Non-bacterial Infection Group Research Articles

Detection and evaluation of positive acute phase reactant protein markers in neonates and adults with sepsis

. Introduction and Aim: Septicemia is a clinical condition caused due to bacterial infection of the blood. Septicemia leading to sepsis could be life-threatening leading to tissue damage, organ failure, and death. The current study aimed to determine the impact of various biomarkers on patients suffering from sepsis, including Serum amyloid A, C-reactive protein, HS- Troponin, fibrinogen, haptoglobin and alpha1-antitrypsin, as well as identify the common bacterial types associated in septic patients. Materials and Methods: This case-control study conducted during October 2022 to May 2023 involved 100 participants that were divided into groups which included patients diagnosed with septicemia due to bacteria (Group A), patients with septicemia with non-bacterial infection (Group B) and healthy individuals as controls (Group C). Results: Serum amyloid A, C-reactive protein, HS-Troponin, Fibrinogen, Haptoglobin, and Alpha-1 antitrypsin levels in neonates and adults with sepsis were found to be elevated when compared to healthy individuals. No significant difference was observed for these parameters between Group A patients (positive for blood culture) and Group B patients (negative for blood culture) among neonates and adult sepsis patients. Conclusion: Neonates and adult sepsis patients exhibited higher levels of serum amyloid A, C-reactive protein, HS-Troponin, fibrinogen, hemoglobin, and Alpha-1 antitrypsin in comparison to healthy controls. Hence, these biochemical parameters could be used as biomarkers to assess a patient's level of sepsis for further therapeutic action.

Diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome complicated by infection: a single center retrospective study.

The purpose was to look into the diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome co-infection. One hundred and forty-nine children with nephrotic syndrome who met the inclusion and exclusion criteria were included in this study. The children were divided into three groups: bacterial infection group, non-bacterial infection group, and non-infection group. The diagnostic value was analyzed and compared using the ROC curve. There was no statistically significant difference in the Leukocyte counts among three groups. The mean results of serum CRP, PCT and IL-6 were significantly higher in the bacterial infection group compared to those in the non-infection group (p < 0.05). AUC of CRP, PCT, IL-6 in bacterial infection were 0.791, 0.859, 0.783. The following combinations CRP + PCT + IL-6, IL-6 + PCT, CRP + PCT significantly increased the efficiency of bacterial infection diagnosis, the AUCs were 0.881, 0.884, and 0.884, respectively. AUC of PCT in non-bacterial infection was 0.663. The combinations of these three clinical indicators performed no better than PCT in ROC analysis. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve the diagnostic value. This study evaluated the diagnostic value of the serum concentrations of CRP, PCT and IL-6 and assessed whether the value of their combined application is better than when used alone for diagnosing primary nephrotic syndrome complicated by infection. The elevation in leukocyte count cannot be used to diagnose children with nephrotic syndromes on long-term glucocorticoid treatment who have bacterial infections. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve diagnostic value, sensitivity, and specificity.

A nomogram for predicting the development of serious bacterial infections in febrile term neonates: A single medical center experience in Southern Taiwan.

Serious bacterial infections (SBIs) could lead to mortality or severe long-term sequelae in neonates and infants aged <3 months. Accordingly, the aim of this study was to develop a quantitative and accurate assessment tool for predicting the risk of SBIs in febrile neonates. This retrospective study enrolled 131 febrile term neonates (aged <30 days) who were hospitalized at Kaohsiung Veterans General Hospital between January 2005 and December 2020. These neonates were classified into SBI and nonbacterial infection (NBI) groups on the basis of microbiological laboratory reports. The clinical characteristics and routine blood tests of both groups at the time of admission were analyzed. Stepwise logistic regression was applied to create and validate the nomogram for SBI prediction. Among the 131 febrile neonates, 38 and 93 developed SBIs and NBIs, respectively. At the time of admission, ill clinical appearance, serum myelocyte/metamyelocyte presence, C-reactive protein (CRP) > 2.5 mg/dL, and pyuria were associated with an increased risk of SBIs. Accordingly, these four factors were used to develop a nomogram for SBI prediction, which exhibited significantly high performance (area under curve = 0.848, p < 0.001) in predicting SBI risk. We developed a nomogram combining clinical appearance, serum myelocyte/metamyelocyte presence, CRP, and pyuria for predicting SBI risk in febrile neonates. This tool can assist clinicians in making early diagnoses and delivering the appropriate treatment.

Value of combined detection of serum amyloid A, C-reactive protein and procalcitonin in differential diagnosis of respiratory tract infection in children of China

Objective To explore the diagnostic value of combined detection of serum amyloid A (SAA), C-reactive protein (CRP) and procalcitonin (PCT) in children with bacteria or non-bacterial respiratory tract infection. Methods 200 children with respiratory tract infections diagnosed in our hospital were included in the study. According to the results of the aetiological examination, they were divided into bacterial infection group and non-bacterial infection group. At the same time, 100 healthy children admitted to the hospital for physical examination during the same period were selected as the healthy subjects control group. Changes in serum SAA, PCT and CRP in three groups were compared. Comparison of a positive rate of the single index and combined detection were performed. Children with bacterial infections were treated with conventional antibiotics. The changes in serum SAA, PCT and CRP in the infection group before and after treatment were compared. The efficacy of SAA, PCT and CRP alone and in combination was compared. Results The serum SAA, PCT and CRP levels in the bacterial infection group were higher than those in the non-bacterial infection group and healthy children, and the differences were statistically significant. The positive detection rates and combined detection rates of serum SAA, PCT and CRP in the bacterial infection group were higher than those in the non-bacterial infection group and the healthy subject's control group. After conventional antibiotic treatment, serum SAA, PCT and CR levels in children with bacterial infection were significantly decreased. Conclusion The combined detection based on SAA, CRP and PCT can effectively identify and diagnose respiratory tract infection in children, providing a certain reference for the promotion of the diagnostic scheme. Key messages Serum SAA, PCT and CRP were highly expressed in children with respiratory tract infection, and the expression level was the highest in children with bacterial pneumonia. The combined detection of serum SAA, CRP and PCT indicators have higher diagnostic efficiency and can effectively make a differential diagnosis of respiratory tract infection in children.

Analysis of Microbiological and Clinical Characteristics of Bacterial Infection in Patients with Pulmonary Infection.

Objective Using data investigation, the microbiology of bacterial infection in patients with pulmonary infection was discussed, and its clinical characteristics were analyzed. Methods The clinical data of 160 patients with pulmonary infection in our hospital from March 2019 to March 2021 were collected and analyzed. Blood samples were collected and cultured, and the pathogens were identified. The distribution, constituent ratio, and drug resistance of pathogens in elderly patients with pulmonary infection were analyzed. Logistics regression analysis was adopted to analyze the risk factors of pulmonary infection. Results Of the 160 patients with pulmonary infection, 107 were males (66.88%) and 53 were females (33.13%). The age ranged from 12 to 97 years old, with an average of 63.82 ± 12.64 years old. Sevent-six patients (47.50%) were over 65 years old. Urban patients accounted for 71.88%, and rural patients accounted for 28.13%, of which workers accounted for 46.25%, and farmers and cadres each accounted for about 4%. 85.62% of smokers have smoked for more than 4 years. Eighty-five patients had chronic diseases such as coronary heart disease, hypertension, diabetes, and cerebrovascular disease. Heart failure occurred in 10.00%, old tuberculosis in 11.25%, and new tuberculosis in 5.63%. The average hospital stay of the patients was 14.93 days, and the improvement rate was 91.25%. Eleven patients died. Among the 160 patients with pulmonary infection, COPD, pneumonia, and lung cancer accounted for the highest proportions, and idiopathic pulmonary fibrosis, bronchitis dilatation, tuberculosis, and bronchial asthma also played an important role. Pathogenic bacteria were detected in 104 of the 160 elderly patients with pulmonary infection, and the detection rate was 65.00%. A total of 444 strains of pathogenic bacteria were detected, including 328 strains of Gram-negative bacteria (73.87%, mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Serratia marcescens), 28 strains of Gram-positive bacteria (6.30%, mainly Staphylococcus aureus), and 88 strains of fungi (20.00%, mainly Candida albicans). Regarding Klebsiella pneumoniae in elderly patients with pulmonary infection, the drug resistance rates were 59.72% for amoxicillin-clavulanate potassium, 52.78% for ampicillin sodium-sulbactam sodium, and 51.39% for cefazolin sodium. Regarding Pseudomonas aeruginosa, the drug resistance rates were 29.31% for ticarcillin sodium-potassium clavulanate, 27.59% for piperacillin sodium, and 24.14% for gentamicin. Regarding Stenotrophomonas maltophilia, the drug resistance rates were 79.55% for ceftazidime, 38.64% for chloramphenicol, and 31.82% for levofloxacin. Regarding Serratia marcescens, the drug resistance rates from high to low were 74.42% for cefotaxime, 72.09% for moxifloxacin, and 69.77% for gentamicin. Regarding Staphylococcus aureus in elderly patients with pulmonary infection, the drug resistance rates were 100.00% for penicillin, 61.54% for erythromycin, 61.54% for clarithromycin, and 61.54% for azithromycin. Regarding Candida albicans, the drug resistance rates from high to low were 22.41% for caspofungin, 15.52% for itraconazole, and 9.09% for fluconazole. The results of univariate analysis of pulmonary bacterial infection indicated that there were no significant differences in sex and body mass index between nonbacterial infection group and bacterial infection group (P > 0.05). There were significant differences in terms of dust or harmful gas exposure, family member smoking, chronic lung disease history, age, smoking, family cooking, hospital stay, and indwelling catheter (P < 0.05). Exposure to dust or harmful gases, family cooking, age, history of chronic lung disease, indwelling catheter, and length of hospital stay were risk factors for pulmonary bacterial infection (P < 0.05). Conclusion Gram-negative bacteria are the main pathogens in elderly patients with pulmonary infection. Antibiotics should be administered reasonably according to the results of the drug sensitivity test. Older age, history of chronic lung disease, catheter indwelling, and length of stay are the risk factors for pulmonary bacterial infection.

A diagnostic test: combined detection of heparin-binding protein, procalcitonin, and C-reactive protein to improve the diagnostic accuracy of bacterial respiratory tract infections.

BackgroundRespiratory tract infection (RTI) is one of the most common diseases worldwide, and its incidence is rising year by year due to environmental pollution. Sputum culture remains the gold standard for RTI diagnosis, but its performance is limited by difficulties related to the sampling and testing of the sputum specimens. Heparin-binding protein (HBP), procalcitonin (PCT), and C-reaction protein (CRP) are Inflammatory markers. They have the advantage of being fast, accurate and reproducible, but limited by their sensitivity and specificity. We explored the clinical value of the combined detection of them in the diagnosis of bacterial RTIs.MethodsPatients who fulfilled the inclusion criteria were selected as the case group, healthy age- and sex-matched subjects were enrolled as a control group. The subjects’ HBP, PCT, and CRP levels were detected. The case group was further divided into two groups according to the bacterial culture results, and the differences in the markers were statistically analyzed. The receiver operating characteristic (ROC) curves were drawn, and the areas under the ROC curve (AUCs) were calculated to analyze the diagnostic values of each marker and their combination in parallel for bacterial RTIs.ResultsThe plasma HBP, PCT, and CRP levels of patients in the bacterial and non-bacterial infection groups were significantly higher than those of patients in the healthy control group, and were positively correlated to the severity of the disease. for HBP with an AUC of 0.785 [95% confidence interval (CI): 0.686–0.884], a sensitivity of 0.821, a specificity of 0.771; PCT with an AUC of 0.767 (95% CI: 0.664–0.870), a sensitivity of 0.773, a specificity of 0.791, and CRP with an AUC of 0.748 (95% CI: 0.642–0.854), a sensitivity of 0.839, a specificity of 0.696 in the bacterial and non-bacterial infection groups. The combined detection of HBP + CRP had the optimal diagnostic performance, with an AUC of 0.797 (95% CI: 0.698–0.895; P<0.001), a sensitivity of 0.809, a specificity of 0.800.ConclusionsThe combined detection of HBP and CRP is valuable for diagnosing bacterial RTIs and may guide the development of reasonable treatment protocols in clinical settings.

Diagnostic value of ROC curve evaluation of serum markers in acute cholecystitis with bacterial infection.

To explore correlation of serum markers human neutrophil lipocalin and C-reactive protein with acute cholecystitis associated with bacterial infection, and to evaluate the diagnostic value of the markers. The cross-sectional study was conducted from January 2018 to April 2020 at the Beijing Luhe Hospital, Capital Medical University, Beijing, China, and comprised acute cholecystitis patients who were divided into bacterial infection group A and non-bacterial infection group B. Serum human neutrophil lipocalin and C-reactive protein were measured for both the groups. Receiver operating characteristic curve was used to evaluate the diagnostic value of the two markers in acute cholecystitis associated with bacterial infection. Data was analysed using SPSS 25. Of the 145 patients, 65(45%) were in group A; 36(55.38%) males and 29(44.62%) females with a mean age of 45.79±2.50 years. In group B there were 80(55%) subjects; 45(56.25%) males and 35(43.75%) females with a mean age of 46.16±2.52 years (p>0.05). In group A, there were 60(92.31%) cases of acute calculous cholecystitis, and 5(7.69%) had acute acalculous cholecystitis compared to 73(91.25%) and 7(8.75%), respectively, in group B (p>0.05). Serum human neutrophil lipocalin and C-reactive protein levels in group A were higher than group B (p<0.001). Serum human neutrophil lipocalin showed a high positive correlation with C-reactive protein in group A (r=0.800, p<0.001), and a moderate positive correlation in group B (r=0.683, p<0.001). Area under the curve of serum human neutrophil lipocalin associated with C-reactive protein was 0.901 (95% confidence interval: 0.850-0.953), which was higher than that of serum human neutrophil lipocalin and C-reactive protein alone, with sensitivity 95.40% and specificity 80%. The combined use of serum human neutrophil lipocalin and C-reactive protein may be used as an effective indicator for early diagnosis, identification and monitoring of acute cholecystitis with bacterial infection.

Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study.

PurposeCoronavirus disease-2019 (COVID-19) is associated with a wide spectrum of clinical symptoms including acute respiratory failure. Biomarkers that can predict outcomes in patients with COVID-19 can assist with patient management. The aim of this study is to evaluate whether procalcitonin (PCT) can predict clinical outcome and bacterial superinfection in patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).MethodsAdult patients diagnosed with SARS-CoV-2 by nasopharyngeal PCR who were admitted to a tertiary care center in Boston, MA with SARS-CoV-2 infection between March 17 and April 30, 2020 with a baseline PCT value were studied. Patients who were presumed positive for SARS-CoV-2, who lacked PCT levels, or who had a positive urinalysis with negative cultures were excluded. Demographics, clinical and laboratory data were extracted from the electronic medical records.Results324 patient charts were reviewed and grouped by clinical and microbiologic outcomes by day 28. Baseline PCT levels were significantly higher for patients who were treated for true bacteremia (p = 0.0005) and bacterial pneumonia (p = 0.00077) compared with the non-bacterial infection group. Baseline PCT positively correlated with the NIAID ordinal scale and survival over time. When compared to other inflammatory biomarkers, PCT showed superiority in predicting bacteremia.ConclusionsBaseline PCT levels are associated with outcome and bacterial superinfection in patients hospitalized with SARS-CoV-2.

Clinical indications for Kawasaki disease in febrile infants aged less than three months.

The purpose of this study was to determine the clinical and laboratory indicators of KD in febrile infants aged less than three months. Febrile infants aged less than three months were enrolled and divided into three groups: KD, bacterial infection (BI), and non-bacterial infection (NBI). Laboratory data were analyzed at two time points: initially upon admission and at follow-up after 48-72h of admission. A total of 491 patients (280 males and 211 females) were enrolled. According to the final diagnosis, 29 patients had KD, 120 had BI, and 342 had NBI. The infants in the KD group were older (p < 0.001), had prolonged pre-admission and total fever duration (p < 0.001), and had a lower rate of decreased activity (p < 0.05) compared to the infants in the BI and NBI groups. The KD group had a significantly higher level of initial c-reactive protein (CRP) compared to the BI and NBI groups, with a cutoff value of 4.85mg/dL in comparison with the BI group and 3.32mg/dL in comparison with the NBI group. Moreover, the KD group had a significantly higher follow-up platelet count compared to the BI and NBI groups, with a cutoff value of 533 × 109/L in comparison with the BI group and 541 × 109/L in comparison with the NBI group. When febrile infants aged less than three months have prolonged fever, less decreased activity, and a higher initial CRP level and follow-up platelet count, we must consider the possibility of KD.

Utility of Procalcitonin Over C-Reactive Protein and WBC as an Early and Rapid Diagnostic Marker of Bacterial Infections in Febrile Patients with or no Hemoculture Results as Gold Standard in a Malaria Endemic Zone of Cameroon

Background & objectives: Early identification of bacterial infection in patients with fever is important for prompt and specific treatment. However, the available biomarkers such as C-reactive protein (CRP) and leukocyte counts are not specific to bacterial diagnosis. This study aimed to assess the diagnostic value of procalcitonin (PCT) over CRP and leukocyte counts for bacterial infection screening in febrile patients while awaiting their hemoculture results, which takes up to 7 Days before results are available though it is the gold standard for the diagnosis of bacterial infections. Methods: Blood samples were collected from febrile patients between January and July 2020 then processed for blood cultures. PCT, CRP and WBC levels were measured. The patients were divided into two groups according to the final diagnosis: bacterial infection group (group1) and non-bacterial infection group (group 2).SPSS version 20.0 software package was used for data analysis and normally distributed variables were calculated using mean, standard deviation and ANOVA test while median and range were used for variables without a normal distribution. Significance testing was done using Kruskal-Wallis h test and Wilcoxon two sample test and the diagnostic accuracy was assessed by calculating the area (AUC) under the receiver operating characteristic curve (ROC). Results: There were significant (P<0.05) difference in the levels of PCT, CRP and WBC among the two groups. The PCT levels of patients in the bacterial infections group were significantly higher than those in the nonbacterial infections group (27.9 vs., 11.7 P < 0.001). The best cut-off value to detect bacterial infections was 1.46 ng/ml for PCT. PCT, CRP and WBC had areas under the curve of 0.71, 0.66 and 0.45 respectively and sensitivity of 100%, 72.7% and 27.3% respectively. Interpretation & conclusions: Our results showed that PCT was a valuable marker for the early and rapid diagnosis of bacterial infections in febrile patients in our setting when compared to CRP and WBC. However, prospective and large scale studies are warranted to confirm these findings in Cameroon.

Application of procalcitonin, white blood cell count and neutrophil-to-lymphocyte ratio in the diagnosis of systemic lupus erythematosus with a bacterial infection.

Systemic lupus erythematosus (SLE) is an autoimmune disease. This study aims to analyze the value of procalcitonin (PCT), white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR) in the differential diagnosis of SLE with a bacterial infection. A total of 164 patients with SLE admitted to our hospital from January 2018 to December 2019 were selected as the research subjects. According to the results of bacterial culture, patients with SLE were divided into the bacterial infection group (46 cases) and the non-bacterial infection group (118 cases). Sixty healthy volunteers without the allergic disease, family history of tumors, or immunodeficiency in the same age group were selected as the control group during the same period. Fasting venous blood was collected in the morning to detect serum macrophage migration inhibitory factor (MIF), C-reactive protein (CRP), red blood cell distribution width (RDW), PCT, WBC, neutrophil count (NEUT) and lymphocyte count (LYMPH), and the NLR (NEUT/LYMPH) was calculated. CRP, PCT, WBC, and NLR levels were significantly higher in the bacterial infection group and the non-bacterial infection group than that in the control group, and which in the bacterial infection group is significantly higher than in the non-bacterial infection group (P<0.05). PCT, WBC and NLR were independent risk factors for SLE with bacterial infection (P<0.05). ROC curve analysis showed the areas under the curve of PCT, WBC, and NLR for the differential diagnosis of SLE with bacterial infection being 0.883, 0.669, and 0.624. Then, the sensitivities of 78.3%, 43.5%, and 69.6% were observed with the specificities of 98.3%, 91.5%, and 56.8%, respectively. The area under the curve of combined prediction was 0.919, with a sensitivity of 78.3%, and a specificity of 97.5%. These results showed that the value of the combined prediction was significantly higher than the single prediction of each indicator. And the levels of PCT, WBC, and NLR gradually decreased with the progress of treatment (P<0.05). The combined detection of PCT, WBC, and NLR levels shows high sensitivity and specificity for SLE with a bacterial infection, which can be used for early auxiliary diagnosis of SLE with a bacterial infection.

Utility of the neutrophil-to-lymphocyte ratio for predicting bacterial infection in patients with rheumatoid arthritis receiving Tocilizumab.

This study aimed to describe the utility of the neutrophil-to-lymphocyte ratio (NLR) for predicting bacterial infections in patients with rheumatoid arthritis (RA) treated with Tocilizumab (TCZ). We extracted RA patients treated with TCZ in whom an infection developed between April 2008 and March 2018 from our hospital database. We divided these patients into the bacterial infection and non-bacterial infection groups and compared their background, C-reactive protein (CRP) values, white blood cell count (WBC), the NLR at the time of infection diagnosis, and the ratio of the NLR at the time of infection diagnosis (post-NLR) to the NLR at baseline (pre-NLR). Of the 196 patients who received TCZ, 21 experienced a bacterial infection and 20 had a non-bacterial infection. The median CRP level, WBC count, post-NLR, and post-NLR/pre-NLR ratio in the bacterial infection group were significantly higher than in the non-bacterial infection group. In receiver operating characteristics (ROC) curve analysis for predicting bacterial infection, the area under the curve (AUC) for CRP, WBC, NLR, and the post-NLR/pre-NLR ratio were 0.787, 0.857, 0.887, and 0.975, respectively. The cut-off value of 2.25 for the post-NLR/pre-NLR ratio showed the greatest sensitivity (90.5%) and specificity (100%). The post-NLR/pre-NLR ratio may be a useful surrogate marker for predicting bacterial infections in patients with RA treated with TCZ.

Diagnostic value of PCT level detection combined with bacterial culture in lower respiratory tract infection

Objective To explore the diagnostic value of procalcitonin (PCT) level detection combined with bacterial culture in lower respiratory tract infection. Methods 88 patients with lower respiratory tract infection admitted to our hospital from March, 2017 to June, 2019 were selected as the research objects. According to the clinical diagnosis, they were divided into a bacterial infection group (44 cases) and a non-bacterial infection group (44 cases). 44 healthy people who underwent physical examination in our hospital at the same time were selected as a control group. The three groups were detected by electrochemical sandwich method. The sputum of the bacterial infection group was collected for bacterial culture. The PCT levels and positive rates of the three groups were compared; and the distribution of bacteria and the detection rate of bacterial culture in the bacterial culture group were counted. Results The PCT level of the bacterial infection group was higher than those of the non-bacterial infection group and the control group, with statistical differences (both P<0.05); the PCT level of the non-bacterial infection group was higher than that of control group, with a statistical difference (P<0.05). The positive rate of the bacterial infection group was higher than those of the non-bacterial infection group and the control group, with statistical differences (both P<0.05); the positive rate of the non-bacterial infection group was higher than that of the control group (P<0.05). The results of bacterial culture showed that 22 cases were positive, and the detection rate was 50.00%, with Pseudomonas aeruginosa accounting for 36.36%, Staphylococcus epidermidis 18.18%, Staphylococcus aureus 13.63%, Klebsiella pneumoniae 18.18%, pneumonia 18.18%, Streptococcus 4.55%, Escherichia coli 4.55%, and Enterobacter cloacae 4.55%. Conclusion PCT level detection combined with bacterial culture can improve the positive detection rate of lower respiratory tract infection, and provide important guidance for clinical identification of bacterial infection, non-bacterial infection, and clinical medication. Key words: Lower respiratory tract infection; PCT level detection; Bacterial culture

Clinical significance of serum procalcitonin, C-reactive protein, interleukin-6 and tumor necrosis factor-alpha levels in the diagnosis of bacterial infectious diseases

Objective To explore the clinical significance of serum procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels in the diagnosis of bacterial infectious diseases. Methods From January 2018 to January 2019, 107 patients with infectious diseases admitted to Weishan Branch of Dongyang People's Hospital were divided into bacterial infection group (61 cases) and non-bacterial infection group (46 cases) according to whether bacterial infection occurred or not.And 50 healthy people from Weishan Branch of Dongyang People's Hospitalwere selected as control group.Peripheral venous blood was collected 24 h after admission, and the serum was separated.The PCT content was determined by dry immunofluorescence method, CRP content was determined by immunoscattering rate method, and IL-6 and TNF-α contents were determined by enzyme-linked immunosorbent assay (ELISA). The serum PCT, CRP, IL-6 and TNF-α levels, the positive rates of PCT, CRP, IL-6 and TNF-α, and the combined diagnostic efficacy of PCT, CRP, IL-6 and TNF-α were compared among the three groups. Results Theserum PCT [(4.73±0.87)ng/L], CRP [(24.31±5.42)mg/L], IL-6 [(15.48±3.24)μg/L] and TNF-α[(19.39±3.24)μg/L] in the bacterial infection group were higher than those in the non-bacterial infection group and the control group which in the non-bacterial infection group were higher than those in the control group, there were statistically significant differences among the three groups (F=19.832, 10.271, 24.352, 29.318, all P<0.05). The positive rates of PCT (95.08%), CRP (93.44%), IL-6 (80.33%) and TNF-α (75.41%) in the bacterial infection group were higher than those in the non-bacterial infection group and the control group, which in the non-bacterial infection group (34.78%, 39.13%, 50.00%, 45.65%) were higher than those in the control group (2.00%, 2.00%, 6.00%, 8.00%), the differences were statistically significant (χ2=16.521, 14.352, 10.298, 7.489, all P<0.05). The sensitivity and specificity of combined diagnosis of PCT, CRP, IL-6 and TNF-α were higher than those of individual indicator. Conclusion Serum PCT, CRP, IL-6 and TNF-α levels are significantly increased in patients with bacterial infectious diseases.The sensitivity and specificity of combined diagnosis are high, which can be used as a basis for the diagnosis of bacterial infectious diseases. Key words: Bacterial infectious diseases; Procalcitonin; C-reactive protein; Interleukin-6; Tumor necrosis factor-alpha; Non-bacterial infectious diseases; Healthy examinees; Diagnosis

Clinical application of the detection of heparin-binding protein in cerebrospinal fluid in intracranial infectious diseases

Objective To investigate the clinical application value of the levels of heparin- binding protein (HBP) in cerebrospinal fluid (CSF) for intracranial infectious diseases. Methods A case-control study was conducted. 150 patients after craniotomy(73 in the postoperative bacterial intracranial infection group, 77 in the postoperative non-infection group) admitted to the Department of Neurology of the People′s Hospital of Liaoning Province from December 2016 to May 2018 were collected. At the same time, 46 patients without operation (14 in the non-bacterial intracranial infection group, 32 patients without intracranial infection were selected as control group whose white blood cell count (WBC) values in CSF were all below 10×106/L) in the same period were also collected. According to the diagnostic criteria for severe intracranial infection, the patients with bacterial intracranial infection were divided into 26 cases of mild intracranial infection group and 47 cases of severe intracranial infection group. According to the Glasgow Outcome Scale (GOS) score at the time of discharge, the patients were divided into 30 cases of good prognosis group (GOS score 4-5 points) and 43 cases of poor prognosis group (GOS score 1-3 points). The concentrations of HBP in CSF were tested with latex immunoturbidimetry, and the concentrations of procalcitonin(PCT) in cerebrospinal fluid and serum were tested with electrochemiluminescence, and cerebrospinal fluid routine were tested with instrument method, and the concentrations of total protein(TP) in cerebrospinal fluid were tested with turbidimetry. The differences of the laboratory test indicators in each group were statistically analyzed, and the levels of HBP in CSF of patients with different degrees of intracranial infection and different prognosis were compared. Comparison of two independent samples was performed using the Mann-Whitney U test. Results The HBP levels in cerebrospinal fluid were 187.00 (73.00, 635.00) ng/ml, 10.00 (3.50, 32.00) ng/ml, 1.50 (0, 4.00) ng/ml, 3.00 (1.00, 4.00) ng/ml in post-craniotomy bacterial intracranial infection group, uninfected group after craniotomy, non-bacterial intracranial infection group and control group respectively. The cerebrospinal fluid levels of WBC count were 1 280.00 (363.00, 4 327.00)×106/L, 63.00 (18.50, 300.00)×106/L, 5.00 (3.00, 14.75)×106/L, 3.00 (2.00, 5.75)×106/L. The absolute value of cerebrospinal fluid neutrophils were 1 216.00 (225.50, 3 895.50)×106/L, 24.00 (2.00, 209.50)×106/L, 1.00 (1.00, 3.00)×106/L, 1.00 (1.00, 1.00)×106/L. The cerebrospinal fluid levels of PCT were 0.16 (0.10, 0.32) ng/ml, 0.09 (0.07, 0.14) ng/ml, 0.07 (0.06, 0.12) ng/ml, 0.07 (0.06, 0.13) ng/ml. The serum levels of PCT were 0.36 (0.15, 1.09) ng/ml, 0.09 (0.04, 0.16) ng/ml, 0.08 (0.04, 0.13) ng/ml, 0.07 (0.03, 0.11) ng/ml. The levels of HBP, WBC, neutrophils, PCT in CSF and serum PCT in the post-craniotomy bacterial intracranial infection group were significantly higher than those in the uninfected group after craniotomy (Z=-9.246,-6.759,-6.741,-4.477,-6.202, P 0.05)between the uninfected group after craniotomy and the non-bacterial intracranial infection group. There were significant differences in the levels of HBP, WBC and neutrophils in CSF(Z=-4.496, -6.685, -4.842, P 0.05)between the uninfected group after craniotomy and the control group. There were no significant differences in the levels of HBP, PCT in CSF and serum PCT (Z=-0.861,-0.514,-0.273, P>0.05)and significant differences in the levels of WBC and neutrophils in CSF(Z=-2.756, -3.060, P<0.05) between the non-bacterial intracranial infection group and the control group. The levels of HBP in CSF in the severe intracranial infection group were significantly higher than those in the mild intracranial infection group(Z=-6.267, P<0.05). The levels of HBP in CSF in the poor prognosis group were significantly higher than those in the good prognosis group(Z=-7.064, P<0.05). The area under the ROC curve for the diagnosis of bacterial intracranial infection by HBP, WBC, neutrophils, TP, PCT in CSF and PCT in serum was 0.986, 0.987, 0.945, 0.945, 0.770 and 0.914, respectively. The area under the ROC curve for differential diagnosis of bacterial intracranial infection and non-bacterial intracranial infection was 0.994, 0.958, 0.961, 0.929, 0.747 and 0.936, respectively. Conclusions HBP in CSF is an ideal indicator for the diagnosis of bacterial intracranial infection. It is important to distinguish between bacterial intracranial infection and non-bacterial intracranial infection. The extent of increase is related to the severity of infection and prognosis of the disease. Key words: Heparin-binding protein; Cerebrospinal fluid; Intracranial infection

Serum Hepcidin-25 Levels Reflect the Presence of Bacteremia in Patients with Systemic Inflammatory Response Syndrome.

Hepcidin-25 is a key regulatory hormone of iron homeostasis in humans, and its production is greatly upregulated by inflammation as well as iron overload. The aim of this study was to investigate the pathophysiological role of hepcidin-25 in patients with systemic inflammatory response syndrome (SIRS). We enrolled 113 consecutive patients (aged 63.4±21, 50 men, 63 women), with 2 or more SIRS criteria, who were admitted to our department of general medicine between August 1, 2015 and August 31, 2017. We measured complete blood cell count and serum levels of hepcidin-25, iron, iron-binding capacity, ferritin, blood urea nitrogen, creatinine, albumin, and C-reactive protein (CRP) on admission. The patients were divided into 3 group: a bacteremia group (27 patients), a culture-negative bacterial infection group (60 patients), and a non-bacterial infection group (26 patients). Hepcidin-25 levels were found to be comparable in terms of SIRS criteria: 162 [2.8-579], 193 [2.24-409], and 180 [89.2-421] ng/mL in patients with 2, 3, and 4 criteria, respectively (P=0.533). However, hepcidin-25 levels were significantly higher in the bacteremia group (209 [56.7-579] ng/mL) than in either the culture-negative bacterial infection group (168 [2.24-418] ng/mL) or the non-bacterial infection group (142 [2.8-409] ng/mL). A significant positive correlation between hepcidin-25 and CRP levels was noted in the bacteremia group (r=0.528, P=0.005) and non-bacterial infection group (r=0.648, P<0.001). Moreover, iron and ferritin levels were significantly lower in the bacteremia group than in the non-bacterial infection group. Our findings suggest that hepcidin-25 level may reflect the presence of bacteremia as well as the severity of inflammation in patients with SIRS.

Procalcitonin and Other Common Biomarkers Do Not Reliably Identify Patients at Risk for Bacterial Infection After Congenital Heart Surgery.

Following surgery, it is difficult to distinguish a postoperative inflammatory reaction from infection. This study examined the predictive value of the biomarkers; procalcitonin, C-reactive protein, lactate, neutrophils, lymphocytes, platelets, and the biphasic activated partial thromboplastin time waveform in diagnosing bacterial infection following cardiac surgery. Prospective, observational study. A regional, PICU in the United Kingdom. Three-hundred sixty-eight children under the age of 16 admitted to the PICU for elective cardiac surgery were enrolled in the study. All biomarker measurements were determined daily until postoperative day 7. Children were assessed for postoperative infection until day 28 and divided into four groups: bacterial infection, culture-negative sepsis, viral infection, and no infection. We used the Kruskal-Wallis test, chi-square test, analysis of variance, and area under the curve in our analysis. In total, 71 of 368 children (19%) developed bacterial infection postoperatively, the majority being surgical site infections. In those with bacterial infection, procalcitonin was elevated on postoperative days 1-3 and the last measurement prior to event compared with those without bacterial infection. The most significant difference was the last measurement prior to event; 0.72 ng/mL in the bacterial infection group versus 0.13 ng/mL in the no infection group (for all groups; p < 0.001). Longitudinal profiles of all biomarkers were indistinct in the bacterial infection and nonbacterial infection groups except in those with culture-negative infections who had distinct procalcitonin kinetics on postoperative days 1-4. Children with culture-negative sepsis required longer ventilatory support and PICU stay and were more likely to develop complications than the other groups. None of the biomarkers studied within 3 days of infection distinguished between infection and postoperative inflammatory reaction. However, procalcitonin kinetics peaked on postoperative day 2 and fell more sharply than C-reactive protein kinetics, which peaked at postoperative day 3. The monitoring of procalcitonin kinetics following cardiac surgery may help guide rational antimicrobial use.

A study on the mechanism of agonists in regulating transcriptional level of pIgR in salivary gland epithelial cells.

The aim of the present study was to explore the mechanism of agonists in regulating transcriptional level of polymeric immunoglobulin receptor (pIgR) in salivary gland epithelial cells, thus revealing the defense effect of salivary immune on bacteria in the oral cavity. Sixty patients with oral bacterial infection and 70 patients suffering from oral diseases without bacterial infection were selected randomly from patients in Renmin Hospital of Wuhan University from April 2015 to April 2017. Ribonucleic acid (RNA) was extracted from salivary gland epithelial cells of all patients. Fluorescent quantitative polymerase chain reaction (FQ-PCR) and western blotting methods were adopted to detect and compare the transcriptional level of pIgR. The salivary gland epithelial cells of the 60 patients with oral bacterial infection were isolated and extracted, and they were divided into two groups (observation group and control group) randomly. Agonists were added to the observation group for acting for 24 h. FQ-PCR and immunofluorescence (IF) were adopted to detect and compare the transcriptional level of pIgR after acting with agonists. The toxicity of agonists on the cells was detected with Cell Counting kit-8 (CCK-8). The isolated salivary gland epithelial cells conformed to the morphology of epithelial cells, and adhered to the wall for growing. The transcriptional level of pIgR in the bacterial infection group was lower than that in the non-bacterial infection group (p<0.05). The transcriptional level of pIgR in the observation group was higher than that in the control group (p<0.05) after acting with agonists. Agonists can promote the rise of transcriptional level of pIgR in salivary gland epithelial cells, and the increase in pIgR is closely related to the cure of oral bacterial infection. Therefore, agonists can improve the oral immune function by regulating the transcription of pIgR.

Procalcitonin may not be a differential diagnostic marker for bacterial infection in febrile patients with chronic gouty arthritis.

ObjectiveThis study aimed to examine the diagnostic value of serum procalcitonin (PCT) levels for identifying bacterial infection in febrile patients with chronic gouty arthritis.MethodsSixty-six febrile patients with chronic gouty arthritis were divided into non-bacterial infection (n = 45) and bacterial infection groups (n = 21). PCT levels were measured by an immunoassay. Other laboratory parameters, including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), and the neutrophil ratio were extracted from medical records. Receiver-operating characteristic curves were used to evaluate diagnostic values and accuracy.ResultsSerum PCT levels, the ESR, CRP levels, WBC count, and neutrophil ratio were not different between the groups. To assess the ability of PCT to discriminate bacterial infection in febrile patients with chronic gouty arthritis (cut-off value: 0.5 ng/mL), the sensitivity and specificity of PCT were 22.2% and 61.5%, respectively. The area under the curve (AUC) of serum PCT levels was 0.526. The AUCs of related inflammatory indicators were 0.530 for the ESR, 0.635 for CRP, 0.577 for the WBC count, and 0.712 for the neutrophil ratio.ConclusionSerum PCT levels may not be a good biomarker for bacterial infection in febrile patients with chronic gouty arthritis.

The role of heparin-binding protein, procalcitonin, C-reactive protein and white blood cell in respiratory tract bacterial infection

Objective To evaluate the diagnostic value of the heparin-binding protein (HBP), procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC) in respiratory tract bacterial infection. Methods 66 respiratory tract bacterial infection patients, 37 respiratory tract non-bacterial infection patients and 39 control group in the Third Xiangya Hospital from October 2015 to March 2017 was selected as objects in this prospective study. The levels of HBP, PCT and CRP in blood of the objects were tested with ELESA, immunofluorescence assay, immunoturbidimetry respectively; WBC counts were taken by Sysmex XE-5000 blood analyzer. The difference among the three groups was analyzed by Student′s t test, one-way ANOVA or Wilcoxon test. Receiver operating characteristic curve was utilized to analyze the diagnostic value of HBP, PCT, CRP and WBC in respiratory tract bacterial infection. Results The plasma level of HBP were 36.30 (7.78-89.36) ng/ml, 5.57 (4.37-8.23) ng/ml, 2.84 (1.53-6.51) ng/ml in respiratory tract bacterial infection group, respiratory tract non-bacterial infection group and control group respectively. The socre of PCT were 0.08 (0.04-0.83) ng/ml, 0.09 (0.04-0.30) ng/ml, 0.04 (0.03-0.08) ng/ml. The socre of CRP were 56.20 (19.33-76.23) mg/L, 34.40 (2.15-83.95) mg/L, (2.20±0.99) mg/L. The socre of WBC count were (10.59±4.58) ×109/L, 8.40 (5.80-11.88) ×109/L, (6.14±1.31) ×109/L. There were statistically significant differences in HBP scores between respiratory tract bacterial infection group and respiratory tract non-bacterial infection group or control group (Z=-4.828, P 0.05; F=0.100, P>0.05; F=2.417, P>0.05), but significant differences between respiratory tract bacterial infection group and control group (Z=-2.881, P<0.05; Z=-6.595, P<0.001; t=6.499, P<0.001). The area under curve (AUC) of HBP, PCT, CRP and WBC diagnosing respiratory tract bacterial infection was 0.89, 0.69, 0.95 and 0.85 respectively. The AUC of HBP differential diagnosising was 0.80. Conclusion HBP can be used as an efficient supplementary indicator for respiratory tract bacterial infection, the differential diagnostic value is superior to PCT, CRP and WBC.(Chin J Lab Med, 2017, 40: 711-715) Key words: Respiratory tract infections; Bacterial infections; Blood proteins; Carrier proteins; Antimicrobial cationic peptides; Calcitonin; C-reactive protein; Leukocyte count