1
|
Lin C, Ge Q, Wang L, Zeng P, Huang M, Li D. Predictors, prevalence and prognostic role of pulmonary hypertension in patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2024; 46:2368082. [PMID: 38938193 PMCID: PMC11216249 DOI: 10.1080/0886022x.2024.2368082] [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: 02/05/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND To estimate the predictors, prevalence and prognostic role of pulmonary hypertension (PH) in patients with chronic kidney disease (CKD) using meta-analysis. METHODS The PubMed, EmBase, and the Cochrane library were systematically searched for eligible studies from inception till May 2024. All of pooled analyses were performed using the random-effects model. RESULTS Fifty observational studies involving 17,558 CKD patients were selected. The prevalence of PH in CKD patients was 38% (95% confidence interval [CI]: 33%-43%), and the prevalence according to CKD status were 31% (95% CI: 20%-42%) for CKD (I-V), 39% (95% CI: 25%-54%) for end stage kidney disease (ESKD) (predialysis), 42% (95% CI: 35%-50%) for ESKD (hemodialysis), and 26% (95% CI: 19%-34%) for renal transplant. We noted the risk factors for PH in CKD included Black individuals (relative risk [RR]: 1.39; 95% CI: 1.18-1.63; p < 0.001), chronic obstructive pulmonary disease (RR: 1.48; 95% CI: 1.21-1.82; p < 0.001), cardiovascular disease history (RR: 1.62; 95% CI: 1.05-2.51; p = 0.030), longer dialysis (RR: 1.70; 95% CI: 1.18-2.46; p = 0.005), diastolic dysfunction (RR: 1.88; 95% CI: 1.38-2.55; p < 0.001), systolic dysfunction (RR: 3.75; 95% CI: 2.88-4.87; p < 0.001), and grade 5 CKD (RR: 5.64; 95% CI: 3.18-9.98; p < 0.001). Moreover, PH in CKD patients is also associated with poor prognosis, including all-cause mortality, major cardiovascular events, and cardiac death. CONCLUSION This study systematically identified risk factors for PH in CKD patients, and PH were associated with poor prognosis. Therefore, patients with high prevalence of PH should be identified for treatment.
Collapse
Affiliation(s)
- Chunlong Lin
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Qilong Ge
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Lei Wang
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Pan Zeng
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Mingmin Huang
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| | - Dan Li
- Department of Respiratory and Critical Care Medicine, Yueyang municipal Hospital of Hunan Normal University, Hunan, China
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Gherlan GS, Hoara MC, Smadu SG, Popescu CP, Ionescu P, Florescu SA. Histopathologically Confirmed Pulmonary Mucormycosis as a Complication of COVID-19: a Case Report from Romania and Insight into Pathology. MAEDICA 2022; 17:215-225. [PMID: 35733728 DOI: 10.26574/maedica.2022.17.1.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
COVID-19 has proven to be an independent risk factor for secondary infectious complications. Amongst them, mucormycosis has recently been noticed more frequently than in the past. Caused by molds belonging to the Mucorales order, this is a rare, but potentially fatal infection unless adequately treated. Ear, nose and throat involvement is prevalent with often expansion to the orbit, sinuses or brain. Pulmonary, cutaneous and gastrointestinal infections are also recognized. Classical risk factors for progression to angioinvasive disease include poorly controlled diabetes mellitus, defects in phagocytic function (prolonged neutropenia, glucocorticoid treatment), immunosuppressive therapy associated with transplantation, malignancy, elevated levels of free iron as well as iron chelators (deferoxamine). In addition, immune dysregulation rendered by COVID-19 itself may contribute or solely lead to invasive mold disease. The largest experience comes from India, which has dealt with a challenging epidemic of COVID-19-associated mucormycosis (CAM). To our knowledge, no previous studies have reported CAM in Romania. We therefore present a case of severe COVID-19 pneumonia initially complicated by bacterial superinfection and secondary sepsis at admission in an unvaccinated 61-year-old male who presented in our clinic with respiratory failure and digestive symptoms. Although improvement occurred rapidly following antiviral, empiric large spectrum Intraantibiotics and pathogenic medication, unfavorable clinical course ensued later on. Biological and imaging investigations were consistent with pulmonary superinfection in the form of multiple different-sized upper right field opacities, which eventually evolved to form cavities. Differential diagnosis was thoroughly performed. Since unable to sterilize the lung by means of medication alone, the patient underwent major thoracic surgery with removal of the entire right lung. Microscopic study of the damaged tissue was able to determine the presence of broad, aseptate hyphae which morphologically belong to Mucorales. A diagnosis of pulmonary mucormycosis was established and proper antifungal treatment was initiated, with full recovery of the patient.
Collapse
Affiliation(s)
- George Sebastian Gherlan
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Maria Cristina Hoara
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Sebastian George Smadu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Corneliu Petru Popescu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Petronela Ionescu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Simin-Aysel Florescu
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| |
Collapse
|
4
|
Abbas ZE, El-Yassin H. The impact of glycemic control on procalcitonin level in patients with type ii diabetes. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Wang YR, Zheng QB, Wei GF, Meng LJ, Feng QL, Yuan WJ, Ou JL, Liu WL, Li Y. Elevated PCT at ICU discharge predicts poor prognosis in patients with severe traumatic brain injury: a retrospective cohort study. J Int Med Res 2021; 48:300060520922456. [PMID: 32368956 PMCID: PMC7218983 DOI: 10.1177/0300060520922456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose Disease severity and inflammatory response status are closely related to a
poor prognosis and must be assessed in patients with severe traumatic brain
injury (STBI) before intensive care unit (ICU) discharge. Whether elevated
serum procalcitonin (PCT) levels can predict a poor prognosis in STBI
patients before ICU discharge is unclear. Methods This retrospective observational cohort study enrolled 199 STBI patients who
were in the ICU for at least 48 hours and survived after discharge. Based on
serum PCT levels at discharge, patients were divided into the high-PCT group
(PCT ≥ 0.25 ng/mL) and the low-PCT group (PCT < 0.25 ng/mL). We assessed
the relationship between serum PCT levels and a poor prognosis. Results The high-PCT group had a higher rate of adverse outcomes compared with the
low-PCT group. Multivariate logistic regression analysis showed that the
Acute Physiology and Chronic Health Evaluation II (APACHE II) score,
Sequential Organ Failure Assessment (SOFA) score, white blood cell (WBC)
count, C-reactive protein (CRP) level, and PCT level at discharge were
significantly associated with adverse outcomes. Conclusions Elevated PCT levels at ICU discharge were associated with a poor prognosis in
STBI patients. The serum PCT level as a single indicator has limited value
for clinical decision-making.
Collapse
Affiliation(s)
- Yu-Rong Wang
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qing-Bin Zheng
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Guang-Fa Wei
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Li-Jun Meng
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qing-Ling Feng
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wen-Jie Yuan
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jin-Lei Ou
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wei-Li Liu
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yong Li
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| |
Collapse
|
6
|
El-Deeb W, Elsohaby I, Fayez M, Mkrtchyan HV, El-Etriby D, ElGioushy M. Use of procalcitonin, neopterin, haptoglobin, serum amyloid A and proinflammatory cytokines in diagnosis and prognosis of bovine respiratory disease in feedlot calves under field conditions. Acta Trop 2020; 204:105336. [PMID: 31926143 DOI: 10.1016/j.actatropica.2020.105336] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 12/13/2022]
Abstract
Bovine respiratory diseases (BRD) have long been considered a serious problem that causes major economic losses in feedlot calves (FC). This study aimed to determine the diagnostic and prognostic effect of selected biological markers including, procalcitonin (PCT), neopterin (NP), proinflammatory cytokines (IL-1β, IL-8, TNF-α, IF-γ), haptoglobin (HP) and serum amyloid A (SAA) on FC with BRD under field conditions. Sixty-nine FC that were identified to be infected with Mannheimia haemolytica and Histophilus somni and had different clinical respiratory signs (diseased group) were selected for this study. In addition, 20 healthy FC have been selected as a control group. We have detected higher serum levels of PCT, NP, HP, SAA, IL-1β, IL-8, TNF-α and IF-γ in diseased FC group compared with the control group. All tested markers revealed a high level of discrimination between BRD infected FC and healthy ones (AUC > 0.90). Moreover, the obtained data showed a high degree of prognostic accuracy for PCT, NP, IL-8, HP, IF-γ and IL-1β in predicting treatment response of FC with BRD at the selected thresholds (AUC = 0.99, 0.99, 0.97, 0.93, 0.88 and 0.82, respectively). Significant inhibition was observed for the selected biochemical markers in treated FC 7 days post-treatment. In conclusion, this study showed that BRD in FC was associated with significant alterations in serum APPs, proinflammatory cytokines, PCT and NPT levels. Furthermore, it demonstrated that these serum biomarkers are much higher in FC with BRD compared to recovered ones. Our data suggest that the measurement of PCT, NPT, APPs and cytokines together with the clinical examination may be a useful diagnostic and prognostic tool for assessment of FC naturally infected with M. haemolytica and H. somni.
Collapse
|
7
|
Covington EW, Roberts MZ, Dong J. Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature. Pharmacotherapy 2018; 38:569-581. [PMID: 29604109 DOI: 10.1002/phar.2112] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Effective antimicrobial stewardship practices are increasingly essential to best utilize the current arsenal of antimicrobials for the shortest necessary duration to minimize the development of antimicrobial resistance, secondary infections, and health care costs. Monitoring of serum procalcitonin (PCT) levels represents an effective antimicrobial stewardship strategy to differentiate bacterial infections from viral infections and noninfectious inflammatory conditions. Current literature illustrates the merits of PCT monitoring in reducing duration of antibiotic therapy without detrimental effects on mortality or infection relapses. However, the interpretation of PCT levels can be challenging, especially in light of comorbid disease states that can elevate PCT levels. This review sheds light on the utility of PCT monitoring, as well as providing insight into the practical interpretation of PCT levels. Much of the current literature surrounding PCT monitoring consists of use among patients with lower respiratory tract infections or in the critically ill. Overall, studies have demonstrated shorter antibiotic therapy durations when PCT monitoring is utilized. No studies to date have found increased rates of mortality or infection relapses, suggesting that PCT monitoring is not only effective, but also safe when used as a guide for antimicrobial therapy. Nonetheless, many conditions were shown to elevate PCT serum concentrations, even in the absence of bacterial infections, which can make interpretation of PCT concentrations challenging. Two common conditions that affect the accurate interpretation of PCT levels are renal dysfunction and congestive heart failure. Limited studies have been performed in these populations, but current available data propose the need for higher PCT thresholds in those with renal dysfunction or congestive heart failure and support utilizing PCT trends to monitor clinical improvement from bacterial infections. Evidence also suggests that PCT monitoring is cost-effective, as long as the test is ordered judiciously. In summary, PCT monitoring represents a promising antimicrobial stewardship strategy to limit exposure to unnecessary antimicrobial therapy.
Collapse
Affiliation(s)
| | - Megan Z Roberts
- Samford University McWhorter School of Pharmacy, Birmingham, Alabama
| | - Jenny Dong
- Samford University McWhorter School of Pharmacy, Birmingham, Alabama
| |
Collapse
|
8
|
Vashist SK, Schneider EM, Barth E, Luong JH. Surface plasmon resonance-based immunoassay for procalcitonin. Anal Chim Acta 2016; 938:129-36. [DOI: 10.1016/j.aca.2016.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023]
|
9
|
Procalcitonin Levels in Survivors and Nonsurvivors of Sepsis: Systematic Review and Meta-Analysis. Shock 2016; 43:212-21. [PMID: 25423128 DOI: 10.1097/shk.0000000000000305] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Procalcitonin (PCT) is an acute-phase reactant that has been used to diagnose and potentially track the treatment of sepsis. Procalcitonin values rise initially as the infection sets in and eventually fall with resolution. Its level has been reported to be significantly higher in potential nonsurvivors of a septic episode than among survivors. However, there is also a significant amount of evidence against this. We thus conducted a meta-analysis to pool data from all the available studies regarding PCT levels in survivors and nonsurvivors of sepsis. An extensive literature search was conducted using the key words "procalcitonin," "sepsis," and "prognosis." The references of the relevant studies were also scanned. The data from the eligible studies were extracted and analyzed for any significant pooled mean difference between survivors and nonsurvivors both on days 1 and 3. The mean difference in the day 1 PCT values between survivors and nonsurvivors was found to be statistically significant (P = 0.02). The mean difference on day 3 was also statistically significant (P = 0.002). However, in a subgroup consisting of studies on patients with severe sepsis and septic shock, day 1 difference was not found to be significant (P = 0.62). We found heterogeneity of 90% in our study population, which decreased to 62% after exclusion of studies conducted in emergency department patients. Procalcitonin levels in early stages of sepsis are significantly lower among survivors as compared with nonsurvivors of sepsis.
Collapse
|