PCT Levels Research Articles

The impact of procalcitonin in assessing outcomes in pediatrics severe trauma cases: A three-year experience from a tertiary hospital.

Although procalcitonin levels are raised in patients with systemic inflammation, its usage in pediatric patients, particularly those in the intensive care unit who are most susceptible to sepsis. It is a retrospective research study that included pediatric patients aged more than two weeks who were brought to the King Fahd Hospital of the University's PICU owing to serious trauma or post-acute postoperative occurrences from January 2017 to December 2019. At 24 h after admission, data such as age, gender, comorbidities, trauma severity as measured by the Injury Severity Score, and PRISM III score were collected. Following a surgery abscess, there were a total of 39 (15.9%) deaths. Patients who died during their hospital stay had significantly higher mean levels of biomarkers such as PRISM III, PCT at 24 h, PCT 48-72 h, and PCT at day 5 (p = 0.001). The area under the ROC curve for PCT level 48/72 h was 0.89 (% CI: 0.85-0.93), p = 0.001, indicating that PCT had highly significant predictive validity in predicting in-hospital mortality at the best cutoff point of >1.35 with a high level of accuracy and precision of 82.1% and 82.0%, respectively. The serum procalcitonin level (PTCL) can help predict the in-hospital prognosis of pediatrics that has had surgery. A combined control system is designed based on PTC expression for the examination of a patient receiving medication over a longer length of time.

Cornelian Cherry (Cornus mas L.) Iridoid and Anthocyanin-Rich Extract Reduces Various Oxidation, Inflammation, and Adhesion Markers in a Cholesterol-Rich Diet Rabbit Model.

Atherogenesis leads to the development of atherosclerosis, a progressive chronic disease characterized by subendothelial lipoprotein retention and endothelial impairment in the arterial wall. It develops mainly as a result of inflammation and also many other complex processes, which arise from, among others, oxidation and adhesion. Cornelian cherry (Cornus mas L.) fruits are abundant in iridoids and anthocyanins-compounds with potent antioxidant and anti-inflammatory activity. This study aimed to determine the effect of two different doses (10 mg and 50 mg per kg of body weight, respectively) of iridoid and anthocyanin-rich resin-purified Cornelian cherry extract on the markers that are important in the progress of inflammation, cell proliferation and adhesion, immune system cell infiltration, and atherosclerotic lesion development in a cholesterol-rich diet rabbit model. We used biobank blood and liver samples that were collected during the previous original experiment. We assessed the mRNA expression of MMP-1, MMP-9, IL-6, NOX, and VCAM-1 in the aorta, and the serum levels of VCAM-1, ICAM-1, CRP, PON-1, MCP-1, and PCT. The application of the Cornelian cherry extract at a dose of 50 mg/kg bw resulted in a significant reduction in MMP-1, IL-6, and NOX mRNA expression in the aorta and a decrease in VCAM-1, ICAM-1, PON-1, and PCT serum levels. The administration of a 10 mg/kg bw dose caused a significant decrease in serum ICAM-1, PON-1, and MCP-1. The results indicate the potential usefulness of the Cornelian cherry extract in the prevention or treatment of atherogenesis-related cardiovascular diseases, such as atherosclerosis or metabolic syndrome.

The clinical and immunological characteristics in fatal severe fever with thrombocytopenia syndrome virus (SFTSV) infection

ObjectiveThis study aimed to make a comprehensive evaluation of peripheral immune profiles for further understanding the immunopathogenesis of severe fever with thrombocytopenia syndrome (SFTS). MethodsForty-seven patients with SFTS virus infection were included, of which 24 were deceased. The percentages, absolute numbers, phenotype of lymphocyte subsets were detected by flow cytometry. ResultsIn patients with SFTS, the numbers of CD3+T, CD4+T, CD8+T and NKT cells were decreased compared with healthy controls (HCs), accompanied with highly active and exhausted phenotypes for T cells, and overproliferating plasmablasts. High inflammatory status, dysregulation of coagulation and host immune response were more obvious in deceased patients than that of survivors. Higher levels of PCT, IL-6, IL-10, TNF-α, APTT, TT and the occurrence of hemophagocytic lymphohistiocytosis were poor prognostic indicators of SFTS. ConclusionsThe evaluation of immunological markers in combination with laboratory tests has critical value for selecting prognostic markers and potential treatment target.

Application of metagenomic next-generation sequencing in patients with infective endocarditis.

Metagenomic next-generation sequencing (mNGS) technology is helpful for the early diagnosis of infective endocarditis, especially culture-negative infective endocarditis, which may guide clinical treatment. The purpose of this study was to compare the presence of culture-negative infective endocarditis pathogens versus culture-positive ones, and whether mNGS test results could influence treatment regimens for patients with routine culture-negative infective endocarditis. The present study enrolled patients diagnosed with infective endocarditis and tested for mNGS in the First Affiliated Hospital of Zhengzhou University from February 2019 to February 2022 continuously. According to the culture results, patients were divided into culture-negative group (Group CN, n=18) and culture-positive group (Group CP, n=32). The baseline characteristics, clinical data, pathogens, 30 day mortality and treatment regimen of 50 patients with infective endocarditis were recorded and analyzed. Except for higher levels of PCT in the Group CN [0.33 (0.16-2.74) ng/ml vs. 0.23 (0.12-0.49) ng/ml, P=0.042], there were no significant differences in the basic clinical data and laboratory examinations between the two groups (all P>0.05). The aortic valve and mitral valve were the most involved valves in patients with infective endocarditis (aortic valve involved: Group CN 10, Group CP 16; mitral valve involved: Group CN 8, Group CP 21; P>0.05) while 9 patients had multiple valves involved (Group CN 2, Group CP 7; P>0.05). The detection rate of non-streptococci infections in the Group CN was significantly higher than that in the Group CP (9/18 vs. 3/32, P=0.004). There was no significant difference in patients with heart failure hospitalization and all-cause death at 30 days after discharge (3 in Group CN vs. 4 in Group CP, P>0.05). It is worth noting that 10 patients with culture-negative infective endocarditis had their antibiotic regimen optimized after the blood mNGS. Culture-negative infective endocarditis should be tested for mNGS for early diagnosis and to guide clinical antibiotic regimen.

Wearable and battery-free wound dressing system for wireless and early sepsis diagnosis.

Sepsis is a severe organ dysfunction typically caused by wound infection which leads to septic shock, organ failure or even death if no early diagnosis and property medical treatment were taken. Herein, we report a soft, wearable and battery-free wound dressing system (WDS) for wireless and real-time monitoring of wound condition and sepsis-related biomarker (procalcitonin [PCT]) in wound exudate for early sepsis detection. The battery-free WDS powered by near-field communication enables wireless data transmission, signal processing and power supply, which allows portable intelligent wound caring. The exudate collection associates with soft silicone based microfluidic technologies (exudate collection time within 15 s), that can filtrate contamination at the cell level and enable a superior filtration rate up to 95% with adopting microsphere structures. The battery-free WDS also includes state-of-the-art biosensors, which can accurate detect the pH value, wound temperature, and PCT level and thus for sepsis diagnosis. In vivo studies of SD rats prove the capability of the WDS for continuously monitoring wound condition and PCT concentration in the exudate. As a result, the reported fully integrated WDS provides a potential solution for further developing wearable, multifunctional and on-site disease diagnosis.

Insights from comparison of the clinical presentation and outcomes of patients hospitalized with COVID-19 in an Italian internal medicine ward during first and third wave.

The reasons of variability of clinical presentation of coronavirus disease-19 (COVID-19) across different pandemic waves are not fully understood, and may include individual risk profile, SARS-CoV-2 lineage and seasonal variations of viral spread. The objective of this retrospective study was to compare the characteristics and outcomes of patients admitted with confirmed coronavirus disease-19 (COVID-19) in the same season during the first (March 2020) and the third pandemic wave (March 2021, dominance of SARS-CoV-2 B.1.1.7 lineage) in an internal medicine ward of a large teaching hospital in Italy. Data of 769 unvaccinated patients (399 from the first and 370 from the third wave) were collected from clinical records, including symptom type and duration, extension of lung abnormalities on chest computed tomography (CT) and PaO2/FiO2 ratio on admission arterial blood gas analysis. Third wave patients were in average younger (median 65, interquartile range [IQR] 55-75, vs. 72, IQR 61-81 years old, p < 0.001), with less comorbidities and better pulmonary (CT visual score median 25, IQR 15-40, vs. 30, IQR 15-50, age- and sex-adjusted p = 0.017) and respiratory involvement (PaO2/FiO2 median 288, IQR 237-338, vs. 233, IQR 121-326 mmHg, age- and sex-adjusted p < 0.001) than first wave patients. Hospital mortality was lower (19% vs. 36%, p < 0.001), but not for subjects over 75 years old (46 vs. 49%). Age, number of chronic illnesses, PCT levels, CT visual score [Odds Ratio (OR) 1.022, 95% confidence interval (CI) 1.009-1.036, p < 0.001] and PaO2/FiO2 (OR 0.991, 95% CI 0.988-0.994, p < 0.001), but not the pandemic wave, were associated with mortality on stepwise multivariate logistic regression analysis. Despite the higher virulence of B.1.1.7 lineage, we detected milder clinical presentation and improved mortality in patients hospitalized during the third COVID-19 wave, with involvement of younger subjects. The reasons of this discrepancy are unclear, but could involve the population effect of vaccination campaigns, that were being conducted primarily in older frail subjects during the third wave.

"Predictors of in-hospital mortality in adult cancer patients with COVID-19 infection presenting to the emergency department: A retrospective study".

Adult cancer patients are at higher risk of morbidity and mortality following COVID-19 infection. Being on the front lines, it is crucial for emergency physicians to identify those who are at higher risk of mortality. The aim of our study was to determine the predictors of in-hospital mortality in COVID-19 positive cancer patients who present to the emergency department. This is a retrospective cohort study conducted on adult cancer patients who presented to the ED of the American university of Beirut medical center from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant data was extracted and analyzed. The association between different variables and in-hospital mortality was tested using Student's t test and Fisher's exact test or Pearson's Chi-square where appropriate. Logistic regression was applied to factors with p <0.2 in the univariate models. The study included 89 distinct patients with an average age of 66 years (± 13.6). More than half of them were smokers (52.8%) and had received chemotherapy within 1 month of presentation (52.8%). About one third of the patients died (n = 31, 34.8%). Mortality was significantly higher in patients who had recently received chemotherapy (67.7% vs 44.8%, p = .039), a history of congestive heart failure (CHF)(p = .04), higher levels of CRP (p = 0.048) and/or PCT(p<0.04) or were tachypneic in the ED (P = 0.016). Adult cancer patients with COVID-19 infection are at higher risks of mortality if they presented with tachypnea, had a recent chemotherapy, history of CHF, high CRP, and high procalcitonin levels at presentation.

Discrimination of serum metabolomics profiles in infants with sepsis, based on liquid chromatography-mass spectrometer

Sepsis is one of the most important problems to be addressed in pediatrics, characterized by insidious onset, rapid progression, and high rates of severe infection and even mortality. Biomarkers with high sensitivity and robustness are urgently required for the early diagnosis of infant sepsis. Serum metabolomic approaches based on liquid chromatography-mass spectrometry were used to analyze the samples from 30 infants with sepsis at an early stage and 30 infants with noninfectious diseases. Multivariate statistical analysis was used to screen for differential metabolites and ROC curves were generated to find potential biomarkers. Six metabolites, including phosphatidic acid (PA (8:0/14:0)), phosphatidyl ethanolamine (PE (16:0/18:2(9Z,12Z))), cytidine 5'-diphosphocholine (CDP-CHO), sphingomyelin (SM (d18:0/16:1(9Z))), prolylhydroxyproline and phosphorylcholine (P-CHO), were identified between the two groups. ROC curve analysis showed that prolylhydroxyproline (AUC = 0.832) had potential diagnostic values for infant sepsis. The AUC value was 0.859 (CI: 0.764, 0.954) in the combined model. Prolylhydroxyproline were found to be correlated with CRP and PCT levels, while PE and CDP-CHO associated with PCT levels. Pathway analysis indicated that glycerophospholipid metabolism, aminoacyl-tRNA biosynthesis and necroptosis pathways played important roles in infant sepsis. Network analysis showed that the differential metabolites were linked to ERK/ MAPK, NF-κB, AMPK, mTOR, and other classical inflammatory and metabolic signaling pathways. This study identified serum metabolite profiles and three metabolites as potential biomarkers in infants with sepsis. The findings will help improve the early diagnosis of sepsis in infants.

Procalcitonin and C-Reactive protein levels among COVID-19 patients in Sulaymaniyah

COVID-19 is a viral disease that affects multiple body organs. The objective of this study is Investigating the role of PCT and CRP in predicting the outcome of patients with COVID-19. Cross-sectional prospective study including 135 patients with SARS-CoV-2 confirmed by RT-PCR. Serum level of PCT and CRP are measured at admission and on day 10 post-admission. Patients are followed up for one month. The mean level of PCT on day 1 was 0.1±0.28 ng/ml compared with 0.3±1.27 ng/ml on day 10. Respectively, the mean serum level of CRP on day 1 and day 10 was 113.57±89.88mg/L and 44.76±43.29 mg/L. At admission, the mean serum level of PCT and CRP in dead patients was 0.22±0.6 ng/ml and 164.0±105.59 mg/L, respectively compared with 0.07±0.08 ng/ml and 101.42±82.03 mg/L, respectively in the survived group. After 10 days of admission, the median serum level of PCT and CRP in dead patients was 1.5±2.74 ng/ml and 70.9±57.87 mg/L. respectively compared with 0.13±0.23 ng/ml and 37.7±34.87 mg/L, respectively in the survived patients. In conclusion, the serum level of PCT and CRP increases from admission to day 10 post-admission, and they are considered as indicators of severe inflammatory response and could increase mortality risk.

THE IMPACT OF TOCILIZUMAB ON THE BIOCHEMICAL MARKER PROCALCITONIN DURING COVID-19 INFECTION.

The aim: The primary objective of our study was to track the TCZ's impact on PCT levels in a cohort of COVID-19 patients who received dexamethasone daily from admission to the day of discharge. Materials and methods: There were two groups: a treatment group of 40 patients who received tocilizumab and a 40-patient control group that did not receive the medication. Both groups' daily blood culture results and serum procalcitonin biochemical indicators were observed for 20 days, or until discharge or death. After 10 days, non-parametric univariate and linear mixed model analyses were used to compare the two groups' differences. Results: Tocilizumab is administered on Day 5 and greatly reduces procalcitonin. The two groups did not differ in the percentage of positive blood cultures. Conclusions: Procalcitonin levels in COVID-19 individuals who have received tocilizumab maybe not a dependable predictor of superinfection with bacteria.

CORRELATION BETWEEN HEPCIDIN AND PROCALCITONIN AND THEIR DIAGNOSTIC ROLE IN PATIENTS WITH COVID-19.

The aim: The purpose of this study is to find out the association between procalcitonin and hepcidin in patients with COVID-19, in addition to their role as diagnostic markers. Materials and methods: A total of 75 patients infected with coronavirus were included in the current study, their age is ranging between 20 to 78 years. Those patients was hospitalized in Al-Sadr Teaching Hospital in Najaf, in Iraq. This study also included 50 healthy subjects which are volunteers and considered as a (control group). Biomarker (procalcitonin and hepcidin) measurements were achieved by electrochemiluminescent immunoassay (ECLIA) in the Elecsys immunoassay system. Results: The present study showed a significant increase the serum cencentration of hepcidin and procalcitonin in patients with COVID-19 as compared tohealthy subjects. There was a highly significant increasing(p < 0.01) in hepcidin and PCT level in patients with severe infection comparing to other catgaries.The current study also revealed that the sensitivity values of the markers were: 0.88%, 0.85 for procalcitonin and hepcidin respectively, which indicate high diagnostic power. Conclusions: Serum levels of hepcidin and procalcitonin are increased as inflammatory markers in COVID-19 patients with relatively high sensitivity. It seems that these imflammatory markers obviously elevate in the severe cases COVID-19dusease.

Assessment of diagnostic and prognostic laboratory biomarkers in severe COVID-19 patients admitted to intensive care unit

Coronavirus disease (COVID-19) is a global pandemic. In the first two years of the pandemic, nearly 15 million people died worldwide. Accurate and rapid laboratory diagnosis of COVID-19 infection is one of the milestones of pandemic control. Therefore, this study aimed to compare the diagnostic and prognostic accuracy of mainly used laboratory biomarkers (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. A total of 120 COVID-19 patients and 50 normal controls were enrolled into our study. Demographic data, hospitalization time, medical history, oxygen saturation, respiratory rate, oxygen supply, laboratory findings and thorax tomography of the patients were obtained from the hospital electronic information system retrospectively. Our results revealed that the serum levels of CRP, ferritin, IL-6, D-dimer, PCT and LDH were highly significantly increased in severe COVID-19 patients as compared to normal controls (p < 0.001), and in non-survivors as compared to survivors (p < 0.001). By using ROC curve analysis, IL-6 appeared to be the most sensitive and specific marker with 80.9% sensitivity and 84.9% specificity; followed by LDH with 85.1% sensitivity and 82.8% specificity in the prediction of death. In conclusion CRP and IL-6 could be the most appropriate biomarkers in the diagnosis of severe COVID-19 disease, while IL-6 and LDH may be good predictors of mortality between severe COVID-19 patients.

Application of PCT, IL-6, CRP, and WBC for Diagnosing Neonatal Sepsis.

The purpose of this study was to investigate the diagnostic value of combined detection of PCT, IL-6, CRP, and WBC in neonatal sepsis. The study selected 50 neonatal sepsis patients treated in Pucheng County Hospital from April 2018 to June 2020 as the patient group, and 50 healthy newborns as the control group. Before treatment, white blood cell count (WBC) was performed on all neonates, and serum PCT, IL-6, and CRP levels were detected by ELISA. After treatment, serum levels of these four biomarkers in the effective/non-effective groups were observed. The results noted higher levels of these four biomarkers in the patient group rather than the control group before treatment, and in the effective group rather than the non-effective group after treatment. ROC analysis found that the area under curve (AUC), specificity and sensitivity of the combined detection were better than those of the single detection. In short, combined detection of these four biomarkers has a high diagnostic value for neonatal sepsis.

Investigation of the relationship between inflammatory markers and grade of disease in patients with acute ischemic stroke with partial anterior circulation infarct

Objectives: The aim of this study was to investigate the relationship between National Institutes of Health Stroke Scale scores and Glasgow coma scores of patients with partial anterior ischemic stroke and laboratory results, particularly serum CRP, albumin, platelet and other complete blood count data, and prognosis. Methods: In this retrospective study 226 of patients with partial anterior circulation infarction who were admitted to the Bolu Abant İzzet Baysal University Neurology Clinic between January 2021 and 2022 with the diagnosis of acute ischemic stroke and hospitalized within the first 24 hours were investigated. The demographic data, stroke etiology and risk factors, National Institutes of Health Stroke Scale, Glasgow coma scores, complete blood count, certain inflammatory markers and biochemical parameters, length of hospital stay and mortality rates were examined. And the relationship between inflammatory markers and grade of disease was evaluated statistically. Results: The patients with moderate Glasgow coma score had a lower lymphocyte level, severe patients had higher PCT level and moderate patients had higher CRP level among others. Patients with moderate GCS had higher CRP/ALB val­ues than those with mild. Patients with moderate and moderate-severe National Institutes of Health Stroke Scale had higher RBC and HGB levels than the patients with mild. Moderate-severe patients had lower albumin lev­els. Conclusion: CRP-albumin ratio, serum platelet and serum albumin levels may have prognostic value in acute partial anterior ischemic stroke patients.

367. Procalcitonin as a Potential Biomarker in the Study of Human Babesiosis

Abstract Background Procalcitonin (Pct) has been gaining momentum as a potential biomarker during parasitic infections as studies have demonstrated that Pct levels are significantly elevated during certain forms of protozoal sepsis. Given this, the goal of this pilot study is to determine the relationship between Pct levels and parasitemia (Par) during infection with Babesia microti and to elucidate the potential for Pct to be used as a biomarker in the study of babesiosis. Methods Babesia cases were collected from Stony Brook University Hospital (SBUH) and South Hampton Hospital (SHH) from 2012 to 2019. Median values of maximum Par and Pct throughout hospitalization were recorded and cases were referenced for admission to the intensive care unit (ICU). Correlation between maximum Par and Pct values were examined with the nonparametric Spearman rank correlation and fractional polynomials were used to assess the functional form of the correlation. Receiver-operator characteristic (ROC) curve analyses were used to identify cutoff points for Pct and maximum Par as markers for prediction of ICU admission. Results A total of 33 patients met the inclusion criteria for acute babesiosis. In fractional polynomial analysis, log-transformed Pct levels had a linear correlation with log-transformed maximum Par, r=0.556 (P=0.001, Fig 1A). In ROC curve analysis, a cut off level of ≥ 1.2 ng/mL for Pct had optimal prediction characteristics for ICU admission (sensitivity 62.5%, specificity 88%; correct classification 82%) with a relevant AUC of 0.77 (95% CI: 0.58–0.89; P=0.005, Fig 1B). A cut off level of ≥ 3.6% for maximum Par had optimal prediction characteristics for ICU admission (sensitivity 75%, specificity 92%, correct classification 88%) with a relevant AUC of 0.75 (95% CI 0.58—0.89; P= 0.005, Fig 1B). Comparison of AUC for Pct and Par yielded no significant difference (P=0.8). Figure 1A. Linear correlation between log10-parasitemia and log10- procalcitonin levels. The linear correlation of the log-transformed variables was r=0.556 (P=0.001), similar to the nonparametric (Spearman) correlation coefficient (ρ=0.567). The red dots represent patients who were admitted to the intensive care unit. Figure 1B. Receiver-operator characteristic curve of parasitemia for prediction of intensive care unit admission (0.75; 95%CI: 0.58—0.89; P=0.005); optimal cut-off is 3.6%. Receiver-operator characteristic curve of procalcitonin for prediction of intensive care unit admission (C=0.77; 95%CI: 0.58–0.89; P=0.005); optimal cut-off is 1.2 ng/mL. Conclusion Our analysis demonstrated a positive linear correlation between Pct and maximum Par, which is the current standard marker for severe disease. Also, our ROC analyses estimate that Pct values ≥ 1.2 ng/mL and Par ≥ 3.6% suggests severe disease and need for ICU admission (Fig 1A, 1B). Given this, our findings suggest that Pct may have potential for predicting severe disease during babesiosis. Disclosures All Authors: No reported disclosures.

191. Predictive Value of Procalcitonin across Disease States within an Inpatient Veteran Population

Abstract Background Procalcitonin (PCT) can be elevated with certain bacterial infections. Debate continues as to how to best use this biomarker to guide antibiotic use. The primary objective of this study was to evaluate the correlation of PCT levels and the presence of bacterial infection on admission in the total population and in different disease states. Methods This was a multicenter retrospective cross-sectional study of patients admitted with specified infectious diagnoses to two VA Medical Centers from 4/1/2019 to 7/1/2021. Patients were stratified into 4 cohorts for analysis; those with COVID-19, sepsis from respiratory source_(S-R), sepsis from non-respiratory source (S-NR), and respiratory source without sepsis (R). Electronic medical records were reviewed to collect the following: initial procalcitonin, cultures, SIRS criteria, comorbidities (CKD, ESRD, HF, immunosuppressed, surgery within the 7 days), and c-reactive protein. PCT elevation was defined as ≥0.25 ng/mL. The frequency of positive cultures within 72 hours was evaluated for patients with elevated and normal PCT levels to determine the diagnostic performance of PCT overall and for each cohort. Results 632 of 664 patients were evaluated in this study. PCT is elevated twice as often in the septic groups as compared to the non-septic groups (figure 1). Positive predictive value (PPV) varies from 27% to 63% as compared to negative predictive value (NPV) 53%-79% among the disease state groups (figure 2). Although small numbers, the NPV of PCT improves to 83% in patients with elevated temperature and white blood cells (WBC) (figure 3). Figure 1Figure 2Figure 3 Conclusion The findings that NPV of PCT appears to be better than PPV, support current recommendations against using this as a diagnostic tool, but rather as a tool to assist with antibiotic de-escalation. Further studies are necessary to confirm whether there are specific markers such as temperature or WBC which may improve the NPV. Our data suggests PCT is less helpful in identifying the presence or absence of bacterial infection in septic versus non-septic patients. Disclosures All Authors: No reported disclosures.

Prospective multicentre study of host response signatures in neonatal sepsis in Sub Saharan Africa

Few biomarkers for sepsis diagnosis are commonly used in neonatal sepsis. While the role of host response is increasingly recognized in sepsis pathogenesis and prognosis, there is a need for evaluating new biomarkers targeting host response in regions where sepsis burden is high and medico-economic resources are scarce. The objective of the study is to evaluate diagnostic and prognostic accuracy of biomarkers of neonatal sepsis in Sub Saharan Africa. This prospective multicentre study included newborn infants delivered in the Abomey-Calavi region in South Benin and their follow-up from birth to 3 months of age. Accuracy of transcriptional (CD74, CX3CR1), proteic (PCT, IL-6, IL-10, IP-10) biomarkers and clinical characteristics to diagnose and prognose neonatal sepsis were measured. At delivery, cord blood from all consecutive newborns were sampled and analysed, and infants were followed for a 12 weeks’ period. Five hundred and eighty-one newborns were enrolled. One hundred and seventy-two newborns developed neonatal sepsis (29.6%) and death occurred in forty-nine infants (8.4%). Although PCT, IL-6 and IP-10 levels were independently associated with sepsis diagnosis, diagnostic accuracy of clinical variables combinations was similar to combinations with biomarkers and superior to biomarkers alone. Nonetheless, CD74, being the only biomarkers independently associated with mortality, showed elevated prognosis accuracy (AUC > 0.9) either alone or in combination with other biomarkers (eg. CD74/IP-10) or clinical criterion (eg. Apgar 1, birth weight). These results suggest that cord blood PCT had a low accuracy for diagnosing early onset neonatal sepsis in Sub Saharan African neonates, while association of clinical criterion showed to be more accurate than any biomarkers taken independently. At birth, CD74, either associated with IP-10 or clinical criterion, had the best accuracy in prognosing sepsis mortality.Trial registration Clinicaltrial.gov registration number: NCT03780712. Registered 19 December 2018. Retrospectively registered.

Fibrinogen-like Protein 1 as a Predictive Marker for the Incidence of Severe Acute Pancreatitis and Infectious Pancreatic Necrosis.

Background and Objectives: Acute pancreatitis (AP) is defined as an acute inflammatory disorder of the pancreas and is a common gastrointestinal disease. Since currently used indicators lack specifics and cannot accurately reflect the phase of disease, better diagnostic approaches need to be explored. Fibrinogen-like protein 1 (FGL-1) is a reactant in acute inflammatory diseases and is increased in the plasma of AP patients. In the current study, we aim to investigate the clinical benefits of FGL-1 in predicting the severity of AP and infected pancreatic necrosis (IPN), which can improve the diagnostic efficiency of AP. Materials and Methods: In this study, 63 patients diagnosed with AP from December 2018 to September 2019 were enrolled. Regarding the severity of AP, patients were separated into severe acute pancreatitis (SAP, n = 12) and No-SAP groups (n = 51). On the basis of infective conditions, patients were divided into IPN (n = 9) and No-IPN (n = 54) groups. The demographic data (sex and age) and blood parameters (WBC, HCT, glucose, calcium, FIB, APTT, PCT, CRP, and FGL-1) were retrospectively analyzed. Results: The plasma FGL-1 levels were increased in both SAP (p < 0.01) and IPN (p < 0.05) subgroups compared to the healthy control group. Multivariate analysis showed that elevated plasma FGL-1 (p < 0.01) and PCT levels (p < 0.05) within 72 h after the onset of AP were positively correlated with the severity of AP, while increased plasma FGL-1 (p < 0.01) and CRP (p < 0.05) levels were positively correlated with the occurrence of IPN. The combination of FGL-1 and PCT showed superiority to both individual markers in SAP prediction. However, the combination of FGL-1 and CRP showed no diagnostic advantage over CRP in IPN prediction. Conclusions: Plasma FGL-1 within 72 h after the onset could be used for the stratification of AP and its infectious complications. The combination of PCT and FGL-1 presents an enormous advantage for the early identification of SAP.

Developing a new sepsis screening tool based on lymphocyte count, international normalized ratio and procalcitonin (LIP score)

Exploring an effective sepsis screening tool that can be widely implemented is important for improving the prognosis of sepsis worldwide. This study aimed to develop a new simple screening tool for sepsis (LIP scoring system) that includes the peripheral blood lymphocyte count, international normalized ratio, and procalcitonin level. In a single-center, prospective, observational study, 444 acute sepsis inpatients and 444 nonsepsis inpatients were ultimately included based on the Sepsis-3 and exclusion criteria. The differences in the Lym, INR, PCT level and other clinical biomarkers were compared between the two groups. Univariable and multivariable logistic regression analyses and receiver operating characteristic analysis were used to establish a LIP screening tool for sepsis with a combination of biomarkers. The Kappa and McNemar tests were used to evaluate the differences between the LIP screening results (LIP score ≥ 3) and Sepsis-3 criteria (SOFA score ≥ 2). Logistic regression analysis showed that the lymphocyte count, INR, PCT level, platelets, neutrophil/lymphocyte ratio (NLR) and prothrombin time (PT) were independent risk factors for the development of sepsis. The ROC analysis showed that the lymphocyte count, INR, and PCT level had high area under the ROC curve values (AUROC (95% CI): Lym 0.84 (0.810–0.860), INR 0.921 (0.902–0.938), PCT level 0.928 (0.909–0.944)). The LIP tool had satisfactory screening efficacy for sepsis (sensitivity, 92.8%; specificity, 94.1%), and a LIP score equal to or greater than 3 points had good agreement with Sepsis-3 criteria in the diagnosis of sepsis (Kappa = 0862 in the Kappa test and P = 0.512 in the McNemar test). The LIP tool has satisfactory sensitivity and specificity for sepsis screening, and it can be used for rapid screening of patients with sepsis in outpatient and emergency departments or in economically underdeveloped areas with limited resources.

Serum Procalcitonin (PCT) Level In Acute Kidney Injury (AKI) In Critical Patients

Early prediction and avoidance of aggravation of AKI will be useful in identifying patients at risk of developing a higher degree of AKI. Many studies have been conducted to prevent AKI and find biomarkers to predict AKI. Many studies have identified biomarkers of AKI, such as neutrophil-associated lipocalin (NGAL), cystatin C, interleukin-18, and tissue inhibitors of metalloproteinase-2 (TIMP-2). Yet few have investigated the role of PCT as a predictor of AKI. The pathophysiological mechanisms that explain the association between serum PCT and AKI remain unclear. Various inflammatory responses are thought to play a role in the AKI development. PCT acts as a chemoattractant in the ​​inflammation area and causes more monocytes to invade the ​​inflammation. PCT is initially produced in adherent monocytes and then contributes to an increase in circulating PCT by attracting parenchymal cells as they attach directly to activated monocytes. High PCT levels ultimately act as a direct chemoattractant to monocyte counts.