[Diagnosis of sepsis and guidance of antibiotic therapy]

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches “alarming” levels according to the World Health Organization, the importance of using biomarkers, such as PCT to limit unnecessary antibiotic exposure has further increased. Randomized trials in patients with respiratory tract infections have shown that PCT has prognostic implications and its use, embedded in stewardship protocols, leads to reductions in the use of antibiotics in different clinical settings without compromising clinical outcomes. However, available data are heterogeneous and recent trials found no significant benefit. Still, from these trials, we have learned several key considerations for the optimal use of PCT, which depend on the clinical setting, severity of presentation, and pretest probability for bacterial infection. For patients with respiratory infections and sepsis, PCT can be used to determine whether to initiate antimicrobial therapy in low-risk settings and, together with clinical data, whether to discontinue antimicrobial therapy in certain high-risk settings. There is also increasing evidence regarding PCT-guided therapy in patients with coronavirus disease 2019 (COVID-19). This review provides an up-to-date overview of the use of PCT in different clinical settings and diseases, including a discussion about its potential to improve the care of patients with COVID-19.

[Procalcitonin in the intensive care unit : Differential diagnostic and differential therapeutic possibilities]

Prokalzitonin (PCT) wird bei systemischen Inflammationszuständen IL6-, IL8- und TNF-α-vermittelt in multiplen Organen und Strukturen des Körpers gebildet. Dabei werden insbesondere bei der Sepsis deutlich erhöhte Werte gemessen. Die Höhe des PCT korreliert dabei gut mit der Krankheitsschwere, ein signifikanter Abfall unter Therapie mit der Prognose. In der differenzialdiagnostischen Abklärung kann die PCT-Bestimmung zwischen bakteriellen und viralen Infektionen unterscheiden. Nichtinfektiösbedingte inflammatorische Reaktionen können jedoch moderat erhöhte PCT-Werte zeigen. Cut-off-Werte sind abhängig von der renalen und hepatischen Funktion. Ein Therapiealgorithmus zur Antibiotikadauer mit PCT-Verlaufsbestimmungen kann den Antibiotikagebrauch reduzieren. In dieser Arbeit sollen die differenzialdiagnostischen und differenzialtherapeutischen Möglichkeiten einer Prokalzitoninbestimmung bei kritisch kranken Patienten erörtert werden.

Correlation of microRNA-125a/b with acute respiratory distress syndrome risk and prognosis in sepsis patients

Objective

This study was conducted to explore the association of microRNA (miR)‐125a and miR‐125b with acute respiratory distress syndrome (ARDS) risk and to investigate their correlation with clinical characteristics and prognosis in sepsis patients.

Methods

Totally 150 sepsis patients admitted to our hospital were consecutively enrolled and another 150 healthy subjects were enrolled as healthy controls (HCs). Their blood samples were collected for miR‐125a and miR‐125b detection by real‐time quantitative polymerase chain reaction. Besides, ARDS occurrence and 28‐day mortality were documented in all sepsis patients.

Results

MiR‐125a and miR‐125b relative expressions were increased in ARDS‐sepsis patients/non‐ARDS‐sepsis patients compared with HCs, while only miR‐125b but not miR‐125a was elevated in ARDS‐sepsis patients compared with non‐ARDS‐sepsis patients. Receiver operating characteristic (ROC) curve presented that miR‐125a (AUC: 0.650, 95%CI: 0.549‐0.750) and miR‐125b (AUC: 0.739, 95%CI: 0.653‐0.823) could differentiate ARDS‐sepsis patients from non‐ARDS‐sepsis patients, and miR‐125b was of increased predictive value compared with miR‐125a numerically. In sepsis patients, miR‐125a relative expression was positively associated with serum creatinine (Scr), chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and miR‐125b was positively associated with Scr, C‐reactive protein (CRP), APACHE II score, SOFA score, and chronic obstructive pulmonary disease. All sepsis patients were categorized into survivors and deaths according to 28‐day mortality, and miR‐125b but not miR‐125a was upregulated in deaths compared with survivors.

Conclusion

Both of miR‐125a and miR‐125b predict ARDS risk, while only miR‐125b is of value in prognosis prediction in sepsis patients.