Procalcitonin and secondary bacterial infections in COVID-19: association with disease severity and outcomes

INTRODUCTION

Procalcitonin (PCT) is an emerging prognostic marker in coronavirus disease 2019 (COVID-19). Whether PCT can detect secondary bacterial infections or reflect target tissue injury in this setting is still unclear. Here we performed a meta-analysis to review the prognostic value of PCT for severe disease and adverse outcome events in COVID-19.

METHODS

We searched relevant publications in online databases. Studies were included if they reported categorical data according to disease severity and/or outcomes. We analysed extracted data using fixed or random-effects meta-analysis models, as appropriate, depending on the presence of significant heterogeneity.

RESULTS

Data from 14 studies (3492 patients) were included in the analysis. Overall, 163 of 256 patients with elevated PCT had severe disease (63.7%) compared with 553 of 2047 with negative PCT (27.0%) (OR: 5.92; 95% CI: 3.20 to 10.94). Elevated PCT was also associated with adverse outcomes (OR: 13.1; 95% CI: 7.37 to 23.1). PCT was increased in 22.8% and 30.6% of patients with the severe course and adverse outcome, respectively. Rates of secondary bacterial infections ranged from 4.7% to 19.5% and were associated with increased risk of severe course or fatal outcomes (OR: 20.8; 95% CI: 11.6 to 37.4).

CONCLUSIONS

Elevated PCT levels could identify a subset of COVID-19 patients at increased risk of severe disease and adverse outcome. Its limitations include low sensitivity and undefined cost-utility ratio. Whether PCT may be used for detecting secondary bacterial infections and guiding antibiotic therapy in COVID-19 is still undefined.

Pneumomediastinum and Subcutaneous Emphysema after Noninvasive Ventilation in a COVID-19 Patient

An 80-year-old man was admitted because of persistent fever and dyspnea [...]

Hospitalisation and morbidity due to adverse drug reactions in elderly patients: a single-centre study

BACKGROUND

Adverse drug reaction (ADR) is a leading but under-recognised cause of illness, particularly in frail subjects with multiple comorbidities.

AIM

To investigate the frequency, patterns and outcomes of ADR as a cause of hospitalisation in elderly patients admitted to an internal medicine ward.

METHODS

We performed a retrospective observational study including every patient aged over 65 years who was admitted to our department during a 12-month period. Patients admitted to short-stay (<24 h) observation unit were excluded.

RESULTS

ADR accounted for 106 of total 1750 recorded admissions, which constituted a proportion of 6.1% (95% confidence interval 5.0-7.3%). The median age of patients was 83.5 (78.0-87.0) years and 56.6% were on polypharmacy. A total of 170 ADR was recorded with 45.3% of subjects experiencing concomitantly more than one ADR from a single molecule. Diuretics were the most commonly imputed molecules (30 events, 17.6%), followed by antithrombotics (25 events, 14.7%) and central nervous system-active drugs (16 events, 9.4%). Interactions were judged responsible for 39 cases of ADR (36.8%). An unfavourable outcome was observed in about one-third of patients (37.7%). Among those subjects, 11 (10.4%) died and 29 (27.4%) had residual disability.

CONCLUSION

ADR are a common cause of hospital admission in elderly patients and are often associated with adverse outcomes. Our data underline the need of appropriate strategies aimed at identifying high-risk patients and avoiding potentially preventable drug toxicities.

Age-associated alterations in cholesterol homeostasis: evidence from a cross-sectional study in a Northern Italy population

Background

The modifications of cholesterol metabolism associated with aging are ill-defined. The objective of this study was to define age-associated alterations of the different metabolic pathways controlling cholesterol homeostasis by analyzing circulating sterols.

Methods

We analyzed serum samples collected from 201 adult (75 male, 126 female) subjects within the epidemiological MICOL study (Multicentrica Italiana Colelitiasi). The age range was 38–79 years; 103 had evidence of gallstones. The concentrations of the different sterols, recognized as markers of the main pathways of cholesterol homeostasis, were analyzed by gas chromatography-mass spectrometry, including lathosterol (synthesis), campesterol and sitosterol (absorption), and 7α-hydroxy-4-cholesten-3-one (degradation to bile acids).

Results

A significant direct correlation was detected between age and cholesterol levels (r =0.34, P<0.01). The lathosterol/cholesterol ratio was lower in older age quartiles (P<0.05 by analysis of variance), with an inverse correlation between the lathosterol/cholesterol ratio and age (r=−0.32, P<0.01). Such correlation was particularly evident in females. The campesterol/cholesterol and sitosterol/cholesterol ratios were inversely correlated with aging in control, but not in gallstone patients. The levels of 7α-hydroxy-4-cholesten-3-one were not correlated with age.

Conclusion

These data show a reduction of cholesterol synthesis with aging which is associated with increased circulating cholesterol levels. The finding might be related to a reduced metabolic need for cholesterol in advancing age, leading to a downregulation of the main mechanisms of cholesterol intake in the liver. A different age-related behavior was observed in gallstone-free versus gallstone patients regarding cholesterol absorption. The possible implications in terms of the pharmacological management of hypercholesterolemia in the elderly remain to be defined.

Glottal patency during experimental cortical seizures in piglets

OBJECTIVE

Systemically-induced seizures produce glottal airflow obstruction in anesthetized pigs, resulting in hypercapnia and respiratory acidosis. Cortically-induced seizures may be more representative of human seizure disorders. The purpose of this study was to describe glottal area patency (GAP) in piglets during cortically-induced seizures.

METHODS

Nineteen spontaneously breathing, lightly anesthetized (alphaxalone-alphadolone IV) piglets (aged 10 +/- 2 days) were instrumented for recording nasal airflow, subglottic pressure, and electrocorticogram. Glottal visualization was achieved supraglottically using a 1.2-mm fiberoptic scope inserted through the thyrohyoid membrane. Following baseline-control, hypoxic-rebreathing, and new baseline recordings, seizures were induced using subcortical injections of crystalline penicillin G (100,000 units/ injection). Five consecutive-breath representative epochs were digitized from baseline-control, hypoxic-rebreathing, and seizure conditions. For each breath, GAP was measured at the onset of inspiratory pressure, peak of inspiratory effort (Ip), and onset of expiration.

RESULTS

The piglets were physiologic at baseline-control and new baseline conditions, and showed expected increases in ventilation and GAP during rebreathing experiments. GAP was maximum at Ip under baseline and rebreathing conditions, but was significantly decreased and airway resistances were increased during seizure conditions (p < 0.05, ANOVA).

CONCLUSIONS

Generalized seizure activity results in reduced GAP at the peak of inspiratory effort. Increased work of breathing during seizures is created by direct mechanical obstruction at the level of the larynx.