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Jiang T, Ouyang WX, Tan YF, Yu Y, Qin XM, Luo HY, Tang L, Zhang H, Li SJ. Serum procalcitonin as a marker of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD). Clinics (Sao Paulo) 2024; 79:100383. [PMID: 38797123 PMCID: PMC11153050 DOI: 10.1016/j.clinsp.2024.100383] [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: 01/05/2024] [Revised: 03/15/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Neonatal Intrahepatic Cholestasis (NICCD), as the early-age stage of Citrin deficiency involving liver dysfunction, lacks efficient diagnostic markers. Procalcitonin (PCT) has been identified as a biomarker for infection as well as various organ damage. This study aimed to explore the potential of PCT as a biomarker for NICCD. METHODS In a single-center retrospective case-control study. Serum PCT concentrations before and after treatment of 120 NICCD patients, as the study group, were compared to the same number of cholestatic hepatitis patients, as the control group. The potential value of PCT to discriminate NICCD from control disease was further explored using Receiver Operating Characteristic (ROC) curve analysis and compared to those of other inflammatory markers. RESULTS There was a significantly higher level of PCT in NICCD patients than in the control group. PCT concentrations were only weakly correlated with neutrophil counts and CRP levels (p ˂ 0.05). At a cut-off value of 0.495 ng/mL, PCT exhibited a significantly higher diagnostic value compared to other inflammatory markers for discriminating NICCD from the control, with a sensitivity of 90.8 % and specificity of 98.3 %. CONCLUSION PCT might be used as an initial biomarker to discriminate children with NICCD from another hepatitis disease.
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Affiliation(s)
- Tao Jiang
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China
| | - Wen-Xian Ouyang
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China
| | - Yan-Fang Tan
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China
| | - Ying Yu
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China
| | - Xiao-Mei Qin
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China
| | - Hai-Yan Luo
- The first Department of Emergency General, Hunan Children's Hospital, Changsha, China
| | - Lian Tang
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China
| | - Hui Zhang
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China
| | - Shuang-Jie Li
- Department of Hepatopathy Center, Hunan Children's Hospital, Changsha, China.
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Zhou C, Liu Y, Li Y, Shi L. Recent advances and prospects in nanomaterials for bacterial sepsis management. J Mater Chem B 2023; 11:10778-10792. [PMID: 37901894 DOI: 10.1039/d3tb02220j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Bacterial sepsis is a life-threatening condition caused by bacteria entering the bloodstream and triggering an immune response, underscoring the importance of early recognition and prompt treatment. Nanomedicine holds promise for addressing sepsis through improved diagnostics, nanoparticle biosensors for detection and imaging, enhanced antibiotic delivery, combating resistance, and immune modulation. However, challenges remain in ensuring safety, regulatory compliance, scalability, and cost-effectiveness before clinical implementation. Further research is needed to optimize design, efficacy, safety, and regulatory strategies for effective utilization of nanomedicines in bacterial sepsis diagnosis and treatment. This review highlights the significant potential of nanomedicines, including improved drug delivery, enhanced diagnostics, and immunomodulation for bacterial sepsis. It also emphasizes the need for further research to optimize design, efficacy, safety profiles, and address regulatory challenges to facilitate clinical translation.
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Affiliation(s)
- Chaoyang Zhou
- Department of Critical Care Medicine, The People's Hospital of Yuhuan, Taizhou, Zhejiang 317600, China.
| | - Yong Liu
- Department of Critical Care Medicine, The People's Hospital of Yuhuan, Taizhou, Zhejiang 317600, China.
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325001, China.
| | - Yuanfeng Li
- Department of Critical Care Medicine, The People's Hospital of Yuhuan, Taizhou, Zhejiang 317600, China.
- Translational Medicine Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
| | - Linqi Shi
- Key Laboratory of Functional Polymer Materials of Ministry of Education, Institute of Polymer Chemistry, College of Chemistry, Nankai University, Tianjin 300071, China
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Shine A, McDaniel CE. The Spin and the Snout: What Is Procalcitonin Actually Useful For? Hosp Pediatr 2023; 13:e339-e341. [PMID: 37781736 DOI: 10.1542/hpeds.2023-007440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Alaina Shine
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
| | - Corrie E McDaniel
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
- Seattle Children's Research Institute, Seattle, Washington
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Papp M, Kiss N, Baka M, Trásy D, Zubek L, Fehérvári P, Harnos A, Turan C, Hegyi P, Molnár Z. Procalcitonin-guided antibiotic therapy may shorten length of treatment and may improve survival-a systematic review and meta-analysis. Crit Care 2023; 27:394. [PMID: 37833778 PMCID: PMC10576288 DOI: 10.1186/s13054-023-04677-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Appropriate antibiotic (AB) therapy remains a challenge in the intensive care unit (ICU). Procalcitonin (PCT)-guided AB stewardship could help optimize AB treatment and decrease AB-related adverse effects, but firm evidence is still lacking. Our aim was to compare the effects of PCT-guided AB therapy with standard of care (SOC) in critically ill patients. METHODS We searched databases CENTRAL, Embase and Medline. We included randomized controlled trials (RCTs) comparing PCT-guided AB therapy (PCT group) with SOC reporting on length of AB therapy, mortality, recurrent and secondary infection, ICU length of stay (LOS), hospital LOS or healthcare costs. Due to recent changes in sepsis definitions, subgroup analyses were performed in studies applying the Sepsis-3 definition. In the statistical analysis, a random-effects model was used to pool effect sizes. RESULTS We included 26 RCTs (n = 9048 patients) in the quantitative analysis. In comparison with SOC, length of AB therapy was significantly shorter in the PCT group (MD - 1.79 days, 95% CI: -2.65, - 0.92) and was associated with a significantly lower 28-day mortality (OR 0.84, 95% CI: 0.74, 0.95). In Sepsis-3 patients, mortality benefit was more pronounced (OR 0.46 95% CI: 0.27, 0.79). Odds of recurrent infection were significantly higher in the PCT group (OR 1.36, 95% CI: 1.10, 1.68), but there was no significant difference in the odds of secondary infection (OR 0.81, 95% CI: 0.54, 1.21), ICU and hospital length of stay (MD - 0.67 days 95% CI: - 1.76, 0.41 and MD - 1.23 days, 95% CI: - 3.13, 0.67, respectively). CONCLUSIONS PCT-guided AB therapy may be associated with reduced AB use, lower 28-day mortality but higher infection recurrence, with similar ICU and hospital length of stay. Our results render the need for better designed studies investigating the role of PCT-guided AB stewardship in critically ill patients.
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Affiliation(s)
- Márton Papp
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Saint John's Hospital, Budapest, Hungary
| | - Nikolett Kiss
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Máté Baka
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
| | - Domonkos Trásy
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
| | - László Zubek
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | - Andrea Harnos
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | - Caner Turan
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1082, Budapest, Hungary.
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Poznan University of Medical Sciences, Poznan, Poland.
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Ahmad R, Narwaria M, Singh A, Kumar S, Haque M. Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools. Diagnostics (Basel) 2023; 13:2441. [PMID: 37510185 PMCID: PMC10378387 DOI: 10.3390/diagnostics13142441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and can lead to patient demise if not immediately treated. From the recent literature, the diabetic ketoacidosis mortality rate, depending on age, is 2-5%. Insulin discontinuation and infection remain the two most common triggers for diabetic ketoacidosis. About 50% of cases of ketoacidosis result from bacterial infections like urinary tract infections and pneumonia. It is also important to diagnose the presence of infection in diabetic ketoacidosis patients to prevent the excessive use of antibiotics, which may lead to antibiotic resistance. Although performing bacterial culture is confirmatory for the presence or absence of bacterial infection, the time required to obtain the result is long. At the same time, emergency treatment needs to be started as early as possible. METHODS This narrative review examines various septic markers to identify the appropriate tools for diagnosis and to distinguish between diabetic ketoacidosis with and without infection. Electronic databases were searched using the Google engine with the keywords "Diabetes Mellitus", "Diabetic Ketoacidosis", "Infection with Diabetic Ketoacidosis", "biomarkers for infection in Diabetic Ketoacidosis", "Procalcitonin", "Inflammatory cytokines in DKA", "Lactic acidosis in DKA", and "White blood cell in infection in DKA". RESULTS This narrative review article presents the options for diagnosis and also aims to create awareness regarding the gravity of diabetic ketoacidosis with infection and emphasizes the importance of early diagnosis for appropriate management. Diabetes mellitus is a clinical condition that may lead to several acute and chronic complications. Acute diabetic ketoacidosis is a life-threatening condition in which an excess production of ketone bodies results in acidosis and hypovolemia. Infection is one of the most common triggers of diabetic ketoacidosis. When bacterial infection is present along with diabetic ketoacidosis, the mortality rate is even higher than for patients with diabetic ketoacidosis without infection. The symptoms and biomarkers of diabetic ketoacidosis are similar to that of infection, like fever, C reactive protein, and white blood cell count, since both create an environment of systemic inflammation. It is also essential to distinguish between the presence and absence of bacterial infection to ensure the appropriate use of antibiotics and prevent antimicrobial resistance. A bacterial culture report is confirmatory for the existence of bacterial infection, but this may take up to 24 h. Diagnosis needs to be performed approximately in the emergency room upon admission since there is a need for immediate management. Therefore, researching the possible diagnostic tools for the presence of infection in diabetic ketoacidosis patients is of great importance. Several of such biomarkers have been discussed in this research work.
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Affiliation(s)
- Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka 1230, Bangladesh
| | - Mahendra Narwaria
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Arya Singh
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
- Department of Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
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Peng Y, Wu Q, Liu H, Zhang J, Han Q, Yin F, Wang L, Chen Q, Zhang F, Feng C, Zhu H. An immune-related gene signature predicts the 28-day mortality in patients with sepsis. Front Immunol 2023; 14:1152117. [PMID: 37033939 PMCID: PMC10076848 DOI: 10.3389/fimmu.2023.1152117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Sepsis is the leading cause of death in intensive care units and is characterized by multiple organ failure, including dysfunction of the immune system. In the present study, we performed an integrative analysis on publicly available datasets to identify immune-related genes (IRGs) that may play vital role in the pathological process of sepsis, based on which a prognostic IRG signature for 28-day mortality prediction in patients with sepsis was developed and validated. Methods Weighted gene co-expression network analysis (WGCNA), Cox regression analysis and least absolute shrinkage and selection operator (LASSO) estimation were used to identify functional IRGs and construct a model for predicting the 28-day mortality. The prognostic value of the model was validated in internal and external sepsis datasets. The correlations of the IRG signature with immunological characteristics, including immune cell infiltration and cytokine expression, were explored. We finally validated the expression of the three IRG signature genes in blood samples from 12 sepsis patients and 12 healthy controls using qPCR. Results We established a prognostic IRG signature comprising three gene members (LTB4R, HLA-DMB and IL4R). The IRG signature demonstrated good predictive performance for 28-day mortality on the internal and external validation datasets. The immune infiltration and cytokine analyses revealed that the IRG signature was significantly associated with multiple immune cells and cytokines. The molecular pathway analysis uncovered ontology enrichment in myeloid cell differentiation and iron ion homeostasis, providing clues regarding the underlying biological mechanisms of the IRG signature. Finally, qPCR detection verified the differential expression of the three IRG signature genes in blood samples from 12 sepsis patients and 12 healthy controls. Discussion This study presents an innovative IRG signature for 28-day mortality prediction in sepsis patients, which may be used to facilitate stratification of risky sepsis patients and evaluate patients' immune state.
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Affiliation(s)
- Yaojun Peng
- Department of Graduate Administration, Medical School of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Emergency, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qiyan Wu
- Institute of Oncology, The Fifth Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Hongyu Liu
- Department of Graduate Administration, Medical School of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Neurosurgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Department of Neurosurgery, Hainan Hospital of Chinese People's Liberation Army (PLA) General Hospital, Sanya, Hainan, China
| | - Jinying Zhang
- Department of Basic Medicine, Medical School of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qingru Han
- Department of Emergency, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fan Yin
- Department of Oncology, The Second Medical Center & National Clinical Research Center of Geriatric Disease, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Lingxiong Wang
- Institute of Oncology, The Fifth Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qi Chen
- Department of Traditional Chinese Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Fei Zhang
- Department of Emergency, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Fei Zhang, ; Cong Feng, ; Haiyan Zhu,
| | - Cong Feng
- Department of Emergency, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Fei Zhang, ; Cong Feng, ; Haiyan Zhu,
| | - Haiyan Zhu
- Department of Emergency, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Fei Zhang, ; Cong Feng, ; Haiyan Zhu,
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Çeliktürk E, Salt Ö, Sayhan MB, Dıbırdık İ. A novel biomarker in acute cholecystitis: YKL-40. Asian J Surg 2022; 46:1564-1570. [PMID: 36241524 DOI: 10.1016/j.asjsur.2022.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/25/2022] [Accepted: 09/19/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The lack of a specific biomarker that can be used in the diagnosis of acute cholecystitis, a common cause of admission to the emergency department, delays physician efforts to diagnose and treat these patients. Therefore, the aim of this study was to measure plasma YKL-40 levels and investigate their diagnostic value in patients with acute cholecystitis (AC). METHODS This study was carried out between February 2020 and September 2020 in the adult emergency department of a tertiary university hospital. Permission was obtained from the Ethics Committee of Scientific Research on 03/02/2020 with Decision No. 03/16. The study included 80 patients who were diagnosed with acute cholecystitis and 80 healthy volunteers without known chronic diseases. RESULTS The median YKL-40 protein level was 798.66 pq/mL in the patient group and 392.45 pq/mL in the control group. A statistically significant difference in YKL-40 protein levels was found between the two groups. YKL-40 protein levels were significantly higher in patients diagnosed with acute cholecystitis than in healthy individuals (p < 0.001). A positive correlation was found between YKL-40 protein levels and ALT, AST, LDH, and GGT levels (r = 0.272, p = 0.015; r = 0.397, p < 0.001; r = 0.386, p < 0.001; and r = 0.264, p = 0.018; respectively). CONCLUSION When evaluated together with physical examination, radiological imaging and other laboratory parameters, we think that plasma YKL-40 levels can be used effectively in the diagnosis of acute cholecystitis.
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Abstract
BACKGROUND Soluble urokinase-type plasminogen activator receptor (suPAR) has the potential to diagnose infectious diseases. Due to the lack of reliable biomarkers and the importance of timely diagnosis for sepsis treatment, we conducted this systematic review and meta-analysis to evaluate the value of suPAR diagnosis and prognosis for sepsis. METHODS PubMed, Embase, Web of Science, and Cochrane Library databases were searched for studies, which reported the value of suPAR diagnosis and/or prognosis in patients with sepsis. RESULTS A total of 30 studies involving 6,906 patients were included. Sensitivity and specificity of suPAR for diagnosing sepsis were 0.76 [95% confidence interval (CI), 0.63-0.86] and 0.78 (95% CI, 0.72-0.83), respectively. The area under the summary receiver-operating characteristic curve (AUC) was 0.83 (95% CI, 0.80-0.86). Pooled sensitivity and specificity for predicting mortality were 0.74 (95% CI, 0.67-0.80) and 0.70 (95% CI, 0.63-0.76), respectively, with AUC of 0.78 (95% CI, 0.74-0.82). In addition, AUC for differentiating sepsis from systemic inflammatory response syndrome (SIRS) was 0.81 (95% CI, 0.77-0.84), and the sensitivity and specificity were 0.67 (95% CI, 0.58-0.76) and 0.82 (95% CI, 0.73-0.88), respectively. CONCLUSION suPAR is a feasible biomarker for timely diagnosis and prognosis of sepsis. Compared with effective value of procalcitonin (PCT) identified by previous meta-analysis, suPAR has similar clinical guiding value, whereas suPAR exhibits higher specificity, which can facilitate the deficiencies of PCT. suPAR also shows a diagnostic value in differentiating sepsis from SIRS. Considering the lack of biomarkers for sepsis and the similar clinical value of suPAR and PCT, suPAR should be considered as a biomarker in clinical practice for sepsis.
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Li P, Wang C, Pang S. The diagnostic accuracy of mid-regional pro-adrenomedullin for sepsis: a systematic review and meta-analysis. Minerva Anestesiol 2021; 87:1117-1127. [PMID: 34134460 DOI: 10.23736/s0375-9393.21.15585-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence and mortality of sepsis are high, and common biomarkers are not perfect. To identify a biomarker with high specificity and sensitivity for sepsis, we evaluated the current literature on the performance of mid-regional pro-adrenomedullin (MR-proADM) in the diagnosis of sepsis. METHODS According to appropriate eligibility and exclusion criteria, PubMed, EMBASE, Cochrane Library, China Journal full-text Database, Wanfang Database and Chinese Journal Full Text Database were searched for "Mid-regional proadrenomedullin", "MR-proADM", "Sepsis", "Pyemia", "Pyohemia", "Septicemia" and "Blood poisoning". The publication dates considered for the search were from inception until August 31, 2020. The risk of bias was assessed according to QUADAS-2 criteria. RESULTS Eleven studies involving 2038 cases were included. MR-proADM had high sensitivity and specificity in the diagnosis of sepsis, with values of 0.83 [95% CI: (0.79-0.87)] and 0.90 [95% CI: (0.83-0.94)], respectively. The odds ratio of a combined diagnosis was 41.35, and the area under the curve (AUC) was 0.91. The best cut-off value for MR-proADM diagnosis of sepsis is 1-1.5 nmol/L. MRproADM may also have value in distinguishing pathogens and identifying sepsis severity and organ failure. CONCLUSIONS MR-proADM is an excellent biomarker for the diagnosis of sepsis with high sensitivity and specificity. The best cut-off value for MR-proADM diagnosis of sepsis is 1-1.5 nmol/L.
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Affiliation(s)
- Peijuan Li
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunmei Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China -
| | - Shuqin Pang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Tsui TL, Huang YT, Kan WC, Huang MS, Lai MY, Ueng KC, Shiao CC. A novel procalcitonin-based score for detecting sepsis among critically ill patients. PLoS One 2021; 16:e0245748. [PMID: 33481913 PMCID: PMC7822524 DOI: 10.1371/journal.pone.0245748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. Methods We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. Results A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, “serum PCT level,” “albumin level” and “neutrophil-lymphocyte ratio” at ICU admission, along with “diabetes mellitus,” and “with vasopressor.” We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74–0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69–0.90; sensitivity 0.64; specificity 0.87). Conclusions We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.
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Affiliation(s)
- Tung-Lin Tsui
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Intensive Care Unit, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
| | - Ya-Ting Huang
- Department of Nursing, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
- Saint Mary’s Junior College of Medicine, Nursing and Management, Yilan, Taiwan
| | - Wei-Chih Kan
- Department of Nephrology, Department of Internal medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Mao-Sheng Huang
- Department of laboratory medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
| | - Min-Yu Lai
- Department of Nursing, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
| | - Kwo-Chang Ueng
- School of Medicine, Chung Shan Medical University, Taichung, Taichung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chih-Chung Shiao
- Saint Mary’s Junior College of Medicine, Nursing and Management, Yilan, Taiwan
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Luodong, Yilan, Taiwan
- * E-mail:
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Xia XY, Wu J, Liu HL, Xia H, Jia B, Huang WX. Epidemiological and initial clinical characteristics of patients with family aggregation of COVID-19. J Clin Virol 2020; 127:104360. [PMID: 32305025 PMCID: PMC7151291 DOI: 10.1016/j.jcv.2020.104360] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/30/2020] [Accepted: 04/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Since December 2019, a new outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan (Hubei, China) and rapidly spread throughout China, however, confirmed cases are still increasing worldwide. OBJECTIVES To investigate the epidemiological history and initial clinical characteristics of 10 patients with family aggregation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Western Chongqing, China. STUDY DESIGN Ten patients positive for SARS-CoV-2 nucleic acid detection by real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR), were collected from The People's Hospital of Dazu District, Chongqing. Epidemiological data and laboratory and imaging results were collected on the first day of admission, and analyzed based on the Diagnosis and Treatment Guideline for COVID-19 (5th edition, China). RESULTS Of the 10 cases, case A had a history of a temporary stay in Wuhan and transmitted the virus to the others through family gathering, living together, and sharing vehicles. The average age was 56.5 years (± 11.16), six patients were males, and the incubation period was 2-14 days. Dry cough was the main symptom, followed by fever and fatigue. Most patients were clinically classified as ordinary-type, with three cases being severe-type. Chest computed tomography results were nonspecific, mainly with ground-glass attenuation and/or shadow images. Extensive lesion distribution was seen in severe cases. CD4+ lymphocyte counts were 61, 180, and 348 cells/uL in severe-type patients, respectively. Notably, viral nucleic acid values in nasopharyngeal swabs were lower (19, 25, and 26) than those of ordinary-type patients, suggesting a higher viral load. Neutrophil-lymphocyte ratio (NLR) was also higher in severe-type patients CONCLUSIONS: Initial examination results of lower CD4+ lymphocyte counts and RT-PCR-CT values coupled with higher NLR may indicate the severity of COVID-19 infection for these family clusters.
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Affiliation(s)
- Xiao-Ying Xia
- Infectious Disease Department, The People's Hospital of Dazu District, Chongqing, 402360, China
| | - Jing Wu
- Infectious Disease Department, The People's Hospital of Dazu District, Chongqing, 402360, China
| | - He-Lei Liu
- Infectious Disease Department, The People's Hospital of Dazu District, Chongqing, 402360, China
| | - Hong Xia
- Infectious Disease Department, The People's Hospital of Dazu District, Chongqing, 402360, China
| | - Bei Jia
- Key Laboratory of Infectious and Parasitic Diseases in Chongqing, Infectious Disease Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Wen-Xiang Huang
- Key Laboratory of Infectious and Parasitic Diseases in Chongqing, Infectious Disease Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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Shilpakar R, Paudel BD, Neupane P, Shah A, Acharya B, Dulal S, Wood LA, Shahi R, Khanal U, Poudyal BS. Procalcitonin and C-Reactive Protein As Markers of Bacteremia in Patients With Febrile Neutropenia Who Receive Chemotherapy for Acute Leukemia: A Prospective Study From Nepal. J Glob Oncol 2020; 5:1-6. [PMID: 31526283 PMCID: PMC6872183 DOI: 10.1200/jgo.19.00147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the clinical significance of the biomarkers procalcitonin (PCT) and C-reactive protein (CRP) in patients with febrile neutropenia (FN) undergoing chemotherapy for acute leukemia. METHODS We conducted a prospective, observational study in patients who developed FN while undergoing chemotherapy for acute leukemia. PCT and CRP were obtained in patients who presented with FN. Blood cultures also were obtained. The primary goals were to evaluate the ability of PCT and CRP to predict bacteremia in patients with FN. The secondary goals were to assess the prognostic role of PCT and CRP and to assess the microbiologic profile and culture sensitivity patterns in the study population. RESULTS A total of 124 episodes of FN that involved 67 patients with acute leukemia occurred in the study. PCT was superior to CRP in the prediction of bacteremia. The median PCT level in the bacteremia group was 3.25 ng/mL compared with 0.51 ng/mL in the group without bacteremia (P < .01). The median values of CRP in the bacteremia and without-bacteremia groups were 119.3 mg/L and 94.5 mg/L, respectively (P = .07). There were no differences in median PCT and CRP in patients who died and those who improved. Of the 42 positive cultures, Gram-negative bacteremia was common (86%), and Escherichia coli was the most frequent organism isolated. Carbapenem resistance was seen in 39% of positive cultures. CONCLUSION PCT is an effective biomarker to predict bacteremia in patients with FN undergoing chemotherapy for acute leukemia.
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Affiliation(s)
- Ramila Shilpakar
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | | | | | - Aarati Shah
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Bibek Acharya
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Soniya Dulal
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Lori Anne Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Abstract
Biomarker panels have the potential to advance the field of critical care medicine by stratifying patients according to prognosis and/or underlying pathophysiology. This article discusses the discovery and validation of biomarker panels, along with their translation to the clinical setting. The current literature on the use of biomarker panels in sepsis, acute respiratory distress syndrome, and acute kidney injury is reviewed.
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Affiliation(s)
- Susan R Conway
- Division of Critical Care Medicine, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
| | - Hector R Wong
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati Children's Research Foundation, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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14
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Diagnostic Value of C-reactive Protein and Interleukin-8 in Risk Stratification of Febrile Neutropenic Children with Allogeneic Hematopoietic Stem Cell Transplantation. Sci Rep 2020; 10:2894. [PMID: 32076032 PMCID: PMC7031361 DOI: 10.1038/s41598-020-59814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/31/2020] [Indexed: 11/09/2022] Open
Abstract
In this analysis, the levels of CRP and IL-8 were employed as a guide for designing the duration of antibiotics administration in the condition of febrile neutropenia. The importance of laboratory biomarkers is in the early diagnosis of critical illness and adjustment of further management. IL-8 is a useful biomarker for the early identification of critically ill patients, compared to CRP in FN.
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15
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Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study. DISEASE MARKERS 2020; 2020:4873074. [PMID: 32076461 PMCID: PMC7008263 DOI: 10.1155/2020/4873074] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/23/2019] [Indexed: 12/23/2022]
Abstract
Objective Gram-negative bloodstream infections (GNBSIs), especially those caused by antibiotic-resistant species, have become a public health challenge. Procalcitonin (PCT) showed promising potential in early diagnosis of GNBSI; however, little was known about its performance under different clinical settings. We here systematically assessed the diagnostic accuracy of PCT in recognizing GNBSI and made direct comparisons with C-reactive protein (CRP) and interleukin 6 (IL-6). Methods PubMed, Embase, ISI Web of Knowledge, and Scopus were searched from inception to March 15th, 2019. Area under the summary receiver operating characteristic curve (AUC), pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated. Hierarchical summary receiver operating characteristic (HSROC) model was used for the investigation of heterogeneity and for comparisons between markers. Results 25 studies incorporating 50933 suspected BSI episodes were included. Pooled sensitivity and specificity for PCT were 0.71 and 0.76, respectively. The overall AUC was 0.80. The lowest AUCs were found in patients with febrile neutropenia (0.69) and hematological malignancy (0.69). The highest AUC was found in groups using electrochemiluminescence immunoassay (0.87). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.85 (95% CI 0.81–0.87) for PCT and 0.78 (95% CI 0.74–0.81) for CRP, but the relative DORs varied with thresholds between PCT and CRP (p < 0.001). No significant difference was found either in threshold (p < 0.001). No significant difference was found either in threshold (p < 0.001). No significant difference was found either in threshold ( Conclusions PCT was helpful in recognizing GNBSI, but the test results should be interpreted carefully with knowledge of patients' medical condition and should not serve as the only criterion for GNBSI. Further prospective studies are warranted for comparisons between different clinical settings.
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Boyarinov G, Zubeyev P, Mokrov K, Voyennov O. Hemofiltration in Patients with Severe Acute Pancreatitis (Review). Sovrem Tekhnologii Med 2020; 12:105-121. [PMID: 34513045 PMCID: PMC8353697 DOI: 10.17691/stm2020.12.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Indexed: 11/19/2022] Open
Abstract
Questions regarding the application of extracorporeal detoxification to patients with severe acute pancreatitis have been considered. Hemodialysis, the historically first method of extracorporeal detoxification for such patients, has been also described in the review. Appropriateness of using renal replacement therapy methods and among them continued renal replacement therapy has been shown. Hemofiltration and hemodiafiltration technologies are described in detail including different modes of their application and the possibility of using various types of filters. Available data on hemofiltration for patients with severe acute pancreatitis have been analyzed. Great attention is paid to the unsolved aspects of hemofiltration in severe acute pancreatitis such as determining renal and extrarenal indices; time of starting hemofiltration; selection of volume replacement modes and a buffer system; procedure duration; anticoagulation measures, defining criteria to assess the adequacy of hemofiltration, state severity, and organ dysfunction degree. Further multicenter investigations are necessary to be able to assess the efficacy of the hemofiltration procedures on the basis of the thoroughly worked out and pathogenically grounded protocol using adequate control methods taking into consideration endogenic intoxication phases and intensity of the multiple organ failure syndrome.
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Affiliation(s)
- G.A. Boyarinov
- Professor, Head of the Department of Anesthesiology and Resuscitation, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - P.S. Zubeyev
- Professor, Head of the Department of Emergency Medical Care, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - K.V. Mokrov
- Head of the Resuscitation and Anesthesiology Unit, City Hospital No.33, 54 Lenin Avenue, Nizhny Novgorod, 603076, Russia
| | - O.V. Voyennov
- Professor, Department of Anesthesiology and Resuscitation, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Gomez JL, Himes BE, Kaminski N. Molecular Diagnostics in Pulmonary Infections. PRECISION IN PULMONARY, CRITICAL CARE, AND SLEEP MEDICINE 2020. [PMCID: PMC7121992 DOI: 10.1007/978-3-030-31507-8_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Infection of the lung parenchyma, or pneumonia, accounts for over four million deaths per year worldwide (Ferkol and Schraufnagel, Ann Am Thorac Soc 11:404–406, 2014). The condition is common, but also over-diagnosed, in part due to relatively poor laboratory and radiographic diagnostics. Indeed, we continue to rely on antiquated tools such as sputum culture and chest X-ray – the former of which lacks speed and sensitivity, and the latter specificity (Albaum et al. Chest 110:343–50, 1996). The resulting presumptive diagnoses of pneumonia lead to excessive use of empiric broad spectrum antibiotics; indeed, by some estimates, 30–70% of antibiotic prescriptions for lower respiratory tract infection are inappropriate (Kraus, PLoS One 12(3): e0174584, 2017). This approach begets microbial resistance, exposes patients to medication side effects, and puts patients at risk of potentially life-threatening complications including Clostridium difficile colitis. To improve diagnostic certainty in patients with suspected pneumonia, we must begin to consider and implement emerging technologies for efficient and accurate characterization of host responses to infection and identification of pathogens. In this chapter, we will discuss precision diagnostics already in common practice and those poised to be, and how these tools may ultimately enable personalization in the diagnosis of pneumonia.
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Affiliation(s)
- Jose L. Gomez
- Assistant Professor Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Yale University School of Medicine, New Haven, CT USA
| | - Blanca E. Himes
- Assistant Professor of Informatics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA USA
| | - Naftali Kaminski
- Boehringer-Ingelheim Endowed, Professor of Internal Medicine, Chief of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT USA
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Abstract
The role of biomarkers for detection of sepsis has come a long way. Molecular biomarkers are taking front stage at present, but machine learning and other computational measures using bigdata sets are promising. Clinical research in sepsis is hampered by lack of specificity of the diagnosis; sepsis is a syndrome with no uniformly agreed definition. This lack of diagnostic precision means there is no gold standard for this diagnosis. The final conclusion is expert opinion, which is not bad but not perfect. Perhaps machine learning will displace expert opinion as the final and most accurate definition for sepsis.
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Affiliation(s)
- Steven M Opal
- Infectious Disease Division, Alpert Medical School of Brown University, Ocean State Clinical Coordinating Center at Rhode Island Hospital, 1 Virginia Avenue Suite 105, Providence, RI 02905, USA.
| | - Xavier Wittebole
- Critical Care Department, (Pr Laterre), Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
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Martiny P, Goggs R. Biomarker Guided Diagnosis of Septic Peritonitis in Dogs. Front Vet Sci 2019; 6:208. [PMID: 31316998 PMCID: PMC6610427 DOI: 10.3389/fvets.2019.00208] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022] Open
Abstract
Septic peritonitis (SP) is common in dogs and is associated with high mortality. Early recognition is essential to maximizing survival and may be aided by biomarker measurement. The present study aimed to evaluate the ability of biomarkers to discriminate septic peritonitis from non-septic ascites (NSA). Eighteen dogs with SP and 19 age-matched controls with NSA were enrolled. Contemporaneous blood and peritoneal effusion samples were obtained. Concentrations of cell-free DNA (cfDNA), cytokines, glucose, lactate, N-terminal pro-C-type natriuretic peptide (NT-proCNP), nucleosomes, and procalcitonin (PCT) were measured using commercial reagents and assays. Paired biomarker concentrations were compared with the Wilcoxon matched-pairs signed rank test, and biomarker concentrations between groups were compared with the Mann-Whitney U-test. P-values were adjusted for multiple comparisons using the Bonferroni correction. Receiver operating characteristic curves were generated to assess the ability of the above biomarkers to discriminate SP from NSA. Dogs with SP had significantly greater blood CCL2 concentrations than dogs with NSA (P = 0.032). Dogs with SP had significantly greater effusion CCL2, IL-6, IL-10, and lactate concentrations than dogs with NSA (P ≤ 0.0121). Blood-effusion concentration gradients of CCL2, glucose, IL-6, IL-10, and lactate were significantly different in dogs with SP compared to dogs with NSA (P ≤ 0.0165). Effusion lactate concentration had the highest AUROC value (0.866, 95% CI 0.751–0.980, P = 0.0001), although other biomarkers performed similarly. An effusion lactate concentration of 4.2 mmol/L was 72.2% (95% CI 46.5–90.3%) sensitive and 84.2% (95% CI 60.4–96.6%) specific for the diagnosis of SP.
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Affiliation(s)
- Pia Martiny
- College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Robert Goggs
- College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Stoma I, Karpov I, Uss A, Krivenko S, Iskrov I, Milanovich N, Vlasenkova S, Lendina I, Belyavskaya K, Cherniak V. Combination of sepsis biomarkers may indicate an invasive fungal infection in haematological patients. Biomarkers 2019; 24:401-406. [PMID: 30907674 DOI: 10.1080/1354750x.2019.1600023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Invasive fungal infections are a major threat to a large cohort of immunocompromised patients, including patients with chemotherapy-associated neutropenia. Early differential diagnosis with bacterial infections is often complicated, which leads to a delay in empirical antifungal therapy and increases risk for adverse outcome. Accessibility and performance of specific fungal antigen and PCR-tests are still limited, while sepsis biomarkers are more broadly used in most settings currently. Methods: Haematological patients hospitalized to receive chemotherapy with proven or probable invasive fungal infection or microbiologically proven bacterial bloodstream infection were included in the study. C-reactive protein was assessed daily during the profound neutropenia period, while procalcitonin or presepsin were measured during the first 48 hours after the onset of febrile episode. Results: There were totally 64 patients included in the study, 53 with bacterial bloodstream infections and 11 with invasive fungal infections. Combination of CRP >120 with PCT <1.25 or presepsin <170 was shown to be a possible combined biomarker for invasive fungal infections in immunocompromised patients, with areas under the ROC-curves: 0.962 (95% CI 0.868 to 0.995) for PCT-based combination and 0.907 (95% CI 0.692 to 0.990) for presepsin-based combination.
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Affiliation(s)
- Igor Stoma
- a Department of Infectious Diseases , Belarusian State Medical University , Minsk , Belarus.,b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Igor Karpov
- a Department of Infectious Diseases , Belarusian State Medical University , Minsk , Belarus
| | - Anatoly Uss
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Svetlana Krivenko
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Igor Iskrov
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Natalia Milanovich
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Svetlana Vlasenkova
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Irina Lendina
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Kristina Belyavskaya
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
| | - Veronika Cherniak
- b Minsk Scientific Practical Center of Surgery, Transplantation and Hematology , Minsk , Belarus
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Wang J, Shang H, Yang X, Guo S, Cui Z. Procalcitonin, C-reactive protein, PaCO2, and noninvasive mechanical ventilation failure in chronic obstructive pulmonary disease exacerbation. Medicine (Baltimore) 2019; 98:e15171. [PMID: 31027061 PMCID: PMC6831316 DOI: 10.1097/md.0000000000015171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
It is unclear whether procalcitonin (PCT) is correlated with noninvasive ventilation (NIV) failure. This retrospective case-control study aimed to compare PCT levels, C-reactive protein (CRP) levels, and PaCO2 in patients (05/2014-03/2015 at the Harrison International Peace Hospital, China) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and NIV failure/success.This was a retrospective case-control study of patients with AECOPD who required NIV between May 2014 and March 2015. All consecutive patients with AECOPD admitted at the Department of Critical Care Medicine and transferred from the general ward were included in the study. Hemogram, PCT, erythrocyte sedimentation rate (ESR), arterial blood gas (ABG), and CRP levels were measured ≤1 hour before NIV was used. NIV was considered to have failed if at least one of the following criteria was met: cardiac arrest or severe hemodynamic instability; respiratory arrest or gasping; mask intolerance; difficulty in clearing bronchial secretions; or worsening of ABGs or sensorium level during NIV. The factors associated with NIV failure were determined.A total of 376 patients were included: 286 with successful NIV and 90 wither NIV failure. The multivariate analysis showed that PCT (OR = 2.0, 95%CI: 1.2-3.2, P = .006), CRP (OR = 1.2, 95%CI: 1.1-1.3, P < .001), and PaCO2 (OR = 1.1, 95%CI: 1.1-1.2, P < .001) ≤1 hour before NIV were independently associated with NIV failure. The optimal cutoff were 0.31 ng/mL for PCT (sensitivity, 83.3%; specificity, 83.7%), 15.0 mg/mL for CRP (sensitivity, 75.6%; specificity, 93.0%), and 73.5 mm Hg for PaCO2 (sensitivity, 71.1%; specificity, 100%). The area under the curve (AUC) was 0.854 for PCT, 0.849 for CRP, and 0.828 for PaCO2. PCT, CRP, and PaCO2 were used to obtain a combined prediction factor, which achieved an AUC of 0.978 (95%CI: 0.961-0.995).High serum PCT, CRP, and PaCO2 levels predict NIV failure for patients with AECOPD. The combination of these three parameters might enable even more accurate prediction.
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Comparison of the Power of Procalcitonin and C-Reactive Protein to Discriminate between Different Aetiologies of Fever in Prolonged Profound Neutropenia: A Single-Centre Prospective Observational Study. Mediterr J Hematol Infect Dis 2019; 11:e2019023. [PMID: 30858961 PMCID: PMC6402549 DOI: 10.4084/mjhid.2019.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/01/2019] [Indexed: 01/03/2023] Open
Abstract
Management of fever in prolonged, profound neutropenia remains challenging with many possible infectious and non-infectious causes. We investigated whether procalcitonin (PCT) is superior to C-reactive protein (CRP) in discriminating between different aetiologies of fever in this setting. CRP and PCT were tested daily during 93 neutropenic episodes in 66 patients. During this study period, 121 febrile episodes occurred and were classified into four categories based on clinical and microbiological findings: microbiologically documented infection (MDI); clinically documented infection (CDI); proven or probable invasive fungal disease (IFD); fever of unknown origin (FUO). Values of PCT and CRP at fever onset as well as two days later were considered for analysis of their performance in distinguishing aetiologies of fever. At fever onset, no significant difference in PCT values was observed between different aetiologies of fever, whereas median CRP values were significantly higher in case of IFD (median 98.8 mg/L vs 28.8 mg/L, p=0.027). Both PCT and CRP reached their peak at a median of 2 days after fever onset. Median PCT values on day 2 showed no significant difference between the aetiologies of fever. Median CRP values on day 2 were significantly higher in IFD (median 172 mg/L versus 78.4 mg/L, p=0.002). In MDI median CRP values rose > 100 mg/L, whereas they did not in CDI or FUO. PCT has no added value over CRP for clinical management of fever in prolonged, profound neutropenia. When performing reassessment 2 days after fever onset, CRP has better discriminatory power between aetiologies of fever.
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Weidhase L, Wellhöfer D, Schulze G, Kaiser T, Drogies T, Wurst U, Petros S. Is Interleukin-6 a better predictor of successful antibiotic therapy than procalcitonin and C-reactive protein? A single center study in critically ill adults. BMC Infect Dis 2019; 19:150. [PMID: 30760225 PMCID: PMC6375140 DOI: 10.1186/s12879-019-3800-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/08/2019] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this study was to evaluate whether Interleukin-6 (IL-6) could be a faster indicator of treatment success in adults with severe sepsis and septic shock compared to procalcitonin (PCT) and C-reactive protein (CRP). Methods Data from adult patients with severe sepsis and septic shock managed at the medical intensive care unit (ICU) of the University Hospital Leipzig between September 2009 and January 2012 were analyzed retrospectively. Values for CRP, PCT and IL-6 on admission as well as after 24 and 48–72 h were collected. Antibiotic therapy was defined as clinically successful if the patient survived ICU stay. Results A total of 328 patients with severe sepsis and septic shock with adequate data quality were included. After 48–72 h, the median IL-6 was significantly lower in survivors than in non-survivors (114.2 pg/ml vs. 746.6 pg/ml; p < 0.001), while there was no significant difference for PCT (5.6 vs. 4.9 ng/ml; p = 0.586) and CRP (158.5 mg/l vs. 172.4 mg/l; p = 0.988). Conclusions The results of this study suggest that IL-6 is better than PCT and CRP in predicting the treatment success in predominantly non-surgical sepsis in the first 48–72 h.
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Affiliation(s)
- Lorenz Weidhase
- Medical Intensive Care Unit, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Daniel Wellhöfer
- Carl-von-Basedow-Klinikum Merseburg, Medical Clinic I, Weiße Mauer 52, 06217, Merseburg, Germany
| | - Gero Schulze
- Department of Internal Medicine, Helios Hospital Schkeuditz, Leipziger Straße 45, 04435, Schkeuditz, Germany
| | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Paul-List-Straße 13/15, 04103, Leipzig, Germany
| | - Tim Drogies
- Medical central laboratory Altenburg, Am Waldessaum 8, 04600, Altenburg, Germany
| | - Ulrike Wurst
- University Hospital of Leipzig, Center for Pediatric Research Leipzig, University Hospital for Children &Adolescents, Liebigstraße 20, 04103, Leipzig, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Low Levels of Procalcitonin or Presepsin Combined with Significantly Elevated C-reactive Protein May Suggest an Invasive Fungal Infection in Hematological Patients With Febrile Neutropenia. Hemasphere 2019; 3:e170. [PMID: 31723809 PMCID: PMC6745942 DOI: 10.1097/hs9.0000000000000170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022] Open
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Procalcitonin Value Is an Early Prognostic Factor Related to Mortality in Admission to Pediatric Intensive Care Unit. Crit Care Res Pract 2018; 2018:9238947. [PMID: 30675399 PMCID: PMC6323529 DOI: 10.1155/2018/9238947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/09/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Procalcitonin (PCT) and C-reactive protein (CRP) are already known predictive markers in serious bacterial infections, and it is emphasized that these biomarkers can be used as a marker of increased mortality in critically ill patients. Herein, we aimed to evaluate the initial serum PCT and CRP levels on the outcome of patients in pediatric intensive care units (PICUs) and find out if these biomarkers can be used to predict mortality. Materials and Methods The relationship between the initial serum PCT and CRP levels and invasive mechanical ventilation (IMV) and noninvasive mechanical ventilation (NIV) support, inotropic drug need, acute renal kidney injury (AKI), continuous renal replacement therapy (CRRT), mortality, and hospitalization period was investigated retrospectively. Results In total, 418 suitable patients (226 males and 192 females) were included in the study. Age distributions of patients ranged from 1 month to 17 years. There was a statistically significant relationship between PCT levels in the first biochemical analysis performed during admission and MV support, inotropic drug use, mortality, ARF, hospitalization in the intensive care unit, CRRT and blood component transfusion. There was a statistically significant relationship between CRP levels and MV support, NIV, inotropic drug use, mortality, AKI, hospitalization in the intensive care unit, CRRT, and blood component transfusion. Conclusion We suggest that the initial PCT and CRP levels during admission can be used to predict the outcome of patients in PICU.
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Urrechaga E, Bóveda O, Aguirre U. Improvement in detecting sepsis using leukocyte cell population data (CPD). ACTA ACUST UNITED AC 2018; 57:918-926. [DOI: 10.1515/cclm-2018-0979] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/20/2018] [Indexed: 01/03/2023]
Abstract
Abstract
Background
The cell population data (CPD) parameters reported by XN analyzers (Sysmex Corporation, Kobe, Japan) reflect the size and internal structure of leukocytes. We explored whether CPD values could contribute to recognize those patients with fever at risk to develop sepsis. A profile of sepsis was developed combining CPD parameters and other markers.
Methods
We recruited 295 patients at the onset of fever, with infection confirmed by positive cultures. We studied the diagnostic performance of the CPD parameters in the differential diagnosis of sepsis vs. non-systemic bacterial infection using receiver operating characteristic (ROC) curve analysis. Additionally, the K-means unsupervised clustering method was applied. Once the clusters had been defined, the relationship between them and the CPD parameter values was assessed with the non-parametric Wilcoxon test. Lastly, the relationship between the clusters obtained and the categorical variables was examined with the χ2-test (or Fisher’s exact test).
Results
ROC analysis demonstrated that NE-FSL, NE-WY, NE-WZ and MO-WZ had areas under the curve (AUCs) >0.700 for predicting sepsis. Using the K-means clustering algorithm, 80 patients (66.67%) were assigned to Cluster 1 and the others to Cluster 2. Out of 80 of patients in Cluster 1, 45 (56.25%) presented a PCT value ≥2 ng/mL, whereas almost 80% of Cluster 2 patients had a PCT <2 ng/mL. Cluster 1 was characterized by high NE-SFL, NE-WY, MO-X, MO-WX and MO-Z values (p<0.05).
Conclusions
CPD related to monocyte complexity and neutrophil activation were found to be significant, with high values suggesting sepsis.
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Affiliation(s)
- Eloísa Urrechaga
- CORE Laboratory , Hospital Galdakao – Usansolo , Galdakao, Vizcaya , Spain
| | - Oihane Bóveda
- CORE Laboratory , Hospital Galdakao – Usansolo , Galdakao, Vizcaya , Spain
| | - Urko Aguirre
- Research Unit, REDISSEC, Health Services Research on Chronic Patients Network , Hospital Galdakao – Usansolo , Galdakao, Vizcaya , Spain
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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.
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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
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Troia R, Giunti M, Calipa S, Goggs R. Cell-Free DNA, High-Mobility Group Box-1, and Procalcitonin Concentrations in Dogs With Gastric Dilatation-Volvulus Syndrome. Front Vet Sci 2018; 5:67. [PMID: 29686994 PMCID: PMC5900424 DOI: 10.3389/fvets.2018.00067] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/20/2018] [Indexed: 12/19/2022] Open
Abstract
Canine gastric dilatation–volvulus (GDV) is a life-threatening disease characterized by extensive tissue ischemia, tissue hypoperfusion, and systemic inflammation. Biomarkers that better reflect the severity of gastric necrosis and systemic inflammation would aid clinicians in the management of these patients. This study aimed to investigate the prognostic significance of cell-free DNA (cfDNA), high-mobility group box-1 (HMGB1), and procalcitonin (PCT) in dogs with GDV. Concentrations of cfDNA, HMGB1, and PCT were measured in citrated plasma samples collected from 29 dogs with GDV at hospital admission. Additional data collected included baseline lactate concentrations, APPLEfast score, evidence of gastric necrosis, occurrence of postoperative complications, and outcome. Twenty-four healthy dogs were sampled as controls. Continuous variables between groups were compared with the Mann–Whitney U and correlations between continuous variables were assessed by calculation of Spearman’s correlation coefficient. Alpha was set at 0.05. Dogs with GDV had significantly greater concentrations of cfDNA, HMGB1, and PCT compared to controls (P = 0.0009, P = 0.004, and P = 0.009, respectively). PCT concentrations were significantly higher in non-survivors compared to survivors (P = 0.008). Dogs with gastric necrosis had significantly greater lactate concentrations compared to dogs without gastric necrosis (P = 0.0005). The APPLEfast score was not prognostic. Lactate and PCT concentrations were moderately, positively correlated (rs 0.51, P = 0.0005). Concentrations of the inflammatory biomarkers cfDNA, HMGB1, and PCT are increased in canine GDV. Only lactate and PCT concentrations were prognostic in this population of GDV dogs and were predictive of the presence of gastric necrosis and of non-survival to hospital discharge, respectively.
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Affiliation(s)
- 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
| | - Stefano Calipa
- Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Abstract
Over the last decade, the biomarkers procalcitonin and C-reactive protein have gained interest in sepsis research. Procalcitonin is a unique biomarker that is specific to bacterial infection and has demonstrated utility in the risk stratification of patients with potential life-threatening bacterial infections. In addition, procalcitonin has been documented as having a role in reducing the rate of unnecessary antibiotics while positively impacting antibiotic resistance rates and cost savings. The purposes of this review article are to discuss the clinical relevance of C-reactive protein and procalcitonin as diagnostic and prognostic markers for sepsis with a focus on the use of serial procalcitonin levels as a component of antibiotic stewardship programs. The federal government has recently become invested in combating the progression of antibiotic resistance; a 5-year national plan has been developed to address these concerns. Establishing a reliable antibiotic stewardship program is one of the goals of this national plan.
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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.
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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
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Hoshino K, Irie Y, Mizunuma M, Kawano K, Kitamura T, Ishikura H. Incidence of elevated procalcitonin and presepsin levels after severe trauma: a pilot cohort study. Anaesth Intensive Care 2017; 45:600-604. [PMID: 28911289 DOI: 10.1177/0310057x1704500510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Procalcitonin (PCT) and presepsin (PSEP) are useful biomarkers for diagnosing sepsis; however, elevated PCT and PSEP levels may be observed in conditions other than sepsis. We hypothesised that PCT and PSEP levels could increase after severe traumatic injuries. Trauma patients with an Injury Severity Score of ≥16 from October 2013 to September 2015 were enrolled in our study. We examined PCT and PSEP levels and their positive rates on days 0 and 1. PCT and PSEP levels on days 0 and 1 were compared. Risk factors for increasing sepsis biomarker levels were identified by multivariate logistic regression analyses. In this study, 75 patients were included. PCT levels on days 0 and 1 were 0.1±0.4 and 1.8±6.3 ng/ml, respectively (P=0.02). PSEP levels on days 0 and 1 were 221±261 and 222±207 pg/ml, respectively (P=0.98). As per multivariate logistic regression analyses, packed red blood cell (PRBC) transfusion was the only independent risk factor for higher PCT levels on day 1 (P=0.04). Using PCT to diagnose sepsis in trauma patients on day 1 requires caution. PRBC transfusion was found to be a risk factor for increasing PCT levels. On the other hand, PSEP levels were not affected by trauma during the early phases.
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Abstract
A biomarker is a characteristic by which a (patho)physiologic process can be identified. Biomarkers can be of diagnostic value (to discriminate infection from noninfectious conditions or to determine the causative pathogen), of prognostic value (assigning risk profiles and predict outcome), and in the future may be of theranostic value (aid in selection and monitoring of therapy). Systems biology provides a promising tool for the discovery of novel biomarkers. Biomarkers can be the key to personalized targeted treatment in the future clinical management of sepsis.
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Affiliation(s)
- Tjitske S R van Engelen
- Division of Laboratory Specialties, Center for Experimental Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, The Netherlands.
| | - Willem Joost Wiersinga
- Division of Laboratory Specialties, Center for Experimental Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, The Netherlands; Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, The Netherlands
| | - Brendon P Scicluna
- Division of Laboratory Specialties, Center for Experimental Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, The Netherlands
| | - Tom van der Poll
- Division of Laboratory Specialties, Center for Experimental Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, The Netherlands; Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, The Netherlands
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Wang XJ, Tan TT, Lim ST, Farid M, Tao M, Quek R, Chan A, Tang T. Role of Procalcitonin in Differentiating between Infectious and Noninfectious Fevers among Patients with Lymphoma. Pharmacotherapy 2017; 37:908-915. [PMID: 28556122 DOI: 10.1002/phar.1963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The primary objective of this study is to prospectively evaluate the role of procalcitonin (PCT) in distinguishing infectious fever from noninfectious fever (NIF) among febrile lymphoma patients. The secondary objective is to evaluate the usefulness of PCT in distinguishing among bloodstream infections (BSI), local infections and unidentified infections (LIUI), and NIF. METHODS Patients with lymphoma and fever were prospectively recruited between August 2014 and November 2015. PCT was measured within 24 hours of fever onset (PCT1) and 24-72 hours thereafter (PCT2). The higher PCT value between PCT1 and PCT2 was also documented (PCTmax ). PCT levels (PCT1, PCT2, and PCTmax ) were compared for BSI, LIUI, and NIF. In addition, the difference between PCT1 and PCT2 was evaluated in patients with complete data on both PCT1 and PCT2. RESULTS Of 108 eligible patients, 12 were diagnosed with BSI, 83 with LIUI, and 13 with NIF. PCTmax was statistically different between the infectious fever (BSI and LIUI combined) and NIF groups (median PCTmax : 0.44 ng/ml vs 0.19 ng/ml; p=0.026). PCT1 was not statistically different for patients with BSI, LIUI, and NIF (p=0.217). However, PCT2 and PCTmax were significantly higher in patients with BSI compared to those with NIF (p=0.026 and 0.002, respectively). Meanwhile, patients with BSI have significantly higher PCTmax values than those with LIUI (p=0.034). Among 90 cases with complete data on both PCT1 and PCT2, PCT2 was significantly higher than PCT1 in patients with BSI (median PCT: 0.98 ng/ml vs 0.47 ng/ml; p=0.045) and patients with LIUI (median PCT: 0.43 ng/ml vs 0.24 ng/ml; p=0.004), while not significant in patients with NIF (p=0.374). CONCLUSION Two separate PCT measurements can differentiate between infectious fever and NIF and predict for BSI in lymphoma patients with fever.
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Affiliation(s)
- Xiao Jun Wang
- Department of Pharmacy, National University of Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Richard Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
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Surviving Sepsis in the Intensive Care Unit: The Challenge of Antimicrobial Resistance and the Trauma Patient. World J Surg 2017; 41:1165-1169. [PMID: 27146052 DOI: 10.1007/s00268-016-3531-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sepsis in the intensive care unit (ICU) presents a great challenge to any critical care clinician. Patients admitted to the ICU are especially vulnerable to sepsis due to the nature of the underlying pathology that warranted admission to the ICU and deranged physiological function coupled with invasive procedures. Nosocomial infections are common in patients admitted to the ICU, and with these infections come the burden of multidrug-resistant organisms. Antimicrobial resistance (AMR) is now a global emergency that warrants the attention of every health-care professional. AMR has escalated to epic proportions and solutions to this problem are now a matter of "life and death." The ICU also represents the "breeding ground" of antibiotic-resistant organisms due to the high broad-spectrum antibiotic consumption. Many would argue that broad-spectrum antimicrobials are overprescribed in this patient population, but do all patients admitted to the ICU warrant such therapy? Is there evidence that narrower-spectrum antimicrobial agents can be employed in specific ICU populations coupled with surveillance strategies? The aims of this review are to focus on strategies with the aim of optimizing antimicrobial use within ICUs, and to highlight the importance of differentiating ICU populations with regard to the use of antimicrobial agents.
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Ludwig KR, Hummon AB. Mass spectrometry for the discovery of biomarkers of sepsis. MOLECULAR BIOSYSTEMS 2017; 13:648-664. [PMID: 28207922 PMCID: PMC5373965 DOI: 10.1039/c6mb00656f] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sepsis is a serious medical condition that occurs in 30% of patients in intensive care units (ICUs). Early detection of sepsis is key to prevent its progression to severe sepsis and septic shock, which can cause organ failure and death. Diagnostic criteria for sepsis are nonspecific and hinder a timely diagnosis in patients. Therefore, there is currently a large effort to detect biomarkers that can aid physicians in the diagnosis and prognosis of sepsis. Mass spectrometry is often the method of choice to detect metabolomic and proteomic changes that occur during sepsis progression. These "omics" strategies allow for untargeted profiling of thousands of metabolites and proteins from human biological samples obtained from septic patients. Differential expression of or modifications to these metabolites and proteins can provide a more reliable source of diagnostic biomarkers for sepsis. Here, we focus on the current knowledge of biomarkers of sepsis and discuss the various mass spectrometric technologies used in their detection. We consider studies of the metabolome and proteome and summarize information regarding potential biomarkers in both general and neonatal sepsis.
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Affiliation(s)
- Katelyn R Ludwig
- Department of Chemistry and Biochemistry and the Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, USA.
| | - Amanda B Hummon
- Department of Chemistry and Biochemistry and the Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, USA.
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Wu C, Hua LX, Zhang JZ, Zhou XR, Zhong W, Ni HD. Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy. Kaohsiung J Med Sci 2016; 33:36-43. [PMID: 28088272 DOI: 10.1016/j.kjms.2016.10.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022] Open
Abstract
This study was proposed to compare the clinical effectiveness of mini-tract percutaneous nephrolithotomy (MPCNL) with standard-tract percutaneous nephrolithotomy (SPCNL) and verify whether MPCNL is associated with both higher renal pelvic pressure (RPP) and incidence of postoperative fever. A total of 228 patients with kidney stone were randomly allocated to the MPCNL group (n=114) and SPCNL group (n=114). Both intraoperative and postoperative indexes along with the incidence of complications were compared between the two treatment groups. RPP was measured using a baroreceptor which was connected to an open-ended ureteric catheter during the operation of percutaneous nephrolithotomy. The MPCNL group exhibited significantly longer average operation time, more average amount of flush water, and lesser average amount of bleeding during the operation than the SPCNL group (p<0.05). Moreover, significantly lesser average amount of postoperative serum creatinine, shorter average hospital stay, and more average amount of postoperative hemoglobin were observed in the MPCNL group than in the SPCNL group (p<0.05). MPCNL were more applicable to clear caliceal stones (p<0.05), whereas SPCNL were more effective for the removal of simple pelvic stones. The difference in the incidence of postoperative fever between the two treatment groups also appeared to be significant (p<0.05). Logistic regression provided solid evidence that both RPP and its accumulation time at which RPP≥30 mmHg significantly affected the incidence of postoperative fever. MPCNL was correlated with both higher RPP and increased likelihood of postoperative fever compared with SPCNL.
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Affiliation(s)
- Cheng Wu
- Department of Urology, DongTai People's Hospital, Dongtai Affiliated Hospital of Nantong University, Dongtai, Jiangsu, China
| | - Li-Xin Hua
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian-Zhong Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xun-Rong Zhou
- Department of Urology, DongTai People's Hospital, Dongtai Affiliated Hospital of Nantong University, Dongtai, Jiangsu, China
| | - Wei Zhong
- Department of Urology, China Meitan General Hospital, Beijing, China
| | - Hao-Dong Ni
- Department of Urology, DongTai People's Hospital, Dongtai Affiliated Hospital of Nantong University, Dongtai, Jiangsu, China.
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Valenzuela-Sánchez F, Valenzuela-Méndez B, Rodríguez-Gutiérrez JF, Estella-García Á, González-García MÁ. New role of biomarkers: mid-regional pro-adrenomedullin, the biomarker of organ failure. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:329. [PMID: 27713887 DOI: 10.21037/atm.2016.08.65] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mid-regional pro-adrenomedullin (MR-proADM) has a good biomarker profile: its half-life is several hours, and its plasma concentrations can be determined in clinical practice, it is essentially irrelevant, but proportionally represents the levels and activity of adrenomedullin (ADM). ADM synthesis is widely distributed in tissues, including bone, adrenal cortex, kidney, lung, blood vessels and heart. Its fundamental biological effects include vasodilator, positive inotropic, diuretic, natriuretic and bronchodilator. It has been described high levels in septic patients, interacting directly with the relaxation of vascular tone, triggering hypotension of these patients. It is also found high levels in other diseases such as hypertension, heart failure, respiratory failure, renal failure, cirrhosis and cancer. MR-proADM has been identified as a prognostic marker, stratifying the mortality risk in patients with sepsis in emergency department (ED) and ICU. Evolutionary MR-proADM levels and clearance marker to the 2nd-5th days of admission help to determine the poor performance and the risk of mortality in patients with severe sepsis admitted to the ICU. The MR-proADM levels are more effective than procalcitonin (PCT) and C-reactive protein (CRP) levels to determine an unfavorable outcome and the risk of mortality in patients with sepsis admitted to the ICU. It has also proved useful in patients diagnosed with organ dysfunction of infectious etiology. MR-proADM levels are independent of the germ conversely it is related to the magnitude of organ failure and therefore severity. We consider advisable incorporating the MR-proADM the panel of biomarkers necessary for the diagnosis and treatment of critically ill patients admitted to the ICU with severe sepsis. The combined PCT and MR-proADM levels could represent a valid tool in the clinical practice to timely identify patients with bacterial infections and guide the diagnosis and treatment of sepsis and septic shock.
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Affiliation(s)
| | - Blanca Valenzuela-Méndez
- Ginecology and Obstetric Department, University Hospital Germans Trias i Pujol, Barcelona, Spain;; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Ángel Estella-García
- Critical Care Medicine Department, University Hospital SAS of Jerez, Jerez de la Frontera, Spain
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Procalcitonin as diagnostic marker of infection in solid tumors patients with fever. Sci Rep 2016; 6:28090. [PMID: 27312877 PMCID: PMC4911581 DOI: 10.1038/srep28090] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 05/23/2016] [Indexed: 01/31/2023] Open
Abstract
In oncologic patients fever is a non-specific clinical marker of different clinical settings. Procalcitonin (PCT) seems to be the most promising infection marker. We aimed to define the potential role of PCT as an earlier diagnostic marker in patients with fever and solid tumor. This retrospective study enrolled 431 patients. All of them performed hemoculture (HE) and basal PCT assessment (reference laboratory cut-off: ≤0.5 or >0.5 ng/dL) before starting antibiotic therapy. Gram positive (G+), negative (G−) or Fungi infection were detected. A statistically significant difference in PCT levels between patients with positive and negative HE was observed (P < 0.0001). Moreover comparing PCT values in patients with positive and negative HE, we obtain in the positive HE subpopulation an AUC of 0.7 and a cut-off of 1.52 ng/dL reached high sensitivity (61.6%) and specificity (70.1%). Using this last cut-off, instead of the normal reference value, we achieve a risk reduction to overestimate an infection status of 23.4%. We support the clinic usefulness of serum PCT dosage in febrile advanced solid tumor patients. A PCT cut-off of 1.52 ng/dL could be helpful in the management of the antibiotic therapy preventing delays of oncologic treatments.
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Fontela PS, Lacroix J. Procalcitonin: Is This the Promised Biomarker for Critically Ill Patients? J Pediatr Intensive Care 2016; 5:162-171. [PMID: 31110901 DOI: 10.1055/s-0036-1583279] [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] [Received: 08/28/2015] [Accepted: 11/19/2015] [Indexed: 12/23/2022] Open
Abstract
Objective Procalcitonin (PCT) has been increasingly used in the critical care setting to determine the presence of bacterial infection and also to guide antibiotic therapy. We reviewed PCT's physiologic role, as well as its clinical utility for the management of pediatric critically ill patients. Findings PCT is a precursor of the hormone calcitonin. Its production is induced by inflammatory conditions, especially bacterial infections. Literature shows that PCT is a moderately reliable diagnostic test for severe bacterial infection in children. Synthesis of available adult studies suggests that the use of PCT-based algorithms to support medical decision making reduces antibiotic exposure without compromising safety in critically ill patients. However, no study has addressed the usefulness and safety of PCT to guide antibiotic therapy in severely ill children. In pediatric patients with acute lower respiratory tract infections, the use of PCT-based algorithms also led to a safe decrease in antibiotic treatment duration. Conclusion PCT has demonstrated clinical utility in the pediatric critical care setting when used for the diagnosis of bacterial infections and to guide antibiotic use in children with acute lower respiratory tract infections. However, more research is needed in critically ill children to determine the utility of PCT-driven antibiotic therapy in this population.
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Affiliation(s)
- Patricia S Fontela
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
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40
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Zhou G, Ho KM. Procalcitonin concentrations as a predictor of unexpected readmission and mortality after intensive care unit discharge: A retrospective cohort study. J Crit Care 2016; 33:240-4. [PMID: 27020769 DOI: 10.1016/j.jcrc.2016.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/20/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
Procalcitonin (PCT) has been used to guide treatment in critically ill patients with sepsis, but whether PCT at intensive care unit (ICU) discharge can stratify risks of post-ICU readmission or mortality is unknown. This cohort study compared the ability of PCT with C-reactive protein (CRP) in predicting unexpected adverse post-ICU events. Of the 1877 patients admitted to the multidisciplinary ICU between 1 April 2012 and 31 March 2014, 1653 (88.1%) were discharged without treatment limitations. A total of 71 (4.3%) were readmitted and 18 patients (1%) died unexpectedly after ICU discharge during the same hospitalization. Both PCT (0.6 vs 0.4 μg/L, P = .002) and a high CRP concentration >100 mg/L (58% vs 41%, P = .004) at ICU discharge were associated with an increased risk of adverse post-ICU events in the univariate analyses; however, the ability of PCT to discriminate between patients with and without adverse post-ICU outcomes was limited (area under the receiver operating characteristic curve = 0.61; 95% confidence interval, 0.55-0.66). In the multivariable analysis, only a high CRP concentration (odds ratio, 1.92; 95% confidence interval, 1.12-3.11; P = .008) was associated with an increased adverse post-ICU events. Elevated PCT concentration at ICU discharge was inadequate in its predictive ability to guide ICU discharge.
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Affiliation(s)
- George Zhou
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, WA 6000, Australia.
| | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, WA 6000, Australia; School of Population Health, University of Western Australia, Perth, WA 6000, Australia; School of Veterinary and Life Sciences, Murdoch University, Perth, 6150, Australia
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41
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Tomasiuk R, Lipowski D, Szlufik S, Peplinska K, Mikaszewska-Sokolewicz M. Higher level of NT-proCNP in cerebrospinal fluid of patients with meningitis. Neurosci Lett 2016; 614:29-32. [PMID: 26742639 DOI: 10.1016/j.neulet.2015.12.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/01/2015] [Accepted: 12/24/2015] [Indexed: 02/05/2023]
Abstract
Aminoterminal pro-C type natriuretic peptide (NT-proCNP) as an active form of CNP, has been recently proven to be a potential marker of sepsis and to be linked to inflammatory diseases. So far, there are no studies describing the level of NT-proCNP in meningitis. The purpose of this study was to evaluate the diagnostic value of NT-proCNP in cerebrospinal fluid (CSF) in patients with meningitis and to compare it with the serum level of CRP and procalcitonin (PCT) in this group of patients. The results were compared to serum levels of CRP, PCT and CSF levels of cytosis, protein and lactate. NT-proCNP levels were statistically significant between the control group and the meningitis groups (p=0.02; R=0.3). We also noted a correlation between the level of NT-proCNP in the CSF of all of the study groups (controls and meningitis patients) and the CSF levels of cytosis (p<0.5; R=0.43), protein (p<0.05; R=0.39) and lactate (p<0.05; R=0.34), and also the serum level of CRP (p<0.05; R=0.30), but not serum PCT (p>0.05; R=0.11). These results suggest that NT-proCNP could be a potential marker of meningitis, but it cannot be used to distinguish between the types of meningitis.
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Affiliation(s)
- Ryszard Tomasiuk
- Department of Laboratory Diagnostics, Mazovian Brodno Hospital in Warsaw, Poland
| | - Dariusz Lipowski
- Department of Adult's Infectious Diseases, Institute of Infectious and Parasitic Diseases in Warsaw, Poland
| | - Stanislaw Szlufik
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Poland.
| | - Krystyna Peplinska
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Poland
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Shen YZ, Guo X, Bai Y. Risk factors for early infection in patients with severe acute pancreatitis complicated with diabetes mellitus. Shijie Huaren Xiaohua Zazhi 2015; 23:5064-5069. [DOI: 10.11569/wcjd.v23.i31.5064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the risk factors for early complications in patients with severe acute pancreatitis (SAP) complicated with diabetes mellitus (DM).
METHODS: Eighty-six patients with SAP complicated with DM treated at our hospital from June 2009 to January 2014 were retrospectively analyzed. According to the presence of infection episodes or not during early symptomatic treatment, the patients were divided into either an infection group (38 cases) or a non-infection group (48 cases). The risk factors for early infection were identified by Logistic regression analysis.
RESULTS: Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, biliary pathogenic factors, fasting time, hyoxemia, high serum creatinine, procalcitonin (PCT), C-reactive protein (CRP), mechanical ventilation and the use of antibiotics were statistically associated with early infection. Logistic multivariate regression analysis showed that APACHE Ⅱ score > 11 (OR = 9.793), hyoxemia (OR = 5.202), fasting time > 7 d (OR = 1.476), increased PCT (OR = 6.861) and the use of antibiotics (OR = 4.125) were independent risk factors for early infection in patients with SAP combined with DM.
CONCLUSION: The development of early infection in SAP combined with DM is closely related with many risk factors, which should be aimed by doctors at early stage to reduce the risk of infection and mortality.
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Using Arden Syntax Medical Logic Modules to reduce overutilization of laboratory tests for detection of bacterial infections-Success or failure? Artif Intell Med 2015; 92:43-50. [PMID: 26476896 DOI: 10.1016/j.artmed.2015.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 09/12/2015] [Accepted: 09/12/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Bacterial infections frequently cause prolonged intensive care unit (ICU) stays. Repeated measurements of the procalcitonin (PCT) biomarker are typically used for early detection and follow up of bacterial infections and sepsis, but those PCT measurements are costly. To avoid overutilization, we developed and evaluated a clinical decision support system (CDSS) in Arden Syntax which computes necessary and preventable PCT orders. METHODS The CDSS implements a rule set based on the latest PCT value, the time period since this measurement, and the PCT trend scenario. We assessed the CDSS effects on the daily rate of ordered PCT tests within a prospective study having two ON and two OFF phases in a surgical ICU. In addition, we performed interviews with the participating physicians to investigate their experience with the CDSS advice. RESULTS Prior to the deployment of the CDSS, 22% of the performed PCT tests were potentially preventable according to the rule set. During the first ON phase the daily rate of ordered PCT tests per patient decreased significantly from 0.807 to 0.662. In subsequent OFF, ON and OFF phases, however, PCT utilization reached again daily rates of 0.733, 0.803, and 0.792, respectively. The interviews demonstrated that the physicians were aware of the problem of PCT overutilization, which they primarily attributed to acute time constraints. The responders assumed that the majority of preventable measurements are indiscriminately ordered for patients during longer ICU stays. CONCLUSION We observed an 18% reduction of PCT tests within the first four weeks of CDSS support in the investigated ICU. This reduction may have been influenced by raised awareness of the overutilization problem; the extent of this influence cannot be determined in our study design. No reduction of PCT tests could be observed during the second ON phase. The physician interviews indicated that time critical ICU situations can prevent extensive reflection about the necessity of individual tests. In order to achieve an enduring effect on PCT utilization, we will have to proceed to electronic order entry.
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[Predictive value of procalcitonin in children with suspected sepsis]. ACTA ACUST UNITED AC 2015; 86:331-6. [PMID: 26320678 DOI: 10.1016/j.rchipe.2015.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 05/26/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The use of biomarkers could be a tool for diagnosis, prognosis and stratifying children with sepsis. Our main goal was to analyze the value of procalcitonin (PCT), C reactive protein (CRP) and lactate in predicting mortality, septic shock and the stratification in children with suspected sepsis PATIENTS AND METHOD Prospective study in 81 patients. Plasma levels of PCT, CRP and lactate were measured at admission in the pediatric intensive care unit. Patients were categorized into systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock. RESULTS Concentrations of PCT (ng/mL) increased significantly according to the severity of sepsis: 0.36 (0-1.2) for systemic inflammatory response syndrome; 1.96 (0.4-3.5) for sepsis; 7.5 (3.9-11.1) for severe sepsis; and 58.9 (35.1-82.7) for septic shock (P<.001). Compared to CRP and lactate, the area under the ROC curve revealed a good discriminative power of PCT to predict septic shock and mortality, 0.91 (95% CI: 0.83-0.97) and 0.80 (95% CI: 0.69-0.88), respectively. CONCLUSIONS In contrast to CRP and lactate, the determination of PCT in pediatric intensive care unit admission is a good predictor of mortality and septic shock and can stratify patients according to severity of sepsis.
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Assfalg V, Wolf P, Reim D, Hüser N, Hellbrügge G, Matevossian E, Friess H, Holzmann B, Emmanuel KL, Novotny AR. Procalcitonin ratio and on-demand relaparotomy for septic peritonitis: validation of the focus index (FI). Surg Today 2015. [PMID: 26212215 DOI: 10.1007/s00595-015-1226-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Secondary peritonitis remains challenging to manage and some recent evidence suggests that on-demand relaparotomy is more appropriate than planned relaparotomy. This study was designed to validate the predictive power of postoperative procalcitonin (PCT) changes in relation to elimination of the septic abdominal focus. METHODS In this prospective trial, postoperative PCT serum levels were monitored in 234 surgical patients with secondary peritonitis. The PCT ratio on postoperative days (PODs) 1 and 2 (focus index; FI) was calculated and correlated with the success of the operation. RESULTS A cutoff value of 1.1 was calculated for the FI. Values below 1.1 indicated insufficient elimination of the focus and values above 1.1 correlated with effective treatment. The optimal time for first PCT sampling was found to be 12-24 h after the index operation. After the respective data cleanup, successful elimination of the intraabdominal focus could be confirmed, with a sensitivity of 93 % and a specificity of 71 %. CONCLUSIONS The FI is a single parameter-based reliable predictor of successful surgical eradication and strengthens the on-demand relaparotomy concept as the method of choice to treat secondary peritonitis.
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Affiliation(s)
- Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Petra Wolf
- Institute of Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Daniel Reim
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Georg Hellbrügge
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Edouard Matevossian
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Bernhard Holzmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
| | - Klaus L Emmanuel
- Department of Surgery, Salzburger Landeskliniken, University of Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Department of Surgery, Krankenhaus der Barmherzigen Schwestern Linz, Seilerstätte 4, 4020, Linz, Austria
| | - Alexander R Novotny
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, Munich, Germany
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Liu Z, Chen J, Liu Y, Si X, Jiang Z, Zhang X, Guan X. A simple bioscore improves diagnostic accuracy of sepsis after surgery. J Surg Res 2015; 200:290-7. [PMID: 26255225 DOI: 10.1016/j.jss.2015.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 06/27/2015] [Accepted: 07/09/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rapid and accurate prediction for sepsis remains a challenge in surgical intensive care units. Detection of individual biomarkers is often of marginal usefulness, and several biomarkers are difficult to measure in the clinical setting. The aim of this study was to evaluate the diagnostic and prognostic performance of three routine biomarkers, procalcitonin (PCT), B-type natriuretic peptide (BNP), and lymphocyte percentage, as individual or in combination for sepsis in surgical critically ill patients. MATERIALS AND METHODS Circulating PCT, BNP, and lymphocyte percentage were measured in surgical patients on admission to the intensive care unit. A bioscore system combining these biomarkers was constructed. All studied variables were analyzed according to the diagnosis and clinical outcomes of sepsis. RESULTS A total of 320 consecutive patients were included in the analysis. One hundred fifty-six patients presented with sepsis. In the patients with sepsis, levels of PCT and BNP increased and lymphocyte percentage decreased. For individual biomarkers, PCT achieved the best area under the curve for the diagnosis of sepsis, whereas the diagnostic performance of the bioscore was better than that of each individual biomarker (area under the curve, 0.914 [95% confidence interval, 0.862-0.951]). Levels of BNP and bioscore increased in nonsurvivors in the entire cohort, but the accuracy of these two variables for mortality prediction was lower than that shown by Acute Physiology and Chronic Health Evaluation II score. Furthermore, bioscore failed to predict outcomes in septic patients. CONCLUSIONS A simple bioscore combining PCT together with BNP and lymphocyte percentage improves the diagnostic accuracy for sepsis in surgical critically ill patients but fails to predict outcomes in surgical patients with sepsis.
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Affiliation(s)
- Zimeng Liu
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Juan Chen
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongjun Liu
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiang Si
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiyi Jiang
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xuyu Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Xiangdong Guan
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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47
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Tong X, Cao Y, Yu M, Han C. Presepsin as a diagnostic marker for sepsis: evidence from a bivariate meta-analysis. Ther Clin Risk Manag 2015; 11:1027-33. [PMID: 26170681 PMCID: PMC4494627 DOI: 10.2147/tcrm.s84811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The diagnosis of sepsis remains a clinical challenge. Many studies suggest that presepsin plays a role in diagnosing sepsis, but the results remain controversial. This study aimed to identify the overall diagnostic accuracy of presepsin for sepsis through meta-analysis. Methods A systematic literature search was performed in PubMed and EMBASE to identify studies evaluating the diagnostic accuracy of presepsin in sepsis patients. Data were retrieved and the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) were calculated. A summary receiver operating characteristic curve and area under curve (AUC) were used to evaluate the overall diagnostic performance. The statistical analysis was performed using Stata 12.0 and Meta-DiSc 1.4 software. Results Eleven publications with 3,106 subjects were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR were 0.83 (95% confidence interval [CI] 0.77–0.88), 0.81 (95% CI 0.74–0.87), 4.43 (95% CI 3.05–6.43), 0.21 (95% CI 0.14–0.30), and 21.56 (95% CI 10.59–43.88), respectively. The area under the curve was 0.89 (95% CI 0.86–0.92). Estimated positive and negative post-probability values for a sepsis prevalence of 20% were 53% and 5%, respectively. No publication bias was identified. Conclusion Based on currently available evidence, presepsin may have a valuable role in the diagnosis of sepsis, and its results should be interpreted carefully in the context of clinical condition and traditional markers.
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Affiliation(s)
- Xiaomeng Tong
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yongtong Cao
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Min Yu
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Chengwu Han
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China
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Chiesa C, Pacifico L, Osborn JF, Bonci E, Hofer N, Resch B. Early-Onset Neonatal Sepsis: Still Room for Improvement in Procalcitonin Diagnostic Accuracy Studies. Medicine (Baltimore) 2015; 94:e1230. [PMID: 26222858 PMCID: PMC4554116 DOI: 10.1097/md.0000000000001230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To perform a systematic review assessing accuracy and completeness of diagnostic studies of procalcitonin (PCT) for early-onset neonatal sepsis (EONS) using the Standards for Reporting of Diagnostic Accuracy (STARD) initiative.EONS, diagnosed during the first 3 days of life, remains a common and serious problem. Increased PCT is a potentially useful diagnostic marker of EONS, but reports in the literature are contradictory. There are several possible explanations for the divergent results including the quality of studies reporting the clinical usefulness of PCT in ruling in or ruling out EONS.We systematically reviewed PubMed, Scopus, and the Cochrane Library databases up to October 1, 2014. Studies were eligible for inclusion in our review if they provided measures of PCT accuracy for diagnosing EONS. A data extraction form based on the STARD checklist and adapted for neonates with EONS was used to appraise the quality of the reporting of included studies.We found 18 articles (1998-2014) fulfilling our eligibility criteria which were included in the final analysis. Overall, the results of our analysis showed that the quality of studies reporting diagnostic accuracy of PCT for EONS was suboptimal leaving ample room for improvement. Information on key elements of design, analysis, and interpretation of test accuracy were frequently missing.Authors should be aware of the STARD criteria before starting a study in this field. We welcome stricter adherence to this guideline. Well-reported studies with appropriate designs will provide more reliable information to guide decisions on the use and interpretations of PCT test results in the management of neonates with EONS.
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Affiliation(s)
- Claudio Chiesa
- From the Institute of Translational Pharmacology, National Research Council (CC), Department of Pediatrics and Child Neuropsychiatry (LP), Department of Public Health and Infectious Diseases (JFO), Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy (EB); and Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (NH, BR)
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Bloos F. Clinical diagnosis of sepsis and the combined use of biomarkers and culture- and non-culture-based assays. Methods Mol Biol 2015; 1237:247-60. [PMID: 25319792 DOI: 10.1007/978-1-4939-1776-1_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sepsis is among the most common causes of death in hospitalized patients, and early recognition followed by immediate initiation of therapy is an important concept to improve survival in these patients. According to the definition of sepsis, diagnosis of sepsis requires the recognition of the systemic inflammatory response syndrome (SIRS) caused by infection as well as recognition of possible infection-related organ dysfunctions for diagnosis of severe sepsis or septic shock. Both SIRS and organ dysfunctions may occur frequently in hospitalized patients for various reasons. However, the fast recognition of acute infection as a cause of SIRS and newly developed organ dysfunction may be a demanding task since culture-based results of microbiological samples will be available only days after onset of symptoms. Biomarkers and PCR-based pathogen detection may help the physician in differentiating SIRS from sepsis. Procalcitonin (PCT) is the best investigated biomarker for this purpose. Furthermore, the current data support the usage of PCT for guidance of antimicrobial therapy. C-reactive protein (CRP) may be used to monitor the course of infection but has only limited discriminative capabilities. Interleukin-6 is widely used for its fast response to the infectious stimulus, but conclusive data for the application of this biomarker are missing. None of the available biomarkers can by itself reliably differentiate SIRS from sepsis but can aid and shorten the decision process. PCR-based pathogen detection can theoretically shorten the recognition of the underlying pathogen to about 8 h. However, this technique is expensive and requires additional staff in the laboratory; controlled prospective studies are missing. Although current studies suggest that PCR-based pathogen detection may be useful to shorten time to adequate antimicrobial therapy and diagnose invasive Candida infections, no general recommendations about the application of PCR for the diagnosis of sepsis can be given.
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Affiliation(s)
- Frank Bloos
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Erlanger Allee 101, 07747, Jena, Germany,
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50
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Wu H, Zhu S, Yu S, Ding G, Xu J, Li T, Qiao L, Chen Y, Yan J, Cheng X, Wan SP, Li G. Early Drastic Decrease in White Blood Count Can Predict Uroseptic Shock Induced by Upper Urinary Tract Endoscopic Lithotripsy: A Translational Study. J Urol 2015; 193:2116-22. [PMID: 25619454 DOI: 10.1016/j.juro.2015.01.071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Haiyang Wu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shibin Zhu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shicheng Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Guoqing Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jun Xu
- Department of Urology, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Tao Li
- Department of Urology, Fujian Provincial Hospital, Fuzhou, People's Republic of China
| | - Ludong Qiao
- Department of Urology, Tongren Hospital of Peking University, Beijing, People's Republic of China
| | - Yue Chen
- Department of Urology, Ningbo First Hospital, Ningbo, People's Republic of China
| | - Jiajun Yan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, People's Republic of China
| | - Xin Cheng
- Department of Urology, Second Hospital of Jiaxing, Jiaxing, People's Republic of China
| | - Shaw P Wan
- Department of Urology, First People's Hospital of Xiaoshan, Hangzhou, People's Republic of China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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