Marker Of Infectious Complications Research Articles

Neutrophil to lymphocyte ratio in predicting complications and prognosis in patients with acute cholangitis

Introduction: Acute cholangitis belongs to urgent conditions in surgery, which are accompanied by high mortality and require clear diagnosis and immediate treatment. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in hepatobiliary surgery.Aim of the study: to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after hepatobiliary surgery.Methods: We evaluated 229 patients with acute cholangitis who underwent biliary drainage. The severity of acute cholangitis was graded according to the Tokyo 2018 guideline. Patients were dichotomized according to the acute cholangitis severity (mild/moderate vs. severe), and blood culture positivity. The baseline NLR, white blood cell (WBC) count, and C-reactive protein (CRP) levels were compared between groups.Results: Of the 229 acute cholangitis patients analyzed, 83 (36.3%) had mild, 111 (48.5%) had moderate, and 35 (15.2%) had severe acute cholangitis. Positive blood culture (n = 114) was more frequently observed in the severe acute cholangitis group than the mild/moderate cholangitis group (83% vs. 43%, p < 0.001). The NLR was significantly higher in patients with severe cholangitis, shock, and positive blood culture. Conclusion: The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in acute cholangitis. The high predictive value of CRP and PCT, as well as high availability and low cost of performing a clinical blood test, make NLR a more promising test in clinical practice.

Neutrophil to lymphocyte ratio in predicting postoperative complications and prognosis in patients with colorectal cancer.

<br><b>Introduction:</b> Biological markers of inflammation are among the main tools for predicting the risk of developing postoperative infectious complications at the preclinical stage. One of these biomarkers is the neutrophil-lymphocyte ratio (NLR), but the insufficient number of studies does not allow judging its value as a marker of infectious complications in colorectal surgery.</br><br><b>Aim:</b> Aim of the study to determine the predictive value of the neutrophil-leukocyte ratio as a predictor of infectious complications after colon surgery.</br><br><b>Methods:</b> From September 2018 to December 2021, 234 patients were enrolled in the study after colon surgery. The frequency of infectious complications, the differences in the levels of NLR in patients with and without infectious complications were determined.</br><br><b>Results:</b> One hundred and thirty-seven patients met the criteria of NLR-low, and 97 patients were categorized as NLR-high. The NLR status was significantly correlated with T-stage, perineural invasion, and increased likelihood of complications. Univariate analysis indicated that both low albumin and meeting the criteria for the NLR-high group correlated with an increased occurrence of complications. Multivariate analysis identified NLR-high and low albumin levels as independent predictors for complications.</br><br><b>Conclusion:</b> The neutrophil-lymphocyte ratio is a reliable predictor in predicting the risk of developing infectious complications in colorectal surgery. In addition, low values of this biomarker are a significant criterion for a safe discharge of patients from hospital. The prevalence and availability of this test makes it easily reproducible in clinical practice.</br&gt.

Invasive pulmonary aspergillosis after heart transplantation

Objective: to assess the incidence, determine the peculiarities of the course of invasive pulmonary aspergillosis (IPA) and identify risk factors for IPA in heart transplant recipients.Materials and methods. From January 2010 to December 2019, 137 heart transplantations (HT) were performed: mean age 46 ± 14 years; male 102 (74%) and female 35 (26%). All patients received a three-component immunosuppressive therapy: calcineurin inhibitors, mycophenolate mofetil (MMF) and Glucocorticoid (GCs). Induction therapy consisted of Basiliximab (81%, n = 111) and antithymocyte immunoglobulin (15%, n = 20). A retrospective analysis of patients with identified post-HT invasive IPA was performed; risk factors for IPA were assessed. In patients with early IPA, the length of stay in the intensive care unit (ICU), the duration of mechanical ventilation, and the initial severity of the condition were studied. All patients with suspected pneumonia underwent bronchoscopy with examination of bronchoalveolar lavage (BAL) and chest computed tomography (chest CT scan).Results. During the follow-up, there were 58 episodes of pneumonia, of which 16 (28%) were IPA (age 33 to 64 years). All patients had a target level of immunosuppressive drugs concentration in blood; basiliximab was used as induction therapy in 15 of 16 patients. Half of the recipients developed IPA in the early post-HT period (less than 3 months after HT), in the rest (n = 8) – at a later date (3 months to 1 year after HT). The diagnosis was verified: 14 out of 16 patients showed an increase in the Aspergillus antigen positivity in the BAL to 7.2 (2.8 ± 1.6); chest CT scan revealed specific changes. In two patients, there were no diagnostic criteria for IPA, but the diagnosis was made based on the results of histological examination after resection of the left lower lobe of the lung. All patients received voriconazole therapy for 2 to 6 months, their immunosuppressive therapy was adjusted (tacrolimus and MMF dose adjustment) and their white blood cell count was monitored. Complete cure of the disease was achieved in 13 (81%) patients. Two patients died within 30 days after HT in the intensive care unit, one died from urogenital diseases caused by bacterial flora and leading to urosepsis, 4 months after IPA treatment was initiated. All patients had risk factors for IPA: taking immunosuppression, including GCs (n = 16), prolonged ICU stay (n = 14), inotropic support exceeding 2 days in the early post-transplant period (n = 10), cachexia during HT (n = 6), leukopenia (n = 9) and neutropenia (n = 14).Conclusion. In heart transplantat recipients, the incidence of IPA among respiratory tract infections is 28%. The risk of developing IPA was highest during the first year following HT. In the majority of recipients, the disease was detected at the early stages; diagnosis required surgical intervention in 12% of cases. A decrease in the risk of developing IPA was associated with correction of the following risk factors for this disease in all patients: volume of immunosuppressive therapy during the first year after transplantation and prevention of the development of neutropenia as a marker of infectious complications or immunosuppression overdose. Early diagnosis of IPA allowed for initiation of timely specific therapy in most recipients and achievement of a positive effect in 80% of them.

SSI Following Construction of Colorectal Anastomoses and C-Reactive Protein as Marker for Infectious Complications

Introduction.Surgical site infection (SSI) incidence amounts to as much as 30% in patients after colorectal surgeries. Infectious complications after colorectal surgeries are characterised by the prevalence of deep forms of SSI with an unclear clinical presentation and difficulties in a timely diagnosis. An important aspect here is finding the earliest marker of the developing infectious complications and establishing its threshold value.Materials and methods. This is a prospective study of outcomes of colon resection and construction of colon anastomoses in 135 patients. Patients were split in two groups depending on the method of anastomosis construction. The C-reactive protein level was recorded prior to surgery and on days 3, 5, and 7 postop.Results and discussion.SSI was diagnosed in 32 patients (23.7%). Comparing the SSI incidence in different groups the authors established a statistically significant difference in favour of mechanical anastomosis; 9 patients (15.2%) against 23 patients (30.3%), р=0,0164. Statistically significant differences in CRP levels have been established between patients with SSI and patients without SSI at all the times the samples were taken postop. At the level of CRP higher than 100.5 mg/l (0.95 confidence range lower limit) the incidence of SSI increases significantly.Conclusion.Mechanical anastomosis conclusively reduces the incidence of SSI in the postop period by 15.1%. The CRP level of higher than 100.5 mg/l from day 3 postop can be considered a reliable predictor for the development of SSI.

Evaluation of Mannose-Binding Lectin is a Useful Approach to Predict the Risk of Infectious Complications Following Autologous Hematopoietic Stem Cell Transplantation

Hematopoietic stem cell transplantation (HSCT) associated immunocompromised state carries high risk of infectious complications. Mannose-binding lectin (MBL) is an acute phase protein involved in innate immune response. Serum MBL level is genetically determined and quite stable. According to literature, significant association was shown between low MBL concentrations and serious infections. The association between serum MBL level and frequency and severity of infections was studied in 186 patients following autologous HSCT. Double-monoclonal antibody sandwich enzyme-linked immunosorbent assay was used to determine MBL antigen level in sera. MBL levels were measured around 100 days following transplantation, in a period without active infection. Twenty-one patients (11%) were MBL deficient. The median time of first infection and number of infections during the first year post-transplantation were not significantly different between patients with MBL deficiency and those without MBL deficiency. The occurrence and number of infections after HSCT correlated with the MBL/C-reactive protein ratio. The number of severe infections was not higher among those with MBL deficiency. The occurrence of infections after the pre-engraftment period during the first year post-transplantation was significantly different in patient groups separated by MBL cut-off level. The MBL/C-reactive protein ratio might be a useful marker of infectious complications. MBL measurement may be helpful in antibiotic treatment. In case of MBL deficiency, earlier and more intensive treatment may be indicated.

Serum Procalcitonin as a Valuable Diagnostic Tool in the Early Detection of Infectious Complications after Open Abdominal Aortic Repair

Aortic aneurysm repair is a resolutive and effective surgical operation, which can be associated with severe postoperative complications. Procalcitonin (PCT) in clinical practice could play a role in early diagnosis and monitoring of therapy for complications, especially infections, making for timely and more effective interventions. Our aim was to investigate whether PCT could be a predictive marker in early diagnosis of infectious complications after open abdominal aortic surgery. Eighty-three consecutive patients who underwent elective open aortic repair at ourinstitution were enrolled. Blood samples were taken before surgery, and each day over the 7-day postoperative period, and measurement of serum PCT, C-reactive protein (CRP), and leukocytes levels were carried out. Data regarding clinical progress, instrumental examinations, and blood chemistry were prospectively collected. Postoperative infectious complications occurred in 24 patients. Within 30days, 1 death occurred. In the study sample, we found a significant difference in PCT curves of patients with and without infectious complications, especially on third postoperative day (POD; P=0.004). On analysis of the area under the curve (AUC curve), PCT was shown to be a fair predictor in distinguishing cases with infectious complications (AUC, 0.765 on third POD; CI, 0.638-0.877). Conversely, other inflammatory markers commonly used (leucocytes and CRP) had similar trends in patients with and without postoperative infections. On the basis of the results collected in this pilot study, despite some limitations, PCT could be considered a better marker of infectious complications after open abdominal aortic repair, when compared with other routinely used parameters.

Time Course of Changes in the Level of Procalcitonin in the Development of Nosocomial Pneumonia in Victims with Severe Concomitant Injury in an Intensive Care Unit

Background. The posttraumatic period in victims with severe concomitant injury is frequently complicated by nosocomial pneumonia, resulting in high mortality rates and longer time and increased cost of treatment in intensive care unit unit patients. Procalcitonin (PCT) is considered to be a marker for infectious complications due to different critical conditions; however, its prognostic value for different patient categories and periods after injury remains unclear; elevated PCT levels maybe related to the development of pneumonia in view of the severity of injury and the duration of mechanical ventilation (MV). Objective: to establish a correlation between the time course of changes in PCT levels and the development of nosocomial pneumonia and sepsis in victims with severe concomitant injury in relation to its severity and the duration of MV. Subjects and methods. The case histories of 271 victims with severe concomitant injury treated in the Intensive Care Unit, N. V. Sklifosovsky Research Institute of Emergency Care, in 2008—2012 were retro- and prospectively analyzed. The admission PCT level and its changes were analyzed in relation to the severity of injury and secondary infectious complications. Severe concomitant injury was ascertained to be accompanied by elevated serum PCT levels. A correlation was found between injury severity, mortality, the development of infectious pulmonary complications, sepsis, and mean PCT levels. The more severe the injury, the higher serum PCT level was revealed. In the first 12 hours, a group of victims without pneumonia exhibited the highest PCT levels (1.91±0.51 ng/ml). Later on there was its smooth fall and normalization by days 3—5. In the group of victims with pneumonia, but without sepsis, the PCT level averaged 1.71±0.64 ng/ml just in the first 6 hours, then its concentration continued to rise and its maximum level (3.93±1.26 ng/ml) was recorded in the first 48 hours. Later on, its decrease and normalization were observed by day 6 if the course of disease was favorable. A distinct pattern was seen in the group of victims with pneumonia and sepsis. Just in the first 6 hours, the mean level of PCT was 6.98±1.3 ng/ml and then its concentration continued to increase to 22.7±7.8 ng/ml in the first 48 hours. ROC analysis revealed the most prognostic effect of PCT at risk for pneumonia in the range from 12 to 24 hours since the ROC curve area was 0.753, which was good, as estimated by experts, and the cut-off was 1.79 ng/ml; moreover, sensitivity was 69.7% and specificity was also 69.7%. Conclusion. It is shown that it is expedient to monitor PCT levels in patients with severe concomitant injury from the admission of victims to hospital. The PCT concentration of more than 1.79 ng/ml during the first 12 hours after injury can serve as an early predictor for nosocomial pneumonia with a risk for further generalization of the process in victims with severe concomitant injury. Key words: severe concomitant injury, procalcitonin, infectious complications, pneumonia, sepsis, biomarker, predictor, mortality, ISS, mechanical ventilation.

Serum ratio of soluble triggering receptor expressed on myeloid cells-1 to creatinine is a useful marker of infectious complications in myeloperoxidase-antineutrophil cytoplasmic antibody-associated renal vasculitis

The contribution of infections to the mortality of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis patients is important and should induce early and careful control of these events. However, the differentiation of infection from active vasculitis is often difficult. The usefulness of serum-soluble triggering receptor expressed on myeloid cells-1 (TREM-1) for detecting the presence of infectious complications regardless of disease activity was investigated. Soluble TREM-1 in serum obtained from 41 patients with myeloperoxidase (MPO)-ANCA-associated vasculitis was measured by an enzyme-linked immunosorbent assay. Twenty-nine samples were from active vasculitis patients, 27 samples from inactive vasculitis patients without infection and 17 samples from inactive vasculitis patients with infectious complications. Serum-soluble TREM-1 was also measured in 10 patients with acute pyelonephritis and 30 patients with chronic kidney disease (CKD). There was a significant correlation between serum levels of soluble TREM-1 and serum creatinine levels among all patients (r = 0.554, P < 0.0001). The serum-soluble TREM-1/creatinine ratio was higher in inactive vasculitis patients with infectious complications than in active vasculitis, inactive vasculitis without infection and CKD patients (P = 0.0005, P < 0.0001 and P < 0.0001, respectively), but not significantly different to that in acute pyelonephritis patients. On receiver-operating-characteristic curve analysis, a lower-limit value of 9.40 ng/mg for this ratio had a sensitivity of 84.6% and a specificity of 90.8% in differentiating patients with infection from those without infection. The serum ratio of soluble TREM-1 to creatinine may be a useful marker for detection of infectious complications in MPO-ANCA-associated vasculitis.

Insulin-like growth factor binding protein-1 in cervix as a marker of infectious complications in pregnant women with bacterial vaginosis

Bacterial vaginosis (BV) is associated with preterm birth, late miscarriage, and postpartum infections. 1 Kurki T Sivonen A Renkonen P-V Savia E Ylikorkala O Bacterial vaginosis in early pregnancy and pregnancy outcome. Obstet Gynecol. 1992; 80: 172-177 Google Scholar , 2 Hay PE Lamont RF Taylor-Robinson D Morgan J Ison C Person J Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ. 1994; 308: 295-308 Crossref PubMed Scopus (551) Google Scholar , 3 Goldenberg RL Thom E Moawad AH Johnson F Roberts J Caritis SN The preterm prediction study: fetal fibronectin, bacterial vaginosis, and peripartum infection. Obstet Gynecol. 1996; 87: 656-660 Crossref PubMed Google Scholar However, randomised controlled trials have not provided evidence that treatment of BV in pregnancy prevents such complications. Insulin-like growth factor binding protein-1 (IGFBP-1) is a protein in decidua. The highly phosphorylated isoform of IGFBP-1 (phIGFBP-1) which is produced by decidua but is not present in amniotic fluid can be detected by the monoclonal antibody (Mab) 6303. 4 Rutanen E-M Kärkkäinen T Lundqvist C Pekonen F Ritvos O Tanner P Welin M Weber T Monoclonal antibodies to the 27–34K insulin-like growth factor binding protein. Biochem Biophys Res Commun. 1988; 152: 208-215 Crossref PubMed Scopus (56) Google Scholar , 5 Martina NA Kim E Chitkara U Wathen NC Chard T Giudice LC Gestational age-dependent expression of insulin-like growth factor binding protein-1 (IGFBP-1) phosphoisoforms in human extraembryonic cavities, maternal serum, and decidua suggests decidua as the primary source of IGFBP-1 in these fluids during early pregnancy. J Clin Endocrinol Metab. 1997; 82: 1894-1898 Crossref PubMed Google Scholar We studied whether leakage of phIGFBP-1 into cervical secretions, similarly to that of fetal fibronectin, 3 Goldenberg RL Thom E Moawad AH Johnson F Roberts J Caritis SN The preterm prediction study: fetal fibronectin, bacterial vaginosis, and peripartum infection. Obstet Gynecol. 1996; 87: 656-660 Crossref PubMed Google Scholar is an indicator of tissue damage at the chorio-decidual interface and a marker of an increased risk of infectious complications of BV in pregnant women.

Electronic Surveillance of Antibiotic Exposure and Coded Discharge Diagnoses as Indicators of Postoperative Infection and Other Quality Assurance Measures

To assess postoperative exposure to parenteral antibiotics and coded discharge diagnoses of infection as markers of nosocomial infection, postoperative morbidity, and potentially inappropriate antibiotic use after cesarean section. Retrospective cohort study to compare automated markers with the criterion of record review. Tertiary care hospital. Women admitted to a large teaching hospital after April 15, 1987, and discharged before October 1, 1989, who underwent a nonrepeat, nonelective cesarean section and had received prophylaxis with a cephalosporin. Antibiotic exposure and discharge diagnosis codes were obtained from a large electronic hospital data base. A sample of charts was reviewed to determine the presence of infection, other postoperative complications, and postoperative antibiotic exposure. A total of 2,197 women who had undergone a nonrepeat nonelective cesarean section were included in the study cohort. These women were assigned to 6 subgroups based on postoperative antibiotic exposure status and discharge codes suggesting endometritis, other postoperative infection, or no infection. Review of 457 records indicated that the overall infection rate was 9%. Eight percent of all the patients had a coded diagnosis for infection, and 16% received some parenteral antibiotics after the first postoperative day. Exposure to at least 2 days of parenteral postoperative antibiotics was the best marker by which to discriminate between infected and uninfected patients, with a sensitivity of 81%, a specificity of 95%, and a positive predictive value of 61% for detecting infection. The corresponding figures for coded diagnoses for infection had rates of 65%, 97%, and 74%, respectively. The combination of discharge codes and exposure to parenteral postoperative antibiotics resulted in a more accurate but less sensitive marker for nosocomial infections, with a positive predictive value of 94% and a sensitivity of 59%. The groups with discordant parenteral postoperative antibiotics exposure and discharge codes for infection were enriched for errors in coding, noninfectious morbidity, and unexplained antibiotic use. Less than 1% of the entire cohort had > or = to 2 days of parenteral postoperative antibiotics without any reason apparent in the medical record. Parenteral postoperative antibiotic exposure determined from automated pharmacy records correlated with the results of the more labor-intensive manual review of medical records for the identification of nosocomial infection. In addition, information on antibiotic exposure combined with coded discharge diagnoses provided a rapid screen to identify subgroups of patients with higher rates of infectious and noninfectious morbidity, unexplained antibiotic use, and errors in discharge coding. Information derived from electronic data bases created for administrative purposes may be useful as a marker for infectious complications, inappropriate antibiotic prescribing, and other issues related to total quality hospital monitoring.