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Diac I, Neculai-Cândea L, Horumbă M, Dogăroiu C, Costescu M, Keresztesi AA. Assessing O.K.N.V.I. RESIST‑5 performance for post‑mortem biological samples: A prospective pilot study. Exp Ther Med 2024; 27:14. [PMID: 38125340 PMCID: PMC10728925 DOI: 10.3892/etm.2023.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023] Open
Abstract
In recent years, the emergence of carbapenem-resistant strains has been increasing worldwide, including in Romania. Rapid tests for post-mortem examinations have been researched and currently have several applications. In the present study, we aimed to test the performance of O.K.N.V.I. RESIST-5 tests on impure post-mortem biological samples compared with a standard of pure cultures. When a death occurs during hospitalization and the issue of malpractice arises, the medico-legal practice would benefit from rapid tests applicable to post-mortem samples. Thus, detection and differentiation of the five targeted carbapenemases, namely oxacilinase-48, Klebsiella pneumoniae carbapenemase, New Delhi metallo-β-lactamase, Verona integron-encoded metallo-β-lactamase and imipenemase, could be useful in guiding sampling for third-party microbiological assessment and could also be an asset from an epidemiological standpoint. The present prospective and observational pilot study included medico-legal autopsy cases performed at Mina Minovici National Institute of Legal Medicine (Romania) between June and July 2022. A total of two sets of O.K.N.V.I. RESIST-5 tests were performed: Test I, which was performed on-site from biological samples obtained during autopsy; and Test II, which was performed on pure cultures after sample inoculation and incubation. Total of 39 O.K.N.V.I. RESIST-5 rapid tests were performed on 19 biological samples, at least one sample per case. The O.K.N.V.I. RESIST-5 tests performed on-site showed an overall sensitivity of 92.3% with a 100% specificity. The results obtained through rapid tests using post-mortem impure samples were comparable to the results obtained from sample cultures with good sensitivity and specificity. Through post-mortem screening for carbapenem resistance, it would be possible to narrow down the number of cases that require further bacteriological assessment.
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Affiliation(s)
- Iuliana Diac
- PhD School, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Clinical Legal Medicine and Forensic Pathology, Mina Minovici National Institute of Legal Medicine, 042122 Bucharest, Romania
| | - Lavinia Neculai-Cândea
- Department of Legal Medicine and Forensic Pathology, Forensic Clinical County Service Constanța, Faculty of Medicine, ‘Ovidius’ University of Constanța, 900439 Constanța, Romania
| | - Mihaela Horumbă
- Department of Cardiology, County Clinical Emergency Hospital Constanta, 900591 Constanta, Romania
| | - Cătălin Dogăroiu
- Department of Morphological Sciences, Discipline of Forensic Medicine and Bioethics, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihnea Costescu
- Department of Clinical Legal Medicine and Forensic Pathology, Mina Minovici National Institute of Legal Medicine, 042122 Bucharest, Romania
- Department of Functional Sciences, Discipline of Pharmacology and Pharmacotherapy, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Arthur-Atilla Keresztesi
- Department of Legal Medicine and Forensic Pathology, Covasna County Institution of Forensic Medicine, 520068 Covasna, Romania
- Faculty of Medicine, Transilvania University of Brasov, 500036 Brasov, Romania
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Tattoli L, Dell'Erba A, Ferorelli D, Gasbarro A, Solarino B. Sepsis and Nosocomial Infections: The Role of Medico-Legal Experts in Italy. Antibiotics (Basel) 2019; 8:E199. [PMID: 31661804 PMCID: PMC6963620 DOI: 10.3390/antibiotics8040199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people's loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers' work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections.
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Affiliation(s)
- Lucia Tattoli
- S.C. Medicina Legale U - Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Alessandro Dell'Erba
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | - Davide Ferorelli
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | | | - Biagio Solarino
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
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Burton JL, Saegeman V, Arribi A, Rello J, Andreoletti L, Cohen MC, Fernandez-Rodriguez A. Postmortem microbiology sampling following death in hospital: an ESGFOR task force consensus statement. J Clin Pathol 2019; 72:329-336. [PMID: 30661015 DOI: 10.1136/jclinpath-2018-205365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022]
Abstract
Postmortem microbiology (PMM) is a valuable tool in the identification of the cause of death and of factors contributory to death where death has been caused by infection. The value of PMM is dependent on careful autopsy planning, appropriate sampling, minimisation of postmortem bacterial translocation and avoidance of sample contamination. Interpretation of PMM results requires careful consideration in light of the clinical history, macroscopic findings and the histological appearances of the tissues. This consensus statement aims to highlight the importance of PMM in the hospital setting and to give microbiological and pathological advice on sampling in deaths occurring in hospital.
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Affiliation(s)
- Julian L Burton
- Academic Unit of Medical Education, University of Sheffield Medical School, Sheffield, UK
| | | | - Ana Arribi
- Microbiology Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Jordi Rello
- CIBERES and Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Laurent Andreoletti
- Molecular and Clinical Virology Department, University of Reims Champagne-Ardenne, Reims, France
| | - Marta C Cohen
- Histopathology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Amparo Fernandez-Rodriguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas, Spain
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Ondruschka B, Woydt L, Bernhard M, Franke H, Kirsten H, Löffler S, Pohlers D, Hammer N, Dreßler J. Post-mortem in situ stability of serum markers of cerebral damage and acute phase response. Int J Legal Med 2018; 133:871-881. [PMID: 30167776 DOI: 10.1007/s00414-018-1925-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/23/2018] [Indexed: 01/04/2023]
Abstract
The aim of the given study was to test the in situ stability of biochemical markers of cerebral damage and acute phase response in the early post-mortem interval to assess their usability for forensic pathology. A monocentric, prospective study investigated post-mortem femoral venous blood samples at four time points obtained within 48 h post-mortem starting at the death of 20 deceased, using commercial immunoassays for the ten parameters: S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), ferritin, soluble tumor necrosis factor receptor type 1 (sTNFR1), and lactate dehydrogenase (LDH). Significant changes in serum levels were observed only later than 2 h after death for all markers. Inter-laboratory comparability was high, and intra-assay precision was sufficient for most markers. Most of the biomarker levels depended on the severity of hemolysis and lipemia but were robust against freeze-thaw cycles. Serum levels increased with longer post-mortem intervals for S100B, NSE, ferritin, sTNFR1, and LDH (for all p < 0.001) but decreased over this period for CRP (p = 0.089) and PCT (p < 0.001). Largely unchanged median values were found for GFAP (p = 0.139), BDNF (p = 0.106), and IL-6 (p = 0.094). Serum levels of CRP (p = 0.059) and LDH (p = 0.109) did not differ significantly between the final ante-mortem (resuscitation) and the first post-mortem sample (moment of death). Collecting the post-mortem blood sample as soon as possible will reduce the influence of post-mortem blood changes. Serum GFAP for detection of cerebral damage as well as serum IL-6 and CRP as proof of acute phase response seemed to be preferable due to their in situ stability in the first 2 days after death.
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Affiliation(s)
- Benjamin Ondruschka
- Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
| | - Lina Woydt
- Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
| | - Michael Bernhard
- Emergency Department, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Heike Franke
- Rudolf Boehm Institute of Pharmacology and Toxicology, University of Leipzig, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.,LIFE Center (Leipzig Interdisciplinary Research Cluster of Genetic Factors, Phenotypes and Environment), University of Leipzig, Leipzig, Germany
| | - Sabine Löffler
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Dirk Pohlers
- Center of Diagnostics GmbH, Klinikum Chemnitz, Chemnitz, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany.,Fraunhofer Institute for Machine Tools and Forming Technology, Dresden, Germany
| | - Jan Dreßler
- Medical Faculty, Institute of Legal Medicine, University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
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A Flowthrough Assay for Rapid Bedside Stratification of Bloodstream Bacterial Infection in Critically Ill Patients: a Pilot Study. J Clin Microbiol 2018; 56:JCM.00408-18. [PMID: 29925639 DOI: 10.1128/jcm.00408-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/12/2018] [Indexed: 12/20/2022] Open
Abstract
Bacterial infections affect more than 2 million people annually. Of these, systemic infections caused by bacteria in critically ill patients may lead to life-threatening conditions such as sepsis. We have developed a point-of-care (POC) device called Septiflo that can detect and stratify the Gram status of bloodstream bacterial infections in less than 10 min from a drop of human plasma. It works on the principle of identifying pathogen-associated molecular patterns (PAMPs), such as lipopolysaccharides (LPS) and lipoteichoic acid (LTA) that are released into the bloodstream at the onset of Gram-negative and Gram-positive bacterial infections, respectively. The biomarkers are captured on a membrane without a receptor, and the Gram status specificity is conferred by the ligands attached to gold nanoparticles (AuNPs) used as signal amplification probes. The ultrasensitive colorimetric results are read by eye down to a 100-fg/ml detection limit without an instrument. No cross-interference between the PAMPs is seen during Gram stratification. Septiflo results also display better performance than commercial enzyme-linked immunosorbent assays (ELISAs). Tests performed on 60 clinical samples from patients showed a correlation accuracy of 70% against procalcitonin (PCT), an accepted surrogate biomarker for sepsis. A direct comparison with eubacterial PCR yielded up to 94% accuracy in 31 patients at a chosen cutoff level for LPS and LTA and area under the curve (AUC) values of 0.927 and 0.885, respectively, though blood culture was negative for most samples. The high sensitivity, low cost, and simple bedside utility of the assay may aid in better sepsis management apparently at the presymptomatic stage, lowering empirical therapy, medical costs, antimicrobial resistance, and mortality.
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Maiese A, Del Nonno F, Dell'Aquila M, Moauro M, Baiocchini A, Mastracchio A, Bolino G. Postmortem diagnosis of sepsis: A preliminary immunohistochemical study with an anti-procalcitonin antibody. Leg Med (Tokyo) 2017; 28:1-5. [PMID: 28728072 DOI: 10.1016/j.legalmed.2017.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/05/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Aniello Maiese
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy.
| | - Franca Del Nonno
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Marco Dell'Aquila
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy
| | - Mario Moauro
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Andrea Baiocchini
- Infectious Diseases Department, National Institute for Infectious Diseases "L. Spallanzani", 00149 Rome, Italy
| | - Antonio Mastracchio
- Medical UOC Pathology Local Health Agency Rome/6, University of Rome "Tor Vergata", 00149 Rome, Italy
| | - Giorgio Bolino
- Department of Anatomy, Histology Forensic Medicine and Orthopaedics, Sapienza University of Rome, Viale Regina Elena 336, Rome 00185, Italy
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Pomara C, Riezzo I, Bello S, De Carlo D, Neri M, Turillazzi E. A Pathophysiological Insight into Sepsis and Its Correlation with Postmortem Diagnosis. Mediators Inflamm 2016; 2016:4062829. [PMID: 27239102 PMCID: PMC4863102 DOI: 10.1155/2016/4062829] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/21/2016] [Accepted: 04/10/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sepsis is among the leading causes of death worldwide and is the focus of a great deal of attention from policymakers and caregivers. However, sepsis poses significant challenges from a clinical point of view regarding its early detection and the best organization of sepsis care. Furthermore, we do not yet have reliable tools for measuring the incidence of sepsis. Methods based on analyses of insurance claims are unreliable, and postmortem diagnosis is still challenging since autopsy findings are often nonspecific. AIM The objective of this review is to assess the state of our knowledge of the molecular and biohumoral mechanisms of sepsis and to correlate them with our postmortem diagnosis ability. CONCLUSION The diagnosis of sepsis-related deaths is an illustrative example of the reciprocal value of autopsy both for clinicians and for pathologists. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insults, is mandatory to illuminate the exact cause of death. This would help clinicians to compare pre- and postmortem findings and to reliably measure the incidence of sepsis.
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Affiliation(s)
- C. Pomara
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - I. Riezzo
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - S. Bello
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - D. De Carlo
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - M. Neri
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
| | - E. Turillazzi
- Department of Clinical and Experimental Medicine, Section of Forensic Pathology, Ospedale Colonnello D'Avanzo, University of Foggia, Viale degli Aviatori 1, 71100 Foggia, Italy
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Procalcitonin as a postmortem sepsis marker. A comparison of the validity of results obtained from blood serum, aqueous humour and cerebrospinal fluid. Int J Legal Med 2014; 129:117-23. [PMID: 25119683 DOI: 10.1007/s00414-014-1057-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/30/2014] [Indexed: 02/07/2023]
Abstract
In recent years, serum levels of the prohormone procalcitonin have been investigated in a number of studies in relation to postmortem sepsis diagnostics, as macroscopic and histomorphological findings are, as a rule, nonspecific. However, due to advanced haemolysis, it is often not possible to determine serum procalcitonin (PCT) levels in cases of sepsis-related death. Moreover, the impact of postmortem interval on PCT levels is largely unclarified. In view of this, the present pilot study investigated PCT levels in the serum, aqueous humour, and cerebrospinal fluid in a study population of 25 persons who died of sepsis and a control population of 25 deaths unrelated to sepsis. Using the Mann-Whitney U test, statistically significant differences in PCT levels were determined for all the analysed samples from the study and control populations. Logistic regression analysis was used to calculate cut-off values for sepsis diagnosis for all the sample types. Furthermore, the serum elimination rates published by Tsokos et al. (Int J Legal Med 114:237-243, 2001) were used to calculate the PCT levels at the time of death for the cases with a known postmortem interval. The results of our study demonstrate that, taking account of the postmortem elimination process, it is possible to infer the value at the time of death from the procalcitonin levels measured in all three sample types and to interpret this with the aid of a defined cut-off value. The findings need to be verified based on a larger study population.
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Tian G, Pan SY, Ma G, Liao W, Su QG, Gu BC, Qin K. Serum levels of procalcitonin as a biomarker for differentiating between sepsis and systemic inflammatory response syndrome in the neurological intensive care unit. J Clin Neurosci 2013; 21:1153-8. [PMID: 24508074 DOI: 10.1016/j.jocn.2013.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/25/2013] [Indexed: 02/07/2023]
Abstract
We explored the value of procalcitonin (PCT) to differentiate sepsis from systemic inflammatory response syndrome (SIRS), and determine sepsis severity in the neurological intensive care unit (NICU). Blood samples were measured for C-reactive protein (CRP) and PCT levels upon NICU admission, on the day of diagnosis of SIRS or sepsis, and at 3 and 7 days after diagnosis. We found that there were significant differences in serum levels of CRP and PCT as well as Glasgow Coma Scale (GCS) score upon admission between the SIRS and sepsis groups (p<0.05). CRP and white blood cell levels were not significantly different when attempting to differentiate sepsis severity (p>0.05). Multiple comparisons showed that significant differences in serum PCT levels were observed between sepsis and severe sepsis groups, as well as sepsis and septic shock groups (p<0.05). We obtained the highest sensitivity and specificity for SIRS and sepsis with cut-off values of 2 ng/mL for PCT, 44 mg/dL for CRP, and 4 for the GCS. There were no differences in CRP and PCT levels between cerebrovascular disease and non-cerebrovascular disease groups (p>0.05). No differences were found between viral and bacterial meningitis groups (p>0.05). PCT levels are valuable in discriminating sepsis from SIRS and determining sepsis severity in critically ill patients with neurological disease.
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Affiliation(s)
- Ge Tian
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Su-yue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Gang Ma
- State Key Laboratory of Oncology in South China, Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Wei Liao
- State Key Laboratory of Oncology in South China, Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Quan-guan Su
- State Key Laboratory of Oncology in South China, Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Bao-chun Gu
- State Key Laboratory of Oncology in South China, Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Kun Qin
- Department of Neurosurgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China.
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Value of sTREM-1, procalcitonin and CRP as laboratory parameters for postmortem diagnosis of sepsis. J Infect 2013; 67:545-55. [DOI: 10.1016/j.jinf.2013.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/15/2013] [Accepted: 08/29/2013] [Indexed: 12/12/2022]
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Bode-Jänisch S, Schütz S, Schmidt A, Tschernig T, Debertin AS, Fieguth A, Hagemeier L, Teske J, Suerbaum S, Klintschar M, Bange FC. Serum procalcitonin levels in the postmortem diagnosis of sepsis. Forensic Sci Int 2013; 226:266-72. [PMID: 23434379 DOI: 10.1016/j.forsciint.2013.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 12/09/2012] [Accepted: 01/27/2013] [Indexed: 02/08/2023]
Abstract
Procalcitonin is regarded as a valuable marker for sepsis in living persons and even in post-mortem investigations. At the Institute of Legal Medicine, 25 autopsy cases with suspected bacterial infectious diseases or sepsis were examined using the semi-quantitative PCT-Q(®)-test (B.R.A.H.M.S., Germany) in 2010 and 2011. As controls, 75 cadavers were used for which there was no suspicion of a bacterial infectious disease or sepsis. Femoral blood was cultured from the cases and from controls, and samples from the brain, heart, lungs, liver, spleen and kidneys were examined histologically for findings seen in sepsis. Twelve cases in the sepsis/infectious disease group (48%) were classifiable as sepsis following synopsis of PCT levels, autopsy results, and histopathological and microbiological findings. This study shows that the semi-quantitative PCT-Q(®)-test is a useful supplementary marker in routine autopsy investigations, capable of classifying death as due to sepsis.
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Affiliation(s)
- S Bode-Jänisch
- Hanover Medical School, Institute of Legal Medicine, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany.
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Augsburger M, Iglesias K, Bardy D, Mangin P, Palmiere C. Diagnostic value of lipopolysaccharide-binding protein and procalcitonin for sepsis diagnosis in forensic pathology. Int J Legal Med 2012; 127:427-35. [DOI: 10.1007/s00414-012-0780-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/04/2012] [Indexed: 01/07/2023]
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13
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Procalcitonin and C-reactive protein in pericardial fluid for postmortem diagnosis of sepsis. Int J Legal Med 2012; 126:567-72. [DOI: 10.1007/s00414-012-0692-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/13/2012] [Indexed: 11/26/2022]
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14
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Postmortem chemistry update part II. Int J Legal Med 2011; 126:199-215. [DOI: 10.1007/s00414-011-0614-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 08/22/2011] [Indexed: 02/02/2023]
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Dong H, Shu W, Liu T, Wang S, Lin G, Li M, Wu Y. Targeting Procalcitonin with Novel Murine Monoclonal Antibodies. Hybridoma (Larchmt) 2010; 29:189-94. [DOI: 10.1089/hyb.2009.0103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Huimin Dong
- Institute of Antibody Engineering, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Wen Shu
- Institute of Antibody Engineering, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Tiancai Liu
- Institute of Antibody Engineering, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Suihai Wang
- Institute of Antibody Engineering, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Guanfeng Lin
- Institute of Antibody Engineering, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Ming Li
- Institute of Antibody Engineering, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Yingsong Wu
- Institute of Antibody Engineering, School of Biotechnology, Southern Medical University, Guangzhou, China
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Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality. Clin Biochem 2009; 42:1025-31. [PMID: 19324026 DOI: 10.1016/j.clinbiochem.2009.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/10/2009] [Accepted: 03/11/2009] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This purpose of this study was to determine if serum procalcitonin (PCT) concentration at the time of admission to the ICU is a predictor of all-cause short-term mortality. DESIGN AND METHODS This prospective cross-sectional study was conducted over a 16-month period with 86 consecutive critically ill patients. The semi-quantitative PCT-Q test was performed and APACHE II scores and C-reactive protein (CRP) concentrations were determined within 24 h of admission. RESULTS PCT-Q test value was a better predictor of all-cause short-term mortality than CRP value or APACHE II score. PCT > or = 10 ng/mL was highly and independently correlated with mortality. Use of PCT-Q > or = 10 ng/mL was superior to use of APACHE II > or = 25 or CRP > or = 10 mg/dL as a predictor of poor outcome. CONCLUSIONS A PCT-Q value > or = 10 ng/mL obtained at the time of admission to the ICU is a strong predictor of short-term mortality.
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