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Hu C, Zhang N, Xu D, Chen Z, Yu J, Yang Z, Zhang C. Clinical presentations and diagnostic approaches of pediatric necrotizing tracheobronchitis with influenza A virus and Staphylococcus aureus co-infections. Sci Rep 2024; 14:20880. [PMID: 39242687 PMCID: PMC11379925 DOI: 10.1038/s41598-024-71867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024] Open
Abstract
In March 2023, our pediatric intensive care unit (PICU) retrospectively examined six cases of pediatric necrotizing tracheobronchitis (NTB), focusing on co-infections with influenza A virus (IAV) and Staphylococcus aureus (S. aureus). This study aimed to elucidate NTB's clinical characteristics, diagnostics, and therapeutic approaches. Diagnostics included symptom assessment, microbiological testing that confirmed all patients were positive for IAV H1N1 with a predominant S. aureus co-infection, and bronchoscopy. The patients predominantly exhibited fever, cough, and dyspnea. Laboratory analysis revealed decreased lymphocyte counts and elevated infection markers like C-reactive protein and procalcitonin. Chest computed tomography (CT) scans detected tracheobronchial obstructions in half of the cases, while bronchoscopy showed severe mucosal congestion, edema, necrosis, and purulent-hemorrhagic exudates. Treatments encompassed comprehensive strategies like oxygen therapy, intubation, bronchoscopic interventions, thoracentesis, oseltamivir, and a regimen of antibiotics. Our findings suggested potential correlations between clinical markers, notably lymphocyte count and procalcitonin, and clinical interventions such as the number of rescues and intensive care unit (ICU) duration. This research highlights the importance of early detection and the role of bronchoscopy and specific markers in assessing NTB, advocating for continued research in larger cohorts to better understand its clinical trajectory and refine treatment approaches for this challenging pediatric disease.
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Affiliation(s)
- Chanchan Hu
- Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China
| | - Nan Zhang
- Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China
| | - Dan Xu
- Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China
| | - Zhenjie Chen
- Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China
| | - Jia Yu
- Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China
| | - Zihao Yang
- Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
| | - Chenmei Zhang
- Department of Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China
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Walker NF, Schutz C, Ward A, Barr D, Opondo C, Shey M, Elkington PT, Wilkinson KA, Wilkinson RJ, Meintjes G. Elevated Plasma Matrix Metalloproteinases Are Associated With Mycobacterium tuberculosis Bloodstream Infection and Mortality in Human Immunodeficiency Virus-Associated Tuberculosis. J Infect Dis 2024:jiae296. [PMID: 39219411 DOI: 10.1093/infdis/jiae296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Indexed: 09/04/2024] Open
Abstract
Mortality from human immunodeficiency virus (HIV)-associated tuberculosis (TB) is high, particularly among hospitalized patients. In 433 people with HIV hospitalized with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality, and Mycobacterium tuberculosis (Mtb) bloodstream infection (BSI). Compared to other diagnoses, MMP-8 was elevated in confirmed TB and in Mtb-BSI, positively correlating with extracellular matrix breakdown products. Baseline MMP-3, -7, -8, -10, and PIIINP were associated with Mtb-BSI and 12-week mortality. These findings implicate MMP dysregulation in pathophysiology of advanced HIV-TB and support MMP inhibition as a host-directed therapeutic strategy for HIV-TB.
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Affiliation(s)
- Naomi F Walker
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, United Kingdom
- Department of Clinical Sciences and Centre for Tuberculosis Research, Liverpool School of Tropical Medicine, United Kingdom
| | - Charlotte Schutz
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Amy Ward
- Department of Medicine, University of Cape Town, Observatory, South Africa
| | - David Barr
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Wellcome-Liverpool-Glasgow Centre for Global Health Research, University of Liverpool
- Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow
| | - Charles Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine
| | - Muki Shey
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Paul T Elkington
- National Institute for Health and Care Research Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton
| | - Katalin A Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Medicine, University of Cape Town, Observatory, South Africa
- The Francis Crick Institute, London
| | - Robert J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Medicine, University of Cape Town, Observatory, South Africa
- The Francis Crick Institute, London
- Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Graeme Meintjes
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, South Africa
- Department of Medicine, University of Cape Town, Observatory, South Africa
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Koho N, Rajamäki MM, Viitanen SJ. Serum procalcitonin as a diagnostic biomarker in dogs with bacterial respiratory diseases. Vet Clin Pathol 2024; 53:273-279. [PMID: 38730224 DOI: 10.1111/vcp.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/11/2024] [Accepted: 04/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Procalcitonin (PCT) is a useful biomarker in humans in the identification of bacterial respiratory infections. OBJECTIVES The aim of this study was to investigate the utility of serum PCT measurements as a diagnostic biomarker in canine bacterial lower respiratory tract diseases. METHODS PCT concentrations were measured in serum samples with an ELISA method previously validated for dogs. All dogs underwent thorough clinical examinations, and the diagnosis of respiratory disease was based on clinical and laboratory findings, diagnostic imaging, as well as cytology and bacterial culture of respiratory samples. PCT concentrations between different cohorts of dogs were compared with an ANOVA-model. RESULTS Sixty-two privately owned dogs with respiratory diseases, 25 with bacterial pneumonia (BP), 17 with bacterial bronchitis caused by Bordetella bronchiseptica (BB), and 20 with chronic bronchitis (CB) as well as 44 healthy controls were included in the study. Serum PCT concentrations in dogs with bacterial respiratory diseases (BP mean 51.8 ng/L ± standard deviation [SD] 40.6 ng/L and BB mean 61.4 ng/L ± SD 35.3 ng/L) were not significantly different when compared with dogs with a non-bacterial respiratory disease (CB mean 89.7 ± SD 73.5 ng/L) or healthy dogs (mean 51.0 ng/L ± SD 37.5 ng/L, p > .05 in all comparisons). CONCLUSIONS These results indicate that despite being a valuable diagnostic, prognostic, and follow-up marker in humans with pneumonia, serum PCT concentrations are not elevated in dogs with bacterial respiratory diseases and, therefore, cannot be used as a diagnostic biomarker in dogs.
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Affiliation(s)
- N Koho
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - M M Rajamäki
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - S J Viitanen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Jenko M, Mencin K, Novak-Jankovic V, Spindler-Vesel A. Influence of different intraoperative fluid management on postoperative outcome after abdominal tumours resection. Radiol Oncol 2024; 58:279-288. [PMID: 38452387 PMCID: PMC11165984 DOI: 10.2478/raon-2024-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/10/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Intraoperative fluid management is a crucial aspect of cancer surgery, including colorectal surgery and pancreatoduodenectomy. The study tests if intraoperative multimodal monitoring reduces postoperative morbidity and duration of hospitalisation in patients undergoing major abdominal surgery treated by the same anaesthetic protocols with epidural analgesia. PATIENTS AND METHODS A prospective study was conducted in 2 parallel groups. High-risk surgical patients undergoing major abdominal surgery were randomly selected in the control group (CG), where standard monitoring was applied (44 patients), and the protocol group (PG), where cerebral oxygenation and extended hemodynamic monitoring were used with the protocol for intraoperative interventions (44 patients). RESULTS There were no differences in the median length of hospital stay, CG 9 days (interquartile range [IQR] 8 days), PG 9 (5.5), p = 0.851. There was no difference in postoperative renal of cardiac impairment. Procalcitonin was significantly higher (highest postoperative value in the first 3 days) in CG, 0.75 mcg/L (IQR 3.19 mcg/L), than in PG, 0.3 mcg/L (0.88 mcg/L), p = 0.001. PG patients received a larger volume of intraoperative fluid; median intraoperative fluid balance +1300 ml (IQR 1063 ml) than CG; +375 ml (IQR 438 ml), p < 0.001. CONCLUSIONS There were significant differences in intraoperative fluid management and vasopressor use. The median postoperative value of procalcitonin was significantly higher in CG, suggesting differences in immune response to tissue trauma in different intraoperative fluid status, but there was no difference in postoperative morbidity or hospital stay.
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Affiliation(s)
- Matej Jenko
- Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Mencin
- Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vesna Novak-Jankovic
- Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alenka Spindler-Vesel
- Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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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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Lacharite-Roberge AS, Toomu S, Aldaas O, Ho G, Pollema TL, Birgersdotter-Green U. Inflammatory biomarkers as predictors of systemic vs isolated pocket infection in patients undergoing transvenous lead extraction. Heart Rhythm O2 2024; 5:289-293. [PMID: 38840769 PMCID: PMC11148492 DOI: 10.1016/j.hroo.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Cardiovascular implantable electronic device (CIED) infections are a common indication for device extraction. Early diagnosis and complete system removal are crucial to reduce morbidity and mortality. The lack of clear infectious symptoms makes the diagnosis of pocket infections challenging and may delay referral for extraction. Objective We aimed to determine if inflammatory biomarkers can help diagnose CIED isolated pocket infection. Methods We performed a retrospective analysis of all patients undergoing transvenous lead extraction for CIED infection at the University of California San Diego from 2012 to 2022 (N = 156). Patients were classified as systemic infection (n = 88) or isolated pocket infection (n = 68). Prospectively collected preoperative procalcitonin (PCT), C-reactive protein, and white blood cell count were compared between groups. Results Pairwise comparisons revealed that the systemic infection group had a higher PCT than the control group (P < .001) and the pocket infection group (P = .009). However, there was no significant difference in PCT value between control subjects and isolated pocket infection subjects. Higher white blood cell count was only associated with systemic infection when compared with our control group (P = .018). Conclusion In patients diagnosed with CIED infections requiring extraction, inflammatory biomarkers were not elevated in isolated pocket infection. Inflammatory markers are not predictive of the diagnosis of pocket infections, which ultimately requires a high level of clinical suspicion.
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Affiliation(s)
- Anne-Sophie Lacharite-Roberge
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Sandeep Toomu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Omar Aldaas
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Gordon Ho
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
| | - Travis L. Pollema
- Division of Cardiovascular and Thoracic Surgery, University of California San Diego, San Diego, California
| | - Ulrika Birgersdotter-Green
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California
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Su M, Wu H, Chen H, Guo J, Chen Z, Qiu J, Huang J. Early prediction of sepsis-induced respiratory tract infection using a biomarker-based machine-learning algorithm. Scand J Clin Lab Invest 2024; 84:202-210. [PMID: 38683948 DOI: 10.1080/00365513.2024.2346914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
Early and differential diagnosis of sepsis is essential to avoid unnecessary antibiotic use and further reduce patient morbidity and mortality. Here, we aimed to identify predictors of sepsis and advance a machine-learning strategy to predict sepsis-induced respiratory tract infection (RTI). Patients with sepsis and RTI were selected via retrospective analysis, and essential population characteristics and laboratory parameters were recorded. To improve the performance of the primary model and avoid over-fitting, a recursive feature elimination with cross-validation (RFECV) strategy was used to screen the optimal subset of biomarkers and construct nine machine-learning models based on this subset; the average accuracy, precision, recall, and F1-score were used for evaluation of the models. We identified 430 patients with sepsis and 686 patients with RTI. A total of 39 features were collected, with 23 features identified for initial model construction. Using the RFECV algorithm, we found that the XGBoost classifier, which only needed to include seven biomarkers, demonstrated the best performance among all prediction models, with an average accuracy of 89.24 ± 2.28, while the Ridge classifier, which included 11 biomarkers, had an average accuracy of only 83.87 ± 4.69. The remaining models had prediction accuracies greater than 88%. We developed nine models for predicting sepsis using a strategy that combined RFECV with machine learning. Among these models, the XGBoost classifier, which included seven biomarkers, showed the best performance and highest accuracy for predicting sepsis and may be a promising tool for the timely identification of sepsis.
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Affiliation(s)
- Mingkuan Su
- Department of Laboratory Medicine, Mindong Hospital of Ningde City, Fuan City, China
- Department of Laboratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan City, China
| | - Haiying Wu
- Department of Laboratory Medicine, Mindong Hospital of Ningde City, Fuan City, China
- Department of Laboratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan City, China
| | - Hongbin Chen
- Department of Laboratory Medicine, Mindong Hospital of Ningde City, Fuan City, China
- Department of Laboratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan City, China
| | - Jianfeng Guo
- Department of Laboratory Medicine, Mindong Hospital of Ningde City, Fuan City, China
- Department of Laboratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan City, China
| | - Zongyun Chen
- Department of Laboratory Medicine, Mindong Hospital of Ningde City, Fuan City, China
- Department of Laboratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan City, China
| | - Jie Qiu
- Department of Laboratory Medicine, Mindong Hospital of Ningde City, Fuan City, China
- Department of Laboratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan City, China
| | - Jiancheng Huang
- Department of Laboratory Medicine, Mindong Hospital of Ningde City, Fuan City, China
- Department of Laboratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fuan City, China
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Wang B, Zhou Q, Qian W, He Z, Yang Z, Chen C, Zheng L, Shi H. The predictive value of laboratory tests in oro-maxillofacial infection of different severity. Oral Dis 2024; 30:1695-1701. [PMID: 37094078 DOI: 10.1111/odi.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 03/19/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE We aimed to investigate the value of individual laboratory tests and combinations of tests for predicting disease severity. METHODS We retrospectively reviewed 62 patients with space infections in the oral and maxillofacial head and neck regions. Patients were divided into three groups according to severity. Laboratory tests associated with disease severity were identified. RESULTS As the severity of infection increased, leukocytes, neutrophils, C-reactive protein (CRP), procalcitonin (PCT), soluble interleukin receptor (sILR) 2, IL6, and creatinine (CR) increased. In the ROC analysis of group 1 (moderate infection) versus group 2 (severe infection), the area under the curve (AUC) values for leukocytes (AUC = 0.724), neutrophils (AUC = 0.714), PCT (AUC = 0.762) and a combination of the 3 tests (AUC = 0.768) suggested a strong predictive value. Furthermore, in the ROC analysis of group 2 (severe infection) versus group 3 (extremely severe infection), the AUC values for CRP (AUC = 0.84), PCT (AUC = 0.799), sIL2R (AUC = 0.937), IL6 (AUC = 0.863) and a combination of the four tests (AUC = 0.943) suggested a strong predictive value. CONCLUSIONS Leukocytes, neutrophils, and PCT were associated with multispace infection and high severity. CRP, PCT, sIL2R, and/or IL6 were associated with extremely severe infections occurring in the oral and maxillofacial head and neck regions.
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Affiliation(s)
- Baoli Wang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Qin Zhou
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Wentao Qian
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zhiyuan He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zuoyi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Changyu Chen
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Lingyan Zheng
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Huan Shi
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
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Agnello L, Vidali M, Ciaccio AM, Lo Sasso B, Iacona A, Biundo G, Scazzone C, Gambino CM, Ciaccio M. A machine learning strategy to mitigate the inappropriateness of procalcitonin request in clinical practice. Heliyon 2024; 10:e26556. [PMID: 38444484 PMCID: PMC10912224 DOI: 10.1016/j.heliyon.2024.e26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Aim The aim of this study was to develop machine learning (ML) models to mitigate the inappropriate request of Procalcitonin (PCT) in clinical wards. Material and methods We built six different ML models based on both demographical data, i.e., sex and age, and laboratory parameters, i.e., cell blood count (CBC) parameters, inclusive of monocyte distribution width (MDW), and C-reactive protein (CRP). The dataset included 1667 PCT measurements of different patients. Based on a PCT cut-off of 0.50 ng/mL, we found 1090 negative (65.4%) and 577 positive (34.6%) results. We performed a 70:15:15 train:validation:test splitting based on the outcome. Results Random Forest, Support Vector Machine and eXtreme Gradient Boosting showed optimal performances for predicting PCT positivity, with an area under the curve ranging from 0.88 to 0.89. Conclusions The ML models developed could represent a useful tool to predict PCT positivity, avoiding unusefulness PCT requests. ML models are based on laboratory tests commonly ordered together with PCT but have the great advantage to be easy to measure and low-cost.
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Affiliation(s)
- Luisa Agnello
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
| | - Matteo Vidali
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Anna Maria Ciaccio
- Internal Medicine and Medical Specialties “G. D'Alessandro”, Department of Health Promotion, Maternal and Infant Care, University of Palermo, 90127, Palermo, Italy
| | - Bruna Lo Sasso
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Alessandro Iacona
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Giuseppe Biundo
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Concetta Scazzone
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
| | - Caterina Maria Gambino
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, AOUP “P. Giaccone”, Palermo, Italy
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10
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Dupuy AM, Yahyaoui A, Bargnoux AS, Coulon C, Badiou S, Cristol JP. New procalcitonin point-of-care test meets analytical performances to stratification of infectious syndrome. Pract Lab Med 2024; 39:e00372. [PMID: 38435332 PMCID: PMC10907192 DOI: 10.1016/j.plabm.2024.e00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- Anne Marie Dupuy
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Ahmed Yahyaoui
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Anne Sophie Bargnoux
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
| | - Caroline Coulon
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Stéphanie Badiou
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
| | - Jean Paul Cristol
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, France
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11
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Delaplain PT, Santos J, Dvorak J, Mele TS, Gelbard RB, Guidry CA, Barie PS, Schubl SD. An Exploratory and Qualitative Analysis of Self-Reported Evaluations for Fever. Surg Infect (Larchmt) 2024; 25:116-124. [PMID: 38324100 DOI: 10.1089/sur.2023.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background: Despite the high prevalence of post-operative fever, a variety of approaches are taken as to the components of a fever evaluation, when it should be undertaken, and when empiric antibiotic agents should be started. Hypothesis: There is a lack of consensus surrounding many common components of a post-operative fever evaluation. Patients and Methods: The Surgical Infection Society membership was surveyed to determine practices surrounding evaluation of post-operative fever. Eight scenarios were posed in febrile (38.5°C), post-operative general surgery or trauma patients, with 19 possible components of work-up (physical examination, complete blood count [CBC], fungal biomarkers, lactate and procalcitonin [PCT] concentrations, cultures, imaging) and management (antibiotic agents). Each scenario was then re-considered for intensive care unit (ICU) patients (intubated/unstable hemodynamics). Agreement on a parameter (<1/4 or >3/4 of respondents) achieved consensus, positive or negative. Parameters between had equipoise; α was set at 0.05. Results: Among the examined scenarios, only CBC and physical examination received positive consensus across most scenarios. Blood/urine cultures, imaging, lactate, inflammatory biomarkers, and the empiric administration of antibiotic agents did not reach consensus; support was variable depending on the clinical scenario, illness severity, and the individual preferences of the answering clinician. The qualitative portion of the survey identified "fever threshold and duration," "clinical suspicion," and "physiologic manifestation" as the most important factors for deciding about the initiation of a fever evaluation and the potential empiric administration of antibiotic agents. Conclusions: There is consensus only for physical and examination routine laboratory work when initiating the evaluation of febrile post-operative patients. However, there are multiple components of a fever evaluation that individual respondents would select depending on the clinical scenario and severity of illness. Parameters demonstrating equipoise are potential candidates for formal guidance or pragmatic prospective trials.
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Affiliation(s)
- Patrick T Delaplain
- Boston Children's Hospital, Harvard Medical System, Boston, Massachusetts, USA
| | - Jeffrey Santos
- Department of Surgery, University of California-Irvine, Orange, California, USA
| | - Justin Dvorak
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Tina S Mele
- Divisions of General Surgery and Critical Care, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Rondi B Gelbard
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher A Guidry
- Division of Trauma/Critical and Acute Care Surgery, Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Sebastian D Schubl
- Department of Surgery, University of California-Irvine, Orange, California, USA
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12
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Aygun U, Yagin FH, Yagin B, Yasar S, Colak C, Ozkan AS, Ardigò LP. Assessment of Sepsis Risk at Admission to the Emergency Department: Clinical Interpretable Prediction Model. Diagnostics (Basel) 2024; 14:457. [PMID: 38472930 DOI: 10.3390/diagnostics14050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
This study aims to develop an interpretable prediction model based on explainable artificial intelligence to predict bacterial sepsis and discover important biomarkers. A total of 1572 adult patients, 560 of whom were sepsis positive and 1012 of whom were negative, who were admitted to the emergency department with suspicion of sepsis, were examined. We investigated the performance characteristics of sepsis biomarkers alone and in combination for confirmed sepsis diagnosis using Sepsis-3 criteria. Three different tree-based algorithms-Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), Adaptive Boosting (AdaBoost)-were used for sepsis prediction, and after examining comprehensive performance metrics, descriptions of the optimal model were obtained with the SHAP method. The XGBoost model achieved accuracy of 0.898 (0.868-0.929) and area under the ROC curve (AUC) of 0.940 (0.898-0.980) with a 95% confidence interval. The five biomarkers for predicting sepsis were age, respiratory rate, oxygen saturation, procalcitonin, and positive blood culture. SHAP results revealed that older age, higher respiratory rate, procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, plaque, leukocyte particle concentration, as well as lower oxygen saturation, systolic blood pressure, and hemoglobin levels increased the risk of sepsis. As a result, the Explainable Artificial Intelligence (XAI)-based prediction model can guide clinicians in the early diagnosis and treatment of sepsis, providing more effective sepsis management and potentially reducing mortality rates and medical costs.
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Affiliation(s)
- Umran Aygun
- Department of Anesthesiology and Reanimation, Malatya Yesilyurt Hasan Calık State Hospital, Malatya 44929, Turkey
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Burak Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Seyma Yasar
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya 44280, Turkey
| | - Ahmet Selim Ozkan
- Department of Anesthesiology and Reanimation, Malatya Turgut Ozal University School of Medicine, Malatya 44210, Turkey
| | - Luca Paolo Ardigò
- Department of Teacher Education, NLA University College, 0166 Oslo, Norway
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13
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Hemmann P, Kloppenburg L, Breinbauer R, Ehnert S, Blumenstock G, Reumann MK, Erne F, Jazewitsch J, Schwarz T, Baumgartner H, Histing T, Rollmann M, Nüssler AK. AZU1: a new promising marker for infection in orthopedic and trauma patients? EXCLI JOURNAL 2024; 23:53-61. [PMID: 38357095 PMCID: PMC10864703 DOI: 10.17179/excli2023-6705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/06/2023] [Indexed: 02/16/2024]
Abstract
Early and reliable detection of infection is vital for successful treatment. Serum markers such as C-reactive protein (CRP) and procalcitonin (PCT) are known to increase with a time lag. Azurocidin 1 (AZU1) has emerged as a promising marker for septic patients, but its diagnostic value in orthopedic and trauma patients remains unexplored. Between July 2020 and August 2023, all patients necessitating inpatient treatment for periprosthetic joint infection (PJI), peri-implant infection (II), soft tissue infection, chronic osteomyelitis, septic arthrodesis, bone non-union with and without infection were enrolled. Patients undergoing elective total joint arthroplasty (TJA) served as the control group. Blood samples were collected and analyzed for CRP, white blood cell count (WBC), PCT, and AZU1. Based on the inclusion and exclusion criteria 222 patients were included in the study (trauma = 38, soft tissue infection = 75, TJA = 33, PJI/II = 39, others = 37). While sensitivity and specificity were comparably high for AZU1 (0.734/0.833), CRP and PCT had higher specificity (0.542/1 and 0.431/1, respectively), and WBC a slightly higher sensitivity (0.814/0.455) for septic conditions. Taken together, the area under the curve (AUC) showed the highest accuracy for AZU1 (0.790), followed by CRP (0.776), WBC (0.641), and PCT (0.656). The Youden-Index was 0.57 for AZU1, 0.54 for CRP, 0.27 for WBC, and 0.43 for PCT. Elevated AZU1 levels effectively distinguished patients with a healthy condition from those suffering from infection. However, there is evidence suggesting that trauma may influence the release of AZU1. Additional research is needed to validate the diagnostic value of this new biomarker and further explore its potential clinical applications.
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Affiliation(s)
- Philipp Hemmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Lisa Kloppenburg
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Regina Breinbauer
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Sabrina Ehnert
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany
| | - Marie K. Reumann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Felix Erne
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Johann Jazewitsch
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Tobias Schwarz
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Heiko Baumgartner
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Mika Rollmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Andreas K. Nüssler
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
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14
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Walker NF, Schutz C, Ward A, Barr D, Opondo C, Shey M, Elkington PT, Wilkinson KA, Wilkinson RJ, Meintjes G. Elevated plasma matrix metalloproteinases associate with Mycobacterium tuberculosis blood stream infection and mortality in HIV-associated tuberculosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.12.23299845. [PMID: 38168355 PMCID: PMC10760259 DOI: 10.1101/2023.12.12.23299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Mortality from HIV-associated tuberculosis (HIV-TB) is high, particularly among hospitalised patients. In 433 people living with HIV admitted to hospital with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality and Mycobacterium tuberculosis (Mtb) blood stream infection (BSI). Compared to other diagnoses, MMP-8 was elevated in confirmed TB and in Mtb-BSI, positively correlating with extracellular matrix breakdown products. Baseline MMP-3, -7, -8, -10 and procollagen III N-terminal propeptide (PIIINP) associated with Mtb-BSI and 12-week mortality. These findings implicate MMP dysregulation in pathophysiology of advanced HIV-TB and support MMP inhibition as a host-directed therapeutic strategy for HIV-TB.
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Affiliation(s)
- N F Walker
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, WC1E 7HT, United Kingdom
| | - C Schutz
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - A Ward
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - D Barr
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Wellcome Liverpool Glasgow Centre for Global Health Research, University of Liverpool, Liverpool, L69 3BX, United Kingdom
- Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, G51 4TF
| | - C Opondo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, WC1E 7HT, United Kingdom
| | - M Shey
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
| | - P T Elkington
- NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, United Kingdom
| | - K A Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- The Francis Crick Institute, London, NW1 1AT, United Kingdom
| | - R J Wilkinson
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
- The Francis Crick Institute, London, NW1 1AT, United Kingdom
- Department of Infectious Diseases, Imperial College London, W12 0NN, United Kingdom
| | - G Meintjes
- Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory 7925, South Africa
- Department of Medicine, University of Cape Town, Observatory 7925, South Africa
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15
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O'Grady NP, Alexander E, Alhazzani W, Alshamsi F, Cuellar-Rodriguez J, Jefferson BK, Kalil AC, Pastores SM, Patel R, van Duin D, Weber DJ, Deresinski S. Society of Critical Care Medicine and the Infectious Diseases Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Med 2023; 51:1570-1586. [PMID: 37902340 DOI: 10.1097/ccm.0000000000006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
RATIONALE Fever is frequently an early indicator of infection and often requires rigorous diagnostic evaluation. OBJECTIVES This is an update of the 2008 Infectious Diseases Society of America and Society (IDSA) and Society of Critical Care Medicine (SCCM) guideline for the evaluation of new-onset fever in adult ICU patients without severe immunocompromise, now using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. PANEL DESIGN The SCCM and IDSA convened a taskforce to update the 2008 version of the guideline for the evaluation of new fever in critically ill adult patients, which included expert clinicians as well as methodologists from the Guidelines in Intensive Care, Development and Evaluation Group. The guidelines committee consisted of 12 experts in critical care, infectious diseases, clinical microbiology, organ transplantation, public health, clinical research, and health policy and administration. All task force members followed all conflict-of-interest procedures as documented in the American College of Critical Care Medicine/SCCM Standard Operating Procedures Manual and the IDSA. There was no industry input or funding to produce this guideline. METHODS We conducted a systematic review for each population, intervention, comparison, and outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as best-practice statements. RESULTS The panel issued 12 recommendations and 9 best practice statements. The panel recommended using central temperature monitoring methods, including thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors when these devices are in place or accurate temperature measurements are critical for diagnosis and management. For patients without these devices in place, oral or rectal temperatures over other temperature measurement methods that are less reliable such as axillary or tympanic membrane temperatures, noninvasive temporal artery thermometers, or chemical dot thermometers were recommended. Imaging studies including ultrasonography were recommended in addition to microbiological evaluation using rapid diagnostic testing strategies. Biomarkers were recommended to assist in guiding the discontinuation of antimicrobial therapy. All recommendations issued were weak based on the quality of data. CONCLUSIONS The guidelines panel was able to formulate several recommendations for the evaluation of new fever in a critically ill adult patient, acknowledging that most recommendations were based on weak evidence. This highlights the need for the rapid advancement of research in all aspects of this issue-including better noninvasive methods to measure core body temperature, the use of diagnostic imaging, advances in microbiology including molecular testing, and the use of biomarkers.
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Affiliation(s)
- Naomi P O'Grady
- Internal Medicine Services, National Institutes of Health Clinical Center, Bethesda, MD
| | - Earnest Alexander
- Clinical Pharmacy Services, Department of Pharmacy, Tampa General Hospital, Tampa, FL
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, Bethesda, MD
| | - Brian K Jefferson
- Division of Hepatobiliary and Pancreatic Surgery, Department of Internal Medicine-Critical Care Services, Atrium Health Cabarrus, Concord, NC
| | - Andre C Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, MN
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - Stanley Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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16
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Collette M, Hauet M, de Visme S, Borsa A, Schweitzer C, Marchand E, Martrille L, Wiedemann A. Procalcitonin is associated with sudden unexpected death in infancy due to infection. Eur J Pediatr 2023; 182:3929-3937. [PMID: 37353601 DOI: 10.1007/s00431-023-05064-3] [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: 03/21/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
Infection is an important cause of death during infancy worldwide and is a frequent etiology of sudden unexpected death in infancy (SUDI). Procalcitonin (PCT) is a useful marker to diagnose infection in patients, and several studies report the stability of PCT after death. The added value of a biological marker, such as the PCT level in the blood, remains controversial in investigating SUDI. The aim of this study was to determine if PCT can help clinicians determine whether infection caused SUDI. We conducted a retrospective, multicenter study with the French SUDI registry (Observatoire National des Morts Inattendues du Nourrisson; OMIN). We collected data from this registry on children who died between May 2015 and June 2021. The levels of PCT in the blood of 540 SUDI patients were measured. We compared PCT and other biological tests performed in terms of infection status, autopsy results, and cause of death using clinical and biological data compiled by pediatricians at the SUDI referral center. PCT levels were significantly higher in the children who died from infection than in those who did not (0.12 µg/L vs. 0.08 µg/L, p < 0.001). A PCT blood level exceeding 0.2 µg/L was more frequently observed when infection was present than in the absence of infection (44.3% vs. 15.4%, p < 0.001). The same data were obtained with a 0.5 µg/L cut-off (36.1% with infection vs. 9.2% without, p < 0.001). Conclusions: PCT is a sensitive biomarker for detecting infections postmortem; thus, additional samples may be necessary during autopsy. What is known: • PCT is a stable marker postmortem and increases earlier than CRP, i.e., 2-4 h after the beginning of an infection vs. 6 h. • PCT can be measured up to 140 h after death. What is new: • PCT is a sensitive marker for detecting infection in SUDI patients postmortem. • This test can reveal an infection from non-standardized samples obtained during autopsy if such an infection was not determined before death.
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Affiliation(s)
- Maritie Collette
- Pediatric Emergency Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
| | - Mathilde Hauet
- Pediatric Emergency Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
| | - Sophie de Visme
- Inserm, Clinical Investigation Centre 1413, University Hospital of Nantes, Nantes, France
| | - Anne Borsa
- Pediatric Emergency Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
| | - Cyril Schweitzer
- Pediatric Department, Children's Hospital, Children's Hospital, University Hospital of Nancy, Vandoeuvre-Les-Nancy, France
- DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, 3450, Vandœuvre-Les-Nancy, EA, France
| | - Elodie Marchand
- Université de Lorraine, CHU Nancy, Service de Médecine Légale, 54000, Nancy, France
| | - Laurent Martrille
- EDPFM, Univ Montpellier, CHU Montpellier, Service de Médecine Légale, Montpellier, France
| | - Arnaud Wiedemann
- Pediatric Intensive Care Unit, Children's Hospital, University Hospital of Nancy, C.H.R.U. Nancy, 54500, Vandoeuvre-Les-Nancy, France.
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France.
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17
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August BA, Kale-Pradhan PB, Giuliano C, Johnson LB. Biomarkers in the intensive care setting: A focus on using procalcitonin and C-reactive protein to optimize antimicrobial duration of therapy. Pharmacotherapy 2023; 43:935-949. [PMID: 37300522 DOI: 10.1002/phar.2834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 06/12/2023]
Abstract
Managing the critically ill patient with infection is complex, requiring clinicians to synthesize considerable information relating to antimicrobial efficacy and treatment duration. The use of biomarkers may play an important role in identifying variation in treatment response and providing information about treatment efficacy. Though a vast number of biomarkers for clinical application have been described, procalcitonin and C-reactive protein (CRP) are the most thoroughly investigated in the critically ill. However, the presence of heterogeneous populations, variable end points, and incongruent methodology in the literature complicates the use of such biomarkers to guide antimicrobial therapy. This review focuses on an appraisal of evidence for use of procalcitonin and CRP to optimize antimicrobial duration of therapy (DOT) in critically ill patients. Procalcitonin-guided antimicrobial therapy in mixed critically ill populations with varying degrees of sepsis appears to be safe and might assist in reducing antimicrobial DOT. Compared to procalcitonin, fewer studies exist examining the impact of CRP on antimicrobial DOT and clinical outcomes in the critically ill. Procalcitonin and CRP have been insufficiently studied in many key intensive care unit populations, including surgical patients with concomitant trauma, renally insufficient populations, the immunocompromised, and patients with septic shock. We believe the available evidence is not strong enough to warrant routine use of procalcitonin or CRP to guide antimicrobial DOT in critically ill patients with infection. So long as its limitations are recognized, procalcitonin could be considered to tailor antimicrobial DOT on a case-by-case basis in the critically ill patient.
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Affiliation(s)
- Benjamin A August
- Critical Care, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Science, Wayne State University, Detroit, Michigan, USA
| | - Pramodini B Kale-Pradhan
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Science, Wayne State University, Detroit, Michigan, USA
- Ascension St. John Hospital, Detroit, Michigan, USA
| | - Christopher Giuliano
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Science, Wayne State University, Detroit, Michigan, USA
- Ascension St. John Hospital, Detroit, Michigan, USA
| | - Leonard B Johnson
- Division of Infectious Diseases, Department of Internal Medicine, Infection Prevention and Antimicrobial Stewardship, Ascension St. John Hospital, Detroit, Michigan, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
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18
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Sinha S, Kumar S, Narwaria M, Singh A, Haque M. Severe Acute Bronchial Asthma with Sepsis: Determining the Status of Biomarkers in the Diagnosis of the Disease. Diagnostics (Basel) 2023; 13:2691. [PMID: 37627950 PMCID: PMC10453001 DOI: 10.3390/diagnostics13162691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Bronchial asthma is a widely prevalent illness that substantially impacts an individual's health standard worldwide and has a significant financial impact on society. Global guidelines for managing asthma do not recommend the routine use of antimicrobial agents because most episodes of the condition are linked to viral respiratory tract infections (RTI), and bacterial infection appears to have an insignificant impact. However, antibiotics are recommended when there is a high-grade fever, a consolidation on the chest radiograph, and purulent sputum that contains polymorphs rather than eosinophils. Managing acute bronchial asthma with sepsis, specifically the choice of whether or not to initiate antimicrobial treatment, remains difficult since there are currently no practical clinical or radiological markers that allow for a simple distinction between viral and bacterial infections. Researchers found that serum procalcitonin (PCT) values can efficiently and safely minimize antibiotic usage in individuals with severe acute asthma. Again, the clinical manifestations of acute asthma and bacterial RTI are similar, as are frequently used test values, like C-reactive protein (CRP) and white blood cell (WBC) count, making it harder for doctors to differentiate between viral and bacterial infections in asthma patients. The role and scope of each biomarker have not been precisely defined yet, although they have all been established to aid healthcare professionals in their diagnostics and treatment strategies.
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Affiliation(s)
- Susmita Sinha
- Department of Physiology, Khulna City Medical College and Hospital, 33 KDA Avenue, Hotel Royal Crossing, Khulna Sadar, Khulna 9100, Bangladesh
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, Gujarat, India
| | - Mahendra Narwaria
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, SG Highways, Ahmedabad 380054, Gujarat, India
| | - Arya Singh
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, SG Highways, Ahmedabad 380054, Gujarat, India
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, Kuala Lumpur 57000, Malaysia
- Department of Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, Gujarat, India
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Ehrlich Z, Magen S, Alexandroni H, Glik I, Grisaru-Granovsky S, Reichman O. The yield of procalcitonin and Interleukin-6 in predicting intraamniotic infection in the presence of intrapartum fever: A pilot study. PLoS One 2023; 18:e0288537. [PMID: 37437055 DOI: 10.1371/journal.pone.0288537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
Intrapartum fever (IF) accompanied by either maternal or foetal tachycardia, elevated WBC, or purulent discharge is classified as "suspected triple 1", the hallmark of intraamniotic infection (IAI). Poor specificity of the clinical diagnosis of IAI results, in retrospect, in the unnecessary treatment of most parturients and neonates. We studied the yield of specific acute phase reactants (APRs): procalcitonin, CRP, IL-6, in detecting bacterial IAI among parturients classified as "suspected triple 1" (cases) compared to afebrile parturients (controls). Procalcitonin, CRP, and IL-6 were all significantly elevated in the cases compared to the controls, yet this by itself was not sufficient for an additive effect in detecting a bacterial infection among parturients clinically diagnosed with "suspected triple 1", as demonstrated by the poor area under the receiver operating characteristic curve of all three APRs.
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Affiliation(s)
- Zvi Ehrlich
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Sophia Magen
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Heli Alexandroni
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Itamar Glik
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
| | - Orna Reichman
- Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel
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Wiley MB, Mehrotra K, Bauer J, Yazici C, Bialkowska AB, Jung B. Acute Pancreatitis: Current Clinical Approaches, Molecular Pathophysiology, and Potential Therapeutics. Pancreas 2023; 52:e335-e343. [PMID: 38127317 DOI: 10.1097/mpa.0000000000002259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Severe acute pancreatitis (SAP), pancreatic inflammation leading to multiorgan failure, is associated with high morbidity and mortality. There is a critical need to identify novel therapeutic strategies to improve clinical outcomes for SAP patients. MATERIALS AND METHODS A comprehensive literature review was performed to identify current clinical strategies, known molecular pathophysiology, and potential therapeutic targets for SAP. RESULTS Current clinical approaches focus on determining which patients will likely develop SAP. However, therapeutic options are limited to supportive care and fluid resuscitation. The application of a novel 5-cytokine panel accurately predicting disease outcomes in SAP suggests that molecular approaches will improve impact of future clinical trials in AP. CONCLUSIONS Inflammatory outcomes in acute pancreatitis are driven by several unique molecular signals, which compound to promote both local and systemic inflammation. The identification of master cytokine regulators is critical to developing therapeutics, which reduce inflammation through several mechanisms.
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Affiliation(s)
- Mark B Wiley
- From the Department of Medicine, University of Washington, Seattle, WA
| | - Kunaal Mehrotra
- From the Department of Medicine, University of Washington, Seattle, WA
| | - Jessica Bauer
- From the Department of Medicine, University of Washington, Seattle, WA
| | - Cemal Yazici
- Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - Agnieszka B Bialkowska
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Barbara Jung
- From the Department of Medicine, University of Washington, Seattle, WA
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21
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Saura O, Luyt CE. Procalcitonin as a biomarker to guide treatments for patients with lower respiratory tract infections. Expert Rev Respir Med 2023; 17:651-661. [PMID: 37639716 DOI: 10.1080/17476348.2023.2251394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Lower respiratory tract infections are amongst the main causes for hospital/intensive care unit admissions and antimicrobial prescriptions. In order to reduce antimicrobial pressure, antibiotic administration could be optimized through procalcitonin-based algorithms. AREAS COVERED In this review, we discuss the performances of procalcitonin for the diagnosis and the management of community-acquired and ventilator-associated pneumonia. We provide up-to-date evidence and deliver clear messages regarding the purpose of procalcitonin to reduce unnecessary antimicrobial exposure. EXPERT OPINION Antimicrobial pressure and resulting antimicrobial resistances are a major public health issue as well as a daily struggle in the management of patients with severe infectious diseases, especially in intensive care units where antibiotic exposure is high. Procalcitonin-guided antibiotic administration has proven its efficacy in reducing unnecessary antibiotic use in lower respiratory tract infections without excess in mortality, hospital length of stay or disease relapse. Procalcitonin-guided algorithms should be implemented in wards taking care of patients with severe infections. However, procalcitonin performances are different regarding the setting of the infection (community versus hospital-acquired infections) the antibiotic management (start or termination of antibiotic) as well as patient's condition (immunosuppressed or in shock) and we encourage the physicians to be aware of these limitations.
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Affiliation(s)
- Ouriel Saura
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRS_1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
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Naser PV, Papadopoulou P, Teuber J, Kopf S, Jesser J, Unterberg AW, Beynon C. Characteristics of inflammatory and infectious diseases of the pituitary gland in patients undergoing transsphenoidal surgery. Pituitary 2023:10.1007/s11102-023-01333-4. [PMID: 37389775 PMCID: PMC10397134 DOI: 10.1007/s11102-023-01333-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Inflammatory and infectious diseases of the pituitary gland (IIPD) are rare lesions often misdiagnosed preoperatively. Immediate surgery is indicated especially in cases of neurological impairment. However, (chronic) inflammatory processes can mimic other pituitary tumors, such as adenomas, and data on the preoperative diagnostic criteria for IIPD are sparse. METHODS We retrospectively reviewed medical records of 1317 patients who underwent transsphenoidal surgery at our institution between March 2003 and January 2023. A total of 26 cases of histologically confirmed IIPD were identified. Patient records, laboratory parameters, and postoperative course were analyzed and compared with an age, sex, and tumor volume-matched control group of nonfunctioning pituitary adenomas. RESULTS Pathology confirmed septic infection in ten cases, most commonly caused by bacteria (3/10) and fungi (2/10). In the aseptic group, lymphocytic hypophysitis (8/26) and granulomatous inflammation (3/26) were most frequently observed. Patients with IIPD commonly presented with endocrine and/or neurological dysfunction. No surgical mortality occurred. Preoperative radiographic findings (cystic/solid tumor mass, contrast enhancement) did not significantly differ between IIPD and adenomas. At follow-up, 13 patients required permanent hormone substitution. CONCLUSION In conclusion, correct preoperative diagnosis of IIPD remains challenging, as neither radiographic findings nor preoperative laboratory workup unequivocally identify these lesions. Surgical treatment facilitates decompression of supra- and parasellar structures. Furthermore, this low-morbidity procedure enables the identification of pathogens or inflammatory diseases requiring targeted medical treatment, which is crucial for these patients. Establishing a correct diagnosis through surgery and histopathological confirmation thus remains of utmost importance.
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Affiliation(s)
- Paul Vincent Naser
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany.
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany.
| | - Penelope Papadopoulou
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Jan Teuber
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Stefan Kopf
- Department of Endocrinology, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
| | - Christopher Beynon
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany
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Kraus CK, Nguyen HB, Jacobsen RC, Ledeboer NA, May LS, O'Neal HR, Puskarich MA, Rice TW, Self WH, Rothman RE. Rapid identification of sepsis in the emergency department. J Am Coll Emerg Physicians Open 2023; 4:e12984. [PMID: 37284425 PMCID: PMC10239543 DOI: 10.1002/emp2.12984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives Recent research has helped define the complex pathways in sepsis, affording new opportunities for advancing diagnostics tests. Given significant advances in the field, a group of academic investigators from emergency medicine, intensive care, pathology, and pharmacology assembled to develop consensus around key gaps and potential future use for emerging rapid host response diagnostics assays in the emergency department (ED) setting. Methods A modified Delphi study was conducted that included 26 panelists (expert consensus panel) from multiple specialties. A smaller steering committee first defined a list of Delphi statements related to the need for and future potential use of a hypothetical sepsis diagnostic test in the ED. Likert scoring was used to assess panelists agreement or disagreement with statements. Two successive rounds of surveys were conducted and consensus for statements was operationally defined as achieving agreement or disagreement of 75% or greater. Results Significant gaps were identified related to current tools for assessing risk of sepsis in the ED. Strong consensus indicated the need for a test providing an indication of the severity of dysregulated host immune response, which would be helpful even if it did not identify the specific pathogen. Although there was a relatively high degree of uncertainty regarding which patients would most benefit from the test, the panel agreed that an ideal host response sepsis test should aim to be integrated into ED triage and thus should produce results in less than 30 minutes. The panel also agreed that such a test would be most valuable for improving sepsis outcomes and reducing rates of unnecessary antibiotic use. Conclusion The expert consensus panel expressed strong consensus regarding gaps in sepsis diagnostics in the ED and the potential for new rapid host response tests to help fill these gaps. These finding provide a baseline framework for assessing key attributes of evolving host response diagnostic tests for sepsis in the ED.
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Affiliation(s)
- Chadd K. Kraus
- Department of Emergency MedicineGeisinger Medical CenterDanvillePennsylvaniaUSA
| | - H. Bryant Nguyen
- Department of MedicinePulmonary and Critical Care DivisionLoma Linda UniversityLoma LindaCaliforniaUSA
| | - Ryan C. Jacobsen
- Department of Emergency MedicineUniversity of Kansas HospitalKansas CityKansasUSA
| | - Nathan A. Ledeboer
- Department of Pathology & Laboratory MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Larissa S. May
- Department of Emergency MedicineUC Davis HealthDavisCaliforniaUSA
| | - Hollis R. O'Neal
- Department of Critical Care MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Michael A. Puskarich
- Department of Emergency MedicineHennepin County Medical CenterUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Todd W. Rice
- Vanderbilt Institute for Clinical and Translational Sciences and Division of AllergyPulmonary and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Wesley H. Self
- Vanderbilt Institute for Clinical and Translational Sciences and Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Richard E. Rothman
- Department of Emergency MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
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Farida H, Triasih R, Lokida D, Mardian Y, Salim G, Wulan WN, Butar-butar DP, Sari RA, Budiman A, Hayuningsih C, Anam MS, Dipayana S, Mujahidah M, Setyati A, Aman AT, Naysilla AM, Lukman N, Diana A, Karyana M, Kline A, Neal A, Lane HC, Kosasih H, Lau CY. Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia. Front Med (Lausanne) 2023; 10:1140100. [PMID: 37275364 PMCID: PMC10233046 DOI: 10.3389/fmed.2023.1140100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Background Discrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP. Methods Data from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression. Results Diarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia's rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08-0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18-18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07-25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively. Conclusion Combining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model.
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Affiliation(s)
- Helmia Farida
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Rina Triasih
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dewi Lokida
- Tangerang District General Hospital, Tangerang, Indonesia
| | - Yan Mardian
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Gustiani Salim
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Wahyu Nawang Wulan
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | | | - Rizki Amalia Sari
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Arif Budiman
- Tangerang District General Hospital, Tangerang, Indonesia
| | | | - Moh Syarofil Anam
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Setya Dipayana
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Mujahidah Mujahidah
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Amalia Setyati
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Abu Tholib Aman
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Muhammad Karyana
- National Institute of Health Research and Development, Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Ahnika Kline
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - H. Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Chuen-Yen Lau
- National Cancer Institute, Bethesda, MD, United States
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Chwala M, Hartmann F, Waller K, Dusick A, Viviano K. Change over time and agreement between clinical markers of disease resolution in dogs with aspiration-induced lung injury. Vet Rec 2023; 192:e2280. [PMID: 36251171 DOI: 10.1002/vetr.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/23/2022] [Accepted: 09/21/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is a lack of consensus regarding which markers of disease resolution to prioritise when assessing treatment response in client-owned dogs with aspiration-induced lung injury. This study describes the change over time and the agreement between the clinical markers used to determine disease resolution. METHODS Physical examination (PE), owner-reported clinical signs (CS-O), thoracic radiographs (TXR) scores and C-reactive protein (CRP) concentrations were determined at enrolment, after 24, 48 and 72 hours, and after 7, 14 and 28 days. RESULTS PE scores were significantly improved at 48 hours, while CRP initially increased (24 hours) and then decreased (48 hours). PE, CS-O and CRP significantly improved earlier (7 days) than TXR (14 days). The median number of days to marker normalisation was 7, 9 and 14 for PE, CRP and CS-O, respectively. Marker agreement was excellent/very good at enrolment and fair/poor during disease recovery. LIMITATIONS Analysis did not control for differences aetiology of aspiration or the lack of standardisation in treatment approach. CONCLUSIONS PE was the earliest and most consistent marker indicating disease resolution. Serial CRP monitoring (72 hours) may provide an objective marker of early treatment response. Alongside PE normalisation, improvement in CS-O, CRP and TRX may assist in determining disease resolution and guide treatments, including limiting antibiotic exposure in dogs with aspiration-induced lung injury.
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Affiliation(s)
| | - Faye Hartmann
- UW Veterinary Care, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kenneth Waller
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Allison Dusick
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Katrina Viviano
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Jichao S, Cuida M, Liwei S, Jiani L, Dongdong Z. Predictive value of procalcitonin level for pharyngocutaneous fistula after laryngectomy. Am J Otolaryngol 2023; 44:103846. [PMID: 37060781 DOI: 10.1016/j.amjoto.2023.103846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Pharyngocutaneous fistula (PCF) is among the most common postoperative infective complications following laryngectomy. Its diagnosis is often late and identified only after the formation of an abnormal, bacterial infection-harboring fistula track between the pharynx and the skin. This study was aimed at determining whether procalcitonin (PCT), white blood cell count (WBC), C-reactive protein (CRP), and neutrophil percentage are good predictors of PCF. METHODS We prospectively analysed 65 consecutive patients undergoing total laryngectomy. Clinicodemographic, surgical, and body mass index data were collected. Data on serum levels of PCT, WBC, CRP, and neutrophils were obtained before surgery and on postoperative days 2, 4, 6, 8, and 10 by immunofluorescence, immune turbidimetry, and automatic blood analyzer. The area under the receiving operating characteristic (ROC) curve was calculated for each marker. RESULTS There were 65 patients with a mean age of 60.34 years. The PCF occurrence rate was 18.46 % (12/65). Serum levels of PCT and CRP determined on postoperative day 2, 4, 6, 8, and 10 after surgery were higher in patients with PCF (P < 0.01). PCT level was identified as a good predictor area under the curve (AUC) > 0.800 on postoperative days 2, 4, and 6. Considering the sensitivity and specificity, the best combination was PCT on postoperative days 4, which with a cutoff level of 0.12 μg/L showed 91.67 % sensitivity and 100 % specificity. CONCLUSIONS Procalcitonin can predict PCF following laryngectomy. PCT > 0.12 μg/L on postoperative day 4 was a reliable predictor of PCF. This may help guide postoperative antibiotic management.
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Bedin F, Benoit V, Ferrazzi E, Aufradet E, Boulet L, Rubens A, Dalbon P, Imbaud P. Procalcitonin detection in human plasma specimens using a fast version of proximity extension assay. PLoS One 2023; 18:e0281157. [PMID: 36795693 PMCID: PMC9934411 DOI: 10.1371/journal.pone.0281157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023] Open
Abstract
An exciting trend in clinical diagnostics is the development of easy-to-use, minimally invasive assays for screening and prevention of disease at the point of care. Proximity Extension Assay (PEA), an homogeneous, dual-recognition immunoassay, has proven to be sensitive, specific and convenient for detection or quantitation of one or multiple analytes in human plasma. In this paper, the PEA principle was applied to the detection of procalcitonin (PCT), a widely used biomarker for the identification of bacterial infection. A simple, short PEA protocol, with an assay time suitable for point-of-care diagnostics, is presented here as a proof of concept. Pairs of oligonucleotides and monoclonal antibodies were selected to generate tools specifically adapted to the development of an efficient PEA for PCT detection. The assay time was reduced by more than 13-fold compared to published versions of PEA, without significantly affecting assay performance. It was also demonstrated that T4 DNA polymerase could advantageously be replaced by other polymerases having strong 3'>5' exonuclease activity. The sensitivity of this improved assay was determined to be about 0.1 ng/mL of PCT in plasma specimen. The potential use of such an assay in an integrated system for the low-plex detection of biomarkers in human specimen at the point of care was discussed.
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Affiliation(s)
- Frederic Bedin
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
- * E-mail:
| | - Vincent Benoit
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | | | | | - Laurent Boulet
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | - Agnes Rubens
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | - Pascal Dalbon
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | - Pierre Imbaud
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
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Parke Å, Unge C, Yu D, Sundén-Cullberg J, Strålin K. Plasma calprotectin as an indicator of need of transfer to intensive care in patients with suspected sepsis at the emergency department. BMC Emerg Med 2023; 23:16. [PMID: 36774492 PMCID: PMC9922172 DOI: 10.1186/s12873-023-00785-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/02/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Deciding whether to transfer patients with sepsis from the emergency department (ED) to intensive care units (ICUs) is challenging. We hypothesised that the new biomarker plasma calprotectin (p-calprotectin) could be used to aid the selection of patients for intensive care transfer, since it has been shown to be a promising tool for the determination of sepsis severity in critical care. METHODS This prospective study was performed on consecutive sepsis alert patients in the ED of Karolinska University Hospital Huddinge. The sepsis alert mandates clinical assessment and decisions regarding treatment, disposition, and level of care by physicians from the ED, the Department of Infectious Diseases, and the ICU. Blood sample analysis for C-reactive protein, procalcitonin, neutrophils, and lymphocytes was routinely performed. P-calprotectin was analysed from frozen plasma samples, using a specific turbidimetric assay. RESULTS Three-hundred fifty-one patients who triggered the sepsis alert were available for the study. Among 319 patients who were considered to have an infection, 66 patients (26%) were immediately transferred to the ICU or high-dependency unit (HDU), and 253 patients (74%) were transferred to ordinary wards. Median p-calprotectin was 2.2 mg/L (IQR 1.2-3.9 mg/L) for all patients with infection, it was 3.3 (IQR 1.6-5.2) for those transferred to ICU/HDU and 2.1 (IQR 1.1-3.5) for those transferred to ward units (p = 0.0001). Receiver operating characteristic curve analysis for transfer to the ICU/HDU showed superiority for p-calprotectin compared with procalcitonin and neutrophil-lymphocyte ratio, regarding both all sepsis alert cases and the patients with infection (p < 0.001 for all comparisons). The best p-calprotectin cut-off, 4.0 mg/L, showed a sensitivity of 42.5% and specificity of 83% for transfer to the ICU/HDU among patients with infection. CONCLUSIONS In sepsis alert patients, p-calprotectin was significantly elevated in patients who were subject to immediate ICU/HDU transfer after assessment by a multidisciplinary team. P-calprotectin was superior to traditional biomarkers in predicting the need for transfer to the ICU/HDU.
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Affiliation(s)
- Åsa Parke
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - Christian Unge
- grid.4714.60000 0004 1937 0626Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden ,grid.412154.70000 0004 0636 5158Department of Medicine, Danderyds Hospital, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Functional Area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - David Yu
- grid.24381.3c0000 0000 9241 5705Functional Area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Functional Area of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Sundén-Cullberg
- grid.4714.60000 0004 1937 0626Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Kristoffer Strålin
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden. .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
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Shojaei M, Chen UI, Midic U, Thair S, Teoh S, McLean A, Sweeney TE, Thompson M, Liesenfeld O, Khatri P, Tang B. Multisite validation of a host response signature for predicting likelihood of bacterial and viral infections in patients with suspected influenza. Eur J Clin Invest 2023; 53:e13957. [PMID: 36692131 DOI: 10.1111/eci.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Indiscriminate use of antimicrobials and antimicrobial resistance is a public health threat. IMX-BVN-1, a 29-host mRNA classifier, provides two separate scores that predict likelihoods of bacterial and viral infections in patients with suspected acute infections. We validated the performance of IMX-BVN-1 in adults attending acute health care settings with suspected influenza. METHOD We amplified 29-host response genes in RNA extracted from blood by NanoString nCounter. IMX-BVN-1 calculated two scores to predict probabilities of bacterial and viral infections. Results were compared against the infection status (no infection; highly probable/possible infection; confirmed infection) determined by clinical adjudication. RESULTS Amongst 602 adult patients (74.9% ED, 16.9% ICU, 8.1% outpatients), 7.6% showed in-hospital mortality and 15.5% immunosuppression. Median IMX-BVN-1 bacterial and viral scores were higher in patients with confirmed bacterial (0.27) and viral (0.62) infections than in those without bacterial (0.08) or viral (0.21) infection, respectively. The AUROC distinguishing bacterial from nonbacterial illness was 0.81 and 0.87 when distinguishing viral from nonviral illness. The bacterial top quartile's positive likelihood ratio (LR) was 4.38 with a rule-in specificity of 88%; the bacterial bottom quartile's negative LR was 0.13 with a rule-out sensitivity of 96%. Similarly, the viral top quartile showed an infinite LR with rule-in specificity of 100%; the viral bottom quartile had a LR of 0.22 and a rule-out sensitivity of 85%. CONCLUSION IMX-BVN-1 showed high accuracy for differentiating bacterial and viral infections from noninfectious illness in patients with suspected influenza. Clinical utility of IMX-BVN will be validated following integration into a point of care system.
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Affiliation(s)
- Maryam Shojaei
- Department of Medicine, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, New South Wales, Australia.,Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia.,Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Uan-I Chen
- Inflammatix, Inc., Sunnyvale, California, USA
| | - Uros Midic
- Inflammatix, Inc., Sunnyvale, California, USA
| | | | - Sally Teoh
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia
| | - Anthony McLean
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia
| | | | | | | | | | - Benjamin Tang
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia.,Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
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Xie Y, Zhuang D, Chen H, Zou S, Chen W, Chen Y. 28-day sepsis mortality prediction model from combined serial interleukin-6, lactate, and procalcitonin measurements: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:77-85. [PMID: 36383295 PMCID: PMC9816294 DOI: 10.1007/s10096-022-04517-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022]
Abstract
Sepsis is a global medical issue owing to its unacceptably high mortality rate. Therefore, an effective approach to predicting patient outcomes is critically needed. We aimed to search for a novel 28-day sepsis mortality prediction model based on serial interleukin-6 (IL-6), lactate (LAC), and procalcitonin (PCT) measurements. We enrolled 367 septic patients based on Sepsis-3 (Third International Consensus Definitions for Sepsis and Septic Shock). Serum IL-6, LAC, and PCT levels were measured serially. Results collected within 24 and 48-72 h of admission were marked as D1 and D3 (e.g., IL-6D1/D3), respectively; the IL-6, LAC, and PCT clearance (IL-6c, LACc, PCTc) at D3 were calculated. Data were split into training and validation cohorts (7:3). Logistic regression analyses were used to select variables to develop models and choose the best one according to the Akaike information criterion (AIC). Receiver operating characteristic curves (ROC), calibration plots, and decision curve analysis (DCA) were used to test model performance. A nomogram was used to validate the model. There were 314 (85.56%) survivors and 53 (14.44%) non-survivors. Logistic regression analyses showed that IL-6D1, IL-6D3, PCTD1, PCTD3, and LACcD3 could be used to develop the best prediction model. The areas under the curves (AUC) of the training (0.849, 95% CI: 0.787-0.911) and validation cohorts (0.828, 95% CI: 0.727-0.929), calibration plot, and the DCA showed that the model performed well. Thus, the predictive value of the risk nomogram was verified. Combining IL-6D1, IL-6D3, PCTD1, PCTD3, and LACcD3 may create an accurate prediction model for 28-day sepsis mortality. Multiple-center research with a larger quantity of data is necessary to determine its clinical utility.
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Affiliation(s)
- Yinjing Xie
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Dehua Zhuang
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Huaisheng Chen
- Department of Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Shiqing Zou
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Weibu Chen
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China.
| | - Yue Chen
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China.
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Bona D, Danelli P, Sozzi A, Sanzi M, Cayre L, Lombardo F, Bonitta G, Cavalli M, Campanelli G, Aiolfi A. C-reactive Protein and Procalcitonin Levels to Predict Anastomotic Leak After Colorectal Surgery: Systematic Review and Meta-analysis. J Gastrointest Surg 2023; 27:166-179. [PMID: 36175720 DOI: 10.1007/s11605-022-05473-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anastomotic leak (AL) is a feared complication after colorectal surgery. Prompt diagnosis and treatment are crucial. C-reactive protein (CRP) and procalcitonin (PCT) have been proposed as early AL indicators. The aim of this systematic review was to evaluate the CRP and CPT predictive values for early AL diagnosis after colorectal surgery. METHODS Systematic literature search to identify studies evaluating the diagnostic accuracy of postoperative CRP and CPT for AL. A Bayesian meta-analysis was carried out using a random-effects model and pooled predictive parameters to determine postoperative CRP and PCT cut-off values at different postoperative days (POD). RESULTS Twenty-five studies (11,144 patients) were included. The pooled prevalence of AL was 8% (95 CI 7-9%), and the median time to diagnosis was 6.9 days (range 3-10). The derived POD3, POD4 and POD5 CRP cut-off were 15.9 mg/dl, 11.4 mg/dl and 10.9 mg/dl respectively. The diagnostic accuracy was comparable with a pooled area under the curve (AUC) of 0.80 (95% CIs 0.23-0.85), 0.84 (95% CIs 0.18-0.86) and 0.84 (95% CIs 0.18-0.89) respectively. Negative likelihood ratios (LR-) showed moderate evidence to rule out AL on POD 3 (LR- 0.29), POD4 (LR- 0.24) and POD5 (LR- 0.26). The derived POD3 and POD5 CPT cut-off were 0.75 ng/ml (AUC = 0.84) and 0.9 ng/ml (AUC = 0.92) respectively. The pooled POD5 negative LR (-0.18) showed moderate evidence to rule out AL. CONCLUSIONS In the setting of colorectal surgery, CRP and CPT serum concentrations lower than the derived cut-offs on POD3-POD5, may be useful to rule out AL thus possibly identifying patients at low risk for AL development.
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Affiliation(s)
- Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Via Luigi Giuseppe Faravelli, n.16, 20149, Milan, Italy
| | - Andrea Sozzi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Marcello Sanzi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Luigi Cayre
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Francesca Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Marta Cavalli
- Department of Surgery, University of Insubria, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Giampiero Campanelli
- Department of Surgery, University of Insubria, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
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Al-Janabi G, Al-Fahham A, Alsaedi ANN, Al-Amery AYK. CORRELATION BETWEEN HEPCIDIN AND PROCALCITONIN AND THEIR DIAGNOSTIC ROLE IN PATIENTS WITH COVID-19. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:65-70. [PMID: 36883492 DOI: 10.36740/wlek202301109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aim: The purpose of this study is to find out the association between procalcitonin and hepcidin in patients with COVID-19, in addition to their role as diagnostic markers. PATIENTS AND METHODS Materials and methods: A total of 75 patients infected with coronavirus were included in the current study, their age is ranging between 20 to 78 years. Those patients was hospitalized in Al-Sadr Teaching Hospital in Najaf, in Iraq. This study also included 50 healthy subjects which are volunteers and considered as a (control group). Biomarker (procalcitonin and hepcidin) measurements were achieved by electrochemiluminescent immunoassay (ECLIA) in the Elecsys immunoassay system. RESULTS Results: The present study showed a significant increase the serum cencentration of hepcidin and procalcitonin in patients with COVID-19 as compared tohealthy subjects. There was a highly significant increasing(p < 0.01) in hepcidin and PCT level in patients with severe infection comparing to other catgaries.The current study also revealed that the sensitivity values of the markers were: 0.88%, 0.85 for procalcitonin and hepcidin respectively, which indicate high diagnostic power. CONCLUSION Conclusions: Serum levels of hepcidin and procalcitonin are increased as inflammatory markers in COVID-19 patients with relatively high sensitivity. It seems that these imflammatory markers obviously elevate in the severe cases COVID-19dusease.
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Affiliation(s)
- Ghusoon Al-Janabi
- CLINICAL LABORATORIES DEPARTMENT, APPLIED MEDICAL SCIENCES COLLEGE, KERBALA UNIVERSITY, KERBALA, IRAQ
| | | | | | - Ali Yas Khudhair Al-Amery
- DEPARTMENT OF MEDICAL LABORATORY TECHNOLOGY, FACULTY OF MEDICAL TECHNOLOGY, ISLAMIC UNIVERSITY, NAJAF, IRAQ
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Influence of Nutritional Parameters on the Evolution, Severity and Prognosis of Critically Ill Patients with COVID-19. Nutrients 2022; 14:nu14245363. [PMID: 36558522 PMCID: PMC9783074 DOI: 10.3390/nu14245363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This study evaluated the clinical and nutritional status, the evolution over three days, and the relationship between nutritional, inflammatory, and clinical parameters of critically ill patients with COVID-19. A longitudinal study was conducted in the Intensive Care Unit of the Virgen de las Nieves University Hospital in Granada (Spain). The study population comprised patients with a positive polymerase chain reaction test for COVID-19 presenting critical clinical involvement. Clinical outcomes were collected, and inflammatory and nutritional parameters (albumin, prealbumin, transferrin, transferrin saturation index, cholesterol, triglycerides and Controlling Nutritional Status (CONUT) score) were determined. A total of 202 critical patients with COVID-19 were selected, presenting highly altered clinical-nutritional parameters. The evolution experienced by the patients on the third day of admission was a decrease in albumin (p < 0.001) and an increase in prealbumin (p < 0.001), transferrin (p < 0.002), transferrin saturation index (p < 0.018), and cholesterol (p < 0.001). Low levels of albumin, prealbumin (on the third day) and high CONUT score (on the third day) showed an association with higher mortality. Nutritional variables were inversely correlated with clinical and inflammatory parameters. Critically ill patients with COVID-19 have poor nutritional status related to a poor prognosis of disease severity and mortality.
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Moreno-Torres V, Royuela A, Gutiérrez-Rojas Á, Mills P. Author's response: "Red blood cell distribution width as a prognostic factor in sepsis: A new use for a classical parameter". J Crit Care 2022; 72:154135. [PMID: 36050199 DOI: 10.1016/j.jcrc.2022.154135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Víctor Moreno-Torres
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain.
| | - Ana Royuela
- Clinical Biostatistics Unit, Health Research Institute Puerta de Hierro-Segovia de Arana, CIBERESP, Madrid, Spain, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Ángela Gutiérrez-Rojas
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
| | - Patricia Mills
- Internal Medicine Service, IDIPHIM (University Hospital Puerta de Hierro Research Institute), Hospital Universitario Puerta de Hierro Majadahonda, C/Joaquín Rodrigo 2, Majadahonda, Madrid, Spain
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Developing a new sepsis screening tool based on lymphocyte count, international normalized ratio and procalcitonin (LIP score). Sci Rep 2022; 12:20002. [PMID: 36411279 PMCID: PMC9678875 DOI: 10.1038/s41598-022-16744-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022] Open
Abstract
Exploring an effective sepsis screening tool that can be widely implemented is important for improving the prognosis of sepsis worldwide. This study aimed to develop a new simple screening tool for sepsis (LIP scoring system) that includes the peripheral blood lymphocyte count, international normalized ratio, and procalcitonin level. In a single-center, prospective, observational study, 444 acute sepsis inpatients and 444 nonsepsis inpatients were ultimately included based on the Sepsis-3 and exclusion criteria. The differences in the Lym, INR, PCT level and other clinical biomarkers were compared between the two groups. Univariable and multivariable logistic regression analyses and receiver operating characteristic analysis were used to establish a LIP screening tool for sepsis with a combination of biomarkers. The Kappa and McNemar tests were used to evaluate the differences between the LIP screening results (LIP score ≥ 3) and Sepsis-3 criteria (SOFA score ≥ 2). Logistic regression analysis showed that the lymphocyte count, INR, PCT level, platelets, neutrophil/lymphocyte ratio (NLR) and prothrombin time (PT) were independent risk factors for the development of sepsis. The ROC analysis showed that the lymphocyte count, INR, and PCT level had high area under the ROC curve values (AUROC (95% CI): Lym 0.84 (0.810-0.860), INR 0.921 (0.902-0.938), PCT level 0.928 (0.909-0.944)). The LIP tool had satisfactory screening efficacy for sepsis (sensitivity, 92.8%; specificity, 94.1%), and a LIP score equal to or greater than 3 points had good agreement with Sepsis-3 criteria in the diagnosis of sepsis (Kappa = 0862 in the Kappa test and P = 0.512 in the McNemar test). The LIP tool has satisfactory sensitivity and specificity for sepsis screening, and it can be used for rapid screening of patients with sepsis in outpatient and emergency departments or in economically underdeveloped areas with limited resources.
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Jin J, Fan X, Dong X, Zhai X, Ma Y, Tang J. Infection and the evaluation of biomarkers in obstetrics and gynecology patients with infectious disease: a retrospective observational study from clinical pharmacists’ consultation experience. Eur J Med Res 2022; 27:229. [PMID: 36329535 PMCID: PMC9635140 DOI: 10.1186/s40001-022-00850-5] [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: 06/24/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background The use of empirical anti-infective medication calls for the identification of common pathogens and accurate infectious biomarkers. However, clinical pharmacists’ anti-infective experience in the field of obstetrics and gynaecology is rare in the literature. This study aimed to retrospectively analyze the correlation between the anti-infective effectiveness after 7 days of antibiotic treatment and infectious biomarkers, according to clinical pharmacists’ consultation cases of gynecological and obstetric infections. Methods In this retrospective study, clinical pharmacists’ anti-infective consultation experiences applied by physicians from January 1, 2018, to December 31, 2020, were included. The exclusion criteria were as follows: (1) the patient died or left the hospital before undergoing an effectiveness evaluation after the consultation; (2) treatment was discontinued due to adverse reactions related to antibiotics; (3) the patient did not undergo an effectiveness evaluation within 3 or 7 days after application of the clinical pharmacist’s treatment plan; and (4) the physician did not adopt the clinical pharmacist’s suggestions. The registered information included patient characteristics, pathological bacteria, anti-infective medication and changes in infection indices before and after treatment. Statistical analysis of temperature, white blood cells (WBCs), C-reactive protein (CRP), procalcitonin (PCT) and WBCs in urine after 3 days and 7 days of anti-infective treatment, compared with before anti-infective treatment, was performed by the chi-square test. A t test was conducted to further study WBC count and CRP. A receiver operating characteristic curve verified the sensitivity and specificity of WBC count, CRP and PCT. Results A total of 265 cases were included. The CRP levels of patients 3 d and 7 d after antibiotic treatment were significantly lower than before antibiotic treatment (P < 0.05, P < 0.01), while the WBC count showed a downward trend after 3 days and a significant decrease after 7 days (P < 0.01). The areas under the curve (AUCs) for prognosis on the 7th day for WBC count, CRP and PCT were 0.90, 0.75 and 0.522, respectively. The AUC for WBC count combined with CRP was 0.90, which was higher than that for the biomarkers tested separately, especially compared to PCT. The most common gynecological infections were surgical site infection (SSI), urinary tract infection and fever of unknown origin, and the most common pathogens were E. coli and E. faecalis in Gram-negative and Gram-positive samples, respectively. Pharmacists’ recommended treatment plans included carbapenems and β-lactam antibiotics. Conclusions Our dual-center study indicates that the combination of WBC count and CRP can improve diagnostic accuracy and treatment efficiency, and PCT alone is insensitive to gynecological infections, according to clinical pharmacists’ experience.
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Zhu TY, Deng XM, Wang GJ, Gao BL, Li RX, Wang JT. Comparison of short-term surgical outcomes between complete mesenteric resection and traditional transhiatal laparoscopic surgery for Siewert type II/III esophagogastric junction adenocarcinoma. Langenbecks Arch Surg 2022; 407:3811-3818. [PMID: 36214868 DOI: 10.1007/s00423-022-02676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore the effectiveness and safety of laparoscopic transhiatal complete mesenteric resection (CME) surgery compared with those of the traditional laparoscopic transhiatal approach in the treatment of Siewert II/III adenocarcinoma of the esophagogastric junction (AEG). MATERIALS AND METHODS Ninety-nine patients with Siewert type II/III AEG were enrolled and divided into two groups: the laparoscopic CME transhiatal approach (CEM-TH, n = 61) group and traditional laparoscopic transhiatal (TH, n = 38) group. Intraoperative and postoperative clinical data of both groups were analyzed. RESULTS The laparoscopic trasihiatal surgery was technically successful in all patients. The surgical time, intraoperative bleeding, and hospital stay were all significantly (P < 0.05) reduced in the CME-TH group compared with those in the TH group. The levels of white blood cells on postoperative day (POD) 1 and 5, postoperative CRP on POD 3 and 5, and postoperative PCT were significantly (P < 0.05) lower while lymph nodes were harvested significantly (P < 0.05) more in the CME-TH group than in the TH group. Complications were not significantly (P > 0.05) different between two groups. No death occurred within 90 days. CONCLUSION The CME theory could be safely and effectively applied laparoscopically to treat patients with Siewert II/III AEG. Mesogastrium and lower mesoesophagus can be completely resected together with the tumor, lymph nodes, adipose tissue, and blood vessels as an "intact package," leading to better short-term outcomes.
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Affiliation(s)
- Tian-Yu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe, Zhengzhou, 450052, China
| | - Xiu-Mei Deng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe, Zhengzhou, 450052, China
| | - Guo-Jun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe, Zhengzhou, 450052, China.
| | - Bu-Lang Gao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe, Zhengzhou, 450052, China
| | - Rui-Xin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe, Zhengzhou, 450052, China
| | - Jing-Tao Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe, Zhengzhou, 450052, China
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Feng DY, Zhou JX, Li X, Wu WB, Zhou YQ, Zhang TT. Differentiation Between Acinetobacter Baumannii Colonization and Infection and the Clinical Outcome Prediction by Infection in Lower Respiratory Tract. Infect Drug Resist 2022; 15:5401-5409. [PMID: 36119640 PMCID: PMC9480586 DOI: 10.2147/idr.s377480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Acinetobacter baumannii is the most common microorganism in sputum cultures from long-term hospitalized patients and is often the cause of hospital-acquired pneumonia (HAP), which is usually associated with poor prognosis and high mortality. It is sometimes difficult to distinguish between A. baumannii infection and colonization. This study aimed to evaluate factors that differentiate infection from colonization and predict mortality in patients with nosocomial pneumonia caused by A. baumannii. Patients and Methods The data used in this study were collected in our hospital between January 2018 and December 2020 from patients whose sputum cultures were positive for A. baumannii. Results A total of 714 patients were included, with 571 in the infection group and 143 in the colonization group. The in-hospital mortality rate in the infection group was 20.5%. Univariate and multivariate logistic regression analyses showed that age, total number of inpatient departments, absolute neutrophil count, and C-reactive protein (CRP) level helped distinguish between infection and colonization. The area under the receiver operating characteristic curve (ROC) of the identification model was 0.694. In the infection group, age, Charlson comorbidity score, neutrophil-to-lymphocyte ratio, blood urea nitrogen/albumin ratio, CRP level, presence of multidrug resistance, and clinical pulmonary infection score (≥6) ratio were associated with in-hospital mortality. The area under the ROC curve for the prediction model was 0.828. The top three drug resistance rates in the infection group were 100% (cefazolin), 98.77% (ceftriaxone), and 71.8% (cefuroxime). Conclusion The combination of common parameters helps identify A. baumannii respiratory tract infection or colonization. Several novel predictors can be used to predict the risk of death from A. baumannii pneumonia to reduce mortality. The drug resistance of A. baumannii remains high.
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Affiliation(s)
- Ding-Yun Feng
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jian-Xia Zhou
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xia Li
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wen-Bin Wu
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yu-Qi Zhou
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Tian-Tuo Zhang
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Forceville X, Laviolle B, Gromadzinska J, Boutten A, Van Antwerpen P, Plouvier E, Annane D, Bellissant E. Delayed increase of plasma selenoproteins and absence of side effect induced by infusion of pharmacological dose of sodium selenite in septic shock: Secondary analysis of a multicenter, randomized controlled trial. J Trace Elem Med Biol 2022; 73:127031. [PMID: 35793609 DOI: 10.1016/j.jtemb.2022.127031] [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: 01/30/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND In sepsis, neutrophil respiratory bursts participate in endothelium damage, the first step to multiple organ failure. In plasma two antioxidant selenoenzymes, which protect the endothelium, decrease: selenoprotein-P, and to a lesser extent glutathione peroxidase (GPX3). Sodium selenite (Na2SeO3) is a Se donor, but also an oxidant chemotherapy drug depending on its concentration. In a previous published study, Na2SeO3 continuous infusion in septic shock patients at a pharmacological dose of 4 mg1 Se/day on day-1, followed by a high nutritional dose of 1 mg Se/day during 9 days, showed no beneficial effect on weaning of catecholamine nor on survival. In this ancillary study, we report clinical and biological effects of such continuous infusion of Na2SeO3. METHODS: This was a multicenter, placebo-controlled, double-blind study on 60 patients. Na2SeO3 or placebo in continuous infusion as described above. Evolution with time of plasma Se, selenoprotein-P, GPX3, Organ dysfunction (sequential organ failure assessment SOFA scores, including PaO2/FiO2, for respiratory failure, and plasma lactate) and quality of life at 6 months (by SF36 scores) were analyzed using two-way (time, treatment) non-parametric repeated-measures analysis of variance (Friedman test). MAIN RESULTS At baseline, plasma Se was about a quarter of reference values. From baseline to day-4 plasma Se, selenoprotein-P and GPX3 significantly increased by 3.9, 2.7 and 1.8 respectively in the Na2SeO3 group as compared with placebo and remained elevated by 2.3, 2.7 and 2.1 at day-14 respectively (p < 0.001). Na2SeO3 did not affect global and organ by organ SOFA Scores and plasma lactate concentration at day-1 and later up to day-14. The evolution of PaO2/FiO2 until day-14 was similar in the two groups. Quality of life in the surviving patients at 6 months was similar between the two groups. CONCLUSION Continuous infusion of Na2SeO3 at 4 mg Se at day-1 seems to have neither beneficial nor toxic effect at day-1 or later and induces a late increase of selenoprotein-P at day-4. Preclinical studies are required to confirm the use of Na2SeO3 as a cytotoxic drug against neutrophils and protection of the endothelium by selenoprotein-P.
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Affiliation(s)
- Xavier Forceville
- Service de Réanimation Médico-Chirurgicale-USC, Grand Hôpital de l'Est Francilien, site de Meaux, Hôpital Saint Faron, 6-8 rue Saint Fiacre, 77104 Meaux, France; Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France.
| | - Bruno Laviolle
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France.
| | - Jolanta Gromadzinska
- Biological and Environmental Monitoring Department, Nofer Institute of Occupational Medicine, 8 Teresy St., 90-950 Lodz, Poland.
| | - Anne Boutten
- Laboratoire de biochimie, Hôpital Bichat-Claude Bernard, APHP, 46 rue Henri Huchard, 75877 Paris cedex 18, France.
| | - Pierre Van Antwerpen
- Pharmacognosy, Bioanalysis and Drug Discovery and Analytical Platform of the Faculty of Pharmacy, Université libre de Bruxelles (ULB), Bld du Triomphe Campus Plaine 205/05, 1050 Bruxelles, Belgium.
| | - Elisabeth Plouvier
- Laboratoire de Biochimie, Grand Hôpital de l'Est Francilien, site de Meaux, Hôpital Saint Faron, 6-8 rue Saint Fiacre, 77104 Meaux, France.
| | - Djillali Annane
- Service de Réanimation Médicale, Hôpital Raymond Poincaré, 104 boulevard Raymond Poincaré, 92380 Garches, France; U1173 Lab. of Inflammation & Infection, (Fédération Hospitalo-Universitaire) FHU SEPSIS, Université Paris Saclay-campus (Université de Versailles Saint-Quentin-en-Yvelines) UVSQ, France.
| | - Eric Bellissant
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France.
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Elgormus Y. Biomarkers and their Clinical Applications in Pediatrics. Biomark Med 2022. [DOI: 10.2174/9789815040463122010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Biomarker studies are becoming increasingly interesting for many fields of
medicine. The use of biomarkers in medicine is involved in detecting diseases and
supporting diagnosis and treatment decisions. New research and new discoveries on the
molecular basis of the disease show that there may be a number of promising new
biomarkers for use in daily clinical practice. Clinical trials in children lag behind adult
research both in quality and quantity. The number of biomarkers validated to optimize
pediatric patient management is limited. In the pathogenesis of many diseases, it should
not be extrapolated to the pediatric clinical setting, taking into account that biomarkers
that are effective in adults are clearly different in children and that ontogeny directly
affects disease development and therapeutic response in children. The search for ideal
biomarkers or markers that can make an early and definitive diagnosis in neonatal
sepsis is still ongoing. The ideal biomarker for pediatric diseases should be costeffective,
noninvasive, applicable to pediatric specific diseases, and its results should
correspond to age-related physiological changes. Lactate, troponin and B-type
natriuretic peptide are valuable biomarkers in the evaluation and management of
critically ill children with cardiac disease. Tumor markers in children are biochemical
substances used in the clinical treatment of pediatric tumors and to detect the presence
of cancer (regression or progression). In this chapter, current and brief information
about biomarkers and their clinical applications used in the diagnosis and monitoring of
pediatric diseases is presented.;
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Affiliation(s)
- Yusuf Elgormus
- Medicine Hospital,Department of Pediatric Health and Diseases,Department of Pediatric Health and Diseases, Medicine Hospital, Istanbul, Turkey,Istanbul,Turkey
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Lin XY, Lin YZ, Lin SH, Lian JJ. Effect of procalcitonin on the severity and prognostic value of elderly patients with a severe infection of oral and maxillofacial space. Medicine (Baltimore) 2022; 101:e30158. [PMID: 36042587 PMCID: PMC9410655 DOI: 10.1097/md.0000000000030158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aimed to investigate the effect on the severity and prognostic value of serum procalcitonin for elderly patients with oral and maxillofacial infections. We divided 163 elderly patients with severe oral and maxillofacial infection into survival and death groups according to the prognosis between June 2015 and May 2021, measured serum procalcitonin by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd, 5th, and 7th day after admission for the dynamic changes of serum procalcitonin level, collected the general physiological and biochemical indexes for the scores of acute physiology and general chronic condition, compared the correlation between serum procalcitonin, mean platelet count and APACHE score, analyzed the prognostic value of serum procalcitonin levels at different time after admission by ROC curve. The serum procalcitonin level increased significantly in both groups after admission, sharply increased at first and then rapidly decreased in the survival group, and continued to rise or declined slowly with fluctuation of high level in the death group. There was a negative correlation between serum procalcitonin level and mean platelet count (r = -0.698, P < .05) and a positive correlation between serum procalcitonin and APACHE II (R = 0.803, P < .05). The ROC curve showed that the serum procalcitonin level had little value on the first day and great value on the third day in predicting the prognosis of elderly patients with severe oral and maxillofacial infection (PCT1d = 0.539, PCT3d = 0.875, P < .05). The serum procalcitonin level is correlated with the severity of the disease in elderly patients with severe oral and maxillofacial space infection. Dynamic observation of it is helpful for the prognosis judgment of patients. After admission, serum procalcitonin level on the third day has a great value for the prognosis judgment of elderly patients with severe oral and maxillofacial space infection.
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Affiliation(s)
- Xin-yan Lin
- Department of Stomatology, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China
| | - Yu-zhao Lin
- Department of Stomatology, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China
| | - Shao-hua Lin
- Department of Infectious Disease, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China
| | - Jun-Jie Lian
- Respiratory and critical illness Department, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China
- *Correspondence: Jun-Jie Lian, Respiratory and critical illness Department, Rongcheng, Hospital Affiliated to Shandong First Medical University, Rongcheng, 264300, P.R. China (e-mail: )
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Peng YY, Guo SL, Yan XF, Zhang LL, Wang J, Yuan GD, Qing G, Xu LL, Zhan Q. Collective outbreak of severe acute histoplasmosis in immunocompetent Chinese in South America: the clinical characteristics and continuous monitoring of serum cytokines/chemokines. BMC PRIMARY CARE 2022; 23:197. [PMID: 35934702 PMCID: PMC9358111 DOI: 10.1186/s12875-022-01771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Background Acute histoplasmosis is a rare fungal disease in China. This study is aimed to summarize the clinical characteristics of the first large-scale outbreak of imported acute histoplasmosis in Chinese, so as to provide suggestions for clinical diagnosis and treatment. Methods We collected the symptoms, signs, laboratory examination and imaging data of 10 patients in so far the biggest outbreak of imported acute histoplasmosis in immunocompetent Chinese. Their clinical characteristics and time-varying cytokine/chemokine levels were analyzed, and rank correlation analysis between these markers was utilized to show their condition. Results The 10 patients of imported acute histoplasmosis were working without any respiratory protection in an abandoned mine tunnel in Guyana. The most common symptoms were fever and cough. Their chest CT imaging showed multiple nodular shadows in lungs. Laboratory examination showed that at admission the CRP, PCT, LDH, CysC, G-test, β2-MG were all increased in at least 9 patients, and the CD4/CD8 was decreased to < 1 in all patients. Most cytokines/chemokines (other than IL-4, IL-12, INF-α, TNF-α) varied widely with patients and time, but their overall trend is higher at admission and decreasing gradually during hospitalization, especially for the IL-6, IL-8, IL-10 and IFN-γ. The LDH, CysC, G-test, β2-MG, N/L, IL-6, IL-8, IL-10, IFN-γ, IL-27 are in positive associations to both CRP and PCT. Conclusions The diagnosis of acute histoplasmosis needs a comprehensive analysis of epidemiological history, clinical symptoms and signs, and results of imaging, laboratory, microbiological and pathological examinations. Although none of the CRP, PCT, G-test, N/L, LDH, CysC, β2-MG, IL-6, IL-8, IL-10, IFN-γ shows specificity in the diagnosis of acute histoplasmosis, there is possibility that the above factors might help in the inflammation and prognosis estimation. However, more studies and further investigation are still required for the verification. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01771-2.
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Krakowczyk H, Szczepańska M, Wróblowska-Grzonka U, Gajewska-Ormińska K, Ziora K, Machura E. Diagnostic difficulties in the diagnosis of high acute-phase proteins levels in a teenage drug addicted female patient. BMC Psychiatry 2022; 22:509. [PMID: 35902840 PMCID: PMC9330923 DOI: 10.1186/s12888-022-04135-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Youth drug addiction is a significant social and health problem. Symptoms of the disease include a number of neurological, gastrointestinal and cardiovascular disorders. Possible hormonal disorders and dysregulation of the immune system could also occur. CASE PRESENTATION We describe a case of a teenage patient with multiple diseases such as esophagitis, allergic disease, and numerous behavioral disorders leading to: self-injury of the body, suicide attempts by drugs overdosing, and experimentation with various psychoactive substances (morphine, amphetamine, methamphetamine, codeine). She was also diagnosed with bipolar disorder. A few hours before the admission to the ward, the patient had an intravenous injection of drugs. Toxicological tests confirmed the presence of amphetamine, ecstasy and opioids in the blood and urine. Laboratory tests revealed extremely increased inflammatory parameters, leucopenia, increased levels of IgG, IgA and IgE (total) immunoglobulins, low concentration of vitamin D. Bacteriological examinations were negative. General condition of the patient got better very quickly, antibiotic therapy was abandoned on the 4th day. It was concluded that the cause of the elevated concentration of acute-phase proteins was most likely caused by intoxication with psychoactive drugs. CONCLUSIONS The discussed case shows the difficulties of differential diagnosis in a teenage patient struggling with many diseases, who has been abusing drugs for several years. Increased inflammatory parameters in the form of an raised PCT, CRP, NLR, PLR values may be caused by many factors. In adolescents who frequently experiment with psychoactive substances, such cause of these disturbances should also be taken into account.
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Affiliation(s)
- Helena Krakowczyk
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Maria Szczepańska
- grid.411728.90000 0001 2198 0923Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | | | - Katarzyna Ziora
- grid.411728.90000 0001 2198 0923Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Edyta Machura
- grid.411728.90000 0001 2198 0923Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Atallah CJ, Panossian VS, Atallah NJ, Roberts MB, Mansour MK. Extra-pulmonary applications of procalcitonin: an updated literature review. Expert Rev Mol Diagn 2022; 22:537-544. [PMID: 35757858 DOI: 10.1080/14737159.2022.2094705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION : Procalcitonin (PCT) is a biomarker with established performance in the differentiation between bacterial and viral infections, predominantly in pulmonary infections, as well as the diagnosis and prognosis of bacterial sepsis. However, the role of PCT in extra-pulmonary infections is not well described. AREAS COVERED : We reviewed the role of PCT in commonly experienced extra-pulmonary infections including meningitis, diabetic foot infection, prosthetic joint infection, osteomyelitis, and skin and soft tissue infection. PubMed and Medline online libraries were searched, from 2013 till 2022, for relevant articles. EXPERT OPINION : For meningitis, PCT could distinguish bacterial from viral meningitis. PCT distinguished septic arthritis from different types of arthritis but had variable performance in discriminating septic arthritis from crystal arthropathy. For periprosthetic joint infections, results were inconclusive. PCT had a potential role in diagnosis of more complex infections such as osteomyelitis and diabetic foot infections, but further studies are needed for a definitive cutoff. In skin and soft tissue infections, PCT performance was more variable requiring further investigation to define cutoff for the discrimination of cellulitis from necrotizing fasciitis. We find that PCT performed best for meningitis and helps in the reduction of unnecessary antibiotic treatment, but has variable outcomes with other extra-pulmonary infections.
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Affiliation(s)
| | - Vahe S Panossian
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Natalie J Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew B Roberts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Patel N, Adams C, Brunetti L, Bargoud C, Teichman AL, Choron RL. Evaluation of Procalcitonin's Utility to Predict Concomitant Bacterial Pneumonia in Critically Ill COVID-19 Patients. J Intensive Care Med 2022; 37:1486-1492. [PMID: 35711161 PMCID: PMC9207592 DOI: 10.1177/08850666221108636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Historically, procalcitonin(PCT) has been used as a
predictor of bacterial infection and to guide antibiotic therapy in hospitalized
patients. The purpose of this study was to determine PCT's diagnostic utility in
predicting secondary bacterial pneumonia in critically ill patients with severe
COVID-19 pneumonia. Methods: A retrospective cohort study was
conducted in COVID-19 adults admitted to the ICU between March 2020, and March
2021. All included patients had a PCT level within 72 h of presentation and
serum creatinine of <1.5mg/dL. A PCT threshold of 0.5ng/mL was used to
compare patients with high( ≥ 0.5ng/mL) versus low(< 0.5ng/mL) PCT. Bacterial
pneumonia was defined by positive respiratory culture. A receiver operating
characteristics (ROC) curve was utilized to evaluate PCT as a diagnostic test
for bacterial pneumonia, with an area under the curve(AUC) threshold of 0.7 to
signify an accurate diagnostic test. A multivariable model was constructed to
identify variables associated with in-hospital mortality. Results:
There were 165 patients included: 127 low PCT versus 38 high PCT. There was no
significant difference in baseline characteristics, vital signs, severity of
disease, or outcomes among low versus high PCT groups (all
p > 0.05). While there was no difference in bacterial
pneumonia in low versus high groups (34(26.8%) versus 12(31.6%),
p = 0.562), more patients in the high PCT
group had bacteremia (19(15%) versus 11(28.9%),
p = 0.050). Sensitivity was 26.1% and
specificity was 78.2% for PCT to predict bacterial pneumonia coinfection in ICU
patients with COVID-19 pneumonia. ROC yielded an AUC 0.54
(p = 0.415). After adjusting for LDH>350U/L and creatinine
in multivariable regression, PCT did not enhance performance of the regression
model. Conclusions: PCT offers little to no predictive utility in
diagnosing concomitant bacterial pneumonia in critically ill patients with
COVID-19 nor in predicting increased severity of disease or worse outcomes
including mortality.
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Affiliation(s)
- Nandini Patel
- 15484Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA
| | - Christopher Adams
- 15484Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA.,43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA
| | - Luigi Brunetti
- 15484Ernest Mario School of Pharmacy, Piscataway, NJ 08854, USA.,43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA
| | | | - Amanda L Teichman
- 43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA.,43982Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Rachel L Choron
- 43982Robert Wood Johnson University Hospital Somerset, Somerville, NJ 08876, USA.,43982Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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Sullivan RC, Schmidt EP. Procalcitonin: A Mediator of Microvascular Dysfunction During Critical Illness. Am J Respir Crit Care Med 2022; 206:375-376. [PMID: 35704285 DOI: 10.1164/rccm.202204-0682ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryan C Sullivan
- University of Colorado, 1878, Division of Pulmonary Sciences and Critical Care Medicine, Aurora, Colorado, United States
| | - Eric P Schmidt
- University of Colorado, 1878, Division of Pulmonary Sciences and Critical Care Medicine, Aurora, Colorado, United States;
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Jin M, Li Z, Li X, Xie M, Li W, Ai L, Sun Y, Cheng X, Sheng Y, Zhang J, Jiang N, Yu Q. Development of a nomogram to assess the impact of the myocardial injury on the prognosis of COVID-19 patients. LE INFEZIONI IN MEDICINA 2022; 30:231-241. [PMID: 35693051 PMCID: PMC9177173 DOI: 10.53854/liim-3002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been spreading worldwide. Many COVID-19 patients were accompanied by myocardial injury during the course of the disease. To evaluate the association of cardiac injury with clinical outcomes in COVID-19 patients, we recruited 261 COVID-19 cases admitted to Tongji Hospital of Huazhong University of Science and Technology in this study. Compared with patients without myocardial injury, those with myocardial injury were older, with shorter hospital stays and lower survival rates. They also had higher levels of inflammatory biomarkers (Interleukin-6,8,10 and C-reactive protein), coagulation biomarkers, liver and kidney function markers. Kaplan-Meier analysis demonstrated that patients with myocardial injury had a higher mortality rate. The multivariate Cox regression model and the nomogram revealed that myocardial injury, co-morbidity, and abnormal procalcitonin (PCT) levels were independent risk factors of the mortality of COVID-19 patients. The linear correlation analysis and the ROC curve suggested a predictive value of the neutrophil-lymphocyte ratio (NLR) in cardiac injury. Summarily, myocardial injury in COVID-19 patients is associated with a higher mortality risk. Attention should be paid to monitoring myocardial injury in patients with significantly elevated myocardial markers and NLR at admission.
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Affiliation(s)
- Mengdi Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Zhijun Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xinwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Mengtong Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Weizhen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Lizhe Ai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yaoyao Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xiaodan Cheng
- Department of Critical Care Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Sheng
- Department of Critical Care Unit, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jinnan Zhang
- Department of Neurosurgery, China-Japan union hospital of Jilin University, Changchun, China
| | - Nan Jiang
- Department of Emergency, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
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STANCIOIU F, IVANESCU B, DUMITRESCU R. Perspectives on the Immune System in Sepsis. MAEDICA 2022; 17:404-414. [PMID: 36032596 PMCID: PMC9375866 DOI: 10.26574/maedica.2022.17.2.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Beyond the modifications shown by the biochemistry labs, profound and ample modifications are seen in septic patients at a molecular level stemming from DNA translation and gene expression, manifested as unique profiles of mRNA (messenger), as well as non-coding, functional RNAs: miRNA (micro) and lncRNAs (long non-coding). Counteracting these modifications requires treatment with pleiotropic molecules and/or combination of molecules and opens the possibility of future treatments with arrays of siRNAs and/or specific panels of small molecules tailored for each patient subpopulation.
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Affiliation(s)
| | | | - Radu DUMITRESCU
- University of Bucharest, Medicover Hospital, Bucharest, Romania
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Liu Z, Li D, Liu X, Zhang B, Zang Y, Ma J, Zhang W, Niu Y, Shen C. Elevated Serum Procalcitonin to Predict Severity and Prognosis of Extensive Burns. J INVEST SURG 2022; 35:1510-1518. [PMID: 35574977 DOI: 10.1080/08941939.2022.2073489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zhaoxing Liu
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Dawei Li
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Xinzhu Liu
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Bohan Zhang
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yu Zang
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jinglong Ma
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Wen Zhang
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yuezeng Niu
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Chuanan Shen
- Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital, Beijing, China
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The science of anastomotic healing. SEMINARS IN COLON AND RECTAL SURGERY 2022; 33. [DOI: 10.1016/j.scrs.2022.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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