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Bhattarai A, Shah S, Baidya S, Thapa R, Bhandari S, Tuladhar ET, Acharya SP, Sah R. Association of copeptin levels with patient prognosis and survival in sepsis syndromes: a meta-analysis. Int J Surg 2024; 110:2355-2365. [PMID: 38668663 PMCID: PMC11019991 DOI: 10.1097/js9.0000000000001069] [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] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/24/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Sepsis syndromes are a major burden in the ICU with very high mortality. Vasopressin and copeptin are released in response to hypovolemia and have shown potential significance in diagnosing sepsis. OBJECTIVE To investigate the levels of copeptin in patients with sepsis syndromes and evaluate its relation with patient prognosis and mortality. METHODS Four databases were searched for literature published from inception to the 8th of November 2022. Original research articles where copeptin was measured in sepsis patients and compared with controls were included. Data extraction and synthesis: study characteristics, levels of copeptin in the participants, and copeptin assay description were extracted. Levels of copeptin in patients were pooled and compared with controls in terms of the standard mean difference (SMD) generated using a random-effects model. RESULTS Fifteen studies met the selection criteria. Copeptin levels were significantly higher in patients with sepsis, severe sepsis, and septic shock as compared to controls [(SMD: 1.49, 95% CI: 0.81-2.16, P<0.0001), (SMD: 1.94, 95% CI: 0.34-3.54, P=0.02), and (SMD: 2.17, 95% CI: 0.68-3.66, P=0.004), respectively]. The highest copeptin levels were noted in septic shock patients. The admission copeptin levels were significantly lower in survivors as compared to nonsurvivors (SMD: -1.73; 95% CI: -2.41 to -1.06, P<0.001). CONCLUSION AND RELEVANCE Copeptin was significantly elevated in sepsis, severe sepsis, and septic shock. Survivors had a significantly lower copeptin during admission. Copeptin offered an excellent predictability to predict 1-month mortality. Measuring the copeptin in sepsis patients can aid treating physicians to foresee patients' prognosis.
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Affiliation(s)
| | | | | | | | | | - Eans T. Tuladhar
- Department of Biochemistry, Institute of Medicine, Tribhuvan University
| | | | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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2
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Cander B, Visneci EF, Karaoglan O, Cakmak F, Tuncar A, Taslidere B. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis. Open Med (Wars) 2023; 18:20230865. [PMID: 38223899 PMCID: PMC10787304 DOI: 10.1515/med-2023-0865] [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: 05/04/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. There is a need for biomarkers that can be used for the diagnosis of sepsis and the early identification of patients at high risk of death. In this study, we aimed to investigate the relationship between Mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT), and copeptin in sepsis. A total of 28 sepsis, 32 septic shock, and 30 control patients were included in our prospective study. Patients' MR-proADM, PCT, and copeptin levels were recorded. Sequential organ failure assessment scores, length of hospital stay, and 30-day mortality were also recorded. These values were compared between the sepsis, septic shock, and control groups. The mean age of all participants was 64.04 ± 15.83 years. In the study, 37 (61.6%) patients were female and 23 (39.3%) were male. There was no statistically significant difference in gender/age between all patient groups and the control group (for all, p > 0.05). We found a significant difference between the survivors and nonsurvivors in terms of MR-proADM, PCT, and copeptin levels. There was a significant difference between the sepsis and septic shock groups in terms of MR-proADM and PCT. A significant correlation was found between the length of hospital stay and MR-proADM and copeptin. MR-proADM, PCT, and copeptin may be useful in the prognosis of sepsis and to predict the length of stay in hospital and mortality.
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Affiliation(s)
- Basar Cander
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Osman Karaoglan
- Department of Emergency Medicine, Konya Numune Hospital, Konya, Turkey
| | - Fatma Cakmak
- Department of Emergency Medicine, Erzurum City Hospital, Erzurum, Türkiye
| | - Alpay Tuncar
- Department of Emergency Medicine, Konya City Hospital, Konya, Türkiye
| | - Bahadir Taslidere
- Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Saleh NY, Aboelghar HM, Garib MI, Rizk MS, Mahmoud AA. Pediatric sepsis diagnostic and prognostic biomarkers: pancreatic stone protein, copeptin, and apolipoprotein A-V. Pediatr Res 2023:10.1038/s41390-023-02499-0. [PMID: 36755189 PMCID: PMC10382317 DOI: 10.1038/s41390-023-02499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 11/21/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND We assessed serum concentrations of pancreatic stone protein (PSP), copeptin, and apolipoprotein A-V (APOA5) biomarkers for the diagnosis and prognosis of pediatric sepsis, a condition associated with high mortality. METHODS This prospective study included 180 children admitted to the Pediatric Intensive Care Unit and 100 healthy controls at Menoufia University Hospital. Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality-2 (PIM2), and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were calculated. Serum PSP, copeptin and APOA5 were measured once within 24 h of admission. RESULTS PSP, copeptin, and APOA5 were significantly higher in the patients than in the controls (p < 0.001). PSP and copeptin were increased among children who required mechanical ventilation (MV), had multiple organ dysfunctions, and were non-survivors, but APOA5 was decreased in those children. Logistic regression analyses showed that high pSOFA, high PSP and copeptin, low APOA5, and use of MV were associated with mortality. The receiver operating characteristic revealed that the area under the curve (AUC) for APOA5, copeptin, and PSP (0.965, 0.960, and 0.868, respectively) demonstrated high sensitivity (96%, 94%, and 80%) for sepsis diagnosis. The AUC values for PSP, copeptin, and APOA5 were 0.709, 0.705, and 0.571, respectively, with sensitivities of 74%, 58%, and 58% for mortality prediction. CONCLUSIONS PSP, copeptin, and APOA5 are promising diagnostic biomarkers for pediatric sepsis but inadequate predictors of mortality. IMPACT Apolipoprotein A-V (APOA5), copeptin, and pancreatic stone protein (PSP) are acute-phase proteins with diagnostic value in evaluating critically ill pediatric patients with sepsis and detecting sepsis severity. PSP and copeptin had the power to discriminate non-survivors from survivors. APOA5 was less powerful than the other biomarkers in discriminating between survivors and non-survivors.
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Affiliation(s)
- Nagwan Y Saleh
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt.
| | - Hesham M Aboelghar
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Mohamed I Garib
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Mohammed S Rizk
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Asmaa A Mahmoud
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
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Liu D, Ghani D, Wain J, Szeto WY, Laudanski K. Concomitant elevated serum levels of tenascin, MMP-9 and YKL-40, suggest ongoing remodeling of the heart up to 3 months after cardiac surgery after normalization of the revascularization markers. Eur J Med Res 2022; 27:208. [PMID: 36271425 PMCID: PMC9585873 DOI: 10.1186/s40001-022-00831-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recovery from cardiac surgery involves resolving inflammation and remodeling with significant connective tissue turnover. Dynamics of smoldering inflammation and injury (white blood cells, platelets, CRP, IL-8, IL-6), vascular inflammation (IL-15, VEGF, RANTES), connective tissue remodeling (tenascin, MMP-9), cardiac injury and remodeling (YKL-40), and vascular remodeling (epiregulin, MCP-1, VEGF) were assessed up to 3 months after cardiac surgery. We hypothesize that at 3 months, studied markers will return to pre-surgical levels. METHODS Patients (n = 139) scheduled for non-emergent heart surgery were included, except for patients with pre-existing immunological aberrancies. Blood was collected before surgery(tbaseline), 24 h later(t24h) after the first sample, 7 days(t7d), and 3 months(t3m) after tbaseline. Serum markers were measured via multiplex or ELISA. Electronic medical records (EMR) were used to extract demographical, pre-existing conditions and clinical data. Disposition (discharge home, discharge to facility, death, re-admission) was determined at 28 days and 3 months from admission. RESULTS Not all inflammatory markers returned to baseline (CRP↑↑, leukocytosis, thrombocytosis, IL-8↓, IL-6↓). Tenascin and YKL-40 levels remained elevated even at t3m. YKL-40 serum levels were significantly elevated at t24h and t7d while normalized at t3m. VEGF returned to the baseline, yet MCP-1 remained elevated at 3 months. CCL28 increased at 3 months, while RANTES and IL-15 declined at the same time. Disposition at discharge was determined by serum MMP-9, while YKL-40 correlated with duration of surgery and APACHE II24h. CONCLUSIONS The data demonstrated an ongoing extracellular matrix turnover at 3 months, while acute inflammation and vascular remodeling resolved only partially.
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Affiliation(s)
- Da Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Danyal Ghani
- College of Art and Sciences, Drexel University, Philadelphia, PA, USA
| | - Justin Wain
- Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
| | - Wilson Y Szeto
- Department of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA. .,Leonard Davis Institute for Health Economics, University of Pennsylvania, JMB 127, 3620 Hamilton Walk, Philadelphia, PA, 19146, USA.
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Deveci OS, Ozmen C, Karaaslan MB, Celik AI, Rahimova H, Akray A, Tepe O, Gurkan E, Deniz A. Increased Circulating Copeptin Levels Are Associated with Vaso-Occlusive Crisis and Right Ventricular Dysfunction in Sickle Cell Anemia. Med Princ Pract 2022; 31:47-53. [PMID: 34852350 PMCID: PMC8995666 DOI: 10.1159/000521216] [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: 05/03/2021] [Accepted: 11/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Vaso-occlusive crisis (VOC) is a common clinical manifestation of sickle cell anemia (SCA) and is associated with increased proinflammatory mediators. Copeptin is the C-terminal part of the prohormone for provasopressin and seems clinically relevant in various clinical conditions. Right ventricular (RV) dysfunction significantly appears in SCA patients due to pulmonary hypertension. This study aimed to investigate the association of copeptin levels in VOC patients and evaluate RV dysfunction. MATERIALS AND METHODS A total of 108 patients were enrolled in the study. Twenty-eight SCA patients in steady state (30.2 ± 0.9 years), 25 SCA patients in VOC (36.8 ± 11.8 years), and 55 healthy individuals (31.9 ± 9.4 years) with HbAA genotype were included. Clinical, echocardiographic, and laboratory data were recorded. ELISA was used for the determination of serum levels of copeptin. RESULTS VOC patients had significantly higher copeptin level compared both with controls and SCA subjects in steady state (22.6 ± 13.0 vs. 11.3 ± 5.7 pmol/L, 22.6 ± 13.0 vs. 12.4 ± 5.8 pmol/L, p = 0.009 for both). Additionally, the copeptin level was significantly higher in SCA patients with RV dysfunction than those without RV dysfunction (23.2 ± 12.2 vs. 15.3 ± 9.5 pmol/L, p = 0.024). Multiple logistic regression analysis revealed that high-sensitivity C-reactive protein and copeptin levels were found to be associated with VOC. CONCLUSION This study showed that copeptin and hs-CRP levels were increased in patients with VOC, and it was found that RV dysfunction was more common in SCA patients with VOC than in the control group. Copeptin can be considered for use as a potential biomarker in predicting VOC crisis in SCA patients and in the early detection of patients with SCA who have the potential to develop RV dysfunction.
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Affiliation(s)
- Onur Sinan Deveci
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
- *Onur Sinan Deveci,
| | - Caglar Ozmen
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | | | - Aziz Inan Celik
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Hatice Rahimova
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Anil Akray
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Omer Tepe
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Emel Gurkan
- Department of Hematology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ali Deniz
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Ozmen C, Deveci OS, Karaaslan MB, Baydar O, Akray A, Deniz A, Cagliyan CE, Hanta I, Usal A. Predictive value of plasma copeptin level for diagnosis and mortality of pulmonary embolism. Rev Assoc Med Bras (1992) 2020; 66:1645-1650. [DOI: 10.1590/1806-9282.66.12.1645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/08/2020] [Indexed: 11/22/2022] Open
Abstract
SUMMARY OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.
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Affiliation(s)
| | | | | | - Oya Baydar
- Cukurova University Faculty of Medicine, Turkey
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Zhang X, Cao Y, Pan CK, Han QY, Guo YQ, Song T, Qi ZD, Huang R, Li M, Yang ZY, Zheng JB, Hou GY, Li JY, Wang SC, Liu YS, Liu RJ, Gao Y, Wang HL. Effect of initiation of renal replacement therapy on mortality in acute pancreatitis patients. Medicine (Baltimore) 2020; 99:e23413. [PMID: 33217887 PMCID: PMC7676528 DOI: 10.1097/md.0000000000023413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study aims to explore effect of initiation of renal replacement therapy (RRT) on mortality in acute pancreatitis (AP) patients. In this study, a total of 92 patients from the surgical intensive care unit (SICU) of the Second Affiliated Hospital of Harbin Medical University who were diagnosed with AP and underwent RRT or not between January 2014 and December 2018 were included in this retrospective study. Demographic and clinical data were obtained on admission to SICU. Patients were divided into early initiation of RRT group (n = 44) and delayed initiation of RRT group (n = 48). Duration of mechanical ventilation (MV), intra-peritoneal pressure, vasopressors infusion, body temperature, procalcitonin, creatinine, platelet counts, length of hospital stay and prognosis were recorded during hospitalization, and then compared between groups. Patients with delayed initiation of RRT exhibited significantly higher APACHE II score, SOFA score and lower GCS score than those with early initiation of RRT (P < 0.001, <0.001, = 0.04, respectively). No difference in the rest of the baseline data and vasopressors infusion was found. Dose of Norepinephrine, maximum and mean PCT, maximum and mean creatinine, maximum and mean intra-peritoneal pressure, length of hospital stay, prognosis of ICU and hospitalization showed significant difference between groups. Early initiation of RRT may be beneficial for AP patients, which can provide some insight and support for patients' treatment in clinic.
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Affiliation(s)
- Xing Zhang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Yang Cao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Chang-Kun Pan
- Department of Critical Care Medicine, the Cancer Hospital of Jiamusi, Jiamusi
| | - Qiu-Yuan Han
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Ya-Qi Guo
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, Qingdao
| | - Ting Song
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University
| | - Zhi-Dong Qi
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Rui Huang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Ming Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Zhen-Yu Yang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Jun-Bo Zheng
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Gui-Ying Hou
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Jia-Yu Li
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin
| | - Si-Cong Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Yan-Song Liu
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Rui-Jin Liu
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Yang Gao
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Hong-Liang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin
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Effect of a novel extracorporeal cytokine apheresis method on endocan, copeptin And interleukin-6 levels in sepsis: An observational prospective study. Transfus Apher Sci 2020; 59:102919. [PMID: 32912735 DOI: 10.1016/j.transci.2020.102919] [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: 03/29/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE There is still an evident need for useful biomarkers and effective therapeutic approaches regarding the challenging management of sepsis. The aim of the study is to evaluate the effect of each Cytosorb hemoadsorption therapy course on blood levels of inflammatory biomarkers of sepsis including endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein. METHODS There were a total of 178 samples belonging to 34 patients that were diagnosed with sepsis and undergone Cytosorb therapy during the study period. Patient demographics were recorded. Arterial blood samples were obtained both before and and after each Cytosorb course. Levels of copeptin, interleukin-6, procalcitonin, C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and creatinine were assessed both before and after each Cytosorb treatment. RESULTS Levels of endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein, and erythrocyte sedimentation rate were all significantly decreased after the Cytosorb course when compared with levels before therapy (p = 0.039, 0.001, 0.010, 0.001, 0.002 and 0.001, respectively). There was no significant difference between white blood cell count and creatinine levels before and after Cytosorb courses (p = 0.204 and 0.277). CONCLUSION Cytosorb courses achieved significant decreases in endocan, copeptin, interleukin-6, procalcitonin and C-reactive protein levels. Decreasing plasma levels of inflammatory cytokines may help alleviate the cytokine storm and may have a role in improve outcomes. Further prospective randomized controlled studies with larger sample size are needed concerning the long-term effects of this decrease in cytokine levels on outcome and mortality.
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Bachler M, Niederwanger C, Hell T, Höfer J, Gerstmeyr D, Schenk B, Treml B, Fries D. Influence of factor XII deficiency on activated partial thromboplastin time (aPTT) in critically ill patients. J Thromb Thrombolysis 2020; 48:466-474. [PMID: 31124034 PMCID: PMC6744379 DOI: 10.1007/s11239-019-01879-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
FXII deficiency results in spontaneous prolongation of activated partial thromboplastin time (aPTT), which is widely used to monitor thromboprophylaxis. Misinterpretation of spontaneously prolonged aPTT may result in omission of thromboembolic treatment or even unnecessary transfusion of blood products. This retrospective analysis was performed to calculate a threshold level of FXII resulting in aPTT prolongation. 79 critically ill patients with spontaneous prolongation of aPTT were included. A correlation analysis and a ROC curve for aPTT prolongation predicted by FXII level were created to find the FXII threshold level. Prolongation of aPTT was associated with disease severity. A significant inverse proportionality between FXII and aPTT was seen. A ROC curve for aPTT prolongation, predicted by FXII level (AUC 0.85; CI 0.76–0.93), revealed a FXII threshold level of 42.5%. Of our patients 50.6% experienced a FXII deficiency, in 80.0% of whom we found aPTT to be prolonged without a significantly higher bleeding rate. The FXII deficiency was more common in patients with higher SAPS3 scores, septic shock, transfusion of red blood cells and platelet concentrates as well as in patients receiving renal replacement therapy. Patients with a FXII deficiency and prolonged aPTT less often received anticoagulatory therapy although they were more severely ill. The rate of thromboembolic events was higher in these patients although the difference was not statistically significant. Of all patients with spontaneous aPTT prolongation 50.6% had a FXII level of 42.5% or less. Those patients received insufficient thromboembolic prophylaxis.
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Affiliation(s)
- Mirjam Bachler
- Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer Zentrum 1, 6060, Hall in Tirol, Austria
| | - Christian Niederwanger
- Department of Pediatrics, Pediatric Intensive Care Unit, Pediatrics I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Tobias Hell
- Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Technikerstraße 13, 6020, Innsbruck, Austria
| | - Judith Höfer
- Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr. Franz Rehrl Platz 5, 5020, Salzburg, Austria
| | - Dominic Gerstmeyr
- Department of General and Surgical Critical Care Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bettina Schenk
- Department of General and Surgical Critical Care Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Benedikt Treml
- Department of General and Surgical Critical Care Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dietmar Fries
- Department of General and Surgical Critical Care Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Relationships between serum procalcitonin level, severity and different stresses of non-septic critically ill patients. REV ROMANA MED LAB 2020. [DOI: 10.2478/rrlm-2020-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract
Background: To explore the relationships between serum procalcitonin (PCT) level, severity and different stresses of non-septic critically ill patients.
Materials and Methods: Patients were divided into traumatic stress, stroke-induced stress and non-infectious inflammatory stress groups. According to 28-day prognosis, they were divided into survival and death groups. The factors affecting prognosis were studied by multivariate logistic regression analysis.
Results: PCT level was significantly positively correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores (P=0.001). The PCT level and abnormality rate of the traumatic stress group significantly exceeded those of other groups (P---lt---0.05). The APACHE II score, SOFA score and 28-day mortality rate of traumatic stress and stroke-induced stress groups significantly exceeded those of the non-infectious inflammatory stress group (P---lt---0.05). The PCT level, APACHE II score and SOFA score of the death group significantly surpassed those of the survival group (P---lt---0.05). With rising PCT level, APACHE II score, SOFA score and 28-day mortality rate all increased, with significant intergroup differences (P---lt---0.01). Multivariate logistic analysis showed that serum PCT level, APACHE II score and SOFA score were independent risk factors for prognosis. The area under ROC curve for prognosis evaluated by PCT level was 0.797 (95%CI = 0.710~0.878, P=0.000). At a 4.3 μg/L cut-off, the sensitivity and specificity for predicting 28-day mortality were 87.4% and 78.1%, respectively.
Conclusion: The serum PCT level of non-septic critically ill patient was positively correlated with severity, which was more likely elevated by traumatic stress than other stresses.
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Deveci F, Öner Ö, Telo S, Kırkıl G, Balin M, Kuluöztürk M. Prognostic value of copeptin in patients with acute pulmonary thromboembolism. CLINICAL RESPIRATORY JOURNAL 2019; 13:630-636. [DOI: 10.1111/crj.13071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Figen Deveci
- Department of Pulmonary Medicine, School of Medicine Firat University Elazig Turkey
| | - Önsel Öner
- Department of Pulmonary Medicine, School of Medicine Firat University Elazig Turkey
| | - Selda Telo
- Department of Biochemistry, Faculty of Medicine, School of Medicine Firat University Elazig Turkey
| | - Gamze Kırkıl
- Department of Pulmonary Medicine, School of Medicine Firat University Elazig Turkey
| | - Mehmet Balin
- Department of Cardiology, School of Medicine Firat University Elazig Turkey
| | - Mutlu Kuluöztürk
- Department of Pulmonary Medicine, School of Medicine Firat University Elazig Turkey
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12
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Gille J, Schmidt J, Kremer T, Sablotzki A. Evaluation of MR-proANP and copeptin for sepsis diagnosis after burn injury. J Crit Care 2019; 52:149-155. [DOI: 10.1016/j.jcrc.2019.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/11/2019] [Accepted: 04/29/2019] [Indexed: 01/02/2023]
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Gu JX, Zhang N, Li SS, Zhang AM, Yin Y, Li YF, Jia M. The detection of bacterial infections in leukemia patients using procalcitionin levels. Leuk Lymphoma 2019; 61:165-170. [PMID: 31352856 DOI: 10.1080/10428194.2019.1646906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Bacteremic infections are the most common complications in patients with leukemia. This study aimed to assess the value of procalctionin levels in the detection of bacterial infections in leukemia patients. Blood samples of in-patients with leukemia were collected. Statistical analysis was performed to assess the correlation between the procalcitionin level on the day of the first positive blood culture and bacteremic infection. Infected patients had significantly higher procalctionin levels than uninfected patients (p < 0.001). Receiver operating characteristic curve analysis showed a high level of accuracy regarding the discrimination of bacterarmic infection (area under the curve, 0.883) and Gram-negative bateremia (area under the curve, 0.779). Procalctionin levels may help in the identification of bacterial infections in leukemia patients. Further multicentre studies are needed to verify our data regarding the use of procalctionin to distinguish between Gram-positive and Gram-negative infections.
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Affiliation(s)
- Jun-Xu Gu
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, P.R. China
| | - Na Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, P.R. China
| | - Shan-Shan Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, P.R. China
| | - Ai-Min Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, P.R. China
| | - Yue Yin
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, P.R. China
| | - Yi-Fan Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, P.R. China
| | - Mei Jia
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, P.R. China
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Largeau B, Le Tilly O, Sautenet B, Salmon Gandonnière C, Barin-Le Guellec C, Ehrmann S. Arginine Vasopressin and Posterior Reversible Encephalopathy Syndrome Pathophysiology: the Missing Link? Mol Neurobiol 2019; 56:6792-6806. [PMID: 30924075 DOI: 10.1007/s12035-019-1553-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by a typical brain edema. Its pathogenesis is still debated through hypoperfusion and hyperperfusion theories, which have many limitations. As PRES occurs almost exclusively in clinical situations with arginine vasopressin (AVP) hypersecretion, such as eclampsia and sepsis, we hypothesize that AVP plays a central pathophysiologic role. In this review, we discuss the genesis of PRES and its symptoms through this novel approach. We theorize that AVP axis stimulation precipitates PRES development through an increase in AVP secretion or AVP receptor density. Activation of vasopressin V1a receptors leads to cerebral vasoconstriction, causing endothelial dysfunction and cerebral ischemia. This promotes cytotoxic edema through hydromineral transglial flux dysfunction and may increase endothelial permeability, leading to subsequent vasogenic brain edema. If our hypothesis is confirmed, it opens new perspectives for better patient monitoring and therapies targeting the AVP axis in PRES.
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Affiliation(s)
- Bérenger Largeau
- CHRU de Tours, Laboratoire de Biochimie et Biologie Moléculaire, Tours, France.
| | - Olivier Le Tilly
- CHRU de Tours, Laboratoire de Biochimie et Biologie Moléculaire, Tours, France
| | - Bénédicte Sautenet
- Université de Tours, Université de Nantes, INSERM, Methods in patients-centered outcomes and health research (SPHERE) - UMR 1246, CHRU de Tours, Service de Néphrologie-Hypertension artérielle, Dialyses et Transplantation Rénale, Tours, France
| | | | - Chantal Barin-Le Guellec
- Université de Tours, Université de Limoges, INSERM, Individual profiling and prevention of risks with immunosuppressive therapies and transplantation (IPPRITT) - UMR 1248, CHRU de Tours, Laboratoire de Biochimie et Biologie Moléculaire, Tours, France
| | - Stephan Ehrmann
- Université de Tours, INSERM, Centre d'étude des pathologies respiratoires (CEPR) - UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC 1415, réseau CRICS-TRIGGERSEP, Tours, France
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15
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Gao Y, Yu KJ, Kang K, Liu HT, Zhang X, Huang R, Qu JD, Wang SC, Liu RJ, Liu YS, Wang HL. Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation. World J Gastroenterol 2017; 23:4422-4427. [PMID: 28706425 PMCID: PMC5487506 DOI: 10.3748/wjg.v23.i24.4422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/19/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the accuracy of serum procalcitionin (PCT) as a diagnostic marker in verifying upper and lower gastrointestinal perforation (GIP).
METHODS This retrospective study included 46 patients from the surgical intensive care unit (ICU) of the Second Affiliated Hospital of Harbin Medical University who were confirmed to have GIP between June 2013 and December 2016. Demographic and clinical patient data were recorded on admission to ICU. Patients were divided into upper (n = 19) and lower (n = 27) GIP groups according to the perforation site (above or below Treitz ligament). PCT and WBC count was obtained before laparotomy and then compared between groups. Meanwhile, the diagnostic accuracy of PCT was analyzed.
RESULTS Patients with lower GIP exhibited significantly higher APACHE II score, SOFA score and serum PCT level than patients with upper GIP (P = 0.017, 0.004, and 0.001, respectively). There was a significant positive correlation between serum PCT level and APACHE II score or SOFA score (r = 0.715 and r = 0.611, respectively), while there was a significant negative correlation between serum PCT level and prognosis (r = -0.414). WBC count was not significantly different between the two groups, and WBC count showed no significant correlation with serum PCT level, APACHE II score, SOFA score or prognosis. The area under the receiver operating characteristic curve of PCT level to distinguish upper or lower GIP was 0.778. Patients with a serum PCT level above 17.94 ng/dL had a high likelihood of lower GIP, with a sensitivity of 100% and a specificity of 42.1%.
CONCLUSION Serum PCT level is a reliable and accurate diagnostic marker in identifying upper or lower GIP before laparotomy.
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Chen M, Lu X, Hu L, Liu P, Zhao W, Yan H, Tang L, Zhu Y, Xiao Z, Chen L, Tan H. Development and validation of a mortality risk model for pediatric sepsis. Medicine (Baltimore) 2017; 96:e6923. [PMID: 28514310 PMCID: PMC5440147 DOI: 10.1097/md.0000000000006923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pediatric sepsis is a burdensome public health problem. Assessing the mortality risk of pediatric sepsis patients, offering effective treatment guidance, and improving prognosis to reduce mortality rates, are crucial.We extracted data derived from electronic medical records of pediatric sepsis patients that were collected during the first 24 hours after admission to the pediatric intensive care unit (PICU) of the Hunan Children's hospital from January 2012 to June 2014. A total of 788 children were randomly divided into a training (592, 75%) and validation group (196, 25%). The risk factors for mortality among these patients were identified by conducting multivariate logistic regression in the training group. Based on the established logistic regression equation, the logit probabilities for all patients (in both groups) were calculated to verify the model's internal and external validities.According to the training group, 6 variables (brain natriuretic peptide, albumin, total bilirubin, D-dimer, lactate levels, and mechanical ventilation in 24 hours) were included in the final logistic regression model. The areas under the curves of the model were 0.854 (0.826, 0.881) and 0.844 (0.816, 0.873) in the training and validation groups, respectively.The Mortality Risk Model for Pediatric Sepsis we established in this study showed acceptable accuracy to predict the mortality risk in pediatric sepsis patients.
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Affiliation(s)
- Mengshi Chen
- Hunan Children's Hospital, Ziyuan RD
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan
| | - Xiulan Lu
- Hunan Children's Hospital, Ziyuan RD
| | - Li Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan
- Beijing Center for Diseases Prevention and Control, Beijing, P. R. China
| | | | | | | | | | - Yimin Zhu
- Hunan Children's Hospital, Ziyuan RD
| | | | - Lizhang Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan
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Krychtiuk KA, Honeder MC, Lenz M, Maurer G, Wojta J, Heinz G, Huber K, Speidl WS. Copeptin Predicts Mortality in Critically Ill Patients. PLoS One 2017; 12:e0170436. [PMID: 28118414 PMCID: PMC5261612 DOI: 10.1371/journal.pone.0170436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/04/2017] [Indexed: 01/06/2023] Open
Abstract
Background Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual’s stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality. Methods In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay. Results Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7–179.3 pmol/L versus 45.6 IQR 19.6–109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2–4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation. Conclusion Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU.
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Affiliation(s)
- Konstantin A. Krychtiuk
- Department of Internal Medicine II—Division of Cardiology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Maria C. Honeder
- Department of Internal Medicine II—Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Max Lenz
- Department of Internal Medicine II—Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Gerald Maurer
- Department of Internal Medicine II—Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II—Division of Cardiology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- Core Facilities, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Department of Internal Medicine II—Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital Vienna, Austria
- Sigmund Freud Private University. Medical School, Vienna, Austria
| | - Walter S. Speidl
- Department of Internal Medicine II—Division of Cardiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Zhang HB, Chen J, Lan QF, Ma XJ, Zhang SY. Diagnostic values of red cell distribution width, platelet distribution width and neutrophil-lymphocyte count ratio for sepsis. Exp Ther Med 2016; 12:2215-2219. [PMID: 27698714 DOI: 10.3892/etm.2016.3583] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/05/2016] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to evaluate the diagnostic efficiency of red blood cell distribution width (RDW), platelet distribution width (PDW), the neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT) and C-reactive protein (CRP) for the prediction of sepsis. A total of 120 consecutive patients who underwent blood culture testing were included. The PCT and CRP levels, and RDW, PDW and NLCR percentages were determined and compared between patients with positive blood cultures and those without. The PCT, CRP, RDW, PDW and NLCR values were significantly higher in patients with positive blood culture compared with those without. PCT and NLCR each had a high diagnostic performance for the prediction of sepsis, with an area under the curve (AUC) for sepsis of 0.829 and 0.718, respectively. A combination of RDW, PDW and NLCR also exhibited a good diagnostic performance for sepsis (AUC, 0.704). NLCR is easily obtained by automated hematological analysis. Moreover, NLCR was found to have a high diagnostic efficiency for the prediction of sepsis, with greater sensitivity and accuracy than CRP. In conclusion, PCT exhibited the optimal diagnostic performance among the tested markers. The combination of the three parameters of RDW, PDW and NLCR, demonstrated a high diagnostic performance similar to that of PCT.
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Affiliation(s)
- Hui-Bing Zhang
- Clinical Laboratory, Affiliated Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Juan Chen
- Clinical Laboratory, Affiliated Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Qiao-Fen Lan
- Clinical Laboratory, Affiliated Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Xiong-Jian Ma
- Clinical Laboratory, Affiliated Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
| | - Shi-Yan Zhang
- Clinical Laboratory, Affiliated Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian 355200, P.R. China
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Assessment of Diagnostic and Prognostic Role of Copeptin in the Clinical Setting of Sepsis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3624730. [PMID: 27366743 PMCID: PMC4913060 DOI: 10.1155/2016/3624730] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/16/2016] [Indexed: 12/14/2022]
Abstract
The diagnostic and prognostic usefulness of copeptin were evaluated in septic patients, as compared to procalcitonin assessment. In this single centre and observational study 105 patients were enrolled: 24 with sepsis, 25 with severe sepsis, 15 with septic shock, and 41 controls, divided in two subgroups (15 patients with gastrointestinal bleeding and 26 with suspected SIRS secondary to trauma, acute coronary syndrome, and pulmonary embolism). Biomarkers were determined at the first medical evaluation and thereafter 24, 48, and 72 hours after admission. Definitive diagnosis and in-hospital survival rates at 30 days were obtained through analysis of medical records. At entry, copeptin proved to be able to distinguish cases from controls and also sepsis group from septic shock group, while procalcitonin could distinguish also severe sepsis from septic shock group. Areas under the ROC curve for copeptin and procalcitonin were 0.845 and 0.861, respectively. Noteworthy, patients with copeptin concentrations higher than the threshold value (23.2 pmol/L), calculated from the ROC curve, at admission presented higher 30-day mortality. No significant differences were found in copeptin temporal profile among different subgroups. Copeptin showed promising diagnostic and prognostic role in the management of sepsis, together with its possible role in monitoring the response to treatment.
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Kerbert AJC, Weil D, Verspaget HW, Moréno JP, van Hoek B, Cervoni JP, Di Martino V, Coenraad MJ, Thevenot T. Copeptin is an independent prognostic factor for transplant-free survival in cirrhosis. Liver Int 2016; 36:530-7. [PMID: 26502363 DOI: 10.1111/liv.12992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/13/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Copeptin is a stable cleavage product of the arginine vasopressin (AVP) precursor and is equimolarly secreted with AVP. Copeptin is currently considered a reliable prognostic marker in a wide variety of diseases other than cirrhosis. We aimed to investigate the association between severity of cirrhosis and copeptin concentrations and to confirm whether copeptin is of prognostic significance in cirrhosis. METHODS One hundred and eighty-four cirrhotic patients hospitalized in two tertiary referral centres were studied. Serum copeptin was measured in samples obtained at hospital admission. Differences in serum copeptin between Child-Pugh classes were evaluated using the Kruskal-Wallis test. Cox proportional hazard regression and Kaplan-Meier analyses were performed to evaluate associations of copeptin and other possible prognostic factors with 6- and 12-month mortality. RESULTS Median serum copeptin (interquartile range) increased significantly through Child-Pugh classes A [5.4 (3.1-10.7) pmol/L], B [9.6 (6.0-17.3) pmol/L] and C [13.8 (5.8-34.1) pmol/L, P < 0.01]. Patients with serum copeptin >12.3 pmol/L displayed significantly higher mortality rates at 6 and 12 months as compared to those with serum copeptin ≤12.3 pmol/L (Log-rank test: P < 0.01). Serum copeptin >12.3 pmol/L was significantly associated with mortality, particularly at 6 months, independently of age, clinical parameters and Model for End stage Liver Disease (MELD), MELD-sodium and Child-Pugh score. CONCLUSIONS Serum copeptin concentration increases significantly along with the severity of cirrhosis as defined by the Child-Pugh classification. A high serum copeptin concentration predicts survival, particularly at 6 months, independently of liver-specific scoring systems in a heterogeneous population of hospitalized cirrhotic patients.
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Affiliation(s)
- Annarein J C Kerbert
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Delphine Weil
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Paul Cervoni
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Vincent Di Martino
- Department of Hepatology, University Hospital of Besançon, Besançon, France
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thierry Thevenot
- Department of Hepatology, University Hospital of Besançon, Besançon, France
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The Cold-Inducible RNA-Binding Protein (CIRP) Level in Peripheral Blood Predicts Sepsis Outcome. PLoS One 2015; 10:e0137721. [PMID: 26361390 PMCID: PMC4567352 DOI: 10.1371/journal.pone.0137721] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/21/2015] [Indexed: 12/12/2022] Open
Abstract
Objectives Sepsis is a lethal and complex clinical syndrome caused by infection or suspected infection. Cold-inducible RNA-binding protein (CIRP) is a widely distributed cold-shock protein that plays a proinflammatory role in sepsis and that may induce organ damage. However, clinical studies regarding the use of CIRP for the prognostic evaluation of sepsis are lacking. The purpose of this research was to investigate the prognostic significance of peripheral blood concentrations of CIRP in sepsis. Sepsis was assessed using several common measures, including the Acute Physiology and Chronic Health Evaluation II (APACHE II) score; the Sepsis-related Organ Failure Assessment (SOFA) score; the lactate, serum creatinine, and procalcitonin (PCT) levels; the white blood cell (WBC) count; and the neutrophil ratio (N%). Design Sixty-nine adult patients with sepsis were enrolled in this study. According to the mortality data from the hospital, 38 patients were survivors, and 31 were nonsurvivors. The plasma levels of the biomarkers were measured and the APACHE II and SOFA scores were calculated within 24 hours of patient enrollment into our study. The CIRP level was measured via ELISA. Results The plasma level of CIRP was significantly higher in the nonsurvivors than in the survivors (median (IQR) 4.99 (2.37–30.17) ng/mL and 1.68 (1.41–13.90) ng/mL, respectively; p = 0.013). The correlations of the CIRP level with the APACHE II score (r = 0.248, p = 0.040, n = 69), the SOFA score (r = 0.323, p = 0.007, n = 69), the serum creatinine level (r = 0.316, p = 0.008, n = 69), and the PCT level (r = 0.282, p = 0.019, n = 69) were significant. Receiver operator characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) for the CIRP level was 0.674 (p = 0.013). According to Cox proportional hazards models, the CIRP level independently predicts sepsis mortality. When the CIRP level in the peripheral blood increased by 10 ng/mL, the mortality risk increased by 1.05-fold (p = 0.012). Thus, the CIRP level reflects the degree of renal injury but does not predict the severity of sepsis or organ damage. Conclusion An elevated plasma concentration of CIRP was significantly associated with poor prognosis among patients with sepsis. Therefore, CIRP is a potential predictor of sepsis prognosis.
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