PCT Levels Research Articles

SEPSIGN: early identification of sepsis signs in emergency department.

Because 20-30% of patients with sepsis deteriorate to critical illness, biomarkers that provide accurate early prognosis may identify which patients need more intensive treatment versus safe early discharge. The objective was to test the performance of sVEGFR2, suPAR and PCT, alone or combined with clinical signs and symptoms, for the prediction of clinical deterioration. This prospective observational study enrolled patients with suspected infection who met SIRS criteria without organ dysfunction (delta SOFA <2 from baseline) from 16 emergency departments. The primary endpoint was clinical deterioration (increased SOFA score ≥2 points, new or increased organ support, or death) within 72 hours of enrollment. Diagnosis and classification of infection status were adjudicated. 724 patients were enrolled, (54% men, median age 55 [38-70] y-o). Infection origin was abdominopelvic (21%), skin and soft tissues (17%), urinary (16%) and pulmonary (15%). 176 (24%) patients deteriorated, with a 28-day mortality of 1.4%. They had lower sVEGFR2 level (6.17 [5.00-7.40] vs 6.52 [5.40-7.84], p=0.024), higher circulating suPAR (5.25 [3.86-7.50] vs 4.18 [3.16-5.68], p<0.001) and higher PCT level (0.32 [0.08-1.80] vs 0.18 [0.05-0.98], p=0.004). suPAR demonstrated superior performance (AUC=0.65 [0.60-0.70]), compared to other biomarkers (PCT, AUC=0.57 [0.52-0.62] and sVEGFR2, AUC=0.58 [0.53-0.64]). Maximum accuracy was achieved from the combination of clinical information, sVEGFR2 and suPAR, yielding an AUC of 0.74 [0.69-0.78] and NPV 0.90 [0.88-0.94]. sVEGFR2 and suPAR were insufficiently accurate to rule out clinical deterioration. Panels of biomarkers will likely be needed to capture the heterogeneous mechanistic pathways involved in sepsis-related organ failure.

T-Cell Phenotypes and Systemic Cytokine Profiles of People Living with HIV Admitted to Hospital with COVID-19

Whether SARS-CoV-2 infection leads to a higher mortality and morbidity in people living with HIV (PLWH) in Africa remains inconclusive. In this study, we explored the differences in the T-cell phenotypes between people with and without HIV on the day of admission (V1) and ±7 days later (V2), as well as their cytokine/chemokine profiles on V1. Patients admitted with COVID-19 were recruited between May 2020 and December 2021 from the Steve Biko Academic and Tshwane District Hospitals in Pretoria, South Africa. Of 174 patients, 37 (21%) were PLWH. T-cell profiles were determined by flow cytometry, and cytokine levels were determined using a multiplex suspension bead array. PLWH were significantly younger than those without HIV, and were more likely to be female. In an adjusted analysis, PLWH had higher percentages of CD4+ central memory (CM) programmed cell death protein 1 (PD-1)+, CD8+ effector memory (EM)2, and CD8+ EM4 CD57+ cells, as well as higher concentrations of interleukin (IL)-35 at admission. PLWH with CD4+ T-cell counts of &gt;200 cells/mm3 had altered CD4+ and CD8+ T-cell profiles, lower levels of systemic inflammation measured by plasma ferritin and PCT levels, and less severe disease. PLWH with CD4+ T-cell counts of &lt;200 cells/mm3 on admission had higher concentrations of IL-6 and lower levels of IL-29. At V2, the percentages of CD4+ CM PD-1+ T-cells and CD8+ EM4 T-cells co-expressing CD57 and PD-1 remained higher in PLWH, while all other CD8+ EM populations were lower. Fewer CD8+ EM T-cells after ±7 days of admission may be indicative of mechanisms inhibiting EM T-cell survival, as indicated by the higher expression of IL-35 and the T-cell maturation arrest observed in PLWH. This profile was not observed in PLWH with severe immunodeficiency, highlighting the need for differentiated care in the broader PLWH population.

A-367 Development of a Multimodal Point-of-Care Diagnostic Platform to Perform Rapid, Accurate, and Cost-Effective Molecular, Immunochemistry, Clinical Chemistry, and Cytometry Tests

Abstract Background Access to point-of-care (POC) testing can make a significant impact on the quality of care. However, because POC diagnostic platforms available today are expensive and only perform one type of test, clinicians are unable to implement all the POC tests they wish to perform. Fluxergy is developing a multimodal POC diagnostic platform that consolidates diverse diagnostic modalities into a single, compact platform to minimize the cost of POC testing and standardize testing workflow for the most common clinical chemistry, hematology, immunochemistry and molecular tests. This study describes feasibility studies performed to benchmark these assay modalities on the Fluxergy Analyzer. Methods Fluxergy Analyzer: The Fluxergy Analyzer integrates conventional detection systems—colorimetric, fluorometric, and electrochemical—into a singular POC platform. This unique design expands -omics testing capabilities, including molecular, immunochemistry, clinical chemistry, and hematology within a single instrument. Benchmarking Feasibility Studies: Molecular benchmarking was performed using a multiplex respiratory panel on contrived samples in UTM/VTM. Immunochemistry benchmarking was performed using a procalcitonin assay on spiked sodium citrate plasma samples. Cytometry benchmarking was performed using a white blood cell count (WBC) assay and testing contrived samples whole blood samples. Results For molecular testing, the Fluxergy Analyzer was able to accurately detect flu A, flu B, SARS-CoV-2, and RSV with agreements with the Luminex ARIES® Flu A/B &amp; RSV Assay and Cepheid Xpert® SARS-CoV-2 test results. For immunochemistry testing, the Fluxergy Analyzer accurate quantified PCT levels at 0.3, 0.6, 1.25 and 2.5 ng/mL. For hematology testing, the Fluxergy Analyzer demonstrated a strong correlation across the reportable range against the standard of care HemoCue analyzer. For clinical chemistry testing, the Fluxergy Analyzer demonstrated a strong correlation against the Siemen’s epoc® Blood Analysis System. Conclusions The Fluxergy Analyzer is uniquely suited to offer a comprehensive menu of the most common POC tests on a single, cost-effective platform.

Three Artificial Liver Models of Treatment of Acute-on-Chronic Liver Failure.

This study aimed to investigate clinical efficacy, safety and short-term prognosis of plasma exchange (PE), plasma perfusion combining PE (PP+PE), dual-plasma molecular adsorption system combining PE (DPMAS+PE) in treating acute-on-chronic liver failure (ACLF). Two hundred and fourteen ACLF patients admitted to our hospital were included and divided into PE (n = 72), PP+PE (n = 75), DPMAS+PE group (n = 67). Laboratory indexes and MELD scores were collected, and clinical efficacy was compared. Patients' adverse reactions during and 24-h after treatment were collected, and safety was compared. Survival status of patients was followed-up within 90 days, and prognosis was analyzed. PE, PP+PE and DPMAS+PE significantly reduce TBiL, DBiL, ALT, AST, SA, PT, INR, PCT and CRP levels, and increase PA and PTA levels, compared with pre-treatments (P < 0.05). WBC and SCR levels in DPMAS+PE group decreased significantly post-treatment (P < 0.05). Na+ and Cl- levels in PE and PP+PE group decreased significantly post-treatment (P < 0.05). Total adverse reaction incidence in PE, PP+PE, DPMAS+PE group were 38.89%, 22.70%, 17.90%, respectively, with significant differences among three groups (P < 0.05). Ninety-day mortality rates of patients in PE, PP+PE, DPMAS+PE group were 41.67%, 34.67%, 20.90%, respectively, with significant differences among three groups (P < 0.05). PE, PP+PE and DPMAS+PE three artificial liver treatment modes can effectively improve liver, kidney and coagulation function of ACLF patients. DPMAS+PE demonstrated better ability to remove endotoxin and inflammatory mediators, showed advantages in reducing ACLF patient mortality within 90 days, and had the least impact on electrolyte post-treatment. Therefore, DPMAS+PE can be used as a better choice for clinical treatment.

IL-6 and procalcitonin levels in hemodialysis patients with fungal infection

Patients with end-stage renal failure suffer from a defect in the immune system and a weakening of cellular and humoral immune defenses and thus an increase in the incidence of fungal infections. The aim of study is to isolate and to identify fungi from urine samples of patients with kidney failure. A study of relationship between fungal infection and the changes occurring in some immune parameters including Interleukin-6, Procalcitonin, high sensitivity-CRP in hemodialysis patients with and without fungi and the control group was made. This study was conducted on 190 samples of renal failure patients undergoing dialysis in the hemodialysis unit at Kirkuk Teaching Hospital during the period from November 2022 to the end of March 2023. Statistical analysis for immunological parameters was conducted using the Statistical Package for Social Sciences (SPSS). The results of laboratory culture showed the isolation of 58 fungal isolates, with a rate of 79.6% for yeasts and 20.4% for molds. Among the diagnosed yeasts, five types of yeasts belonging to the Candida genus showed different colors when cultivated on the differential medium Chrom Candida Agar (CCA) included Candida tropicalis, C. glabrata, C. parapsilosis, C. krusei and C. albicans. Immunological parameters of IL-6, PCT and hs-CRP showed higher levels in patients compared to the control group. The results also recorded an increase in the serum level of IL-6 in those with yeasts than in those with mold. Furthermore, there was also a level of PCT and hs-CRP in mortality compared to survivors patients. The study showed prevalence of fungal infections among patients of renal failure and identification species of fungi . Study of the signification differences in immunological parameters, such as IL-6 and procalcitonin, provide valuable insights into the associations between fungal infections and immune responses in patients.

A host immune-related LncRNA and mRNA signature as a discriminant classifier for bacterial from non-bacterial sepsis in children

BackgroundThe variations in non-coding RNA alterations and the host immune response between patients with bacterial and non-bacterial sepsis, along with their clinical characteristics, are largely unknown. MethodsThe landscape of long non-coding RNA (lncRNA) and mRNA in whole blood cells from pediatric patients with bacterial sepsis or non-bacterial sepsis were characterized using an Arraystar human LncRNA microarray. Weighted correlation network analysis (WGCNA) were conducted to identify immune-related LncRNA-mRNA signatures. Least absolute shrinkage and selection operator (Lasso) regression and Ridge regression analysis were employed to develop a specific LncRNA-mRNA signature, serving as a discriminant classifier for bacterial and non-bacterial sepsis in children. ResultsA total of 33 differentially expressed lncRNAs and 52 mRNAs were identified in pediatric patients with either bacterial sepsis or non-bacterial sepsis. Among these, 69 lncRNAs and mRNAs were pinpointed using WGCNA and found to be significantly correlated with clinical parameters. Further intersection analysis identified 12 lncRNAs and 16 mRNAs as immune-related signature for discerning bacterial infections in children with sepsis. Additionaly, the lncRNA-mRNA co-expression network highlighted the key lncRNAs (AC090159.1 and AC080129.2) and mRNAs (S100A8 and TCF7L2) as an infection score model. Lasso regression analysis revealed that this infection score model achieved an area under the received operating curve (AUROC) of 0.96 in the training set and 0.86 in the validation set. Ultimately, the expression levels of these 4 key lncRNAs and mRNAs showed significant correlation with CRP or PCT levels. ConclusionThe machine learning model, developed utilizing key lncRNAs (AC090159.1 and AC080129.2) and mRNAs (S100A8 and TCF7L2), demonstrates robust discrimination and calibration capabilities for distinguishing between bacterial and non-bacterial sepsis in children.

Persistently high plasma procalcitonin levels despite successful treatment of tuberculous pleuritis and tuberculous lymphadenitis patients

In a prospective cohort study, we evaluated plasma PCT levels in 48 TB lymphadenitis (TBLN) and 41 TB pleuritis (TBPE) patients. Measurements of PCT were done in unstimulated plasma of microbiologically and clinically confirmed TBLN and TBPE patients registered for anti-TB treatment at a tertiary care hospital in Lahore, Pakistan. Plasma levels of PCT were found to be raised in 89% of the patients at baseline with a median of 1.5 ng/ml. Levels were higher (p = 0.001) in TBLN as compared to TBPE (2.69, 0.96 ng/ml). PCT levels were not related to the bacterial burden depicted by culture positivity in these patients. PCT showed a negative correlation with the severity of constitutional symptoms (rho = − 0.238, p = 0.034), and inflammatory biomarkers; ferritin (rho = − 0.43, p < 0.001), INF-γ (rho = − 0.314, p = 0.003), TNF-α (rho = − 0.220, p = 0.039), IL-6 (rho = − 0.224, p = 0.035), and several chemokines of CCL and CCXL group. Raised plasma levels of PCT did not decrease with anti-TB treatment, indicating it is not a good biomarker to monitor treatment response in TBLN and TBPE patients. More studies with a larger number of confirmed EPTB cases are needed to define the role of PCT and its interaction with other biomarkers in EPTB.

The Utility of C-Reactive Protein, Procalcitonin, and Leukocyte Values in Predicting the Prognosis of Patients with Pneumosepsis and Septic Shock

Background and Objectives: The predictive value of changes in C-reactive protein (CRP), procalcitonin, and leukocyte levels, which are commonly used in the diagnosis of infection in sepsis and septic shock, remains a topic of debate. The aim of this study was to evaluate the effectiveness of changes in CRP, procalcitonin, and leukocyte counts on the prognosis of 230 patients admitted to the intensive care unit (ICU) with the diagnosis of sepsis and pneumonia-related septic shock between 1 April 2022 and 31 December 2023, and to investigate whether any of these markers have a superior predictive value over the others in forecasting prognosis. Materials and Methods: This single-center, retrospective, cross-sectional observational study included patients who developed sepsis and septic shock due to community-acquired pneumonia and were admitted to the ICU. Demographic data, 1-month and 90-day mortality rates, length of stay in the ICU, discharge to the ward or an outside facility, need for dialysis after sepsis, need for invasive or noninvasive mechanical ventilation during the ICU stay and the duration of this support, whether patients admitted with sepsis or septic shock required inotropic agent support during their stay in the ICU and whether they received monotherapy or combination therapy with antibiotics during their admission to the ICU, the Comorbidity Index score (CCIS), CURB-65 score (confusion, uremia, respiratory rate, BP, age ≥ 65), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) score were analyzed. Additionally, CRP, procalcitonin, and leukocyte levels were recorded, and univariate and multivariate logistic regression analyses were performed to evaluate their effects on 1- and 3-month mortality outcomes. In all statistical analyses, a p-value of &lt;0.05 was accepted as a significant level. Results: According to multivariate logistic regression analysis, low BMI, male gender, and high CCIS, CURB-65, and APACHE-II scores were found to be significantly associated with both 1-month and 3-month mortality (p &lt; 0.05). Although there was no significant relationship between the first-day levels of leukocytes, CRP, and PCT and mortality, their levels on the third day were observed to be at their highest in both the 1-month and 3-month mortality cases (p &lt; 0.05). Additionally, a concurrent increase in any two or all three of CRP, PCT, and leukocyte values was found to be higher in patients with 3-month mortality compared with those who survived (p = 0.004). Conclusions: In patients with pneumoseptic or pneumonia-related septic shock, the persistent elevation and concurrent increase in PCT, CRP, and leukocyte values, along with male gender, advanced age, low BMI, and high CCIS, CURB-65, and APACHE-II scores, were found to be significantly associated with 3-month mortality.

The Effect of NPWT on Odontogenic Cervical Necrotizing Fasciitis.

To investigate the clinical efficacy of negative pressure wound therapy (NPWT) in the treatment of odontogenic cervical Necrotizing fasciitis (CNF). Sixteen cases of odontogenic cervical necrotizing fasciitis were randomly divided into observation group and control group after routine debridement and disinfection. The patients in the control group were treated with drainage tube and regular dressing changes, while those in the observation group were treated with NPWT. The therapeutic effects of the 2 groups were compared. The frequency of operation, treatment length, and cost of treatment in the observation group were significantly less than those in the control group (P<0.05). During the treatment, the VAS (visual analog scale of pain) in the observation group was significantly lower than that in the control group (P<0.05). The levels of WBC, CRP, PCT, IL-6, and TNF-α in the observation group were lower than those in the control group (P<0.05). The levels of Il-10 and VEGF in the observation group were higher than those in the control group (P<0.05), the difference was statistically significant. The condition of odontogenic cervical necrotizing fasciitis progresses rapidly. Compared with conventional drainage and dressing change, NPWT can control infection in a short time, reduce operation frequency and treatment cost, and promote wound healing, shorten the treatment time, ease the pain of patients, improve the quality of life. The therapeutic scheme is safe, effective, and suitable for clinical application.

Non-Conventional Prognostic Markers in Life-Threatening COVID-19 Cases-When Less Is More.

Background/Objectives: In this study, we aimed to compare the predictive power of non-conventional (neutrophil/lymphocyte ratio-NLR; platelet/lymphocyte ratio-PLR) and conventional markers (C-reactive protein-CRP; procalcitonin-PCT; interleukin-6-IL-6) in terms of disease progression and mortality in severe SARS-CoV-2 patients. Methods: In this prospective observatory study, blood samples were collected daily, focusing on the established inflammatory markers. Critically ill COVID-19 patients who required ICU admission were included. Patient treatment followed established COVID-19 protocols, and the data analysis was performed using SPSS with non-normal distribution methods. The study cohort primarily included patients infected with the delta variant. Results: A mortality rate of 76.6% was observed among 167 patients during the study period. Significant differences in conventional and non-conventional markers between survivor and non-survivor groups were observed. The PCT levels were significantly elevated (p < 0.005) in the deceased group. Among the non-conventional markers, the NLR was consistently higher in non-survivors and emerged as a significant predictor of mortality, whereas the PLR was not elevated among the non-survivors. ROC analyses indicated that PCT and the NLR were the markers with the highest predictive power for mortality. The multivariate logistic regression analysis identified NLR, PCT, CRP, and IL-6 as significant predictors of mortality across different days. The NLR showed a consistent, though not always statistically significant, association with increased mortality risk, particularly on Days 2 and 5. Conclusions: The NLR's accessibility and simplicity of determination make it a valuable and practical tool for monitoring inflammatory processes in viral infections. Our findings suggest that incorporating NLR analysis into routine clinical practice could enhance the early identification of high-risk patients, thereby improving patient management and outcomes.

Evaluation of Relationship Between C-Reactive Protein, Leukocyte Count and Platelet Indices in Dogs with Leukocytosis

A complete blood count and acute-phase protein analyses are the laboratory tests that are used in veterinary medicine practice. Leukocytes, also known as white blood cells (WBCs), are the primary biological components of inflammatory and immunological responses. C-reactive protein (CRP) is a powerful predictor of inflammation and/or infection in veterinary medicine. Starting at that point, the investigation of the alterations and relationship between WBC count, platelet indices, and blood serum CRP levels in dogs with leukocytosis was the aim of this study. A total of 135 bloodwork records, from January 2018 to December 2022, of dogs were analyzed. The inflammatory panel of complete blood count data, including WBC, PLT, MPV, PDW, PCT, and MPV/PLT, and CRP levels in blood serum chemistry analyses were investigated. The inflammatory panel of complete blood count data was categorized according to CRP levels in blood serum chemistry analyses. There was no significant difference in platelet indices according to the blood serum levels of CRP in the dogs’ bloodwork records. The WBC count in dogs with an equal or above 10 mg/dL CRP level was significantly higher than the other levels of CRP. A moderately positive correlation was detected between CRP and WBC in the bloodwork of all dogs, undivided according to inflammatory status, and of dogs with an inflammatory status. Consequently, in veterinary clinical practice, C-reactive protein measures in dogs may be more applicable in cases where an important rise in WBC over the cut-off value is observed in the complete blood count, commonly used to diagnose inflammatory or infectious status.

C-reactive protein compared to procalcitonin in guiding of anti-microbial stoppage in patients with septic shock

BackgroundOne of the greatest and most effective strategies to decrease the likelihood of discovering antibiotic-resistant bacteria in patients receiving critical care is to shorten the duration of antibiotic therapy.ObjectivesTo assess the utility of procalcitonin compared to traditional inflammation markers like C-reactive protein in an antimicrobial stoppage in patients with septic shock.MethodsThis was a comparative, prospective, randomized, observer-blind clinical experiment conducted on 60 septic patients hospitalized in intensive care units at Benha University hospitals between May 2021 and May 2022. Groups for PCT and CRP patients were separated. The full clinical history, co-morbidities that were related, and patient history were recorded. The baseline PCT and CRP values were determined on days 4, 7, 10, and 14. They were contrasted with sepsis ratings obtained from the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sepsis-related Organ Failure Assessment (SOFA). Days 4, 7, and 10 were used to evaluate the antibiotic's efficacy.ResultsThere was no correlation between CRP levels and APACHE II and SOFA scores on days 1, 4, and 7, but on days 7 and 10, PCT levels were strongly linked with both (P < 0.05). PCT was linked to lower antibacterial exposure (23.3% of PCT participants ceased taking antibiotics on day 4, compared to 6.6% of CRP participants; P = 0.07). After 10 days, 30% of the PCT group and 70% of the CRP group kept up their antimicrobial regimen (P = 0.0001).ConclusionProcalcitonin dramatically reduced the duration of antimicrobial treatment. Procalcitonin use has reduced hospital expenses, complications of extended hospital stay, side effects of excessive antibiotic use, and hence, the mortality rate in septic patients.

Surge in Mycoplasma Pneumoniae infection and Respiratory Viruses Co-infection in Children With Community-Acquired Pneumonia in the Post-Pandemic.

During the COVID-19 pandemic, multifaceted non-pharmaceutical interventions have not only reduced the transmission of SARS-CoV2 but also affected the prevalence of other respiratory pathogens. With the lifting of many restrictions, a surge in cases of pneumonia in children has been reported in many hospitals in China. The study assessed the changes in pathogen and symptoms of children with community-acquired pneumonia (CAP) before and after the adjustments of prevention and control measures of epidemic and provided recommendations for CAP in children. Children diagnosed with CAP were enrolled in the study from 2022 to 2023. A cross-sectional retrospective study was conducted in a general hospital. We analyzed the data about demographic data, clinical symptoms, pathogens, and medical treatments. The Chi-square and Mann-Whitney U-test were used to assess the statistical significance of groups. We studied 1103 children, 339 in 2022 and 764 in 2023. Compared with children in 2022, more children were diagnosed with CAP in 2023 and these children had a higher body temperature and levels of CRP and PCT, which indicated these children got severe inflammation. The positive rate of the pathogen was also higher in 2023, especially the detective rate of Mycoplasma pneumoniae. The number of children infected with more than two pathogens was higher in 2023, especially those co-infected with the virus and M. Pneumoniae. Concerning the medicine therapy, the usage of β-lactam antibiotics, Macrolide antibiotics, and antiviral drugs kept rapid growth. After the adjustment of epidemic prevention and control policies in 2023, more children got CAP with severe clinical symptoms, and more antibiotics and antiviral drugs were used. Further study is needed to explore the reasons for the increase in children with CAP and to explore the rationality of treatment.

Assessing the impact of HBB gene polymorphisms on the risk of beta thalassemia in the population of Diyala Governorate, Iraq

Objective The current research aims to investigate the genetic polymorphisms of the HBB gene and their relationship to the incidence of beta-thalassemia. Methods The study included 30 patients with beta-thalassemia major. Samples were collected during the period between August 2023 and February 2024. Their ages ranged from 2–31 years, in addition to 30 healthy people who did not suffer from hereditary blood diseases as a control group. Their ages ranged from 1–35 years. The exon region of the HBB gene was sequenced using nucleotide sequencing in order to identify the kind and location of mutations that alter the amino acid sequence that makes up the hemoglobin protein. Results The results of DNA sequencing of the exon region of the HBB gene, which consists of 382 base pairs, showed the presence of the rs713040 variant. This variant revealed that the GG genotype and the G allele, and the AA genotype and the A allele, were more frequent in the patient group compared to the healthy group and may be associated with risk. When comparing some physiological variables with the genotypes of the HBB gene between the group of patients and healthy controls at the rs713040 variant site, the results showed that there were significant differences (P&lt;0.001, P&lt;0.05) in the levels of WBC, HB, PLT, PCT, ALP, and Vitamin D in the three genotypes of the variant GG, GA, and AA. Conclusion The findings suggest that the rs713040 variant of the HBB gene may be associated with an increased risk of beta-thalassemia and that there are significant physiological differences between the genotypes of this variant in patients and healthy controls. Further research is needed to understand the underlying mechanisms and the potential clinical implications of these genetic differences.

PIMS-TS Complicating SARS-CoV-2 Infection: A Report of 10 Pediatric Cases

SARS-CoV-2, or COVID-19, is a betacoronavirus identified by the WHO as the cause of the 2020 pandemic. Unlike most respiratory virus, children exhibit lower susceptibility to COVID-19 and generally develop milder disease courses, with reduced mortality rates. Recently, there have been reports of clustered cases characterized by shock states associated with elevated cardiac biomarkers and vasoplegia, necessitating treatment with inotropes, vasopressors, and fluid resuscitation. This clinical presentation has been linked to the emergence of Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), also known as Kawasaki-like syndrome. This study is a retrospective analysis of 10 pediatric patients diagnosed with PIMS-TS secondary to COVID-19 infection, who were admitted to Mohammed VI International University Hospital in Casablanca, Morocco, from January 2021 to October 2023. The cohort&amp;apos;s ages ranged from 2 to 13 years, with a mean age of 6 years, and demonstrated a male predominance (sex ratio 9M:1F). Clinical manifestations included prolonged fever, gastrointestinal disturbances, rash, conjunctivitis, and cheilitis. Laboratory findings revealed elevated levels of CRP, PCT, and ferritin, indicative of an atypical Kawasaki syndrome. These patients responded to intravenous immunoglobulin therapy, with adjunctive corticosteroids administered as needed. All patients experienced favorable outcomes, with resolution of systemic involvement and normalization of inflammatory markers, and no relapses or fatalities were recorded. The risk factors for PIMS-TS complicating COVID-19 infection remain unclear. However, there are noted parallels between PIMS-TS and Kawasaki syndrome diagnostic criteria, suggesting possible pathophysiological overlap. In conclusion, a novel multisystem inflammatory syndrome associated with COVID-19 infection, resembling Kawasaki syndrome, has been identified in pediatric patients. This emerging syndrome enhances our understanding of the complex pathophysiology associated with COVID-19 and underscores the need for continued research into its etiology and optimal management strategies.

Clinical value of prokineticin 2 in the diagnosis of neonatal necrotizing enterocolitis

Background Necrotizing enterocolitis (NEC) is an inflammatory and necrotizing intestinal emergency that occurs in preterm infants and low birth weight newborns; however, no specific serum biomarkers for the diagnosis of NEC has been identified so far. Methods Serum samples were collected from healthy neonatal controls and patients with NEC newly admitted to the Children’s Hospital of Chongqing Medical University. ELISA was used to measure serum PK2 levels, and ROC curve analysis was sued to evaluate the diagnostic efficacy of PK2 and other clinical biomarkers. Results Serum PK2 levels in the NEC group (n = 53) were significantly lower than those in the control group (n = 18), but increased to near-normal levels after the postoperative recovery period. The NLR value of NEC group was higher than that of control group (P < 0.05). There was no significant difference in WBC and PLT count between NEC group and control group (P > 0.05). Serum CRP and PCT levels in NEC group were significantly higher than those in control group (P < 0.001 for CRP and P < 0.05 for PCT, respectively). After surgery, serum CRP, NLR and PCT levels were lower than before surgery, while serum PK2 levels were higher than before surgery (P < 0.05). The areas under the ROC curve (AUC) of PK2, PCT and CRP for the diagnosis of NEC were 0.837, 0.662 and 0.552, respectively. The AUC of PK2 combined with PCT, PK2 combined with CRP, and PK2 combined with PCT and CRP were 0.908, 0.854 and 0.981, respectively. PK2 exhibited the highest diagnostic efficacy for NEC. Conclusion PK2 has higher diagnostic efficacy than PCT and CRP in the diagnosis of NEC; the combination of PK2 and PCT or CRP can significantly improve its diagnostic efficiency, especially when the three are combined at the same time.

Evaluation of immune and pyroptosis status in a model of sepsis-induced secondary pneumonia

In recent years, researchers have focused on studying the mechanism of sepsis-induced immunosuppression, but there is still a lack of suitable animal models that accurately reflect the process of sepsis-induced immunosuppression. The aim of this study was to evaluate the immune status at various stages in a model of sepsis-induced secondary pneumonia and to demonstrate whether pyroptosis is one of the modes of immune cell death in sepsis. Firstly, we established a sepsis model in C57BL/6J mice using cecal ligation and puncture (CLP). The surviving mice were treated with a 40 μL suspension of P.aeruginosa (Pa) under anesthesia on day 4 post-CLP to establish a sepsis-induced secondary pneumonia model. Secondly, routine blood tests, serum ALT and PCT levels, gross lung specimens, and H&E staining of the lung and liver tissues were used to assess the successful establishment of this model. Serum levels of TNF-α and IL-6, the CD4+/CD8+ratio in blood, H&E staining of the spleen, and immunohistochemistry of CD4 and CD8 in the spleen were detected to evaluate the immune status of the model mice. Finally, the expression levels of pyroptosis-related proteins in the spleen were detected by Western blot. The expression of GSDMD was assessed using immunohistochemistry, and pyroptosis was directly observed through transmission electron microscopy. The experimental results above confirmed the successful construction of the model for sepsis-induced secondary pneumonia, demonstrating its ability to reflect sepsis-induced immunosuppression. Moreover, the expression of pyroptosis-related proteins, immunohistochemical GSDMD, and transmission electron microscopy of the spleen showed that pyroptosis was one of the modes of immune cell death in sepsis.

The performance of various serum parameters in blood during the first trimester in the early detection of pre-eclampsia

Aims: The aim of this study is to examine the alterations in various serum parameters within the circulatory system throughout the first trimester and assess their efficacy in identifying pre-eclampsia at an early stage. Methods: This retrospective analysis undertook an examination of the medical records pertaining to 225 pregnancies that met the eligibility criteria at a tertiary referral center, spanning the years 2018 to 2021. Furthermore, an examination of laboratory parameters during the first trimester was performed, which included neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index, systemic inflammation response index, pan-immune inflammation value, AST-to-platelet ratio index, delta neutrophil index, and prognostic nutritional index (PNI). A receiver operating characteristic curve analysis was performed to determine the optimal cut-off values for inflammatory and nutritional biomarkers to predict early- onset pre-eclampsia. Results: The group of individuals with early-onset pre-eclampsia displayed notably elevated levels of neutrophil, lymphocyte, PCT, MPV, ALT, and creatinine, while displaying significantly reduced levels of albumin, bilirubin, PLR, MLR, and PNI (p

The performance of a combination of heparin-binding protein with other biomarkers for sepsis diagnosis: an observational cohort study

BackgroundHBP, a novel biomarker released from neutrophils, may induce inflammatory responses and exacerbate vascular permeability, representing the pathophysiological characteristics of sepsis and septic shock. However, it remains uncertain whether the combination of HBP with other biomarkers yields enhanced diagnostic capacity for sepsis. We hypothesized that measurements included IL-6·IL-8·HBP, IL-6·IL-8·HBP/ALB and HBP/ALB which based on HBP will improve its diagnostic efficacy and even better than the traditional infection biomarkers.MethodsBetween July 2021 and June 2022, we carried out a comprehensive, multi-center, observational cohort study spanning six leading tertiary hospitals located in Heilongjiang Province, China. Patients were stratified into three categories based on the severity of infection: non-sepsis, sepsis, and septic shock. We collected clinical and laboratory data, along with infection and inflammation biomarkers, for analysis.ResultsA total of 195 patients were enrolled. Among the three groups, patients with septic shock (n = 75, 38.5%) had significantly higher baseline levels of HBP, WBC, Lac, CRP, PCT, IL-6, IL-8, and IL-10 compared to non-sepsis patients (n = 43, 22.0%) and sepsis patients (n = 77, 39.5%), with statistically significant differences (p < 0.05) observed for all parameters. When compared to SOFA score and traditional markers of CRP, PCT, IL-6 and IL-8, the combined indexes of IL-6·IL-8·HBP and IL-6·IL-8·HBP/ALB demonstrated significantly improved diagnostic performance for sepsis and septic shock (AUC 0.911 and 0.902 respectively, p < 0.001).ConclusionsThe combined measurements of IL-6·IL-8·HBP and IL-6·IL-8·HBP/ALB can augment the diagnostic capacity of HBP for sepsis, and offer reliable early supplementary indicators to traditional biomarkers for assessing disease severity in patients with infection.

Effect of Fu Zheng Jie Du Formula on outcomes in patients with severe pneumonia receiving prone ventilation: a retrospective cohort study.

The effect of combining prone ventilation with traditional Chinese medicine on severe pneumonia remains unclear. To evaluate the effect of Fu Zheng Jie Du Formula (FZJDF) combined with prone ventilation on clinical outcomes in patients with severe pneumonia. This single-center retrospective cohort study included 188 severe pneumonia patients admitted to the ICU from January 2022 to December 2023. Patients were divided into an FZJD group (receiving FZJDF for 7 days plus prone ventilation) and a non-FZJD group (prone ventilation only). Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was the change in PaO2/FiO2 ratio after treatment. Secondary outcomes included 28-day mortality, duration of mechanical ventilation, length of ICU stay, PaCO2, lactic acid levels, APACHE II score, SOFA score, Chinese Medicine Score, inflammatory markers, and time to symptom resolution. After PSM, 32 patients were included in each group. Compared to the non-FZJD group, the FZJD group showed significantly higher PaO2/FiO2 ratios, lower PaCO2, and lower lactic acid levels after treatment (p < 0.05 for all). The FZJD group also had significantly lower APACHE II scores, SOFA scores, Chinese Medicine Scores, and levels of WBC, PCT, hs-CRP, and IL-6 (p < 0.05 for all). Time to symptom resolution, including duration of mechanical ventilation, length of ICU stay, time to fever resolution, time to cough resolution, and time to resolution of pulmonary rales, was significantly shorter in the FZJD group (p < 0.05 for all). There was no significant difference in 28-day mortality between the two groups. FZJDF as an adjuvant therapy to prone ventilation can improve oxygenation and other clinical outcomes in severe pneumonia patients. Prospective studies are warranted to validate these findings.