PCT Levels Research Articles

Inflammatory Markers upon Admission as Predictors of Outcome in COVID-19 Patients

Background: Coronavirus disease 2019 (COVID-19) may cause dysregulation of the immune system, leading to hyperinflammation. Inflammatory markers can be used to predict in-hospital mortality in COVID-19 patients. This research was aimed to investigate the association between the levels of various inflammatory markers and mortality in COVID-19 patients.Methods: This study was conducted at Persahabatan National Respiratory Referral Hospital, Indonesia. Blood tests were performed upon admission, measuring the C-reactive protein, PCT, leukocyte, differential counts, and platelet count. The outcome measured was the mortality of hospitalized COVID-19 patients. Statistical analysis methods included the Mann–Whitney U test, receiver operating characteristic (ROC) analysis, and area under the curve (AUC) test.Results: Total 110 patients were included, and the laboratory values were analyzed to compare survivors and non-survivors. The non-survivor group had significantly higher leukocyte count, lower lymphocyte count, higher CRP and PCT levels, higher neutrophil-to-lymphocyte ratio (NLR), higher platelet-to-lymphocyte ratio (PLR), and lower lymphocyte-to-CRP ratio. As predictors of mortality, AUC analysis revealed that PCT, CRP, NLR, and PLR had AUCs of 0.867, 0.82, 0.791, and 0.746, respectively.Conclusions: Routine and affordable inflammatory markers tested on admission may be useful as predictors of in-hospital mortality in COVID-19 patients requiring hospitalization.

Results of the use of selective adsorption of endotoxin in the complex treatment of surgical sepsis and septic shock.

Objective. To estimate the results of the use of LPS-adsorption in the complex treatment of surgical or obstetric sepsis and septic shock and to determine the risk factors for the development of lethal outcomes.
 Materials and methods. Since 2014, twenty-nine patients with surgical or obstetric sepsis and septic shock have been treated at the Perm Regional Clinical Hospital using selective endotoxin adsorption in addition to conventional medical therapy. Endotoxin elimination was performed using hemoperfusion with the Alteco LPS Adsorber (Sweden). The patients were divided into two groups according to the final results of the treatment. The data of clinical and laboratory examinations were compared before and 24 hours after LPS elimination.
 Results. Based on the correlation analysis, the most significant risk factors for the development of fatal outcomes are identified. It was found that neither the initial scores on the APACHE, SOFA scale, nor the level of CRP, PCT, EAA have a significant correlation with the lethal outcome. The only indicator before LPS-adsorption that has a direct correlation of the average value with the fatal outcome is the initial dose of norepinephrine. In our study, the mortality rate depends on the decrease in SOFA scores and its components in 24 hours after the procedure. Patients with the lower score after LPS-adsorption would have lower mortality. The predictors of ineffectiveness of treatment, despite the LPS-adsorption, were an unreliable decrease in the dose of vasopressors and the level of PCT, light improvements in the oxygenation index, the presence of bacteremia, septic shock and the delayed procedure.
 Conclusion. In surviving patients with surgical sepsis and septic shock, the use of LPS-adsorption in complex treatment significantly improved the function of the cardiovascular and respiratory systems, reduced the level of PCT. The risk factors for the development of lethal outcomes were the initial severity of cardiovascular insufficiency, the selective sorption of endotoxin with a delay, the presence of bacteremia, septic shock, insignificant decrease in SOFA scores and the level of PCT after selective sorption of endotoxin.

Clinical study of serum procalcitonin in the early diagnosis of burns and sepsis under the background of healthy clouds

Abstract‘Health Cloud’ refers to the provision of hospital management and residents' health file management application services to all hospitals and related medical institutions in the area where the cloud computing industry base is located in the form of SaaS (software as a service). In the process of treating burn sepsis, it is particularly important to prevent burn sepsis. The purpose of this study is to diagnose burn sepsis early, after adding serum procalcitonin clinical research. First, use PCT during the experiment to observe the efficacy of antibiotics according to the situation and prognosis. In order to reduce the inappropriate use of antibiotics, it can be used as a reliable indicator to guide antibiotic management and allow patients with sepsis to receive accurate treatment. Second, according to the main observation indicators of burn sepsis, analyse the degree of injury of the patient. Finally, identifying burn sepsis as early as possible, and early intervention and prevention based on related technologies is a problem that needs to be solved by the research institute. The clinical symptoms and vital signs of burn sepsis are not particularly abnormal, and imaging examination may cause the focus of infection to be incorrect. As a result, the positive rate of positive results is low, which seriously affects the timely diagnosis and treatment of patients. Experimental data show that serum PCT of non‐septic patients is obvious during the six groups of experiments 1–5 days, 6–10 days, 11–15 days, 16–20 days, 21–25 days, 26–30 days after treatment serum PCT levels below sepsis. The data recorded during the experiment are in accordance with the relevant principles of statistics to ensure that the experiment is true and effective. The experimental results show that the PCT of burn sepsis group is higher than that of the cured group without burns, and the serum PCT level is crucial for the diagnosis of burn sepsis.

Intervention Effect of Probiotics in Gastric Cancer Patients with Complications of Coronary Heart Disease and Heart Failure.

Objective To investigate the characteristics of intestinal flora in patients with gastric cancer complicated by coronary heart disease and heart failure and the guiding value of probiotics intervention for clinical treatment. Methods (1) One hundred and sixty-eight gastric cancer patients with complications of coronary heart disease and heart failure from August 2017 to December 2020 were selected as the observation group. A total of 125 patients with coronary heart disease treated at the same time were selected as control group 1, and 89 healthy subjects were selected as control group 2. Fecal samples were retained to extract the total RNA, and high-throughput sequencing was applied to complete the analysis of microbial diversity and structure differences, so as to obtain the biological species information of the specimens. (2) Patients in the observation group were randomly divided into two equal groups of 84 patients, namely, group A and group B. Group A was treated with conventional methods, and group B was combined with probiotics intervention on the basis of group A; then, the differences in the intestinal mucosal barrier between the two groups were compared. Results The Chao, ACE, and Simpson index in the observation group were lower than those in control group 1 (P < 0.05), and the Shannon index was higher than that in control group 1 (P < 0.05). The Chao, ACE, and Shannon index in control group 1 were lower than those in control group 2 (P < 0.05), whereas the Simpson index was higher than in control group 2 (P < 0.05). The abundance of Bacteroidetes in the observation group was lower than that in control group 1 and control group 2 (P < 0.05). The abundance of Firmicutes was higher than that of control group 1 and control group 2 (P < 0.05). Four weeks after treatment, the levels of ET, D-lactic acid, and PCT in the group B were (0.10 ± 0.01), (3.99 ± 0.32), and (0.41 ± 0.10), respectively, which were lower than those in group A (0.19 ± 0.03), (4.51 ± 0.46), and (0.81 0.13). Conclusion Gastric cancer patients with complications of coronary heart disease and heart failure are associated with intestinal flora disorder, which may be involved in the occurrence and development of the disease. Probiotics intervention is helpful to repair the intestinal mucosal barrier in patients, which is worthy of popularization and application.

Effect of Paroxetine Combined with Probiotics in Patients with Type 2 Diabetes Mellitus Complicated with Gastrointestinal Dysfunction and Liver Cancer.

Background To explore the effect of paroxetine combined with probiotics in patients with type 2 diabetes mellitus with gastrointestinal dysfunction and liver cancer and its effect on nutritional status. Materials and Methods 96 patients with type 2 diabetes mellitus combined with gastrointestinal dysfunction and liver cancer were selected as subjects from March 2018 to March 2021. They were randomly divided into control group and observation group, with 48 cases in each group. The control group was treated with probiotics, and the observation group was combined with paroxetine on the basis of the control group. After 4 weeks of treatment, the gastrointestinal mucosal function, nutritional status, Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) score, and the safety were compared between the two groups. Results The levels of D-lactic acid, PCT, and endotoxin in the observation group were (1.75 ± 0.38), (4.39 ± 0.79), and (0.20 ± 0.06), respectively, which were significantly lower than those in the control group (2.69 ± 0.46), (7.84 ± 1.32), and (0.29 ± 0.08) (P < 0.05). Moreover, the nutritional status TP, ALB, Hb, PA, and TLC levels of the observation group were higher than those of the control group (P < 0.05). The HAMA and HAMD scores in the observation group were (5.76 ± 1.06) and (8.94 ± 1.26), respectively, which were significantly lower than those in the control group (10.69 ± 2.21) and (13.42 ± 2.34) (P < 0.05). However, there was no statistical significance in the incidence of nausea and vomiting, blurred vision, chest arthralgia, palpitation, anaesthesia, dizziness, and drowsiness between the two groups (P > 0.05). Conclusions Paroxetine combined with probiotics could help to improve the gastrointestinal mucosal function of patients with type 2 diabetes mellitus complicated with gastrointestinal dysfunction and liver cancer, improve the nutritional status of patients, and reduce anxiety and depression, and the drug was safe and worthy of promotion and application.

The Liver Injury and Coagulation Dysfunction in the Patients with Severe/Critical COVID-19

The clinical data of 53 COVID-19 patients were collected from a single center in Wuhan from February 8, 2020 to March 25, 2020. The patients were divided into severe type group (38 patients) and critical type group (15 patients). The clinical characteristics, indexes of liver function, coagulation function and inflammatory markers were analyzed retrospectively. According to the degree of abnormal liver function in the process of diagnosis and treatment, the patients were divided into three groups: combined liver injury, mild abnormal liver function and normal liver function group. Statistical analysis was performed by using Student t test, Mann-Whitney U test, Kruskal-Wallis test and Chi-square test. Among the 53 patients, 29 were male (54.7%) and 24 were female (45.3%), the median age was 57(27－80) years old. The time from onset to admission was (11.5±7.7) days. The levels of AST, TBIL, DBIL, ALP, GGT, LDH, D-dimer, PCT and hsCRP in critical patients were higher than those in severe patients (P<0.05). The levels of Alb in critical patients was lower than those in severe patients (P<0.05). Among the 53 patients, 34 (64%) patients showed abnormal elevation of ALT, AST or TBIL, while 4 (7.5%) patients showed the criteria of COVID-19 with liver injury. After the patients were grouping according to the degree of liver dysfunction, the levels of ALP, GGT and D-dimer of the patients in the liver injury group were significantly higher than those in the normal liver function group, D-dimer levels of the patients in the liver injury group was significantly higher than those in the mild abnormal liver function group, while the levels of ALP and GGT in the mild abnormal liver function group were significantly higher than those in the normal liver function group, and the differences were statistically significant(P<0.05). In this group, the patients with COVID-19 severe/critical type have a certain proportion of liver injury accompanied by significantly increased D-dimer levels, critical type patients have more severe liver function and coagulation dysfunction, which may promote the progression of COVID-19.

Evaluation of the Level of Vitamin D and Angiopoetic Factors in Preeclampsia

Objective: Preeclampsia (PE), a pregnancy complication whose pathogenesis is still not fully clarified. Studies in the literature evaluating vitamin D deficiency more frequently in women with PE have conflicting results. Considering these contradictions, we aimed to evaluate the level and predictable potential of Vitamin D and angiogenic factors causing many disorders in maternal deficiency/insufficiency in women with PE.&#x0D; Materials and Methods: Thirty-one (31) women diagnosed with PE and thirty-two (32) healthy pregnant women were included in this study. Vitamin D levels were measured by the chemiluminescence immunoassay (CLIA) TNF-α and PLGF levels by ELISA and PCT levels by electrochemiluminescence assay (ECLIA) method. ROC curves were created to determine the role of biochemical parameters in the prediction of PE.&#x0D; Results: Vitamin D and PLGF levels were found lower and TNF-α and PCT levels were found higher in the PE group compared to the control group. The area under the ROC was 0.814, 0.7681, 0.8201, 0.9251 for gestational week (GW), Vitamin D, TNF-α and PLGF, respectively.&#x0D; Conclusion: Vitamin D, TNF-a, PLGF values are consistent with the literature and they could be important markers in the prediction of PE. Our data revealed that these markers, which are already routinely analyzed, do not require an additional cost and time. Thereby, women with PE could be identified and followed up closely

Analysis of Risk Factors of Intracranial Infection After Traumatic Brain Injury Surgery

Background: Craniocerebral operation is the main method for the treatment of traumatic brain injury. However, it is very easy to be complicated with intracranial infection after operation, which affects the surgical efficacy and patient’s prognosis. It is also the main cause of surgical failure. It may also cause patient’s death for some patients with serious diseases. It is found that the infection after craniocerebral operation is often accompanied with abnormal changes of body-related treatment, in which the changes of serological indicators are more significant. Therefore, it is helpful to provide guidance for the prevention and judgment of patient’s postoperative infection by analyzing the patient’s serological indicators. Objective: To investigate the risk factors of intracranial infection and the levels of serum procalcitonin (PCT) and endothelin-1 (ET-1) in patients after traumatic brain injury. Methods: From January 2018 to January 2021, 58 patients with intracranial infection after traumatic brain injury (infection group) were selected, and 116 patients without intracranial infection after traumatic brain injury (non-infection group) were selected. The difference of clinical data between the two groups was analyzed. Serum PCT and ET-1 levels were measured in the two groups. Results: In the infection group, admission GCS scoring &lt;8 points, operation time ≥4h, indwelling time of drainage tube ≥ 2d, preoperative ALB &lt;35g/ L, mechanical ventilation and cerebrospinal fluid leakage were 63.79%, 72.41%, 43.10%, 68.97%, 32.76% and 68.97% respectively, which were obviously higher than those in the non-infection group (P&lt;0.05). Logistic regression analysis results showed that admission GCS scoring, operation time, indwelling time of drainage tube, preoperative ALB, mechanical ventilation and cerebrospinal fluid leakage were the influencing factors of intracranial infection after traumatic brain injury (OR = 0.712,1.556,1.451,0.641,1.954 and 1.667, P&lt;0.05); serum PCT and ET-1 in the infection group were (0.83 ± 0.20) mg/L and (0.87 ± 0.23) ng/L, respectively, which were significantly higher than those in the non-infection group (P&lt;0.05); serum PCT and ET-1 in patients with different sex, age and pathogen had no significant difference (P&gt;0.05); serum PCT and ET-1 area under ROC curve were 0.828 and 0.751, respectively P&lt;0.05. Conclusion: The intracranial infection of patients with traumatic brain injury are affected by many factors including, admission GCS scoring, operation time, and so on, the levels of serum PCT and ET-1 in patients with intracranial infection are increased, which may be useful in predicting intracranial infection.

Clinical Significance of Serum HMGB1 In COPD and Correlation with Severity of Airflow Restriction and Immune Function

BACKGROUND: We aimed to explore the serum HMGB1 levels in patients with smoking-induced chronic obstructive pulmonary disease (COPD) and the correlations with airflow restriction and immune function. METHODS: A total of 136 COPD patients were divided into mild, moderate and severe + extremely severe groups. Thirty-five healthy subjects were selected as control group. Serum HMGB1 levels were measured by ELISA, and the correlations with pulmonary and immune function indices were analyzed. Receiver operating characteristic (ROC) curve was plotted. RESULTS: Pa02, eosinophil count, FEV1/FVC, FEV1% pred, and IgA, IgM, IgG levels of COPD patients were lower than those of control group, and decreased with airflow restriction aggravation. PaC02, leukocyte count, neutrophil percentage, modified British Medical Research Council (mMRC) scale and COPD Assessment Test (CAT) scores, D-Dimer (D-D), PCT, CRP and HMGB1 levels, myeloid dendritic cell (mDC) and plasmacytoid dendritic cell (pDC) counts, and mDCs/pDCs of COPD patients exceeded those of control group, and increased with airflow restriction aggravation (P&lt;0.05). HMGB1 levels of COPD patients were negatively correlated with FEV1/FVC, FEV1% pred, IgA, IgM and IgG levels, and positively correlated with mDC count, pDC count and mDCs/pDCs (P&lt;0.0001). The area under ROC curve was 0.883, the optimal cutoff value was 3.63 ng/mL, and sensitivity and specify were 86.7% and 85.9%, respectively. CONCLUSIONS: Serum HMGB1 level in patients with smoking-induced COPD rises with airflow restriction aggravation and has significant correlations with the decline of pulmonary and immune functions, with high predictive value for COPD. HMGB1 is a potential biomarker for evaluating COPD progression.

The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU.

Background: Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0–29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). Conclusions: Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient’s age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.

Mortality Rate of Sepsis Patients in the Intensive Care Unit: The Prognostic Role of Ejection Fraction and Procalcitonin.

Dear EditorSepsis is the second leading cause of death in the intensive care unit (ICU) and is one of the important causes of death for all hospitalized patients [1]. Evidence revealed procalcitonin as the critical risk factor for determining the prognosis of septic patients [2,3].Also, new studies indicated that diastolic dysfunction and low ejection fraction (EF) were identified as risk factors for death in septic patients [4]. Indeed, septic patients with lower EF had higher mortality rates than other septic patients [5]. Hence, in the pilot study, we determine the mortality rate of hospitalized patients in our clinic during 2020. Besides, EF was evaluated via echocardiography, and also serum PCT was measured on the first day of admission to ICU. Our results indicate that 35 % and 65 % of patients were expired and discharged, respectively. The association between EF and mortality is shown in Figure-1. There were no significant differences between EF and mortally among studied patients (P=0.79). The mean PCT in expired patients was 7.67 ±5.52 ng/ml, while in the discharged patients was 4.21±3.1 ng/ml. On the other hand, although the mean PCT level in the expired patients was higher than those discharged, this difference was not significant. Our study revealed that although PCT and EF statistically were not different in expired patients compared to those discharged, both PCT and EF could be considered important prognostic factors for mortality among sepsis patients in the ICU. However, more studies with larger sample sizes and more parameters for the determination of EF and PCT are recommended.

Analysis of procalcitonin and urine nitrite to predictor sepsis patients

Background: Sepsis is a significant health problem worldwide. Various sepsis biomarkers have been studied before, but few data link PCT and urinary nitrite levels to culture result in septic patients.Purposes: This study compares PCT, Urine Nitrite on culture results against their sensitivity to determine variables that can be used to predict sepsis patients.Methods: This is a cross-sectional study by taking data on patients with sepsis aged ≥18 years in 207. Diagnostic tests were performed to determine sensitivity and specificity of PCT, Urine Nitrite, and Blood Culture of septic patients. A Chi-square test was carried out to see the relationship between two parameters and the outcome of sepsis.Results: PCT sensitivity was higher than Urine Nitrite: 74.5%. Specificity of Urine Nitrite was higher than PCT: 88.2%. Procalcitonin has a significant relationship with sepsis patient outcomes (p&lt;0.005).Conclusion: PCT can predict septic patients because it has a higher sensitivity than urine nitrite

Total cholesterol/HDL cholesterol ratio and monocyte/HDL cholesterol ratio are related with subclinical hypothyroidism in polycystic ovary syndrome

Abstract Objectives There is an association between serum thyrotropin (TSH) and lipid profile. However, there is a little information regarding the relation between subclinical hypothyroidism (SCH), atherogenic indices and inflammation in polycystic ovary syndrome (PCOS). Herein, we aimed to evaluate the impact of SCH on lipids and inflammatory markers in newly diagnosed PCOS patients. Methods Two groups were performed for total 99 PCOS patients: SCH (TSH&gt;2.5 mIU/L) and euthyroid groups (TSH&lt;2.5 mIU/L). Complete blood count, lipids, atherogenic indices were evaluated, inflammatory markers as platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), monocyte/high density lipoprotein ratio (MHR) and mean platelet volume/platelet ratio (MPR) were calculated. Results SCH group had higher WBC, PLT, PCT, PLR, MPR and non-high density lipoprotein cholesterol levels. Differences between MHR, total cholesterol/HDL cholesterol (TC/HDL), triglycerides/HDL cholesterol (TG/HDL) and low density lipoprotein/HDL cholesterol (LDL/HDL) levels were significantly higher (p=0.001; 0.01; 0.01; 0.02, respectively), TC/HDL cholesterol levels were positively correlated with TSH (p=0.028, r=0.402) in SCH group. TC/HDL levels were also correlated with WBC, PLT, PDW, PCT, MPR and MHR (p=0.003; 0.011; 0.031; 0.037; 0.006; 0.002; r=0.515; 0.442; −0.382; 0.370; −0.471; 0.523, repectively). Conclusions TC/HDL and MHR may serve as beneficial markers for evaluating the inflammatory state of PCOS with SCH. Screening thyroid hormones and curing SCH in PCOS may lower lipids, decelerate developing hypothyroidism and cardiovascular morbidities.

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma.

Bone infection is one of the common complications of orthopedic surgery. After bone trauma occurs in the human body, the infection of Staphylococcus aureus and Gram-negative bacteria into the fracture area can lead to double infection of the soft tissue and bone tissue at the fracture site, leading to a variety of complications, mostly in the lower extremities. Bone infection easily causes bone destruction, bone nonunion, and bone defect, seriously affecting the quality of life of patients. The traditional treatment method of bone infection is to control the infection first and then repair the bone graft, but this method has a long course, poor efficacy, and high disability rate. In this study, anti-infective reconstituted bone xenograft (ARBX) combined with external fixation was used to treat patients with posttraumatic bone infections of the long bones of the lower extremities, to explore its efficacy, and to analyze its effects on serum CRP, PCT levels, and prognosis. Our results showed that ARBX combined with the external fixator had a good effect on the treatment of patients with bone infection after lower extremity long bone trauma, which could effectively enhance the repair and functional recovery of the limb bone, significantly alleviate the infection degree of patients, reduce the inflammatory response of the body, and have a good prognosis.

Baseline Characteristics and Outcomes of 180 Egyptian COVID-19 Patients ‎Admitted to Quarantine Hospitals of Ain Shams University: A Retrospective ‎Comparative Study‎

Background and study aim: COVID-19 mortality, severity, and recovery are major global concerns, but they are still ‎insufficiently understood, particularly in the Middle East. This retrospective study aimed to ‎investigate the link between baseline clinical and laboratory data of COVID-19 patients and ‎disease severity and mortality‎‎‎. Patients and Methods: ‎‎‎ A total of 180 adult Egyptian COVID-19 patients were compared according to their disease ‎severity and mortality ‎‎.‎ Results: The Of all, 27.8% had severe disease, and 13.9% died during their hospital stay. Diabetes (46.7%), ‎hypertension (36.1%), and chronic obstructive pulmonary disease (COPD) (33.3%) were the most ‎frequent associated co-morbidities. Severe patients and non-survivors were significantly older ‎compared to their corresponding groups. Their neutrophil count, PCT, ESR, CRP, AST, ALT, ‎LDH, D-dimer, and ferritin levels were significantly higher (P ≤ 0.05). In contrast, their ‎lymphocyte count was significantly lower (P ≤ 0.05). COPD (OR: 3.294; 95% CI: 1.199-9.053), ‎diabetes (OR: 2.951; 95% CI:1.070-8.137), ferritin ≥ 350 ng/mL (OR: 11.08; 95% CI: 2.796-‎‎41.551), AST ≥ 40 IU/L (OR: 3.07; 95% CI: 1.842-7.991), CT-scoring system (CT-SS) ≥ 17 (OR: ‎‎1.205; 95% CI: 1.089-1.334) and lymphocyte count < 1×103/µL (OR: 4.002; 95% CI: 1.537-‎‎10.421), were all linked to higher COVID-19 severity. While mortality was predicted by dyspnea ‎‎(OR: 4.006; 95% CI: 1.045-15.359), CT-SS ≥ 17 (OR: 1.271; 95% CI: 1.091-1.482) and AST ≥ ‎‎40 IU/L (OR: 2.89; 95% CI: 1.091-7.661)‎‎. Conclusion: Clinical and laboratory data of COVID-19 patients at their hospital admission may aid in ‎identifying early risk factors for severe illness and mortality rates ‎‎‎‎‎‎.

Real-World Application of a Procalcitonin Monitoring Protocol in a Pediatric Intensive Care Unit.

Procalcitonin (PCT) is a biomarker used as an indicator for inflammation and bacterial infections. In October 2018, our PICU implemented a PCT monitoring protocol incorporating cutoffs established in previous studies to help guide antibiotic decision-making in patients undergoing sepsis evaluation. The study objective was to evaluate adherence to the protocol with regard to PCT monitoring and antibiotic use. This retrospective review included PICU patients with systemic inflammatory response syndrome ages > 1 month to 18 years with at least 1 PCT level and blood culture obtained during the 9 months following protocol implementation. Patients were excluded if they received < 48 hours of antibiotic therapy, were neutropenic, or had antibiotics initiated at another hospital. Patients were evaluated for protocol adherence, defined as antibiotic continuation or discontinuation per protocol guidance without excess PCT monitoring. Descriptive statistics were employed. Out of 100 patients evaluated, 50 patients were included. Full adherence was observed in 17 patients (34%). Reasons for non-adherence were excess PCT monitoring (54.5%), antibiotic continuation (30.3%), or both (15.2%). Of patients who were non-adherent due to antibiotic continuation, 61.5% had a positive respiratory viral panel (RVP). A total of 49 excess PCT levels were drawn, resulting in an additional $2,000 in health care costs and $15,000 in patient charges. Overall, the impact of our PCT monitoring protocol was difficult to evaluate due to non-adherence, but it highlights potential areas of focus for improving PCT monitoring and antimicrobial stewardship, such as inclusion of RVP results.

Dexamethasone and tocilizumab treatment considerably reduces the value of C-reactive protein and procalcitonin to detect secondary bacterial infections in COVID-19 patients

BackgroundProcalcitonin (PCT) and C-reactive protein (CRP) were previously shown to have value for the detection of secondary infections in critically ill COVID-19 patients. However, since the introduction of immunomodulatory therapy, the value of these biomarkers is unclear. We investigated PCT and CRP kinetics in critically ill COVID-19 patients treated with dexamethasone with or without tocilizumab, and assessed the value of these biomarkers to detect secondary bacterial infections.MethodsIn this prospective study, 190 critically ill COVID-19 patients were divided into three treatment groups: no dexamethasone, no tocilizumab (D−T−), dexamethasone, no tocilizumab (D+T−), and dexamethasone and tocilizumab (D+T+). Serial data of PCT and CRP were aligned on the last day of dexamethasone treatment, and kinetics of these biomarkers were analyzed between 6 days prior to cessation of dexamethasone and 10 days afterwards. Furthermore, the D+T− and D+T+ groups were subdivided into secondary infection and no-secondary infection groups to analyze differences in PCT and CRP kinetics and calculate detection accuracy of these biomarkers for the occurrence of a secondary infection.ResultsFollowing cessation of dexamethasone, there was a rebound in PCT and CRP levels, most pronounced in the D+T− group. Upon occurrence of a secondary infection, no significant increase in PCT and CRP levels was observed in the D+T− group (p = 0.052 and p = 0.08, respectively). Although PCT levels increased significantly in patients of the D+T+ group who developed a secondary infection (p = 0.0003), this rise was only apparent from day 2 post-infection onwards. CRP levels remained suppressed in the D+T+ group. Receiver operating curve analysis of PCT and CRP levels yielded area under the curves of 0.52 and 0.55, respectively, which are both markedly lower than those found in the group of COVID-19 patients not treated with immunomodulatory drugs (0.80 and 0.76, respectively, with p values for differences between groups of 0.001 and 0.02, respectively).ConclusionsCessation of dexamethasone in critically ill COVID-19 patients results in a rebound increase in PCT and CRP levels unrelated to the occurrence of secondary bacterial infections. Furthermore, immunomodulatory treatment with dexamethasone and tocilizumab considerably reduces the value of PCT and CRP for detection of secondary infections in COVID-19 patients.

Continuous Blood purification on Influenza-Associated Neurological Disease in children: a retrospective cohort study

BackgroundDue to lack of proven therapies, we evaluated the effect of CBP on Influenza-Associated Neurological Disease in children.MethodsA single-center, retrospective, cohort study was conducted in Luoyang, Henan province, China from January 2018 to January 2020. Children (<18 years) with influenza-associated neurological disease were enrolled in the study. Children with indications for CBP and parental consent received CBP (Continuous Blood purification), while others received maximal intensive care treatment because of the absence of parental consent. The outcomes of the CBP and non-CBP groups were compared. Categorical variables were presented as percentage and compared by Chi-square test. Continuous variables were expressed as median (interquartile ranges) and compared with non-parametric independent sample test. Statistical analyses were carried out by SPSS (version 26.0) and p < 0.05 (2 tailed) was considered to be statistically significant.Results30 children with influenza-associated neurological disease were recruited to the study. 18 received CBP and the other 12 received maximal intensive care. There were no differences between CBP and non-CBP children in age, sex, body weight, type of influenza virus, neurological complications, Glasgow score, PIM-2 score and PCIS at admission (p > 0.05). The inflammatory factors (CRP, PCT and IL-6) of 30 cases were tested at admission and after 3 days of admission. In the CBP group, there was a significant decrease in IL-6 levels at 3 days of admission (p = 0.003) and a decrease in CRP and PCT levels, but no significant difference (p > 0.05). In the non-CBP group, there were no significant difference on levels of CRP, PCT and IL-6 at admission and 3-day of admission (p > 0.05). The 28-day mortality was significantly lower in the CBP group compared with the non-CBP group (11.11% vs. 50%, p = 0.034).ConclusionsCBP definitely reduces IL-6 levels significantly. We did find that the survival rate of patients in the CBP group was improved. But we don’t know if there is a relationship between the reduction of IL-6 levels and the survival rate. Trial registration: http://www.chictr.org.cn/index.aspx(ChiCTR2000031754).

Kinetics of serum procalcitonin in patients with acute mesenteric ischemia and bowel infarction after cardiac surgery

The present study reported perioperative changes in PCT levels occurring in cardiac patients with acute mesenteric ischemia (AMI) undergoing laparotomy. The aim of this study was to demonstrate that PCT kinetics may confirm the presence of AMI after cardiac surgery, distinguishing between bowel infarction and diffuse ischemia. PCT values from adult patients undergoing laparotomy for AMI after elective or urgent cardiac surgery (January 2010-December 2019) were determined at the ICU admission after cardiac surgery, 24 hours later and at the onset of clinical symptoms. Patients affected by diffuse intestinal ischemia with no need for bowel resection were allocated to Group A (N. 8), patients presented with intestinal necrosis requiring small or large bowel resection were allocated to Group B (N. 12). At the beginning of the abdominal symptoms, PCT levels increased in both groups, compared to those immediately after cardiac surgery. The PCT increasing resulted much more evident in patients presenting with intestinal necrosis in Group B (20.65 ng/mL [IQR8.47-34.5] vs. 4.31 ng/mL [IQR 8.47-34.5], P<0.05), rather than in those with diffuse ischemia in Group A (13.25 ng/mL [IQR 5.97-27.65] vs. 10.4 ng/mL [IQR 3.68-14.05], P=0.260). This trend was confirmed in the subgroup of patients undergoing CVVHD and in patients who experience AMI recurrence. Increasing PCT values after cardiac surgery are proportional to the severity of wall ischemia and high levels of PCT are predictive of intestinal necrosis. Routine PCT monitoring after cardiac surgery should be considered extremely useful in suggesting the possibility of abdominal complications, alerting medical staff to the need of prompt treatment.

#54: Sensitivity and Specificity of Procalcitonin vs C Reactive Protein in Identifying Pediatric Bacterial infections

Abstract Background Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis. Methods In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs. Results Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P&amp;lt;0.0001) and temperature (39.2C vs 39C, P&amp;lt;0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p&amp;lt;0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection. Conclusion In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.