Elevated Procalcitonin Levels Research Articles

Association Between Procalcitonin and Post-hepatectomy Liver Failure in Hepatocellular Carcinoma Patients.

Objectives: Procalcitonin (PCT) has long been proved as an early diagnostic signal for postoperative outcomes. The purpose of this study is to explore the value of serum procalcitonin levels in predicting post-hepatectomy liver failure (PHLF), and further to declarethe relationship between postoperative PCT and short-term prognosis in patients after hepatectomy. Methods: Clinical data of patients with hepatocellular carcinoma (HCC) who underwent hepatectomy from June 1st, 2019 to September 31st, 2020 at Shanghai Eastern Hepatobiliary Surgery Hospital had been retrospectively analyzed. Logistic regression analysis was used to evaluate the risk factors related to PHLF. The Kaplan-Meier method was used to calculate the PHLF rate and 30-day survival after surgery. Results: A total of 885 patients with complete data were finally included in analysis, 311 of them with elevated serum PCT (≥1 ng/ml). Results of the logistic regression analysis suggested a significant association between PCT and PHLF [HR, 95%CI; 3.801 (1.825, 7.917), p < 0.001]. Other significant risk factors for PHLF included portal hypertension, portal blocking time (>30 min) and blood transfusion (>200 ml). Kaplan-Meier analysis also suggested a higher PHLF rate in elevated PCT patients [9.0% (95% CI, 7.3 to 12.8 VS. 1.9% (95% CI, 1.1–4.3)); p < 0.001]. For secondary outcomes, elevated PCT was also highly associated with postoperative sepsis, ICU admission, 30-day mortality and 3-month mortality. Conclusion: Elevated procalcitonin level in patients after hepatectomy is related to higher PHLF rate, with lower 30-day survival and poor short-term postoperative outcomes.

Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study

AimsDysglycemia, including the three domains hyperglycemia, hypoglycemia, and increased glycemic variability (GV), is associated with high mortality among critically ill patients. However, this association differs by diabetes status, and reports in this regard are limited. This study aimed to evaluate the associations between the three dysglycemia domains and mortality in critically ill patients by diabetes status and determined the contributing factors for dysglycemia.MethodsThis retrospective study included 958 critically ill patients (admitted to the ICU) with or without DM. Dysglycemia was defined as abnormality of any of the three dimensions. We evaluated the effects of the three domains of glucose control on mortality using binary logistic regression and then adjusted for confounders. The associations between dysglycemia and other variables were investigated using cumulative logistic regression analysis.ResultGV independently and similarly affected mortality in both groups after adjustment for confounders (DM: odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.03-1.08; p <0.001; non-DM: OR, 1.07; 95% CI, 1.03-1.11; p = 0.002). Hypoglycemia was strongly associated with ICU mortality among patients without DM (3.12; 1.76-5.53; p <0.001) and less so among those with DM (1.18; 0.49-2.83; p = 0.72). Hyperglycemia was non-significantly associated with mortality in both groups. However, the effects of dysglycemia seemed cumulative. The factors contributing to dysglycemia included disease severity, insulin treatment, glucocorticoid use, serum albumin level, total parenteral nutrition, duration of diabetes, elevated procalcitonin level, and need for mechanical ventilation and renal replacement therapy.ConclusionThe association between the three dimensions of dysglycemia and mortality varied by diabetes status. Dysglycemia in critical patients is associated with excess mortality; however, glucose management in patients should be specific to the patient’s need considering the diabetes status and broader dimensions. The identified factors for dysglycemia could be used for risk assessment in glucose management requirement in critically ill patients, which may improve clinical outcomes.

Antibiotic stewardship: Early discontinuation of antibiotics based on procalcitonin level in COVID-19 pneumonia.

Procalcitonin (PCT) levels rise in systemic inflammation, especially if bacterial in origin. COVID-19, caused by the novel coronavirus SARS-CoV-2, presents with acute respiratory distress syndrome. Elevated procalcitonin in COVID-19 is considered as a marker for severity of disease. There is no study available that indicates whether elevated PCT in COVID-19 is associated with inflammation or superimposed bacterial infection. The objective of this study is to evaluate the association between PCT levels and superadded bacterial infection, and the effect of discontinuation of antibiotic in the low PCT (<0.25ng/ml) group on patients' outcomes. A retrospective chart review of patients admitted with COVID-19 pneumonia at a single tertiary care centre. We collected information on demographics, co-morbidities, PCT level, antibiotic use, culture results for bacterial infection, hospital length of stay (LOS) and mortality. Continuous variables were summarized with the sample median, interquartile range, mean and range. Categorical variables were summarized with number and percentage of patients. We studied a total of 147 patients with COVID-19 pneumonia. 101 (69%) patients had a low PCT level (< 0.25ng/ml). Bacterial culture results were negative for all patients, except 1 who had a markedly elevated PCT level (141.ng/ml). In patients with low PCT, 42% received no antibiotics, 59% received antibiotics initially, 32 (57%) patients antibiotic discontinued early (within 24hours) and their culture remained negative for bacterial infections during hospitalizations. LOS was shorter (6days in low PCT group compared to 9days) in high PCT group. LOS was 1day shorter (5days vs 6days) in no antibiotic group compared to antibiotic group. Our study examines the association between PCT level and superadded bacterial infection in COVID-19 pneumonia. Our results demonstrate that most patients admitted with COVID-19have a low PCT (<0.25ng/ml), which suggests no superadded bacterial infection and supports the previously published literature regarding low PCT in viral pneumonia. Procalcitonin level remains low in the absence of bacterial infection. Early de-escalation/discontinuation of antibiotics is safe without adverse outcomes in COVID-19 pneumonia. Early de-escalation/discontinuation of antibiotics is associated with lower LOS.

Serum procalcitonin levels associate with Clostridioides difficile infection in patients with inflammatory bowel disease

BackgroundClostridioides difficile infection (CDI) is a major cause of morbidity among patients with inflammatory bowel disease (IBD). Diagnostic biomarkers for early detection of CDI are needed in clinical practice. The relationship between serum procalcitonin and CDI in IBD patients has not been investigated so far. Therefore, we aimed to evaluate the usefulness of measuring serum procalcitonin level to detect CDI in patients with the flare of IBD.MethodsOne hundred twenty patients with IBD were enrolled in this study. Bacterial identification was performed using standard microbiological and molecular methods. The serum procalcitonin levels were measured in all patients. Receiver operating characteristic (ROC) curve analysis was applied to assess the value of procalcitonin for the prediction of CDI among IBD patients.ResultsThe median serum procalcitonin level was significantly increased in IBD patients with CDI compared to non-CDI IBD patients (0.69 ng/mL vs 0.32 ng/mL). In univariate analysis, log10 procalcitonin was associated with CDI (OR 2.81, 95% CI 1.54–4.09, P-value < 0.001). Procalcitonin 1.1 ng/mL was 85% sensitive and 88% specific for the prediction of CDI. In the multivariable model including the covariates log10 procalcitonin, age, hospitalization, type of IBD, duration of the disease, and antibiotic usage, procalcitonin showed a robust association with CDI (OR 4.59, 95% CI 2.49–6.70, P-value < 0.001). An elevated procalcitonin level was associated with the presence of CDI among IBD patients.ConclusionsOur results indicate that procalcitonin level can be a good candidate biomarker for assessing the CDI in IBD patients. Further studies are required to decipher whether procalcitonin can predict CDI therapy or its recurrence.

Surge in Procalcitonin Levels Post ATG During Stem Cell Transplantation for Aplastic Anemia: A Diagnostic Dilemma with Sepsis?

Allogenic Stem Cell Transplantation (AlloSCT) has paved way for curative therapy in numerous hematologic diseases such as Aplastic Anemia. Anti-Thymocyte Globulin (ATG), a polyclonal T-cell antibody is an integral part of the numerous conditioning regimens. Its purpose is the T-cell depletion of the recipient, which is of utmost importance for the prevention of graft rejection and successful engraftment. Febrile responses after ATG administration pose a diagnostic dilemma in these patients who are frequently neutropenic [1]. During the conditioning phase before AlloSCT, patients undergo substantial immunosuppression and immune-alteration under the effect of pharmacotherapy and total body irradiation. Conditioning with ATG can be associated with febrile episodes, circulatory instability and/or respiratory insufficiency. The severity of this reaction especially in a neutropenic patient can closely resemble sepsis. Since blood cultures can take a few days in reporting, biochemical markers of inflammation, such as C-Reactive Protein (CRP) and Procalcitonin (PCT) levels have a diagnostic value. In contrast to CRP, Procalcitonin is a sensitive and specific marker for systemic bacterial infection and fungal sepsis [2,3]. We observed a surge in procalcitonin levels after ATG administration in a patient suffering from severe aplastic anemia undergoing conditioning for allogenic bone marrow transplantation from a matched sibling donor. The patient weighing 72 kilograms, received rabbit ATG as GVHD prophylaxis at the rate 1.5mg/kg (5 vials of 25mg each) on Day - 3 of conditioning and developed high grade fever with chills, reaching a peak temperature of 103.6 degrees Fahrenheit. Microbiological cultures and procalcitonin levels were sent to rule out sepsis as part of the protocol. First line intravenous antibiotics were started and antipyretics were administered. Fever settled on its own once the ATG therapy was completed. On day -2 and -1, the same dose of ATG was given and the patient did not develop any febrile episodes. The median PCT elevation on day 1 after ATG infusion was 87.68mcg/L, nearly 70 times the baseline level. Patient was clinically stable with no features of sepsis. There was a steady decline in PCT levels over the next 4 days, 58.54, 24.79, 4.38 and 1.13 (mcg/L) respectively. No derangements in liver function tests or renal function tests were observed. Subsequently, the microbiological cultures were sterile ruling out sepsis. Several previous reports suggested limited diagnostic value of PCT and CRP in the presence of anti-T-lymphocyte antibodies. Dornbusch et al. compared 15 consecutive febrile episodes after T cell antibody infusion without clinical signs of infection with nine episodes of Gram-negative sepsis. After T-cell antibody infusion PCT and CRP serum levels increased to a similar extent as in Gramnegative sepsis. They concluded that during T-cell antibody treatment neither PCT nor CRP are adequate for differentiating between fever due to infection or to unspecific cytokine release. The median PCT elevation on day1 after T-cell antibody infusion was nearly 40 times the baseline [4]. In our patient, the levels reached 70 times the baseline value probably related to higher ATG dose according to the weight of the patient. Brodska et al., prospectively evaluated the validity of CRP and PCT to diagnose infection in patients receiving ATG prior to hematopoietic stem cell transplantation. They assessed renal and liver functions and their relationship to PCT and CRP changes. They found no interrelationship between PCT levels and BL markers of renal or liver functions (P &gt; 0.05 for all comparisons) [5]. Similarly in our patient, no derangements in LFT or RFTs were seen. To conclude, febrile episodes during treatment with ATG are associated with markedly elevated levels of PCT directly proportional to the dose of ATG given. This causes a diagnostic dilemma with sepsis and early use of antimicrobials, which may be kept in reserve during actual crisis in the post-transplant period. In such a scenario, detailed clinical assessment of patient’s condition and careful interpretation of biochemical and microbiological investigations is of utmost importance for judicious use of antimicrobials in this era of emerging antibiotic resistance.

Procalcitonin Levels in COVID-19 Patients Are Strongly Associated with Mortality and ICU Acceptance in an Underserved, Inner City Population.

Background and Objectives: This study aimed to identify demographic and clinical factors at the time of critical care consultation associated with mortality or intensive care unit acceptance in a predominantly Afro-Caribbean population during the first wave of the COVID19 pandemic. Materials and Methods: This retrospective, single-center observational cohort study included 271 COVID19 patients who received a critical care consult between March 11 and April 30, 2020 during the first wave of the COVID19 pandemic at State University of New York Downstate Health Sciences University. Results: Of the 271 patients with critical care consults, 33% survived and 67% expired. At the bivariate level, age, blood urea nitrogen, and blood neutrophil percentage were significantly associated with mortality (mean age: survivors, 61.62 ± 1.50 vs. non-survivors, 68.98 ± 0.85, p < 0.001). There was also a significant association between neutrophil% and mortality in the univariate logistic regression model (quartile 4 vs. quartile 1: odd ratio 2.73, 95% confidence interval (1.28–5.82), p trend = 0.044). In the multivariate analyses, increasing levels of procalcitonin and C-reactive protein were significantly associated with mortality, adjusting for age, sex, and race/ethnicity (for procalcitonin quartile 4 vs. quartile 1: odds ratio 5.65, 95% confidence interval (2.14–14.9), p trend < 0.001). In contrast, higher platelet levels correlated with significantly decreased odds of mortality (quartile 4 vs. quartile 1, odds ratio 0.47, 95% CI (0.22–0.998), p trend = 0.010). Of these factors, only elevated procalcitonin levels were associated with intensive care unit acceptance. Conclusions: Procalcitonin showed the greatest magnitude of association with both death and likelihood of intensive care unit acceptance at the bivariate level. Our data suggests that procalcitonin reflects pneumonia severity during COVID-19 infection. Thus, it may help the intensivist identify those COVID19 patients who require intensive care unit level care.

79 Specific Bandemia Cut-Off and Elevated Procalcitonin Associated With Bacteremia and in Hospital Mortality Regardless of Leukocytosis

Previously literature has suggested an association between bandemia and elevated procalcitonin levels with bacteremia, but conflicting reports in whether they were predictive of in-hospital mortality. There is a paucity of literature reporting a specific cut-off for when these elevated levels are most predictive. The primary objective of this study was to determine if there was a specific cut-point in which a bandemia or elevated procalcitonin was predictive of bacteremia and/or in-hospital mortality.

PROCALCITONIN AS A PREDICTOR OF CLINICAL OUTCOMES IN PATIENTS WITH COVID-19

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The purpose of this study was to retrospectively determine if elevated procalcitonin (PCT) in patients hospitalized with COVID-19 was associated with increased in-hospital mortality, intensive care unit (ICU) length of stay, or hospital length of stay. METHODS: We collected data on 402 adult patients with positive COVID-19 PCR testing admitted to hospitals within our health system from March 1, 2020 until July 10, 2020. Patient characteristics including age, tobacco use, coronary artery disease, hypertension, chronic kidney disease, malignancy, vital signs on admission, PCT levels upon admission, peak PCT levels, and CT chest results were collected. Clinical outcomes including hospital length of stay, ICU length of stay, and in-hospital mortality were also obtained. A PCT measurement on admission of 0.25 ng/mL was used to stratify patients into two mutually exclusive groups. Comparisons of the two groups were made with Mann-Whitney for continuous variables and Chi-square or Fisher’s exact test based on expected frequencies. Multivariable binary logistic regression models were used to model mortality. Kaplan-Meier was used to examine potential differences in overall length of stay as well as ICU length of stay while considering death to be a censoring event. SAS v. 9.4 was used for all analyses;P < 0.05 was deemed significant. RESULTS: Results of the multivariable analysis demonstrated elevated PCT level on hospital admission was not associated with increased odds of mortality (OR = 1.00;95% Cl: 0.97 to 1.02;P = 0.713). Results of the Kaplan-Meier curve revealed no evidence of a significant difference between PCT groups for hospital length of stay (P = 0.144) or ICU length of stay (P = 0.260). Results from the mortality model demonstrated every additional ten years of age was associated with increased odds of mortality (OR = 2.42;95% CI: 1.59 to 4.09;P < 0.001) after adjusting for all other variables. Increased duration of mechanical ventilation was also associated with increased odds of mortality (OR = 2.67;95% CI: 1.52 to 5.10;P = 0.001). CONCLUSIONS: This retrospective study of patients hospitalized with COVID-19 demonstrated no evidence that elevated PCT levels on hospital admission were associated with increased in-hospital mortality, ICU length of stay, or hospital length of stay. CLINICAL IMPLICATIONS: Further studies are needed to fully assess the use of PCT in COVID-19 patients as a prognostic biomarker to predict mortality and other clinical outcomes. DISCLOSURES: No relevant relationships by Ali Aldamen, source=Web Response No relevant relationships by Sarah Aurit, source=Web Response No relevant relationships by Chris Destache, source=Web Response No relevant relationships by Ian Jackson, source=Web Response No relevant relationships by Hadi Jaradeh, source=Web Response No relevant relationships by Shraddha Narechania, source=Web Response No relevant relationships by Manasa Velagapudi, source=Web Response

Determination of procalcitonin content in blood serum, urine, and ejaculate for the diagnosis of urogenital tract pathology

The determination of the concentration of procalcitonin (PCT) in blood serum and other biological fluids is used for the diagnosis and monitoring of the course of sepsis and the syndrome of a systemic inflammatory reaction. This review summarizes the data on the diagnostic value of the definition of procalcitonin in the practice of urologists and andrologists. The content of procalcitonin in such biological fluids as urine, seminal plasma is almost 10 times higher than the level of this protein in blood serum: this phenomenon is manifested in physiological conditions and in pathological processes. The relationship of clinical and laboratory indicators of inflammation with the severity of urosepsis was analyzed. Elevated serum procalcitonin levels are considered as a predictor of septic shock in patients with urolithiasis, and determine the management tactics of patients with urinary tract obstruction. The marker function of this protein was studied in inflammation in the renal parenchyma, in malignant neoplasms of the kidneys, bladder, ureter, prostate and testis; in the diagnosis of testicular torsion and orchiepididymitis. The article describes the regular changes in the level of urinary procalcitonin depending on the severity of vesicoureteral reflux, the severity of the manifestations of the inflammatory reaction. There were significant differences in the concentration of procalcitonin in seminal plasma between the groups of men with reduced and normal ejaculate fertility.

Laboratory analysis of symptomatic and asymptomatic pregnant patients with SARS-CoV-2 infection

BACKGROUNDInflammatory biomarkers have been used to portend disease severity in nonpregnant individuals with SARS-CoV-2 infection. However, currently, limited data are available, and with mixed results, to elucidate which inflammatory biomarkers may be most associated with clinical phenotype in pregnant patients.OBJECTIVEWe aimed to compare laboratory findings among pregnant patients with SARS-CoV-2 infection by symptom status and disease severity.STUDY DESIGNWe retrospectively evaluated pregnant patients with positive SARS-CoV-2 infection, confirmed through polymerase chain reaction testing, at an urban academic US hospital between March 2020 and October 2020, performed for reported symptoms or universal screening on admission. In our hospital, all patients with SARS-CoV-2 infection were recommended to have baseline laboratory testing, including leukocyte, neutrophil, and lymphocyte counts; aspartate aminotransferase and alanine aminotransferase; high-sensitivity C-reactive protein; procalcitonin; lactate dehydrogenase; D-dimer; and ferritin. We performed multivariable logistic regression to evaluate peak laboratory abnormalities significantly associated with symptomatic SARS-CoV-2 infection and disease severity with gestational age at diagnosis, maternal age, and obesity as covariates. The sensitivity and specificity of laboratory abnormalities were calculated to identify symptomatic vs asymptomatic infection and severe to critical disease vs mild to moderate disease.RESULTSWe identified 175 pregnant patients with SARS-CoV-2 infection, of whom 100 (57%) were symptomatic; 17 (17%) of those who were symptomatic had a severe to critical disease. Laboratory data were available for 128 patients, of whom 67 (52%) were symptomatic. Compared with asymptomatic individuals, symptomatic individuals were more likely to exhibit elevated high-sensitivity C-reactive protein levels after adjusting for gestational age (adjusted odds ratio, 5.67; 95% confidence interval, 1.42–22.52; sensitivity, 81%; specificity, 43%). In symptomatic individuals, transaminitis (adjusted odds ratio, 5.67; 95% confidence interval, 1.27–25.43), elevated procalcitonin levels (adjusted odds ratio, 16.60; 95% confidence interval, 2.61–105.46), and elevated lactate dehydrogenase levels (adjusted odds ratio, 17.55; 95% confidence interval, 2.51–122.78) were independently associated with severe to critical disease rather than mild to moderate disease after adjusting for maternal age and obesity. For differentiating disease severity, sensitivity rates for transaminitis, procalcitonin elevation, and lactate dehydrogenase elevation were 47%, 87%, and 53%, respectively, whereas the specificity rates were 89%, 63%, and 90%, respectively.CONCLUSIONInflammatory biomarkers in pregnant patients with SARS-CoV-2 infection exhibited vast heterogeneity, poor discriminative ability, and thereby limited clinical utility. Larger registry studies should evaluate which inflammatory biomarkers may be most useful for risk stratification and prognostication of pregnant patients with SARS-CoV-2 infection, taking into account the physiology of pregnancy.

Evaluation of Procalcitonin Levels in Patients with Various Forms of Acute Coronary Syndrome, Depending on the Presence of Adverse Hospital Outcomes

Aim. to study the levels of procalcitonin in patients with various forms of acute coronary syndrome (ACS), depending on the presence of adverse hospital outcomes.Materials and Methods. The study included 222 patients admitted to the emergency cardiology department with a diagnosis of ACS in the period from March 2014. until January 2017. Of these, 106 (47.7 %) patients were diagnosed with unstable angina (NS) and 116 (52.3%) with myocardial infarction (MI). Non ST segment elevation MI (NSTEMI) was diagnosed in 47 (40.5%) patients with MI, and ST elevation MI (STEMI) – in 69 (59.5%) patients with MI. After the assessment of the patient's compliance with the criteria for inclusion/exclusion in the study, the procedure for signing the patient's informed consent form was carried out. The protocol of the study was approved by the local Ethics committee of the M. E. Zhadkevich State Clinical Hospital. In each study subgroup, the presence of adverse outcomes during the current hospitalization was assessed: cardiovascular death, nonfatal MI, nonfatal acute cerebrovascular accident, acute heart failure, as well as a combined endpoint, including all of the listed adverse outcomes. All patients, in addition to routine laboratory methods of investigation, were examined for the level of procalcitonin at admission to the hospital, on 2-3 and 4-5 days.Results. Patients with MI compared to patients with NS were characterized by a large number of registered endpoints in general (24.1% vs. 6.6%, p&lt;0.001), while in the group of patients with MI, cardiovascular death was more often recorded (10.3% vs. 0.9%, p&lt;0.001) and acute heart failure (12.9% vs. 5.6%, p=0.009). Patients with MI, in particular with STEMI, who had adverse hospital outcomes, were characterized by statistically significantly higher levels of procalcitonin compared to patients without adverse hospital outcomes. Patients with STEMI showed significantly higher levels of procalcitonin at all stages of the disease, and patients with MI-only at 2-3 and 4-5 days. There were no statistically significant differences in the level of procalcitonin at all stages of the disease in patients with NSTEMI and with unstable angina, depending on the hospital outcomes.Conclusion. Elevated procalcitonin levels in patients with MI, in particular with STEMI, are associated with adverse hospital outcomes; for other forms of ACS, no statistically significant differences were observed with different hospital outcomes.

Prognostic values of procalcitonin and platelet in the patient with urosepsis.

Background:The patient suffering from urinary sepsis is often accompanied by elevated serum procalcitonin (PCT) levels and a decline in the average platelet count (PLT), which could result in a poor prognosis. This study aimed to evaluate the value of PCT and PLT in determining the severity of urinary sepsis.Methods:A total of 120 urosepsis patients enrolled were divided into a survival group and a death group, respectively, according to their status within 14 days after admission. Changes in PCT and PLT levels between the 2 groups were compared at different time points. A receiver operating characteristic (ROC) curve was eventually obtained to predict the prognostic value of PCT and PLT.Results:The PCT levels in the survival group declined gradually after admission, and the PLT decreased at first but increased rapidly in subsequence. The PCT level in the death group, however, declined in a flat-slope trend or was hardly noticeable together with the number of PLT reduced significantly. In particular, it is on the 3rd day that PCT tended to positively correlate with acute physiological and chronic health score II (APACHE II) score (r = 0.730, P < .05), but negatively with PLT (r = 0.472, P < .05). The APACHE II score and PLT (r = 0.612, P < .05) were also negatively correlated with each other. As indicated by the ROC curve, the PCT level on the 3rd day after admission was of great value for the clinical mortality prognosis, and the area under the curve was 0.858. Moreover, PLT also has a high predictive value for prognosis. Area under the curve is 0.951. When the PLT was more than 51 × 109 /L, the sensitivity was up to 90%, and the specificity was 90%.Conclusion:PLT and PCT levels are closely related to the APACHE II score, which could indicate the severity of urosepsis in patients. The contribution of this study was to confirm that dynamic monitoring of the changes in PCT and PLT helps determine the prognosis of urosepsis patients.

Effect of Community-Acquired Pneumonia on Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Community-acquired pneumonia (CAP) is a major contributor to hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The clinical manifestations of AECOPD with and without CAP are confusing. The difference in the survival or readmission rate of AECOPD with or without CAP remains controversial. A prospective cohort study was conducted to evaluate the clinical and laboratory characteristics and in-hospital outcomes of patients who were consecutively hospitalized due to AECOPD from May 2015 to December 2019. Grouping was based on chest computed tomography findings. Multivariable logistic regression was used to explore the predictors for early identification between CAP exacerbations and non-CAP exacerbations. Kaplan–Meier analysis was used to compare the cumulative survival rate and readmission rate for a 12-month follow-up between the two groups. A total of 378 patients with AECOPD were enrolled, including 200 patients with CAP and 178 patients without CAP. The presence of pleuritic pain, usage of ICS, and elevated levels of C-reactive protein and procalcitonin on admission were the predictors for the early discrimination between AECOPD with and without CAP. During a 1-year follow-up, the cumulative survival rate was lower in patients with AECOPD with CAP than in those with AECOPD without CAP (13.0% vs. 3.37%; HR: 4.099; 95% CI, 2.049–8.199; p < 0.001), but the readmission rate was similar in both groups. Patients with first-time exacerbation due to CAP were more likely to experience subsequent pneumonic exacerbation. CAP is frequent among patients hospitalized for AECOPD and associated with increased mortality and successive pneumonic exacerbation.

CLINICAL EFFICACY OF TOCILIZUMAB IN THE TREATMENT OF SEVERE COVID-19 IN THE VOLYN REGION OF UKRAINE

Treatment of coronavirus disease COVID-19 is currently unresolved. Whether it is advisable to use Tocilizumab (TM), whether it is effective and safe for patients with Covid-19 - this question remains open to physicians.The aim of the study: To evaluate the safety and therapeutic efficacy of TM on the course and prognosis of severe COVID-19 during treatment with standard treatment according to the National Protocol without antiviral therapy.Materials and methods: Retrospective cohort study of adult patients (≥18 years) with severe COVID-19, who were admitted to the infectious department №2 KP «Volyn Regional Clinical Hospital» from September 2020 to December 2020.The statistical analysis included a group of patients who received TM and recovered (n=42), a group of patients who recovered without TM (n=59), and a group of patients who received or did not receive TM and died (n=58). Statistical methods of interval estimation, null hypothesis according to U Mann-Whitney criteria, binomial criteria, and T-test for two independent dichotomous samples according to the Bernoulli scheme using SPSS Statistics 26 stepwise direct method LR were used for the analysis.Results: 77.7% of patients with severe COVID-19 who received TM recovered, however, based on the analysis of data from a cohort of patients with severe COVID-19 who did not receive TM, it was found that recovery did not depend on TM. Adverse events associated with TM were noted in 3.7%. It has been found that TM reduces recovery time in the hospital and reduces the risk of being admitted to the intensive care unit. The average value of C-reactive protein (СRP) in the group of recovering those who received TM - 114.1 mg/l, and elevated levels of Procalcitonin (PC) above normal by 59.52% with an average value of 0.35 ng / ml.Conclusions: The high statistical significance of the obtained results in terms of therapeutic efficacy and safety of TM makes it possible to implement the obtained results in wide practice for the use of this drug in the treatment of severe COVID-19.

The Assessment of Pentraxin 3: A Novel Biomarker in Early Detection of Infection in Newborns.

Introduction As the clinical manifestation of neonatal infection is nonspecific and characterised by varied clinical features, it is highly problematic to establish an early diagnosis. Recently, hopes have been raised by the new acute-phase protein—pentraxin 3 (PTX3). PTX3 belongs to the family of long pentraxins, which is synthesized in numerous cells like endothelial cells, macrophages, and monocytes infiltrating sites of inflammation. Material and Methods. In our research, we have enrolled 29 newborns with infection as the study group and 47 healthy ones as the control group, as well as their mothers. The C-reactive protein (CRP), procalcitonin (PCT), and PTX3 levels were determined in venous blood samples from all investigated neonates and their mothers. Moreover, PTX3 concentrations were assessed in the umbilical cord. Results There were statistically significant differences in PTX3 levels between healthy and sick newborns both in the umbilical cord (p = 0.02) and venous blood (p = 0.01). The highest PTX3 concentrations were observed in children with infection in the presence of premature rupture of membranes (PROM). PTX3 concentrations in this group were significantly higher compared to those in healthy children without PROM. We observed elevated PCT levels in newborns with infection. No differences in CRP levels in 12 hours of life were noticed between the investigated groups. A comparison of ROC curves for PTX3 and PCT concentrations revealed similar sensitivity and specificity in the prediction of infection in neonates. Conclusions Serum PTX3 is an important and specific biomarker of early infection. It is already elevated in the umbilical cord, so measuring PTX3 concentration might be useful in the early prediction of infection in newborns.

Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis.

ObjectiveTo describe the laboratory parameters and biomarkers of the cytokine storm syndrome associated with severe and fatal COVID-19 cases.MethodsA search with standardized descriptors and synonyms was performed on November 28th, 2020 of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, LILACS, and IBECS to identify studies of interest. Grey literature searches and snowballing techniques were additionally utilized to identify yet-unpublished works and related citations. Two review authors independently screened the retrieved titles and abstracts, selected eligible studies for inclusion, extracted data from the included studies, and then assessed the risk of bias using the Newcastle-Ottawa Scale. Eligible studies were those including laboratory parameters—including serum interleukin-6 levels—from mild, moderate, or severe COVID-19 cases. Laboratory parameters, such as interleukin-6, ferritin, hematology, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer, were extracted from the studies. Meta-analyses were conducted using the laboratory data to estimate mean differences with associated 95% confidence intervals.Data synthesisThe database search yielded 9,620 records; 40 studies (containing a total of 9,542 patients) were included in the final analysis. Twenty-one studies (n = 4,313) assessed laboratory data related to severe COVID-19 cases, eighteen studies (n = 4,681) assessed predictors for fatal COVID-19 cases and one study (n = 548) assessed laboratory biomarkers related to severe and fatal COVID-19 cases. Lymphopenia, thrombocytopenia, and elevated levels of interleukin-6, ferritin, D-dimer, aspartate aminotransferase, C-Reactive-Protein, procalcitonin, creatinine, neutrophils and leucocytes were associated with severe and fatal COVID-19 cases.ConclusionsThis review points to interleukin-6, ferritin, leukocytes, neutrophils, lymphocytes, platelets, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer as important biomarkers of cytokine storm syndrome. Elevated levels of interleukin-6 and hyperferritinemia should be considered as red flags of systemic inflammation and poor prognosis in COVID-19.

Predictive Ability of Procalcitonin for Acute Kidney Injury: A Narrative Review Focusing on the Interference of Infection.

Acute kidney injury (AKI) is a common yet complicated clinical entity with high morbidity and mortality. An essential strategy to improve AKI patients’ prognoses is finding optimal biomarkers to identify AKI in a timely manner. Procalcitonin (PCT), a well-recognized biomarker for diagnosing infection and guiding antibiotics therapy, has been proposed to predict AKI development and recovery in many clinical settings. The current review provides comprehensive and updated information from relevant studies to evaluate PCT’s AKI-predictive ability and the influence of infection on this predictive ability. PCT has demonstrated optimal predictive ability for AKI in various populations irrespective of infection. However, the predictive ability seems to be blunted by infection since infection and inflammation have a more potent influence than AKI on PCT elevation. We furthermore explain the complicated association between elevated PCT levels and AKI in infection and inflammation situations and recommend directions for further investigations to clarify the essential issue. In conclusion, although conflicting data exist, serum PCT level is a potential biomarker for predicting AKI in many clinical settings regardless of infection. Nevertheless, further studies are warranted to clarify the association between PCT, infection, and AKI and to confirm the utilization of PCT for AKI prediction.

Extremely Elevated Procalcitonin in a Case of Acetaminophen Overdose and Acute Liver Injury

We herein report a 46-year-old man who suffered an intentional acetaminophen overdose. Laboratory results revealed leukocytosis and an elevated procalcitonin level (8.48 ng/mL). Computed tomography showed findings suggesting possible colitis. Due to concerns about sepsis in addition to acetaminophen overdose, oral N-acetyl cysteine and piperacillin/tazobactam were started. His procalcitonin levels further increased; however, the patient remained afebrile, and the C-reactive protein levels were normal. Piperacillin/tazobactam was discontinued, and he remained stable without antibiotics. The present case shows that the toxicokinetics of acetaminophen overdose can cause an elevated procalcitonin level. Furthermore, procalcitonin levels alone should not guide the need for antibiotics in such cases.

Characteristics and outcomes of COVID-19 infection in 45 patients with breast cancer: A multi-center retrospective study in Hubei, China

BackgroundThe COVID-19 pandemic is a significant worldwide health crisis. Breast cancer patients with COVID-19 are fragile and require particular clinical care. This study aimed to identify the clinical characteristics of breast cancer patients with COVID-19 and the risks associated with anti-cancer treatment. MethodsThe medical records of breast cancer patients with laboratory-confirmed COVID-19 were collected among 9559 COVID-19 patients from seven designated hospitals from 13th January to 18th March 2020 in Hubei, China. Univariate and multivariate analyses were performed to assess risk factors for COVID-19 severity. ResultsOf the 45 breast cancer patients with COVID-19, 33 (73.3%) developed non-severe COVID-19, while 12 (26.7%) developed severe COVID-19, of which 3 (6.7%) patients died. The median age was 62 years, and 3 (6.7%) patients had stage IV breast cancer. Univariate analysis showed that age over 75 and the Eastern Cooperative Oncology Group (ECOG) score were associated with COVID-19 disease severity (P < 0.05). Multivariate analysis showed that patients who received chemotherapy within 7 days had a significantly higher risk for severe COVID-19 (logistic regression model: RR = 13.886, 95% CI 1.014–190.243, P = 0.049; Cox proportional hazards model: HR = 13.909, 95% CI 1.086–178.150, P = 0.043), with more pronounced neutropenia and higher LDH, CRP and procalcitonin levels than other patients (P < 0.05). ConclusionsIn our breast cancer cohort, the severity of COVID-19 could be associated with baseline factors such as age over 75 and ECOG scores. Chemotherapy within 7 days before symptom onset could be a risk factor for severe COVID-19, reflected by neutropenia and elevated LDH, CRP and procalcitonin levels.

The Diagnostic Utility of Procalcitonin for the Detection of Infection among Systemic Lupus Erythematosus Patients in a Tertiary Care Hospital

Background: Clinical manifestations of infection in patients with systemic lupus erythematosus (SLE) are variable and involve significant diagnostic challenges. Delays in diagnosis and treatment strongly affect the clinical outcomes and mortality. The elevation of one’s serum procalcitonin (PCT) level may be a diagnostic biomarker of infection in SLE. Objective: To determine the diagnostic accuracy of PCT for bacterial and fungal infections in patients with SLE. Materials and Methods: Samples of serum PCT were prospectively collected in all patients with SLE admitted to medical wards at Siriraj Hospital, a tertiary care center, between February 2011 and March 2012. Results: One hundred twenty-four patients with SLE were enrolled. The mean age was 31.9±10.9 years. The median disease duration of SLE was five years. The Median Mexican SLE Disease-Activity Index Score was 8 (IQR 6 to 11.8). Ninety-five percent of patients had active SLE and 70% of them were treated with prednisolone of more than 15 mg/day or equivalent doses of other corticosteroids. The serum PCT levels of SLE patients with infection (n=39; median 0.52 ng/mL, IQR 0.15 to 1.49) were significantly increased, compared to those of SLE patients with no infection (n=85; median 0.09 ng/mL, IQR 0.04 to 0.16), p&lt;0.001. The cut-off point of elevated serum PCT (0.5 ng/mL) for the diagnosis of bacterial or fungal infections in patients with SLE had sensitivity, specificity, positive predictive value, and negative predictive values of 51.3%, 95.3%, 83.3%, and 81%, respectively. The independent factors associated with elevated serum PCT levels of 0.5 ng/mL or more were the presence of a bacterial or fungal infection, a low hemoglobin level, and serum Cr of 2 mg/dL or more. Conclusion: The elevation of one’s serum PCT level may be a useful biomarker to detect bacterial and fungal infections in patients with SLE. Keywords: Systemic lupus erythematosus; Procalcitonin; Sensitivity; Specificity; Infection; Sepsis; Flare