PCT Levels Research Articles

Increased serum interleukin-6 and lactate dehydrogenase levels among nonsurvival severe COVID-19 patients when compared to survival ones

BackgroundAccurate and rapid laboratory diagnosis of COVID-19 infection and its deterioration is one of the milestones of pandemic control. Therefore, this study aimed to compare the diagnostic and prognostic accuracy of the mainly used laboratory biomarkers (WBCS, neutrophil and lymphocyte percentages, CRP, ferritin, IL-6, D-dimer, procalcitonin, and LDH) in the sera of severe COVID-19 Egyptian patients to assess the most appropriate biomarker used in severe COVID-19 patients. MethodsA total of 180 unvaccinated severe COVID-19 patients were enrolled in our study. Demographic data, hospitalization time, medical history, oxygen saturation, respiratory rate, oxygen supply, laboratory findings, and thorax tomography of the patients were obtained retrospectively from the hospital's electronic information system. ResultsOur results revealed that the levels of neutrophil percentage, CRP, IL-6, PCT, and LDH were significantly increased while lymphocyte percentage was significantly decreased among nonsurvival severe COVID-19 patients when compared with survival ones. By using ROC curve analysis, IL-6, and LDH are the most sensitive and specific markers for the prediction of bad prognosis and mortality among severe COVID-19 patients with 100% and 93% sensitivity and 93.7% specificity; respectively. IL-6 and LDH showed significant correlations with the other parameters, which suggested their association with the severity of COVID-19. ConclusionBy using survival severe COVID-19 patients as a control group, our results showed that blood neutrophil percentage, serum CRP, IL-6, PCT, and LDH were significantly increased in non-survivors as compared to survivors. As biomarkers, our results revealed that IL-6 and LDH are good predictors of mortality among severe COVID-19 patients.

Comparative efficacy between retrograde intrarenal surgery with vacuum-assisted ureteral access sheath and minimally invasive percutaneous nephrolithotomy for 1-2 cm infectious upper ureteral stones: a prospective, randomized controlled study.

To observe the efficacy and safety of retrograde intrarenal surgery combined with vacuum-assisted ureteral access sheath (V-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 1-2 cm infectious upper ureteral stone. A total of 173 patients with 1-2 cm infectious upper ureteral stone were prospectively randomized into two groups. Eighty-six in the V-UAS group and 87 cases as control in the MPCNL group. The SFRs at different times (Postoperative 1 day, 2nd week and 4th week) was considered as the primary outcome of the study. The secondary end points were operative time, postoperative hospital stay and operative complications. There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that the SFR at postoperative 1 day in the V-UAS group was significantly lower than that in the MPCNL group (73.2% vs. 86.2%, P = 0.034). However, there was no statistical significance between two groups in SFRs during postoperative 2 weeks and 4 weeks (All P > 0.05). The levels of WBC, CRP and PCT were all significant lower in the V-UAS group than those in the MPCNL group at the postoperative 24 h and 48 h (all P < 0.05). Postoperative complications included fever (≥38.5°C), bleeding, pain and urosepsis. In terms of the rates of fever, pain and urosepsis, MPCNL group were all significantly higher than those in the V-UAS group (10.3 vs. 2.4%, P = 0.031; 14.9 vs. 2.4%, P = 0.003; 4.6 vs. 0.0%, P = 0.044; respectively). No significant difference was found between two groups in bleeding. Meanwhile, postoperative hospital stay in the V-UAS group was more shorten than that in the MPCNL group (3.7 vs. 5.9 days, P < 0.001). Our study showed that RIRS with V-UAS, a new partnership to treat 1-2 cm infectious upper ureteral stones, was satisfying as it achieved a high SFR rate and a low rate of infectious complications. This method was safe and reproducible in clinical practice.

To Assess the Role of Immune Infiltrating Immune Cells of Patients With Chronic Heart Failure With Atrial Fibrillation and Nursing Care in These Patients.

This research aimed to assess the role of immune infiltrating immune cells of patients with chronic heart failure with atrial fibrillation and nursing care inthesepatients. For this aim, 400 patients from 22 centres across our nations were recruited in the index cohort based on worsening signs/symptoms and poor management of HF. The validation cohort consisted of patients who had previously participated in the index cohort. The primary goal was to reduce all-cause mortality as well as unscheduled hospitalisations due to heart failure. Hospitalizations for heart failure (HF), total mortality, and death attributable to cardiovascular disease were secondary objectives. Results showed that interleukin-6 (IL-6) levels in patients ranged from 3.1 to 11.21 pg/mL on average, with 228 patients (or 57% of the total) having IL-6 levels that were higher than the 95th percentile of normal values (> 4.45 pg/mL). The average age of the group was 69.85±9.68 years, and there were 295 males in the group (73.75 percent). 17 Patients who had higher levels of IL-6 tended to be older, more frequently suffered from heart failure with preserved ejection fraction (HFpEF), and more frequently suffered from anaemia, diabetes, and atrial fibrillation. Patients who had higher levels of IL-6 also had a greater likelihood of suffering from these conditions. Patients who had higher levels of IL-6 also had a shorter distance travelled during the 6MWT and had a lower chance of completing the test. Both test completion [OR (95% CI) per doubling of IL-6: 0.81 (0.71 - 0.91), P< 0.001] and total distance covered [B (95% CI) per doubling of IL-6: 28.11 (32.58 to-21.98), P< 0.001] were negatively associated with increasing levels of IL-6, Patients who had high levels of IL-6 had higher median hepcidin levels than patients who had low levels of IL-6. This was discovered by comparing the two groups' hepcidin levels. There was a correlation between increased levels of IL-6 and increased levels of NT-proBNP and CRP, as well as a reduction in eGFR. In conclusion, independent predictors of IL-6 were younger age, high-flow partial ejection fraction (HFpEF), atrial fibrillation (AF), iron insufficiency, and higher levels of NT-proBNP, PCT, hepcidin, and TNF-/IL-1 related biomarkers. Last but not least, IL-6 levels in the plasma were able to predict death and/or hospitalisation due to HF on their own, although they did not contribute to differentiation in prior models.

The dose-response relationship between smoking and the risk factor for invasive pulmonary aspergillosis in patients with severe fever with thrombocytopenia syndrome.

Invasive pulmonary aspergillosis (IPA) is common in immuno-compromised people, and a high incidence of IPA has been found in patients with severe fever with thrombocytopenia syndrome (SFTS). Our study aimed to determine the independent risk factors for IPA and the relationship between smoking status and the risk of IPA in SFTS patients. A retrospective analysis of SFTS patients in the First Affiliated Hospital of Nanjing Medical University from May 2011 to December 2021 was reviewed. The patients were divided into two groups: IPA and non-IPA groups. We compared demographic characteristics, clinical manifestation, laboratory parameters, treatment, and prognosis, and explored the risk factors of IPA using logistic regression and ROC curve. The dose-dependent effect of smoking on the risk of IPA was further estimated, including the age of smoking initiation, daily smoking amount, smoking duration, and pack-years of smoking. In total, 189 individuals were included. Compared with the non-IPA group, the IPA group had higher levels of smoking, drinking, cough, dyspnea, aCCI scores, Dabie bandavirus (DBV) RNA load, ferritin, PCT, IL-6, APTT, LDH, BUN, creatinine, and lower levels of FT4 and TSH. The incidences of MODS, admission to ICU, ventilation, and broad-spectrum antibiotic treatment were significantly higher in the IPA group than in the non-IPA group. Multivariable logistic analysis showed that smoking history, cough, creatinine, admission to ICU, broad-spectrum, and corticosteroid therapies were the independent risk factors for IPA in SFTS patients. We further confirmed that the age of smoking initiation <30 years, smoking at least one pack per day, smoking for at least 40 years, and having at least 40 pack-years of smoking exposure were the independent risk factors for IPA among smokers. The prognosis of SFTS patients in the IPA group is worse than that of the non-IPA group. Attention should be paid to SFTS patients with a smoking history, cough, creatinine, admission to ICU, and broad-spectrum and corticosteroid therapies. There is a strong dose-dependent association between smoking and IPA development in SFTS patients. Prophylactic antifungal therapy should be considered for SFTS patients with these risk factors, but further studies are necessary to determine if it is beneficial for the prognosis of these patients.

Safety and efficacy of waterjet debridement vs. conventional debridement in the treatment of extremely severe burns: A retrospective analysis

IntroductionPatients with extremely severe burns often require rapid wound closure with a tangential excision or escharectomy combined with a skin graft to reduce life-threatening complications such as infection. Traditional tangential excision surgery using the Watson or Humby knife does not allow accurate excision of necrotic tissue and often removes too much active tissue, which is detrimental to the rapid healing of the wound. Importantly, the Versajet hydrosurgical system, with its smaller handle, allows for more precise excision of necrotic burn tissue and preserves more active dermal tissue, positively affecting wound healing and scarring. This study compared the safety and efficacy of hydrosurgical combined with autologous skin grafting to conventional excision combined with autologous skin grafting in patients with extremely severe burn. MethodsInformation of sixty burn patients with total body surface area (TBSA) > 50 % treated at the first affiliated hospital of Anhui Medical University from January 2019 to August 2022 were analyzed. The patients were divided into a conventional debridement group (n = 37) and a hydrosurgical debridement group (n = 23) according to the approach used. The hydrosurgical debridement group and the conventional debridement group were compared from the difference between the duration of the first debridement surgery, wound healing time, the changes of red blood cells and hemoglobin concentration postoperative, total blood transfusion, hospitalization cost, skin grafting frequency, procalcitonin, wound bacterial culture, albumin and prealbumin. ResultsInformation on age, gender, weight, inhalation injury, hypovolemic shock, preoperative procalcitonin, preoperative albumin, preoperative prealbumin, the operation frequency (n ≥ 3), preoperative trauma culture and postoperative trauma culture were compared between both groups (P > 0.05). Operative time and wound healing time were significantly shorter in patients with hydrosurgical debridement combined with autologous skin grafting than those in the control group (P < 0.05), while hospitalization costs were not significantly different between the two groups (P > 0.05). The changes of red blood cells and hemoglobin concentration during the postoperative period in the hydrosurgical debridement group were less significantly than those in the conventional debridement group (P < 0.05). The total amount of red blood cells transfused during hospitalization was significantly lower in the hydrosurgical debridement group than that in the conventional debridement group (P < 0.05), but the total amount of fresh frozen plasma transfused during hospitalization was not statistically significant between the two groups (P > 0.05). Albumin on the third day after surgery and prealbumin on the first, third and fifth day after surgery improved more significantly than those in the control group(P < 0.05), however, there were no significant differences between the two groups in albumin on the first and fifth postoperative days (P > 0.05). The PCT level in the conventional debridement group was significantly higher than that in the hydrosurgical debridement group on the first, third and fifth days after surgery(P < 0.05). ConclusionThe hydrosurgical debridement group presented with shorter operative time, less blood loss during surgery, faster postoperative nutritional recovery, less postoperative inflammatory response and faster wounds healing, and did not increase the hospitalization cost, postoperative bacterial culture of the wounds and the number of skin grafting surgeries. In patients with extremely severe burn, hydrosurgical debridement combined with autologous skin grafting group is safer and more effective than those in the conventional debridement combined with autologous skin grafting group.

#4858 THE CHANGES OF THE C REACTIVE PROTEIN LEVEL DURING THE CRRT PROCEDURE

Abstract Background and Aims Continuous renal replacement therapy (CRRT) is recommended for critically ill patients (pts). Various infections and sepsis often occur in these pts. In addition to being frequently used as inflammation parameter, C reactive protein (CRP) is considered an important regulator of inflammatory processes and may have an active role in atherosclerosis. Changes in its level can have indirect effects on these processes. The aim of this study was to monitor change of CRP level during the CRRT procedure and to evaluate the potential correlation between this change and other monitored parameters. Method The study was done as the observational, retrospectively prospective study on 154 pts, on whom 343 CRRT procedures (proc) were performed. All pts were treated at the Clinics of the University Clinical Centre of Vojvodina, by the Dialysis Department, during 2021. and 2022. Procedures that lasted longer than 5 hours were included. CRRT modalities were CVVHD and CVVHDF, with the use of different filters (EMiC2, Kit8/CiCa1000, oXiris, ST150), according to the device (MultiFiltrate, PrismaFlex) and anticoagulation used. Demographic, clinical and CRRT proc data were collected from the medical documentation. Blood for laboratory testing was sampled at the beginning and the end of the proc. An increase or decrease of CRP level by more than 5% compared to the initial value was considered significant. The collected data were statistically processed. Results From 154 pts, 86.83% were men, 13.17% women, with average (avg.) age of 56.52 years. From 343 proc, 41.69% were CVVHD, 58.31% CVVHDF, with avg. duration of 1033 min. Average ultrafiltration (UF) was 2670mL, with avg. UF/hour of 161.54mL/h. Average initial CRP level was 176.25mg/l, with avg. level of 174.6mg/l at the end of the proc. In 44.9% proc an increase and in 43.44% proc a decrease in the CRP level was verified. The CRP level did not change significantly during 11.66% proc (40/343). Patients' age (p = 868) and gender (p = 752) did not affect the change in CRP level during CRRT proc. Procedures in which CRP level decreased lasted longer (1084min) than those with CRP level increase (1023min), but the difference is not statistically significant (p = 199). Prescribed CRRT dose (p = 485), nor total UF (p = 164) did not affect change in CRP level during proc. Hourly UF was significantly lower for CRRT proc during which CRP level decreased (148.18mL/h) compared to those with the CRP level increase (172.23mL/h) (p = 000). CRRT modality had a significant impact on changes of CRP level during the proc. In a higher percentage of CVVHD proc (48.32%) a decrease in CRP level was seen compared to CVVHDF proc (36.36%) (p = 035). A significant difference was found in the changes of CRP levels in relation to the filters used (p = 011). The use of the EMiC2 filter most often resulted in a decrease in CRP level (56.25%), compared to the use of other filters. Septic condition was present in 85.91% of proc that ended with a decrease of CRP level and in 66.23% of proc with the CRP level increase (p = 000). In proc with the CRP level decrease, basal levels of PCT and fibrinogen were significantly higher than in those with the CRP level increase (p = 037, p = 000 retrospectively). Initial number of WBC did not differ between two groups (p = 424). Comorbidities such as diabetes (p = 489), malignancy (p = 5) or autoimmune disease (p = 25) did not affect change in CRP level during CRRT proc, nor did surgery precede the proc (p = 782). No association between the changes of CRP level during the CRRT proc and the subsequent pts mortality (p = 289) or recovery of renal function (p = 808) was found. Conclusion During the CRRT procedure, the level of CRP in significantly influenced by the average hourly ultrafiltration, the CRRT modality, the filter used, and the presence of septic condition, with high levels of PCT and fibrinogen.

Comparison of Interleukin-6 with Other Markers in Diagnosis of Ovarian Cancer.

The lack of specific symptoms in ovarian cancer delays onset of the diagnostic process. Hence, most cases are recognized in late stages of the disease. The aim of this study was to confirm the role of Il-6 compared to other markers in diagnosis and survival in ovarian cancer. The database was collected from 13 January 2021 to 15 February 2023. In total, 101 patients with pelvic tumors with a mean age of 57.86 ± 16.39 participated in the study. In every case, CA125, HE4, CEA, CA19-9, Il-6, C-reactive protein and procalcitonin measurements were taken. Patients with ovarian borderline tumor and metastatic ovarian tumors were excluded from further analysis. Statistically significant correlations were found between diagnosis of ovarian cancer and levels of CA125, HE4, CRP, PCT and Il-6. Comparison of Il-6 with other markers revealed that longer overall survival correlated with lower values of Il-6. In the case of a higher concentration of Il-6, OS and PFS were shorter. Sensitivity and specificity of Il-6 in diagnosis of ovarian cancer were 46.8% and 77.8%, respectively, while for CA125, CRP and PCT were 76.6% and 63%; 68% and 57.5%; 36% and 77%, respectively. More investigations are needed to identify the most specific and sensitive marker for ovarian cancer.

Phase I clinical trial using a unique immunotherapeutic combination of MUC1-targeted CAR-T cells with PD-1-knockout in the treatment of patients with advanced esophageal cancer.

e16061 Background: Combining CAR-T with programmed cell death-1 (PD-1) inhibition may be a more efficacious approach for treatment of solid tumors. This clinical study was designed to assess the safety and tolerability of PD-1 knockout MUC1-Targeted CAR-T engineered Cells to treat advanced esophageal cancer. Methods: Patients with advanced esophageal cancer were recruited according to the criteria in NCT03706326. PD-1 gene knockout (KO) MUC1-targeted CAR-T cells were prepared by constructing MUC1-specific CARs using the SM3 scFv in patient-derived T-cells, and PD-1 gene KO was achieved in these CAR positive T cells using the CRISPR-Cas9 system. Efficiency and validation were confirmed by sequencing and flow cytometry. MUC1-CAR+/PD-1- KO engineered T cells at a starting dose of 5x107 were infused over 60 min. The dose was escalated to 5x109 cells. Following treatment, the safety and tolerability of dose of the therapeutic cells were assessed using CTCAE v4.0. Patients’ general condition, levels of lymphocytes, IL-6, hs-CRP, PCT, CYFRA21, NSE(E), and SCC were monitored at regular intervals. Circulating CART cells were checked regularly. Tumor size were examined by MRI/CT scans. Efficacy was also assessed. Results: A total of 9 patients (aged 48 to 80) diagnosed with esophageal cancer/esophageal squamous cell carcinoma (IIIb to IV), were included in this study. All participants received at least one cycle of CART cell treatment. Among the 9 treated patients, 4 received 1 cycle, other 5 received 2, 3, 4, 7 and 10 cycles, respectively. The most common adverse events (AE) were acute fever (8 patients, 38.0-40.5 C◦), chills (5 patients, occurred in the subsequent cycle of infusion), skin rash (4 patient). No grade 3-5 AEs were found, and no cytokine release syndrome (CRS) was observed. Of the 9 assessed patients, 6 had stable disease (SD) while 3 had progressive disease. All patients had significant symptom improvements after infusion. Circulating CART cells gradually declined after infusion; the number dropped down to approximately 25% in 4 months after one cycle treatment indicating the necessity of receiving more cycles. Patients who received multiple cycles of infusion showed long-term and steady SD status. Two patients who received a multiple cycle of CAR-T cells had an overall survival (OS) of 24 months. Conclusions: Our data suggests that the treatment of patients with advanced esophageal cancer with PD-1 disrupted MUC1-targeted CAR-T cells is safe and well-tolerated by all patients. No CRS and other serious EAs were observed throughout the study. The efficacy of this unique combined therapy is currently being assessed. Our limited data indicate that the OS of the patients extended significantly in the treated patients. Two out of 6 patients with an OS of greater than 24 months, an outstanding clinical outcome. Clinical trial information: NCT03706326 .

Effect of recombinant human thrombopoietin on IL-2, IL-4 and platelet parameters in thrombocytopenic purpura.

The objective of this study was to observe the effect of recombinant human thrombopoietin on IL-2, IL-4 and platelet parameters in thrombocytopenic purpura. For this purpose, a convenient sampling method was used to select 84 patients with thrombocytopenic purpura who visited the hospital from January 2018 to December 2022. The patients were divided into the norm group and rhTPO group with 42 cases each by random number table. The norm group was treated with routine treatment, while the rhTPO group was treated with recombinant thrombopoietin based on routine treatment. The changes in IL-2, IL-4, platelet parameters, immune recovery and treatment efficiency of the two groups were compared before and after treatment. Findings suggested that the levels of IL-2 and IL-4 in both groups decreased after treatment compared with those before treatment. However, the level of IL-2 in the rhTPO group after treatment was lower than that in the norm group, and the level of IL-4 in the rhTPO group after treatment was higher than that in the norm group (P<0.05). The levels of platelet parameters PLT and PCT in the two groups after treatment were higher than those before treatment, but the levels of PLT and PCT in the rhTPO group after treatment were higher than those in the norm group (P<0.05). The PLT of the rhTPO group was (69.57±6.73)×109/L after 7 days of treatment, which was higher than that in the norm group (62.05 ± 8.52)×109/L (P<0.05). The levels of PDW and MPV in the two groups after treatment decreased compared with those before treatment, but the levels of PDW and MPV in the rhTPO group after treatment were lower than those in the norm group (P<0.05). The overall immune recovery and treatment effectiveness of the rhTPO group were significantly better than those of the norm group. In summary, recombinant human thrombopoietin used in patients with thrombocytopenic purpura can maintain the balance between T cell activation and inhibition homeostasis, and promote faster recovery of platelet parameters.

To Assess Platelet Indices in Type 2 Diabetic Patients with or Without Complications

Background: The main feature of diabetes mellitus (DM), a complicated metabolic illness with significant global impact, is persistent hyperglycemia brought on by either insulin resistance or deficiency, or both. Aim: To assess platelet indices in type 2 diabetic patients with or without complications. Study Design: cross-sectional study. Methodology: This study was carried at Combine Military Hospital-Multan. Total patients (n=120) were enrolled and were divided into two equal groups with complication and without complication. In addition to providing standard follow-up care, the diabetes follow-up clinic screens all DM patients for diabetes-related complications at the initial visit. Patients were then checked for these issues every six months. The data was entered and analyzed in SPSS 23. Mean ± SD were given for numeric data i.e., age and platelet indices. The frequency and percent were calculated for categorical data i.e., gender. Independent sample t-test was used to compare the age and platelet indices between the two groups. Chi-square test was used to compare the gender distribution between the two groups. A p-value ≤ 0.05 was considered significant. Results: Independent sample t test revealed that there was no significant difference in mean age between both groups. The results revealed that the mean PDW, MPV, PLCR and PCT levels was significantly higher in patients with complicated diabetes. Practical implication: This study helped in exploring platelets indices as platelet indices results have notable impact on patient diagnosis and follow-up. With increasing demands and burden of patients in Hospital, new reliable and quick diagnosis is need of hour. Conclusion: It was concluded that all platelet indices like MPV, PDW, and P-LCR increased significantly in patients with complicated diabetes. However, platelet indices can be used as a simple, low-cost metric to track and gauge the likelihood of problems. Keywords: Diabetes Mellitus, Hyperglycemia, Platelet Indices, Complications and Hematological Parameters.

Effectiveness of Negative Pressure Wound Therapy of Diabetic Foot Ulcers Using Periplaneta Americana (Kangfuxin Liquid) Irrigation.

This study was to evaluate the efficacy of Periplaneta Americana (Kangfuxin Liquid) relative to normal saline when applied in negative-pressure wound therapy (NPWT) with instillation for facilitating diabetic foot ulcers (DFUs) healing. Eighty patients with Wagner grades 3 or 4 DFUs were enrolled in this retrospective study. Based on the treatment type, patients were equally assigned to either (i) an NPWT with Kangfuxin liquid instillation group (NPWT-K) or (ii) an NPWT with normal saline instillation group (NPWT-I). The primary study outcome was the wound healing rate and Kaplan-Meier survival estimate was used to examine the cumulative wound healing rate, while the secondary outcomes were the amputation rate, inpatient days, duration of antibiotic treatments, reinfection rate, new ulcer formation rate, readmission rate, and changes in the inflammatory markers (such as ESR, CRP, and PCT) and serum growth factors (including VEGF, EGF, and bFGF). The 12-week wound healing rate (31 of 40[77.5%] vs 22 of 40[55.0%], P = .033) and the cumulative wound healing rate was higher in the NPWT-K group than in the NPWT-I group (P = .004). The wound healing time was shorter in the NPWT-K group (55 days [95% CI 50-60]) than in the NPWT-K group (64 days [95% CI 59-69], P = .016). Patients who received NPWT-K had fewer inpatient days and duration of antibiotic treatment and faced lower reinfection and readmission rates (P < .05). After 1 week of treatment, the ESR, CRP, and PCT levels in the blood were lower in the NPWT-K group than in the NPWT-I group (P < .05), while the VEGF, EGF, and bFGF levels in the NPWT-K group were higher than those in the NPWT-I group (P < .001). The present study showed that NPWT with Kangfuxin liquid instillation was effective and showed significantly accelerated DFUs healing. Thus, Kangfuxin liquid is an effective instillation solution for use in the treatment of DFUs with NPWT.

Acute Infections and Inflammatory Biomarkers in Patients with Acute Pulmonary Embolism.

Although infections are frequent in patients with pulmonary embolism (PE), its effect on adverse outcome risk remains unclear. We investigated the incidence and prognostic impact of infections requiring antibiotic treatment and of inflammatory biomarkers (C-reactive protein [CRP] and procalcitonin [PCT]) on in-hospital adverse outcomes (all-cause mortality or hemodynamic insufficiency) in 749 consecutive PE patients enrolled in a single-centre registry. Adverse outcomes occurred in 65 patients. Clinically relevant infections were observed in 46.3% of patients and there was an increased adverse outcome risk with an odds ratio (OR) of 3.12 (95% confidence interval [CI] 1.70-5.74), comparable to an increase in one risk class of the European Society of Cardiology (ESC) risk stratification algorithm (OR 3.45 [95% CI 2.24-5.30]). CRP > 124 mg/dL and PCT > 0.25 µg/L predicted patient outcome independent of other risk factors and were associated with respective ORs for an adverse outcome of 4.87 (95% CI 2.55-9.33) and 5.91 (95% CI 2.74-12.76). In conclusion, clinically relevant infections requiring antibiotic treatment were observed in almost half of patients with acute PE and carried a similar prognostic effect to an increase in one risk class of the ESC risk stratification algorithm. Furthermore, elevated levels of CRP and PCT seemed to be independent predictors of adverse outcome.

New-Onset Atrial Fibrillation in the Setting of COVID-19 Infection Is a Predictor of Mortality in Hospitalized Patients: CovAF-Study.

Recent studies show that hospitalized COVID-19 patients have an increased incidence of arrhythmia, especially atrial fibrillation (AF). This single-center study included 383 hospitalized patients with positive polymerase chain reaction tests for COVID-19 from March 2020 to April 2021. Patient characteristics were documented, and data were analyzed for episodes of AF on admission or during the hospital stay, intrahospital mortality, need for intensive care and/or invasive ventilation, inflammatory parameters (hs-CRP, IL-6, and procalcitonin), and differential blood count. We demonstrated that in the setting of hospitalized cases of COVID-19 infection, there is an incidence of 9.8% (n = 36) for the occurrence of new-onset AF. Furthermore, it was shown that a total of 21% (n = 77) had a history of episodes of paroxysmal/persistent AF. However, only about one-third of patients with pre-existing AF had relevant documented tachycardic episodes during the hospital stay. Patients with new-onset AF had a significantly increased intrahospital mortality compared to the control and the pre-existing AF without rapid ventricular rate (RVR) group. Patients with new-onset AF required intensive care and invasive ventilation more frequently. Further analysis examined patients with episodes of RVR and demonstrated that they had significantly elevated CRP (p < 0.05) and PCT (p < 0.05) levels on the day of hospital admission compared to patients without RVR.

Identifying Early Infections in the Setting of CRS With Routine and Exploratory Serum Proteomics and the HT10 Score Following CD19 CAR-T for Relapsed/Refractory B-NHL.

Early fever after chimeric antigen receptor T-cell (CAR-T) therapy can reflect both an infection or cytokine release syndrome (CRS). Identifying early infections in the setting of CRS and neutropenia represents an unresolved clinical challenge. In this retrospective observational analysis, early fever events (day 0-30) were characterized as infection versus CRS in 62 patients treated with standard-of-care CD19.CAR-T for relapsed/refractory B-cell non-Hodgkin lymphoma. Routine serum inflammatory markers (C-reactive protein [CRP], interleukin-6 [IL-6], procalcitonin [PCT]) were recorded daily. Exploratory plasma proteomics were performed longitudinally in 52 patients using a multiplex proximity extension assay (Olink proteomics). Compared with the CRSonly cohort, we noted increased event-day IL-6 (median 2243 versus 64 pg/mL, P = 0.03) and particularly high PCT levels (median 1.6 versus 0.3 µg/L, P < 0.0001) in the patients that developed severe infections. For PCT, an optimal discriminatory threshold of 1.5 µg/L was established (area under the receiver operating characteristic curve [AUCROC] = 0.78). Next, we incorporated day-of-fever PCT levels with the patient-individual CAR-HEMATOTOX score. In a multicenter validation cohort (n = 125), we confirmed the discriminatory capacity of this so-called HT10 score for early infections at first fever (AUCROC = 0.87, P < 0.0001, sens. 86%, spec. 86%). Additionally, Olink proteomics revealed pronounced immune dysregulation and endothelial dysfunction in patients with severe infections as evidenced by an increased ANGPT2/1 ratio and an altered CD40/CD40L-axis. In conclusion, the high discriminatory capacity of the HT10 score for infections highlights the advantage of dynamic risk assessment and supports the incorporation of PCT into routine inflammatory panels. Candidate markers from Olink proteomics may further refine risk-stratification. If validated prospectively, the score will enable risk-adapted decisions on antibiotic use.

SARS-CoV-2 RT-PCR positivity rate and predictor factors for RT-PCR results in COVID-19 disease

Background/Aim: In December 2019, a novel coronavirus was identified and caused the SARS-CoV-2 (COVID-19) pandemic. The gold standard diagnostic method is the detection of nucleic acid in respiratory tract samples by real-time polymerase chain reaction (RT-PCR). But there might be false-negative results. The aim of this retrospective study was to find the SARS-CoV-2 RT-PCR positivity rate in patients hospitalized due to viral pneumonia consistent with COVID-19 disease and to find predictor factors for RT-PCR results. Materials and methods: Adult (≥18 years of age) patients hospitalized due to viral pneumonia consistent with COVID-19 were enrolled. Results: One hundred ninety-one patients were enrolled in the study. Sixty six (34.6%) were female, and 125 (65.4%) were male. The mean age was 59.7. The RT-PCR positivity rate was 11.5%. Smoking status, confirmed fever, bronchial changes, left lower lobe involvement, and ≥3 affected lobes in CT, leukopenia, high PCT level, and &lt;3 RT-PCR examinations per patient were found to be independent factors for the PCR result (P &lt; 0.05). Conclusion: We found independent predictors for SARS-CoV-2 RT-PCR positivity and negativity in viral pneumonia consistent with COVID-19. Despite false negative results, COVID-19 patients could be diagnosed with the help of clinical, laboratory, and radiological findings.

Evaluation of the Selected Parameters of Inflammation in Patients with Haemorrhagic Stroke

Introduction. In the acute phase of stroke, the development of inflammation within the stroke focus can be observed.Therefore, in response to the inflammatory process in the brain, an inflammatory reaction occurs in the peripheral blood.Aim. The aim of the study was to assess the parameters of inflammation in peripheral blood in a group of patientswith haemorrhagic stroke.Material and Methods. The study included 64 patients with haemorrhagic stroke hospitalized at the Stroke Centreof the Department of Neurology, University Hospital no. 1 in Bydgoszcz. The type and location of the stroke wereverified by a head CT scan performed on the first day of hospitalization. On the first day of stroke, together withroutine laboratory tests, the level of CRP1, WBC1, PCT, OB and fibrinogen1 was determined. CRP2, WBC2 andfibrinogen2 levels were repeated on the 14th day of stroke. Patients with infection were excluded from the study.Non-parametric statistical methods were used in the analysis: the Mann–Whitney test, the Kruskal–Wallis test andthe Spearman correlation coefficient.Results. Subcortical localization of the haemorrhagic focus was found in the majority of patients. Both baselineand control CRP and WBC values were outside the laboratory range. There were no statistically significant differencesbetween the baseline and control CRP and WBC values, while the control fibrinogen level was significantly higherthan baseline (p&lt;0.041). Patients who died and/or those with impaired consciousness had statistically significantlyhigher values of inflammatory parameters (except OB, PCT and FIBR1) compared to patients who survived andwere conscious.Conclusions. In our study, we observed a significant increase in fibrinogen levels 14 days after the onset of the stroke.In addition, the control level of fibrinogen correlated with the size of the haemorrhagic focus and the clinical conditionof the patients. Further research is needed in this area. (JNNN 2023;12(1):3–8)

Prognostic Value of Serum Procalcitonin in Patients with Sepsis in a Tertiary Level Hospital

Background: Sepsis is a complex, life-threatening, heterogeneous infectious disease associated with increased rates of morbidity and mortality. Early assessment of the prognosis of sepsis is key to achieving a favorable outcome for the disease. This study aimed to identify the prognostic value of PCT for sepsis patients. Materials and Methods: We conducted a prospective analytical study involving 100 adult patients with sepsis who were admitted to the Medicine dept and intensive care unit from 2019 to 2020. At least one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection. Results: Our study found that a maximum number of patients (43.0%) were between 51-60 years age group, mean age of the patient was 49.35 ± 11.7 years. Out of 100 cases, 65% were male and 35% were female. The male and female ratio was 1.85:1. In this study serum, procalcitonin levels 0.5-2.0 ng/were detected in 15.0% of patients with mean±SD 1.3±0.8. Serum procalcitonin levels 2.1-10.0 ng/mL were detected in 29.0% of patients with mean±SD 5.9±2.5 and &gt;10.0 ng/mL was detected in 56 patients. Based on the receiver-operator characteristic (ROC) curves, procalcitonin had the area under curve 0.923, with 89.4% sensitivity and 87.5% specificity. In our study, procalcitonin showed the best predictive value for the short-term outcome of sepsis with a cut-off value of 14.8 ng/mL (AUC 0.923). Study shows that 76.0% of the patients recovered completely, but 24.0% of patients expired during the hospital stay. Conclusion: There was a statistically significant correlation in serum procalcitonin with the outcome of sepsis (p &lt; 0.001). So the effectiveness of serum procalcitonin has proven significant in the prediction of mortality in sepsis patients. J MEDICINE 2023; 24: 18-22

CD5L is elevated in the serum of patients with candidemia and promotes disease progression in mouse models

To investigate the changes of CD5L levels in patients with candidemia and explore the role of CD5L in progression of candidemia. Twenty healthy control individuals, 27 patients with bacteremia and 35 patients with candidemia were examined for serum CD5L levels using ELISA, and the correlations of CD5L level with other serological indicators were analyzed. A C57BL/6 mouse model of candidemia induced by intravenous injection of Candida albicans were treated with intraperitoneal injection of recombinant CD5L protein, and renal histopathological and serological changes were analyzed to assess renal injures. The effects of CD5L treatment on general condition, fungal burden, of survival of the mice were observed, and the changes in serum IL-6 and IL-8 levels of the mice were detected using ELISA. CD5L levels were significantly elevated in patients with candidemia and positively correlated with WBC, BDG, Scr and PCT levels. The mouse model of candidemia also showed significantly increased serum and renal CD5L levels, and CD5L treatment significantly increased fungal burden in the renal tissue, elevated IL-6 and IL-8 levels in the serum and kidney, aggravated renal tissue damage, and reduced survival rate of candidemia mice. Serum CD5L levels are increased in patients with candidemia, and treatment with CD5L aggravates candidemia in mouse models.

The Predictive Value of PCT and Other Infection Indicators in Postoperative Infection of Epithelial Ovarian Cancer.

To study the early predictive value of WBC, CRP and PCT on infectious complications after epithelial ovarian cancer surgery, draw ROC curves, and construct a nomogram prediction model. The clinical data of patients with epithelial ovarian cancer in Shengjing Hospital from August 2019 to August 2022 were included. The levels of WBC, CRP and PCT were statistically analyzed on the first, third and fifth days after surgery, and the ROC was plotted. Multivariate logistic regression analysis determined independent influencing factors, individualized nomogram model for predicting the occurrence of postoperative infectious complications was constructed, and the correction curve was used for verification. A total of 116 patients were enrolled. The postoperative test levels of WBC, CRP and PCT were compared between two groups, and the differences on POD3 and POD5 were statistically significant. The ROC area on POD5 was 0.739, 0.838 and 0.804, respectively, better than that on POD3. Among them, CRP has the greatest value; The predicted value of the combined test of WBC, CRP and PCT on POD5 was greater than that of a single index on POD5. The nomogram model on POD5 was constructed, and the ROC analysis showed that it had a good degree of differentiation. WBC, CRP and PCT can effectively predict the occurrence of postoperative infectious complications, among which CRP alone has the greatest diagnostic value on POD5, and the combined test value of the three indicators is higher than that of a single index. The nomogram model constructed by the combined indicators on POD5 can assess the risk individually.

Prognostic accuracy of biomarkers of immune and endothelial activation in Mozambican children hospitalized with pneumonia.

Pneumonia is a leading cause of child mortality. However, currently we lack simple, objective, and accurate risk-stratification tools for pediatric pneumonia. Here we test the hypothesis that measuring biomarkers of immune and endothelial activation in children with pneumonia may facilitate the identification of those at risk of death. We recruited children <10 years old fulfilling WHO criteria for pneumonia and admitted to the Manhiça District Hospital (Mozambique) from 2010 to 2014. We measured plasma levels of IL-6, IL-8, Angpt-2, sTREM-1, sFlt-1, sTNFR1, PCT, and CRP at admission, and assessed their prognostic accuracy for in-hospital, 28-day, and 90-day mortality. Healthy community controls, within same age strata and location, were also assessed. All biomarkers were significantly elevated in 472 pneumonia cases versus 80 controls (p<0.001). IL-8, sFlt-1, and sTREM-1 were associated with in-hospital mortality (p<0.001) and showed the best discrimination with AUROCs of 0.877 (95% CI: 0.782 to 0.972), 0.832 (95% CI: 0.729 to 0.935) and 0.822 (95% CI: 0.735 to 0.908), respectively. Their performance was superior to CRP, PCT, oxygen saturation, and clinical severity scores. IL-8, sFlt-1, and sTREM-1 remained good predictors of 28-day and 90-day mortality. These findings suggest that measuring IL-8, sFlt-1, or sTREM-1 at hospital presentation can guide risk-stratification of children with pneumonia, which could enable prioritized care to improve survival and resource allocation.