AND MAIN RESULTS The primary analysis of interest was the relationship between a procalcitonin decrease of more than 80% from baseline to day 4 and 28-day mortality using Cox proportional hazards regression. Among 858 enrolled patients, 646 patients were alive and in the hospital on day 4 and included in the main intention-to-diagnose analysis. The 28-day all-cause mortality was two-fold higher when procalcitonin did not show a decrease of more than 80% from baseline to day 4 (20% vs 10%; p = 0.001). This was confirmed as an independent predictor in Cox regression analysis (hazard ratio, 1.97 [95% CI, 1.18-3.30; p < 0.009]) after adjusting for demographics, Acute Physiology and Chronic Health Evaluation II, ICU residence on day 4, sepsis syndrome severity, antibiotic administration time, and other relevant confounders. CONCLUSIONS Results of this large, prospective multicenter U.S. study indicate that inability to decrease procalcitonin by more than 80% is a significant independent predictor of mortality and may aid in sepsis care.
Collapse
Affiliation(s)
- Philipp Schuetz
- 1Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; and Medical Faculty, University of Basel, Switzerland. 2Department of Emergency Medicine, New York Methodist Hospital, New York, NY. 3Emergency Departments, Sinai Grace Hospital and Detroit Receiving Hospital, Detroit, MI. 4Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS. 5Department of Emergency Medicine, Stony Brook University, Stony Brook, NY. 6Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC. 7Department of Emergency Medicine, Vanderbilt University, Nashville, TN. 8Department of Emergency Medicine, Northwestern University, Chicago, IL. 9Department of Emergency Medicine, Henry Ford Health System, Detroit, MI. 10Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA. 11Global Medical Affairs, B·R·A·H·M·S GmbH, Hennigsdorf, Germany. 12Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
89
|
Cousin VL, Lambert K, Trabelsi S, Galetto-Lacour A, Posfay-Barbe KM, Wildhaber BE, McLin VA. Procalcitonin for infections in the first week after pediatric liver transplantation. BMC Infect Dis 2017; 17:149. [PMID: 28201980 PMCID: PMC5311857 DOI: 10.1186/s12879-017-2234-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/31/2017] [Indexed: 01/05/2023] Open
Abstract
Background Procalcitonin (PCT) has become a commonly used serum inflammatory marker. Our aim was to describe the kinetics and usefulness of serial post-operative PCT measurements to detect bacterial infection in a cohort of children immediately after pediatric liver transplantation (pLT). Methods We performed a retrospective chart review of a cohort of pLT recipients with serial serum PCT measurements in the first week following pLT. The presence of infection was determined on clinical and biological parameters. Normal PCT was defined as < 0.5 (ng/ml). Results Thirty-nine patients underwent 41 pLT. PCT was measured daily during the first week post pLT. Values first increased following surgery and then decreased, nearing 0.5 ng/ml at day seven. Peak PCT reached a median of 5.61 ng/ml (IQR 3.83-10.8). Seventeen patients were considered to have an infection. There was no significant difference in daily PCT or peak PCT between infected and non infected patients during the first post-operative week. AUC of ROC curve for PCT during first week was never higher than 0.6. Conclusions We conclude that serial PCT measurements during the first week after pLT is not useful to identify patients with bacterial infections. Rather, we propose that serum PCT may be useful after the first week post pLT. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2234-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vladimir L Cousin
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Rue Willy-Donzé 6, 1211, Geneva, Switzerland.
| | | | | | | | - Klara M Posfay-Barbe
- Pediatric Infectious Disease Unit, Department of Pediatrics, University Hospitals Geneva & University of Geneva, Geneva, Switzerland
| | - Barbara E Wildhaber
- University Center of Pediatric Surgery of Western Switzerland, Division of Pediatric Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Valérie A McLin
- Pediatric Gastroenterology Unit, University Hospitals Geneva, Rue Willy-Donzé 6, 1211, Geneva, Switzerland
| |
Collapse
|
90
|
Procalcitonin Impairs Liver Cell Viability and Function In Vitro: A Potential New Mechanism of Liver Dysfunction and Failure during Sepsis? BIOMED RESEARCH INTERNATIONAL 2017; 2017:6130725. [PMID: 28255555 PMCID: PMC5309405 DOI: 10.1155/2017/6130725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 01/09/2023]
Abstract
Purpose. Liver dysfunction and failure are severe complications of sepsis and result in poor outcome and increased mortality. The underlying pathologic mechanisms of hepatocyte dysfunction and necrosis during sepsis are only incompletely understood. Here, we investigated whether procalcitonin, a biomarker of sepsis, modulates liver cell function and viability. Materials and Methods. Employing a previously characterized and patented biosensor system evaluating hepatocyte toxicity in vitro, human hepatocellular carcinoma cells (HepG2/C3A) were exposed to 0.01-50 ng/mL procalcitonin for 2 × 72 h and evaluated for proliferation, necrosis, metabolic activity, cellular integrity, microalbumin synthesis, and detoxification capacity. Acetaminophen served as positive control. For further standardization, procalcitonin effects were confirmed in a cellular toxicology assay panel employing L929 fibroblasts. Data were analyzed using ANOVA/Tukey's test. Results. Already at concentrations as low as 0.25 ng/mL, procalcitonin induced HepG2/C3A necrosis (P < 0.05) and reduced metabolic activity, cellular integrity, synthesis, and detoxification capacity (all P < 0.001). Comparable effects were obtained employing L929 fibroblasts. Conclusion. We provide evidence for procalcitonin to directly impair function and viability of human hepatocytes and exert general cytotoxicity in vitro. Therapeutical targeting of procalcitonin could thus display a novel approach to reduce incidence of liver dysfunction and failure during sepsis and lower morbidity and mortality of septic patients.
Collapse
|
91
|
Milić L, Grigorov I, Krstić S, Ćeranić MS, Jovanović B, Stevanović J, Peško P. Serum Level of HMGB1 Protein and Inflammatory Markers in Patients with Secondary Peritonitis: Time Course and the Association with Clinical Status. J Med Biochem 2017; 36:44-53. [PMID: 28680349 PMCID: PMC5471659 DOI: 10.1515/jomb-2016-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/12/2016] [Indexed: 01/09/2023] Open
Abstract
Background Intra-abdominal infection in secondary peritonitis drives as excessive production of inflammatory mediators and the development of systemic inflammatory response syndrome (SIRS) or sepsis. Finding a specific marker to distinguish SIRS from sepsis would be of immense clinical importance for the therapeutic approach. It is assumed that high-mobility group box 1 protein (HMGB1) could be such a marker. In this study, we examined the time course changes in the blood levels of HMGB1, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) in patients with secondary peritonitis who developed SIRS or sepsis. Methods In our study, we evaluated 100 patients with diffuse secondary peritonitis who developed SIRS or sepsis (SIRS and SEPSIS group) and 30 patients with inguinal hernia as a control group. Serum levels of HMGB1, CRP, PCT, and SAA were determined on admission in all the patients, and monitored daily in patients with peritonitis until discharge from hospital. Results Preoperative HMGB1, CRP, PCT and SAA levels were statistically highly significantly increased in patients with peritonitis compared to patients with inguinal hernia, and significantly higher in patients with sepsis compared to those with SIRS. All four inflammatory markers changed significantly during the follow-up. It is interesting that the patterns of change of HMGB1 and SAA over time were distinctive for SIRS and SEPSIS groups. Conclusions HMGB1 and SAA temporal patterns might be useful in distinguishing sepsis from noninfectious SIRS in secondary peritonitis.
Collapse
Affiliation(s)
- Ljiljana Milić
- Clinic for Emergency Surgery, Emergency Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Ilijana Grigorov
- Department of Molecular Biology, Institute for Biological Research, Belgrade, Serbia
| | - Slobodan Krstić
- Clinic for Emergency Surgery, Emergency Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Miljan S Ćeranić
- Clinic for Digestive Surgery, University Clinical Center of Belgrade, School of Medicine, University of Belgrade, Serbia
| | - Bojan Jovanović
- Center for Anesthesiology, Emergency Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Jelena Stevanović
- Department of Molecular Biology, Institute for Biological Research, Belgrade, Serbia
| | - Predrag Peško
- Clinic for Digestive Surgery, University Clinical Center of Belgrade, School of Medicine, University of Belgrade, Serbia
| |
Collapse
|
92
|
Procalcitonin: A new biomarker for the cardiologist. Int J Cardiol 2016; 223:390-397. [DOI: 10.1016/j.ijcard.2016.08.204] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 02/04/2023]
|
93
|
N'Diaye AR, Leclerc C, Kentache T, Hardouin J, Poc CD, Konto-Ghiorghi Y, Chevalier S, Lesouhaitier O, Feuilloley MGJ. Skin-bacteria communication: Involvement of the neurohormone Calcitonin Gene Related Peptide (CGRP) in the regulation of Staphylococcus epidermidis virulence. Sci Rep 2016; 6:35379. [PMID: 27739485 PMCID: PMC5064375 DOI: 10.1038/srep35379] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/23/2016] [Indexed: 02/08/2023] Open
Abstract
Staphylococci can sense Substance P (SP) in skin, but this molecule is generally released by nerve terminals along with another neuropeptide, Calcitonin Gene Related Peptide (CGRP). In this study, we investigated the effects of αCGRP on Staphylococci. CGRP induced a strong stimulation of Staphylococcus epidermidis virulence with a low threshold (<10−12 M) whereas Staphylococcus aureus was insensitive to CGRP. We observed that CGRP-treated S. epidermidis induced interleukin 8 release by keratinocytes. This effect was associated with an increase in cathelicidin LL37 secretion. S. epidermidis displayed no change in virulence factors secretion but showed marked differences in surface properties. After exposure to CGRP, the adherence of S. epidermidis to keratinocytes increased, whereas its internalization and biofilm formation activity were reduced. These effects were correlated with an increase in surface hydrophobicity. The DnaK chaperone was identified as the S. epidermidis CGRP-binding protein. We further showed that the effects of CGRP were blocked by gadolinium chloride (GdCl3), an inhibitor of MscL mechanosensitive channels. In addition, GdCl3 inhibited the membrane translocation of EfTu, the Substance P sensor. This work reveals that through interaction with specific sensors S. epidermidis integrates different skin signals and consequently adapts its virulence.
Collapse
Affiliation(s)
- Awa R N'Diaye
- Laboratory of Microbiology Signals and Microenvironnement, LMSM, EA 4312, Normandie Université, Evreux, France
| | - Camille Leclerc
- Laboratory of Microbiology Signals and Microenvironnement, LMSM, EA 4312, Normandie Université, Evreux, France
| | - Takfarinas Kentache
- Laboratory of Polymers, Biopolymers and Surfaces, CNRS UMR 6270, Normandie Université, Mont-Saint-Aignan, France
| | - Julie Hardouin
- Laboratory of Polymers, Biopolymers and Surfaces, CNRS UMR 6270, Normandie Université, Mont-Saint-Aignan, France
| | - Cecile Duclairoir Poc
- Laboratory of Microbiology Signals and Microenvironnement, LMSM, EA 4312, Normandie Université, Evreux, France
| | - Yoan Konto-Ghiorghi
- Laboratory of Microbiology Signals and Microenvironnement, LMSM, EA 4312, Normandie Université, Evreux, France
| | - Sylvie Chevalier
- Laboratory of Microbiology Signals and Microenvironnement, LMSM, EA 4312, Normandie Université, Evreux, France
| | - Olivier Lesouhaitier
- Laboratory of Microbiology Signals and Microenvironnement, LMSM, EA 4312, Normandie Université, Evreux, France
| | - Marc G J Feuilloley
- Laboratory of Microbiology Signals and Microenvironnement, LMSM, EA 4312, Normandie Université, Evreux, France
| |
Collapse
|
94
|
Tavares E, Antequera D, López-González I, Ferrer I, Miñano FJ, Carro E. Potential Role of Aminoprocalcitonin in the Pathogenesis of Alzheimer Disease. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:2723-35. [PMID: 27497681 DOI: 10.1016/j.ajpath.2016.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/25/2016] [Accepted: 06/09/2016] [Indexed: 11/15/2022]
Abstract
Increasing evidence suggests that inflammatory responses cause brain atrophy and play a prominent and early role in the progression of Alzheimer disease. Recent findings show that the neuroendocrine peptide aminoprocalcitonin (NPCT) plays a critical role in the development of systemic inflammatory response; however, the presence, possible function, regulation, and mechanisms by which NPCT may be involved in Alzheimer disease neuropathology remain unknown. We explored the expression of NPCT and its interaction with amyloid-β (Aβ), and proinflammatory and neurogenic effects. By using brain samples of Alzheimer disease patients and APP/PS1 transgenic mice, we evaluated the potential role of NPCT on Aβ-related pathology. We found that NPCT is expressed in hippocampal and cortical neurons and Aβ-induced up-regulation of NPCT expression. Peripherally administered antibodies against NPCT decreased microglial activation, decreased circulating levels of proinflammatory cytokines, and prevented Aβ-induced neurotoxicity in experimental models of Alzheimer disease. Remarkably, anti-NPTC therapy resulted in a significant improvement in the behavioral status of APP/PS1 mice. Our results indicate a central role of NPCT in Alzheimer disease pathogenesis and suggest NPCT as a potential biomarker and therapeutic target.
Collapse
Affiliation(s)
- Eva Tavares
- Clinical and Experimental Pharmacology Research Unit, Valme University Hospital, Seville, Spain.
| | - Desiree Antequera
- Group of Neurodegenerative Diseases, Instituto de Investigacion Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Neurodegenerative Diseases Biomedical Research Center (CIBERNED), Madrid, Spain
| | - Irene López-González
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Neurodegenerative Diseases Biomedical Research Center (CIBERNED), Madrid, Spain; Institut de Neuropatologia, IDIBELL-Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Hospitalet de Llobregat, Spain; Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Isidro Ferrer
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Neurodegenerative Diseases Biomedical Research Center (CIBERNED), Madrid, Spain; Institut de Neuropatologia, IDIBELL-Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Hospitalet de Llobregat, Spain; Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco J Miñano
- Clinical and Experimental Pharmacology Research Unit, Valme University Hospital, Seville, Spain; Department of Pharmacology, Pediatrics and Radiology, Faculty of Medicine, University of Seville, Seville, Spain
| | - Eva Carro
- Group of Neurodegenerative Diseases, Instituto de Investigacion Hospital 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Neurodegenerative Diseases Biomedical Research Center (CIBERNED), Madrid, Spain.
| |
Collapse
|
95
|
Mohammad RS, El-Sorougi WM, Eissa HH, Mohamed AS, Hassan KE. Effect of procalcitonin-guided therapy on antibiotic usage in the management of patients with chronic obstructive pulmonary disease with acute exacerbation. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.184376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
96
|
Qu J, Feng P, Luo Y, Lü X. Impact of hepatic function on serum procalcitonin for the diagnosis of bacterial infections in patients with chronic liver disease: A retrospective analysis of 324 cases. Medicine (Baltimore) 2016; 95:e4270. [PMID: 27472699 PMCID: PMC5265836 DOI: 10.1097/md.0000000000004270] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Although procalcitonin (PCT) is a valid marker for early diagnosis of bacterial infections, it is unclear whether its accuracy in predicting bacterial infections is affected by impaired liver function. This study aimed to assess the impact of compromised liver function on the diagnostic value of PCT.This retrospective study was conducted between January 2013 and May 2015. A total of 324 patients with chronic liver disease were enrolled. Routine laboratory measurements and PCT were performed. Patients were divided into 3 groups according to clinical diagnosis: chronic hepatitis (group 1), decompensated cirrhosis (group 2), and acute-on-chronic liver failure/chronic liver failure (group 3). The correlation between PCT and liver function was analyzed. The area under the receiver operating characteristic (AUCROC) curve of PCT was analyzed according to infection status and liver function.PCT was more accurate than white blood cell count (P < 0.001) and percentage of neutrophils (P < 0.001) in detecting bacterial infections in patients with impaired liver function. In patients without infection, PCT had a moderate positive correlation with serum total bilirubin (TBIL) (r = 0.592), and a weak correlation with model for end-stage liver disease score (r = 0.483) and international normalized ratio (r = 0.389). The AUCROC and optimum thresholds of PCT and for predicting bacterial infections at different levels of TBIL were 0.907 (95% CI 0.828-0.958) and 0.38 ng/mL, respectively, for TBIL <5 mg/dL, 0.927 (95% CI 0.844-0.974) and 0.54 ng/mL (5 mg/dL ≤TBIL<10 mg/dL), 0.914 (95% CI 0.820-0.968) and 0.61 ng/mL (10 mg/dL ≤TBIL<20 mg/dL), 0.906 (95% CI 0.826-0.958) and 0.94 ng/mL (TBIL ≥20 mg/dL), respectively.This study demonstrated that PCT was a valuable marker of bacterial infection in patients with chronic liver diseases. TBIL affected PCT threshold, so different cut-offs should be used according to different TBIL values.
Collapse
Affiliation(s)
| | | | - Yan Luo
- Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lü
- Center of Infectious Disease
- Correspondence: Xiaoju Lü, Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China (e-mail: )
| |
Collapse
|
97
|
Kim J, Kim SE, Park BS, Shin KJ, Ha SY, Park J, Kim SE, Park KM. Procalcitonin as a Diagnostic and Prognostic Factor for Tuberculosis Meningitis. J Clin Neurol 2016; 12:332-9. [PMID: 27165424 PMCID: PMC4960218 DOI: 10.3988/jcn.2016.12.3.332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose We investigated the potential role of serum procalcitonin in differentiating tuberculosis meningitis from bacterial and viral meningitis, and in predicting the prognosis of tuberculosis meningitis. Methods This was a retrospective study of 26 patients with tuberculosis meningitis. In addition, 70 patients with bacterial meningitis and 49 patients with viral meningitis were included as the disease control groups for comparison. The serum procalcitonin level was measured in all patients at admission. Differences in demographic and laboratory data, including the procalcitonin level, were analyzed among the three groups. In addition, we analyzed the predictive factors for a prognosis of tuberculosis meningitis using the Glasgow Coma Scale (GCS) at discharge, and the correlation between the level of procalcitonin and the GCS score at discharge. Results Multiple logistic regression analysis showed that a low level of procalcitonin (≤1.27 ng/mL) independently distinguished tuberculosis meningitis from bacterial meningitis. The sensitivity and specificity for distinguishing tuberculosis meningitis from bacterial meningitis were 96.2% and 62.9%, respectively. However, the level of procalcitonin in patients with tuberculosis meningitis did not differ significantly from that in patients with viral meningitis. In patients with tuberculosis meningitis, a high level of procalcitonin (>0.4 ng/mL) was a predictor of a poor prognosis, and the level of procalcitonin was negatively correlated with the GCS score at discharge (r=-0.437, p=0.026). Conclusions We found that serum procalcitonin is a useful marker for differentiating tuberculosis meningitis from bacterial meningitis and is also valuable for predicting the prognosis of tuberculosis meningitis.
Collapse
Affiliation(s)
- Jinseung Kim
- Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sam Yeol Ha
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
| |
Collapse
|
98
|
Schuetz P, Mueller B. Procalcitonin: An Effective Screening Tool and Safe Therapeutic Decisionmaking Aid for Emergency Department Patients With Suspected Sepsis. Ann Emerg Med 2016; 66:318-9. [PMID: 26304251 DOI: 10.1016/j.annemergmed.2015.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Philipp Schuetz
- Medical University Department, Internal Medicine and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Internal Medicine and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
99
|
Landman GWD, Kleefstra N, Groenier KH, Bakker SJL, Groeneveld GH, Bilo HJG, van Hateren KJJ. Inflammation biomarkers and mortality prediction in patients with type 2 diabetes (ZODIAC-27). Atherosclerosis 2016; 250:46-51. [PMID: 27179179 DOI: 10.1016/j.atherosclerosis.2016.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/19/2016] [Accepted: 04/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (MR-proADM) are inflammation markers associated with long-term mortality risk. We compared the associations and predictive capacities of CRP, PCT and MR-proADM with cardiovascular and all-cause mortality in patients with type 2 diabetes. METHODS This study included primary care treated patients with type 2 diabetes participating in the ZODIAC cohort study. A total of 1005 out of 1688 patients (60%) had complete baseline variables. Baseline CRP, PCT and MR-proADM were assessed in relation to cardiovascular and all-cause mortality with Cox proportional hazard analyses. Hazard Ratios (HR) were adjusted for age, gender, BMI, smoking, systolic blood pressure, cholesterol-HDL ratio, duration of diabetes, HbA1c, history of cardiovascular diseases, albumin-creatinine ratio and creatinine. Risk prediction capabilities were assessed with Harrell's C statistics and proportion of explained variance (R(2)). RESULTS After a median follow-up of 11 years, 472 (47%) of 1005 patients had died. The likelihood ratio test showed that CRP and MR-proADM significantly improved prediction in cardiovascular mortality [HRs 1.20 (95%CI 1.09-1.33) and 1.56 (95%CI 1.06-2.30)] and in all-cause mortality [HRs 1.10 (95%CI: 1.03-1.18) and 1.31 (95%CI 1.02-1.69)]. Harrell's C values and R(2) measures showed slightly improved discrimination for cardiovascular mortality in patients without macrovascular disease (C: 0.80 to 0.81; R(2): 0.50 to 0.52) and MR-proADM (C: 0.80 to 0.82; R(2): 0.50 to 0.52). CONCLUSIONS CRP and MR-proADM, but not PCT, were independently associated with cardiovascular and all-cause mortality. In patients without macrovascular diseases, CRP and MR-proADM slightly improved discrimination, in absolute sense, of patients at risk for cardiovascular mortality.
Collapse
Affiliation(s)
- Gijs W D Landman
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
| | - Nanne Kleefstra
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geert H Groeneveld
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
| | | |
Collapse
|
100
|
Schuetz P, Müeller B. Procalcitonin in critically ill patients: time to change guidelines and antibiotic use in practice. THE LANCET. INFECTIOUS DISEASES 2016; 16:758-760. [PMID: 26947524 DOI: 10.1016/s1473-3099(16)00064-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Philipp Schuetz
- University of Basel, Medical University Department, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland.
| | - Beat Müeller
- University of Basel, Medical University Department, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland
| |
Collapse
|