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Nadir Y, Kiran P, Erturk D, Barut HS, Degirmenci M, Karabulut SS, Senger SS. Optimal cut-off value of procalcitonin and procalcitonin/albumin ratio for predicting bacteremia among patients living with cancer: a test-negative case-control study. Curr Med Res Opin 2024; 40:1179-1185. [PMID: 38814135 DOI: 10.1080/03007995.2024.2362274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/24/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE The occurrence of bacteremia is critically important for the survival of cancer patients. Therefore, our study aims to evaluate the efficacy of procalcitonin (PCT) and the procalcitonin to albumin ratio (PAR) in predicting bacteremia among this population. METHODS In this retrospective test-negative case-control study, we included 903 hospitalized cancer patients, divided into two groups: the bacteremia-positive group (BSI group, n = 384) and the bacteremia-negative group (non-BSI group, n = 519). We assessed the diagnostic significance of PCT and PAR through receiver operating characteristic (ROC) analysis and determined the optimal cut-off values using Youden's index. RESULTS Both the duration of hospital stay and the 30-day mortality rate were significantly higher in the BSI group. The areas under the curve (AUC) for PAR and PCT were 0.749 (95% CI: 0.715-0.782) and 0.742 (95% CI: 0.708-0.776), respectively, indicating higher levels in the BSI group. The optimal cut-off values for predicting bacteremia were 0.72 for PAR and 1.32 for PCT. PAR showed the highest specificity (92.7%) and positive predictive value (PPV = 83.4%), while PCT demonstrated the highest sensitivity (51.3%) and negative predictive value (NPV = 71.6%). DISCUSSION This study is the first in the literature to suggest that PAR and PCT are valuable biomarkers for diagnosing bacteremia in cancer patients. The identified cut-off values offer practical thresholds for bacteremia diagnosis.
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Affiliation(s)
- Yasemin Nadir
- Izmir Provincial Health Directorate, Tepecik Training and Research Hospital, Izmir University of Health Sciences, Izmir, Turkey
| | - Pinar Kiran
- Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Damla Erturk
- Izmir Provincial Health Directorate, Tepecik Training and Research Hospital, Izmir University of Health Sciences, Izmir, Turkey
| | - Huseyin Sener Barut
- Izmir Provincial Health Directorate, Tepecik Training and Research Hospital, Izmir University of Health Sciences, Izmir, Turkey
| | - Mustafa Degirmenci
- Izmir Provincial Health Directorate, Tepecik Training and Research Hospital, Izmir University of Health Sciences, Izmir, Turkey
| | - Sevim Selen Karabulut
- Izmir Provincial Health Directorate, Tepecik Training and Research Hospital, Izmir University of Health Sciences, Izmir, Turkey
| | - Suheyla Serin Senger
- Izmir Provincial Health Directorate, Tepecik Training and Research Hospital, Izmir University of Health Sciences, Izmir, Turkey
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Agnello L, Vidali M, Ciaccio AM, Lo Sasso B, Iacona A, Biundo G, Scazzone C, Gambino CM, Ciaccio M. A machine learning strategy to mitigate the inappropriateness of procalcitonin request in clinical practice. Heliyon 2024; 10:e26556. [PMID: 38444484 PMCID: PMC10912224 DOI: 10.1016/j.heliyon.2024.e26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Aim The aim of this study was to develop machine learning (ML) models to mitigate the inappropriate request of Procalcitonin (PCT) in clinical wards. Material and methods We built six different ML models based on both demographical data, i.e., sex and age, and laboratory parameters, i.e., cell blood count (CBC) parameters, inclusive of monocyte distribution width (MDW), and C-reactive protein (CRP). The dataset included 1667 PCT measurements of different patients. Based on a PCT cut-off of 0.50 ng/mL, we found 1090 negative (65.4%) and 577 positive (34.6%) results. We performed a 70:15:15 train:validation:test splitting based on the outcome. Results Random Forest, Support Vector Machine and eXtreme Gradient Boosting showed optimal performances for predicting PCT positivity, with an area under the curve ranging from 0.88 to 0.89. Conclusions The ML models developed could represent a useful tool to predict PCT positivity, avoiding unusefulness PCT requests. ML models are based on laboratory tests commonly ordered together with PCT but have the great advantage to be easy to measure and low-cost.
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Affiliation(s)
- Luisa Agnello
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
| | - Matteo Vidali
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Anna Maria Ciaccio
- Internal Medicine and Medical Specialties “G. D'Alessandro”, Department of Health Promotion, Maternal and Infant Care, University of Palermo, 90127, Palermo, Italy
| | - Bruna Lo Sasso
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Alessandro Iacona
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Giuseppe Biundo
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Concetta Scazzone
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
| | - Caterina Maria Gambino
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
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Zhou Y, Wang X, Yuan H, Wu L, Zhang B, Chen X, Zhang Y. Impact of recombinant human brain natriuretic peptide on emergency dialysis and prognosis in end-stage renal disease patients with type 4 cardiorenal syndrome. Sci Rep 2023; 13:20752. [PMID: 38007545 PMCID: PMC10676370 DOI: 10.1038/s41598-023-48125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023] Open
Abstract
Recombinant human brain natriuretic peptide (rhBNP) effects on type 4 cardiorenal syndrome (CRS) and adverse events such as heart failure rehospitalization and all-cause mortality have not been assessed in large-scale research. This study evaluated the impact of rhBNP on emergency dialysis and prognosis in end-stage renal disease (ESRD) patients with type 4 CRS, and the risk factors of emergency dialysis. This retrospective cohort study included patients with type 4 CRS and ESRD admitted for decompensated heart failure between January 2016 and December 2021. Patients were divided into the rhBNP and non-rhBNP cohorts, according to whether they were prescribed rhBNP. The primary outcomes were emergency dialysis at first admission and cardiovascular events within a month after discharge. A total of 77 patients were included in the rhBNP cohort (49 males and 28 females, median age 67) and 79 in the non-rhBNP cohort (47 males and 32 females, median age 68). After adjusting for age, residual renal function, and primary diseases, Cox regression analysis showed that rhBNP was associated with emergency dialysis (HR = 0.633, 95% CI 0.420-0.953) and cardiovascular events (HR = 0.410, 95% CI 0.159-0.958). In addition, multivariate logistic regression analysis showed that estimated glomerular filtration rate (eGFR) (OR = 0.782, 95% CI 0.667-0.917, P = 0.002) and procalcitonin (PCT) levels (OR = 1.788, 95% CI 1.193-2.680, P = 0.005) at the first visit were independent risk factors for emergency dialysis while using rhBNP was a protective factor for emergency dialysis (OR = 0.195, 95% CI 0.084-0.451, P < 0.001). This study suggests that RhBNP can improve cardiac function and reduce the occurrence of emergency dialysis and cardiovascular events in ESRD patients with type 4 CRS.
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Affiliation(s)
- Yue Zhou
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Xiaojian Wang
- Department of Nephrology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China
| | - Hongbo Yuan
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Linke Wu
- Department of Respiratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Bin Zhang
- Department of Cardiology, Nanjing Yuhua Hospital, Nanjing, 210039, China
| | - Xiaoxia Chen
- Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yafeng Zhang
- Department of Public Health, Affiliated Hospital of Jiangsu University, Zhenjiang, 212003, China.
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Radulescu D, Cuiban E, Vacaroiu IA. Unusual Extreme Leukocytosis in Metformin Overdose. MAEDICA 2023; 18:357-362. [PMID: 37588821 PMCID: PMC10427101 DOI: 10.26574/maedica.2023.18.2.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
We present the challenging differential diagnosis of an extreme leukocytosis noted at hospital admission of a patient with severe lactic acidosis and acute kidney injury secondary to metformin overdose. Laboratory and imaging work-up ruled out an infectious or malignant cause for severely increased leukocytes count; thus, it was established that the process of leukocyte demargination was the main cause of increased count of leukocytes. Discussion of available literature data is also presented. Our case report highlights the importance for clinicians to be aware of this possible spurious increase of leukocytes in acute non-infectious stressful conditions in order to avoid unnecessary antibiotics.
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Affiliation(s)
- Daniela Radulescu
- Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Elena Cuiban
- Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Sf. Ioan Department of Nephrology and Dialysis, Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Ileana Adela Vacaroiu
- Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Sf. Ioan Department of Nephrology and Dialysis, Emergency Clinical Hospital, 421422 Bucharest, Romania
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Antimicrobial Stewardship Techniques for Critically Ill Patients with Pneumonia. Antibiotics (Basel) 2023; 12:antibiotics12020295. [PMID: 36830205 PMCID: PMC9952097 DOI: 10.3390/antibiotics12020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Pneumonia is common in the intensive care unit (ICU), infecting 27% of all critically ill patients. Given the high prevalence of this disease state in the ICU, optimizing antimicrobial therapy while minimizing toxicities is of utmost importance. Inappropriate antimicrobial use can increase the risk of antimicrobial resistance, Clostridiodes difficile infection, allergic reaction, and other complications from antimicrobial use (e.g., QTc prolongation, thrombocytopenia). This review article aims to discuss methods to optimize antimicrobial treatment in patients with pneumonia, including the following: procalcitonin use, utilization of methicillin-resistant Staphylococcus aureus nares testing to determine need for vancomycin therapy, utilization of the Biofire® FilmArray® pneumonia polymerase chain reaction (PCR), and microbiology reporting techniques.
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Alubaidi G, Humadi Y, Hamoodi D, Mahdi H, Anid B, Jasim IA, Abdalfatah IM. Serum Interleukin-6 is associated with hypocalcemia, hypoferritinemia and hyperkalemia in end-stage renal disease patients. ITALIAN JOURNAL OF MEDICINE 2023. [DOI: 10.4081/itjm.2022.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Both of chronic inflammation and mineral disturbance are major concerns in patients with chronic kidney disease, particularly end-stage renal disease (ESRD). Objectives: The present study aimed to investigate the association between circulating IL-6 and minerals dysregulation in patients diagnosed with ESRF and on a continuous hemodialysis regimen. Methods: This cross-sectional study included 74 patients undergoing continuous hemodialysis. Serum samples were tested for IL-6 using an enzyme-linked immunosorbent assay. Mineral were analyzed using an electrolyte analyzer and biochemical tests. Parameter correlations were analyzed using the Pearson’s correlation test. Results: Among the studies group, the male: female ratio was 1:0.72. IL-6 mean value was 13.77 pg/ml ±9.79 SD. IL-6 was significantly negatively correlated with circulating iron and calcium levels (r= - 0.229, P= 0.049; r= -0.252, P= 0.03, respectively). IL-6 was significantly positively correlated with K+ levels (r= 0.269,P= 0.02). Conclusion: The present study highlighted the substantial role of IL-6 in mineral dysregulation in hemodialysis patients, highlighting this cytokine as a potential therapeutic target for minimizing and monitoring the clinical effects of mineral disturbances, including cardiovascular and neurological complications.
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Ferritin and procalcitonin in COVID-19 associated acute kidney injury – gender disparities, but similar outcomes. REV ROMANA MED LAB 2023. [DOI: 10.2478/rrlm-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Abstract
Background: Acute kidney injury is a severe complication of COVID-19. Both COVID-19 and related acute kidney injury are reported in the literature to be more prevalent and more severe in males.
Methods: We performed a retrospective analysis of the COVID-19 associated acute kidney injury cases in order to search for differences between genders regarding patients’ and renal outcome.
Results: 250 patients with acute kidney injury were included in the study: 93 women (37.20%), 157 men (62.80%). There were no differences between sexes regarding age. Diabetes mellitus was significantly more present in women. Peak ferritin and procalcitonin levels were significantly higher in men, but other severity markers for COVID-19 did not differ between genders. There were no differences between sexes regarding history of chronic kidney disease, timing of acute kidney injury, need for dialysis or recovery of renal function. ICU admission and in-hospital mortality were similar between men and women.
Conclusions: In our study, COVID-19 related-AKI was more prevalent in men than in women, but the patients’ and renal outcome were similar. Significantly higher ferritin and procalcitonin serum levels registered in male patients when compared to women may have additional explanations beside more severe SARS-CoV-2 infection in males.
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Nešković N, Drenjančević D, Kvolik S, Škiljić S, Budrovac D, Drenjančević IH. Predictive role of selected biomarkers in differentiating gram-positive from gram-negative sepsis in surgical patients: a retrospective study. Anaesthesiol Intensive Ther 2023; 55:319-325. [PMID: 38282497 PMCID: PMC10801538 DOI: 10.5114/ait.2023.134214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/09/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients. MATERIAL AND METHODS A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days. RESULTS Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes. CONCLUSIONS PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.
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Affiliation(s)
- Nenad Nešković
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Domagoj Drenjančević
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
- Department of Clinical Microbiology and Hospital Infections, Osijek University Hospital, Croatia
| | - Slavica Kvolik
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Sonja Škiljić
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Dino Budrovac
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
| | - Ivana Haršanji Drenjančević
- Department of Anaesthesiology, Resuscitation, and Intensive Care, Osijek University Hospital, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer Osijek, Croatia
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Luo P, Long Y, Ma L, Tao Y, Gou S. The Sustained and Marked Elevation of Serum Procalcitonin in a Hemodialysis Patient with Tuberculous Lymphadenitis, but Without the Evidence of Sepsis: A Case Report. Infect Drug Resist 2022; 15:5161-5166. [PMID: 36082243 PMCID: PMC9447446 DOI: 10.2147/idr.s378894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background The elevation of serum procalcitonin (PCT) has been considered as a marker of systemic bacterial infection and sepsis. However, the marked elevation of PCT in non-sepsis conditions was rare. Here, we report a rare case of sustained markedly elevation of serum PCT in a dialysis patient with tuberculosis, but without the evidence of sepsis. Case Presentation A 25-year-old man on maintenance hemodialysis was admitted to the hospital for kidney transplantation. On admission, physical examination revealed multiple lymph nodes were palpable on both sides of the neck which was later confirmed as tuberculosis with biopsy pathology. On the 3rd day after admission, the patient suffered from fever with a temperature of 38.8°C. The white blood cells 12.35 × 109/L and the PCT level was 5.73 ng/mL. Lately the PCT increased to 63.10 ng/mL, and the level of C-reactive protein was 186.00 mg/L. After the antibiotics upgraded from cefmetazole to meropenem, and vancomycin was added, the body temperature dropped to the normal range on the 17th day and remained normal thereafter. The PCT level declined gradually to 4.18 ng/mL on the 21st day and an antituberculosis regimen was started. After that, the PCT levels fluctuated between 2.9 ng/mL and 94.9 ng/mL without any manifestation of sepsis. The markedly elevation of serum PCT level persisted despite normal C-reactive protein level and leukocyte counts. Conclusion Persistently elevated serum PCT level might occur in conditions without evidence of sepsis. Taking consideration of multiple inflammatory factors to determine infection when the markedly elevated PCT level was not correlated with the clinical manifestations.
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Affiliation(s)
- Peiyi Luo
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Yanqiong Long
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Liang Ma
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Ye Tao
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
- Correspondence: Ye Tao; Shenju Gou, Department of Nephrology, West China Hospital of Sichuan University, Chengdu, 610041, People’s Republic of China, Tel/Fax +86-28-85423341, Email ;
| | - Shenju Gou
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
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A retrospective cohort study of the effect of rapid versus delayed-result procalcitonin testing on antibiotic use at a community hospital. Int J Clin Pharm 2022; 44:1188-1194. [PMID: 35947325 DOI: 10.1007/s11096-022-01462-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Procalcitonin is a serum biomarker used to distinguish bacterial infection from viral or noninfectious syndromes. Primary literature shows mixed data on use of procalcitonin for de-escalation of antimicrobials. Delays in test results of send-out procalcitonin assays may result in prolonged antimicrobial durations. It is unknown whether availability of rapid-result assays may shorten time to antibiotic de-escalation. AIM This retrospective, cohort study compared antibiotic durations of treatment between groups with rapid-result versus delayed send-out, procalcitonin test modality. This study was exempt from Ethics Committee Approval, as determined by the Institutional Review Board at the study site. METHOD Adult hospitalized patients were included if they had at least one procalcitonin test performed during the study period. The primary outcome compared mean duration of antimicrobial therapy between groups receiving a rapid-result procalcitonin test and a send-out test. Secondary outcomes included incidence of Clostridiodes difficile infection, mention of procalcitonin testing in the electronic medical record in reference to antimicrobial therapy decision making, and presence of comorbidities which affect procalcitonin levels independent of infection. RESULTS A total of 350 lab results were analyzed. The duration of antimicrobial treatment between groups was not statistically different with the median duration of treatment in the send-out group being 2.95 days compared to 3.35 in the rapid result group, p = 0.856. Patient comorbidities with potential to lead to a noninfectious elevation or falsely high level of procalcitonin were common. CONCLUSION Use of a rapid-result procalcitonin assay does not reduce hospital antimicrobial therapy duration as compared with send-out testing.
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Osamura Y, Nishiyama H, Hattori T, Gunji M, Yuasa N. Clinico-bacterial and prognostic factors in patients with suspected blood stream infection and elevated serum procalcitonin levels. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:230-246. [PMID: 35967939 PMCID: PMC9350570 DOI: 10.18999/nagjms.84.2.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
This study determined prognostic factors by comparing clinico-bacterial factors based on significant elevated serum procalcitonin levels in patients with suspected bloodstream infection (BSI). We retrospectively analyzed the medical records of 1,052 patients (age ≥16 years) with fever (temperature ≥38°C) and serum procalcitonin levels of ≥2.0 ng/mL, and blood culture results. The optimal cutoff value of the significant elevation of procalcitonin was determined using the minimum P-value approach. Clinico-bacterial factors were analyzed per the procalcitonin levels, and significant independent factors for short-term survival were investigated in 445 patients with BSI. Patients with suspected BSI were aged, on average, 72.3 ± 15.1 years, and the incidence of positive blood culture was 42.3%; and the 14-day survival was 83.4%. Procalcitonin ≥100 ng/mL was the most significant predictor for survival. Multivariate analysis in patients with suspected BSI showed that estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 and procalcitonin ≥100 ng/mL were significant independent unfavorable prognostic factors. Microorganisms were similar between patients with procalcitonin level 2-99 ng/mL (n=359) and those with ≥100 ng/mL (n=86). Multivariate analysis in patients with BSI showed that eGFR <30 mL/min/1.73 m2, procalcitonin ≥100 ng/mL, and primary infectious foci were significant independent prognostic factors. Patients with foci in the gastrointestinal tract and respiratory system had unfavorable 14-day survival. In conclusions, eGFR <30 mL/min/1.73 m2 and procalcitonin ≥100 ng/mL were significant independent unfavorable prognostic factors for suspected BSI. Primary infectious foci (gastrointestinal tract and respiratory system) were associated with unfavorable short-term survival in patients with positive blood culture.
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Affiliation(s)
- Yoko Osamura
- Department of Clinical Laboratory, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hideki Nishiyama
- Department of Clinical Laboratory, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Takuya Hattori
- Department of Clinical Laboratory, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Masaharu Gunji
- Department of Clinical Laboratory, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Norihiro Yuasa
- Department of Clinical Laboratory, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
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Mouche A, Parmentier C, Herbez Rea C, Kwon T, Boyer O, Delbet JD, Ulinski T. Procalcitonin serum levels in stage 5 chronic kidney disease children on hemodialysis. Pediatr Nephrol 2021; 36:2405-2409. [PMID: 33730285 DOI: 10.1007/s00467-021-04966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/10/2021] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infections are responsible for morbidity and mortality in children on hemodialysis (HD). Procalcitonin (PCT) is rarely used in this population, even though it is an efficient biomarker of infection and sepsis. Our aim was to study PCT baseline level in uninfected children with stage 5 chronic kidney disease (CKD 5) on HD, and determine how to use it in this population. METHODS Prospective observational study including 40 uninfected children on classical HD or hemodiafiltration (HDF) in three pediatric HD centers in the Paris region. PCT was monitored before and after three consecutive sessions within 1 week. RESULTS Median pre-dialysis PCT was 0.60 ng/mL [0.36-1.15], median post-dialysis PCT was 0.23 ng/mL [0.10-0.47], PCT reduction rate was 59.8% [37.5-75.8]. Seventy percent of pre-dialysis PCT were <1 ng/mL. Anuric patients had higher pre-dialysis PCT than those with residual urine output (0.70 [0.42-1.30] vs. 0.48 [0.30-0.93] ng/mL, p=0.01). HDF was more efficient than HD to clear PCT during sessions (reduction rate 75% [67-80] vs. 37 [31-50]), p<0.001). CONCLUSION PCT levels in pediatric HD patients without infection are higher than normal, but this increase is relatively moderate compared to massive increases of PCT in children with bacterial infections on HD. If PCT is measured after dialysis sessions, the specific technique-dependent reduction rates should be taken into consideration. Moderately increased PCT levels around 2 ng/ml should be interpreted with caution; however, higher PCT serum levels can be used to motivate rapid start of antibiotic treatment in pediatric HD patients.
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Affiliation(s)
- Antoine Mouche
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France
| | - Cyrielle Parmentier
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Claire Herbez Rea
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Thérèsa Kwon
- Pediatric Nephrology Unit, Robert Debré Hospital, APHP, Paris, France
| | - Olivia Boyer
- Pediatric Nephrology Unit, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Jean Daniel Delbet
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France
| | - Tim Ulinski
- Pediatric Nephrology Unit, Armand Trousseau Hospital, APHP, DMU Origyne, Sorbonne Université, 75012, Paris, France. .,Sorbonne Université, Paris, France.
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13
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Heilmann E, Gregoriano C, Wirz Y, Luyt CE, Wolff M, Chastre J, Tubach F, Christ-Crain M, Bouadma L, Annane D, Damas P, Kristoffersen KB, Oliveira CF, Stolz D, Tamm M, de Jong E, Reinhart K, Shehabi Y, Verduri A, Nobre V, Nijsten M, deLange DW, van Oers JAH, Beishuizen A, Girbes ARJ, Mueller B, Schuetz P. Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials. Clin Chem Lab Med 2020; 59:441-453. [PMID: 32986609 DOI: 10.1515/cclm-2020-0931] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/31/2020] [Indexed: 12/25/2022]
Abstract
Objectives Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission. Methods We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15-89 [CKD 2-4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality. Results Mean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to control patients (n=2,510) (9.5-7.6 days; adjusted difference in days -2.01 [95% CI, -2.45 to -1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6 days [95% CI -3.59 to -1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p interaction >0.05). Conclusions This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.
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Affiliation(s)
- Eva Heilmann
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Yannick Wirz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), 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 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Florence Tubach
- Département d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetology and Clinical Nutrition, 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
| | - Djillali Annane
- Department of Critical Care, Hyperbaric Medicine and Home Respiratory Unit, Center for Neuromuscular Diseases, Raymond Poincaré Hospital (AP-HP), Garches, France
| | - Pierre Damas
- Department of General Intensive Care, University Hospital of Liege, Domaine universitaire de Liège, Liege, Belgium
| | | | - Carolina F Oliveira
- Department of Internal Medicine, School of Medcine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Daiana Stolz
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Evelien de Jong
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Yahya Shehabi
- Critical Care and Peri-operative Medicine, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alessia Verduri
- Department of Medical and Surgical Sciences,Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Vandack Nobre
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maarten Nijsten
- University Medical Centre, University of Groningen, Groningen, The Netherlands
| | | | | | | | - Armand R J Girbes
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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14
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Chen Z, Lin L, Yang W, Chen N, Lin Y. Clinical characteristics and prognostic risk factors of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). Int Immunopharmacol 2020; 87:106819. [PMID: 32717565 DOI: 10.1016/j.intimp.2020.106819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The complement alternative pathway is involved in the development of AVV. Several studies showed that AVV patients with low serum complement C3 (sC3) levels tend to have a poor prognosis. The aim of this study was to determine whether low sC3 measured at AAV onset is a risk factor for survival prognosis in patients with AVV, and further identified other potential risk factors for predicting patient survival prognosis. METHODS A retrospective analysis of 52 newly onset AAV patients was performed. The clinical parameters of the AAV patients were collected. The laboratory parameters before immunosuppressive treatment were evaluated. According to the level of sC3, the patients were divided into low sC3 group (n = 19) and normal sC3 group (n = 33). Disease outcome measures included end-stage renal disease (ESRD) or death. The clinical parameters and survival rate between the two groups were compared. Spearson correlation analysis was used to analyze the correlation between sC3 and other laboratory parameters. RESULTS Significant differences were found regarding Birmingham Vasculitis Activity Score (BVAS), sC3, sC4, lactate dehydrogenase, blood urea nitrogen, procalcitonin (PCT), and estimated glomerular filtration rate (eGFR) between the two groups (p = 0.006, 0.000, 0.001, 0.049, 0.019, 0.000 and 0.045, respectively). The survival rate of the low sC3 group was significantly lower than that of the normal sC3 group (Log Rank Chi-square = 4.416, P = 0.036). Low sC3 was significantly associated with lower sC4 (r = 0.570, P = 0.000), lower serum albumin (r = 0.311, P = 0.025), lower eGFR (r = 0.289, P = 0.037), higher PCT (r = -0.566, P = 0.000), and higher lactate dehydrogenase (r = -0.323, P = 0.019). CONCLUSION This retrospective study demonstrates that AAV patients with low sC3 level at diagnosis tend to have lower baseline eGFR and poorer survival prognosis than those of the normal sC3 level. Furthermore, the high procalcitonin (PCT), low serum albumin and high lactate dehydrogenase in AVV patients may be predictors of poor prognosis.
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Affiliation(s)
- Zhufeng Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China; Department of Internal Medicine, Fujian Provincial Hospital, Jinshan Branch, Fuzhou, Fujian Province, China
| | - Leng Lin
- Department of Internal Medicine, Fujian Provincial Hospital, Jinshan Branch, Fuzhou, Fujian Province, China
| | - Wentao Yang
- Department of Internal Medicine, Fujian Provincial Hospital, Jinshan Branch, Fuzhou, Fujian Province, China
| | - Ning Chen
- Department of Internal Medicine, Fujian Provincial Hospital, Jinshan Branch, Fuzhou, Fujian Province, China
| | - Youcheng Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China; Department of Urology, Fujian Provincial Hospital, Jinshan Branch, Fuzhou, Fujian Province, China.
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15
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Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients. J Clin Med 2020; 9:jcm9061939. [PMID: 32575833 PMCID: PMC7355446 DOI: 10.3390/jcm9061939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/29/2022] Open
Abstract
It is unclear whether serum procalcitonin (PCT) levels rise in patients with acute kidney injury (AKI), and it is also unclear whether the elevation of PCT levels in this setting is independent of the existence of infection and impaired renal clearance. We conducted a retrospective study in a regional teaching hospital in Taiwan to evaluate the AKI-predictive ability of serum PCT among critically ill patients. We enrolled 330 patients (mean age, 70.5 ± 16.4 years; 57.0% men) who were admitted to the intensive care unit (ICU) from 1 July 2016, to 31 December 2016, and who had serum PCT measurement performed within 24 h after ICU admission. We used the generalized additive model and generalized linear model to evaluate the association of serum PCT levels and renal function variables. In addition, we used the multivariate logistic regression method to demonstrate serum PCT level as an independent predictor of AKI in both the non-infected patients (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.12–1.71, p = 0.003) and the infected patients (OR = 1.23, 95% CI = 1.03–1.46, p = 0.020). In conclusion, serum PCT level at ICU admission is an independent predictor of developing AKI irrespective of infection among critically ill patients.
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16
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Wu SC, Liang CX, Zhang YL, Hu WP. Elevated serum procalcitonin level in patients with chronic kidney disease without infection: A case-control study. J Clin Lab Anal 2019; 34:e23065. [PMID: 31617251 PMCID: PMC7031592 DOI: 10.1002/jcla.23065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/14/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
Background Inflammation is a necessary component of chronic kidney disease (CKD) that can be attributed to an accumulation of toxins and a reduced clearance of proinflammatory cytokines. Procalcitonin (PCT) is a widely applied biomarker in the diagnosis of infection, and considering the presence of pre‐existing inflammation in CKD patients, the PCT level could be high in such a population; however, no reference value for PCT in CKD patients has been available to date. Methods During the present study period, 361 CKD patients and 119 healthy controls were included. The PCT level and other biochemistry parameters were assayed by using a COBAS system. Statistical analysis was conducted to compare the differences in PCT levels and other biochemistry parameters between the two groups, and linear regression was used to assess the correlation between two variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of PCT and the optimal cutoff value to differentiate between CKD patients and healthy controls. Results The PCT level in CKD patients was significantly higher than that in healthy controls, and among the CKD patients, the PCT level was increased with advanced clinical stage. Moreover, PCT was moderately correlated with CysC. The optimal off‐value was 0.075 with a sensitivity of 94.7% and specificity of 90.8%. Conclusion The PCT level was significantly higher in CKD patients than in healthy controls, and the reference value for CKD patients should be adjusted to avoid unnecessary antibiotic treatments which may pose a negative impact on residual renal function.
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Affiliation(s)
- Sen-Chao Wu
- Department of Nephrology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, China
| | - Cai-Xia Liang
- Department of Nephrology, Second Affiliated Hospital of Guizhou Medical University, Kaili, China
| | - Yan-Lin Zhang
- Department of Nephrology, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wei-Ping Hu
- Department of Nephrology, First Affiliated Hospital of Xiamen University, Xiamen, China.,School of Clinical Medicine, Fujian Medical University, Fuzhou, China
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