PCT Levels Research Articles

Accuracy of Procalcitonin Levels for Diagnosis of Culture-Positive Sepsis in Critically Ill Trauma Patients: A Retrospective Analysis

BackgroundAbdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients.MethodologyThis was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly.ResultsA total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p < 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p < 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p < 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p < 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, with a PPV of 87.8% and NPV of 54.2%.ConclusionOur study determined two cut-values for PCT to predict sepsis, one with the highest sensitivity and the other with better specificity. Other than that, higher PCT levels were significant in female trauma patients. We conclude that PCT is a reliable marker for culture-proven diagnosis of sepsis and may aid physicians/surgeons to promptly manage patients accordingly.

Associations of PER3 polymorphisms with clopidogrel resistance among Chinese Han people treated with clopidogrel.

BackgroundChanges in circadian rhythm are related to various diseases, such as immune system diseases and cardiovascular diseases. The PERIOD3 (PER3) clock gene is one of the most important genes in the rhythm regulation system. Our goal was to evaluate the possible association between the PER3 rs228729 (T/C) polymorphism or PER3 rs2797685(T/C) polymorphism and clopidogrel resistance (CR) and to study the impact of clinical baseline data on clopidogrel resistance.Methods PER3 polymorphisms rs2797685 (T/C) and rs228729 (T/C) were assessed in 156 patients with (72) and without (84) CR. Blood samples were collected and analyzed after the application of clopidogrel for interventional therapy.ResultsAge, albumin, PLT, and PCT levels influenced the risk of CR (p < 0.05). For rs2797685, when the PCT value was greater than 0.19, patients with the TT + TC genotype had an increased risk of clopidogrel resistance compared with those with the CC genotype (PCT ≥ 0.19, p = 0.014; PCT p = 0.004). In patients with albumin values greater than 40 or PCT greater than 0.19, those with the rs228729 TT + TC genotype had an increased risk of clopidogrel resistance compared with those with the CC genotype (albumin≥40, TT+TC:CC, p = 0.01, albumin p = 0.005; PCT ≥ 0.19, TT+TC:CC, p < 0.001, PCT p = 0.004). Logistic regression analysis of clinical baseline data and genotype showed that high albumin is a protective factor against clopidogrel resistance. The PER3 gene polymorphism has no clear correlation with clopidogrel resistance.ConclusionIn summary, our research shows that PER3 SNPs may be helpful to assess the pathogenesis of CR.

A novel procalcitonin-based score for detecting sepsis among critically ill patients.

BackgroundProcalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients.MethodsWe conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort.ResultsA total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, “serum PCT level,” “albumin level” and “neutrophil-lymphocyte ratio” at ICU admission, along with “diabetes mellitus,” and “with vasopressor.” We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74–0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69–0.90; sensitivity 0.64; specificity 0.87).ConclusionsWe proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.

Co-Infection with Common Respiratory Pathogens and SARS-CoV-2 in Patients with COVID-19 Pneumonia and Laboratory Biochemistry Findings: A Retrospective Cross-Sectional Study of 78 Patients from a Single Center in China.

BackgroundThis retrospective study aimed to investigate co-infections with common respiratory pathogens and SARS-CoV-2 and laboratory biochemistry findings in patients with COVID-19 in the Zhuzhou area of China, in order to provide a reference for the disease assessment and clinical treatment of COVID-19.Material/MethodsThe clinical data of COVID-19 patients admitted to the hospital of Zhuzhou City from January 28 to March 15, 2020, as well as laboratory test results for respiratory pathogens and biochemical indicators, were collected to conduct correlation analyses. All patients were diagnosed based on fluorescence-based PCR assay for SARS-CoV-2.ResultsEleven of the 78 patients (14.1%) were co-infected with other respiratory pathogens, among which Mycoplasma pneumoniae (n=5, 45.5%) and respiratory syncytial virus (n=4, 36.4%) were the most frequent. There were 8 patients co-infected with 1 other pathogen and 3 patients co-infected with 2 other pathogens. Compared with mono-infected COVID-19 patients, patients with co-infections had significantly higher levels of procalcitonin (P=0.002).ConclusionsThe findings showed that Mycoplasma pneumonia and respiratory syncytial virus were the most common co-infections in patients with COVID-19 pneumonia. Increased levels of PCT in patients with COVID-19 pneumonia were associated with co-infection.

Role of immature platelet fraction (IPF) in sepsis patients: A systematic review.

Sepsis is extremely common amongst critically ill patients and requires early diagnosis. Hence, identifying a biomarker that could acknowledge sepsis at its prior stage is of vital significance. Immature platelets are a percentage of circulating platelets that contain RNA and is a newer parameter that is measured using automated hematology analyzers in diagnosing sepsis. This review article discusses 10 articles that reveal the role of immature platelet fraction in predicting the onset of sepsis and its relationship with mortality in sepsis. Literature search was done using PubMed, Scopus and Google Scholar and words like platelet indices and immature platelet fraction were typed in the search bar. The aim of this review article is to present a precise form of data that talk about immature platelet fraction (IPF) and its association with the severity and mortality of sepsis. Five out of 10 articles suggest that immature platelet fraction can predict the onset of sepsis and eight out of 10 articles suggest that increased IPF values are associated with high mortality.

1217. Clinical and Microbiological Characteristics of Patients with Bacteremia and Normal Procalcitonin at Single Tertiary Care Medical Center

BackgroundProcalcitonin (PCT) is a serum biomarker used to diagnose bacterial infections and guide antibiotic therapy. Many studies highlight its high sensitivity, specificity, and negative predictive value for bacteremia. PCT > 2ng/mL has been reported to be strongly indicative of systemic bacterial infection, with values of .5-2ng/mL suggesting localized infection and < .5ng/mL strongly suggesting absence of infection. However, emerging reports have raised concerns about PCT in bacteremia, demonstrating low sensitivity. Few studies have characterized patients with bacteremia and low PCT. We aimed to analyze the clinical and microbiological characteristics of patients with bacteremia and PCT < 2ng/mL.MethodsAdult patients admitted at Westchester Medical Center with bacteremia and associated PCT level within 24 hours (hrs) prior to 48 hrs post blood culture collection from 1/1/2014-9/30/2019 were included. Demographic, clinical, laboratory, and microbiological data were retrospectively collected and analyzed.ResultsThere were 414 total cases of bacteremia with an associated PCT level within 24 hrs prior to 48 hrs post blood culture collection. 209 of 414 (50.5%) patients had PCT < 2ng/mL. Of these, 86 were excluded (73 contaminants, defined as bacteremia not causing systemic inflammation and not treated, 10 fungal cultures, and 3 lacking data). Of the remaining 123 (37.5%) patients with PCT < 2ng/mL, 66 (53.7%) had PCT<. 5ng/mL. The leading infection source was endovascular/line-related at 31.7%, followed by intraabdominal/gastrointestinal and urinary. 30.9% of bloodstream organisms were gram negative. Among these 123 patients with PCT < 2ng/mL, in-hospital mortality with bacteremia clinically contributing to death was 13%.Characteristics of patients with bacteremia and procalcitonin < 2ng/mL ConclusionDespite literature supporting the use of PCT algorithms in initiation and de-escalation of antibiotics in patients with suspected bacterial infections, a substantial percentage of bacteremic patients can have low PCT but significant infection-related mortality. Therefore, PCT should not be the only factor utilized by clinicians in the management of such patients, including initiating or deescalating antibiotics. Further studies are needed to characterize patient characteristics as contributing factors for bacteremia with low PCT.Disclosures All Authors: No reported disclosures

Levels of Biomarkers PCT,CRP and Neopterin in COPD patients with exacerbations

The motive of this study was to establish the role of various circulating biomarkers in identification of etiology of exacerbation in COPD and assessment of prognosis of COPD on the basis of these biomarkers i.e PCT, CRP and neopterin. In this study 200 patients of COPD were enrolled 36 in the stable state, 116 in the exacerbation phase and 48 with pneumonia. Serum sample was collected in all the groups at the time of inclusion in the study and after one month 20 samples were collected from the exacerbation group. Sputum culture, microbiological findings, biomarkers levels and clinical characteristics were compared in each group. PCT and CRP levels were measured by immunofluorescence assay and neopterin by competitive assay. Significant differences were observed in the three groups with regard to PCT and CRP being increased in pneumonic and exacerbation groups as compared to stable group. (P = 0.0001). For paired samples of 20 patients in the exacerbation group PCT and CRP levels were found to be decreased after a period of one month whereas neopterin was found to be increased. All the three biomarkers were increased in patients who died within a month as compared to patients who died later on. Our results showed that biomarker levels vary with the clinical status of the patients and this helps in identification of the aetiology of exacerbation which therefore helps in better assessment of prognosis and management of COPD patients.

68Ga-citrate positron emission tomography/computed tomography findings in an experimental model of acute appendicitis in rabbits.

Acute appendicitis (AA) is a common urgent surgical situation of the gastrointestinal tract. Gallium-68 (68Ga)-citrate has been recently investigated as a radiopharmaceutical for infection and inflammation imaging. Aim of the study was to determine the effectiveness of 68Ga-citrate positron emission tomography/computed tomography (PET/CT) imaging in rabbits with experimentally induced AA. In the AA group (n=6), the appendices of the rabbits were surgically ligated. The sham group (n=6) was used as control. Gallium-68-citrate was synthesized. All rabbits were imaged using 68Ga-citrate PET/CT at 36th following the establishment of experimental models, and at 36th h, all rabbits were appendectomised. Appendices were examined histopathologically. Blood samples were drawn from all rabbits at the beginning and end of the experimental process. Interleukin-6 (IL-6) and procalcitonin (Pct) levels were measured. Acute appendicitis was confirmed histopathologically and biochemically. Gallium-68-citrate PET/CT showed acute appendicitis in all rabbits. The sensitivity, specificity and accuracy of 68Ga-citrate PET/CT in AA were 100%, 83.3% and 91.7%, respectively. Acute appendicitis is accurately imaged in an experimental rabbit model by using 68Ga-citrate with PET/CT.

Selective Polymyxin Hemoperfusion in Complex Therapy of Sepsis in Children after Cardiac Surgery

Background: To date, sepsis remains one of the main challenges of intensive care in pediatrics. Newborns with low birth weight and infants with chronic diseases and congenital disorders are particularly at risk. The incidence of infectious complications in pediatric cardiac surgery is known to be approximately 15–30%. The main etiological factor of sepsis is endotoxin. Aim: To evaluate the efficiency and safety of polymyxin (PMX) B-immobilized column-direct hemoperfusion in complex intensive therapy of sepsis in children after cardiac surgery with cardiopulmonary bypass. Design: Prospective cohort study. Methods: This study enrolled 15 children, aged 9–96 months, with congenital heart diseases and with body weights of 6.2–22.5 kg. The criteria for admission were body weight >6 kg and clinical and laboratory signs of sepsis (microbiological analysis, procalcitonin [PCT] >2 ng/mL, and endotoxin activity assay [ЕАА] >0.6). Intensive care included inotropic and vasopressor support, mechanical ventilation, broad-spectrum antibiotic therapy, and PMX hemoperfusion procedures. Extracorporeal therapy was initiated within 24 h following the sepsis diagnosis. Every patient underwent 2 hemoperfusion sessions with the use of a PMX B-immobilized column; the session duration was 180 min. Results: We noted improvements in hemodynamic parameters, oxygenation index, and laboratory signs of sepsis, with decreases in the endotoxin concentration according to the EAA, PCT, and presepsin levels. The 28-day survival of the patients in this severely affected group was 80%. Main Conclusion: The inclusion of extracorporeal methods of blood purification, aimed at the selective elimination of circulating endotoxin, in the treatment of sepsis increases the survival rates of children after open heart surgery. Second Conclusion: The obtained results of sepsis therapy with PMX hemoperfusion in children after cardiac surgery enable us to suggest the sufficient safety and efficiency of the procedures in this category of severely affected patients.

The effect of smoking on chronic inflammation, immune function and blood cell composition

Smoking is the number one risk factor for cancer mortality but only 15–20% of heavy smokers develop lung cancer. It would, therefore, be of great benefit to identify those at high risk early on so that preventative measures can be initiated. To investigate this, we evaluated the effects of smoking on inflammatory markers, innate and adaptive immune responses to bacterial and viral challenges and blood cell composition. We found that plasma samples from 30 heavy smokers (16 men and 14 women) had significantly higher CRP, fibrinogen, IL-6 and CEA levels than 36 non-smoking controls. Whole blood samples from smokers, incubated for 7 h at 37 °C in the absence of any exogenous stimuli, secreted significantly higher levels of IL-8 and a number of other cytokines/chemokines than non-smokers. When challenged for 7 h with E. coli, whole blood samples from smokers secreted significantly lower levels of many inflammatory cytokines/chemokines. However, when stimulated with HSV-1, significantly higher levels of both PGE2 and many cytokines/chemokines were secreted from smokers’ blood samples than from controls. In terms of blood cell composition, red blood cells, hematocrits, hemoglobin levels, MCV, MCH, MCHC, Pct and RDW levels were all elevated in smokers, in keeping with their compromised lung capacity. As well, total leukocytes were significantly higher, driven by increases in granulocytes and monocytes. In addition, smokers had lower NK cells and higher Tregs than controls, suggesting that smoking may reduce the ability to kill nascent tumor cells. Importantly, there was substantial person-to person variation amongst smokers with some showing markedly different values from controls and others showing normal levels of many parameters measured, indicating the former may be at significantly higher risk of developing lung cancer.

Association of D-dimer, inflammatory markers, cytokines abnormality, and disease severity in COVID-19 severe/critical patients in Wuhan

目的分析2019新型冠状病毒肺炎（COVID-19）重型及危重型患者D-二聚体、炎症指标、细胞因子水平与疾病严重程度的关系。方法收集华中科技大学同济医院中法新城院区山西援鄂国家医疗一队2020年2月8日至3月25日收治的41例COVID-19患者病例资料，重型28例，危重型13例，比较不同临床分型COVID-19患者的基本临床特征，入院时D-二聚体、炎症指标[WBC、ANC、降钙素原（PCT）、超敏C-反应蛋白（hsCRP）]、细胞因子（IL-2R、IL-6、IL-8、TNF-α）水平；比较有无D-二聚体异常患者的细胞因子（IL-2R、IL-6、IL-8、TNF-α）水平；并比较抗凝治疗前后患者D-二聚体、细胞因子指标（IL-2R、IL-6、IL-8、TNF-α）水平变化。结果41例患者中，男23例（56.1%），女18例（43.9%），平均年龄（55.4±11.9）岁。危重型患者平均年龄[（61.1±10.4）岁]高于重型患者[（52.8±11.7）岁]，差异有统计学意义（t=2.264，P=0.032）。危重型患者合并高血压（χ2=10.420，P=0.001）、心血管疾病（χ2=6.972，P=0.008）、脑血管疾病（χ2=6.972，P=0.008）比例高于重型患者。危重型患者出现呼吸困难、盗汗及乏力症状比例均高于重型患者，差异均有统计学意义（χ2分别为14.898、6.972、7.823，P值分别为<0.001、0.008、0.005）。危重型患者D-二聚体、WBC、ANC、PCT、hsCRP、IL-8水平均高于重型患者，差异均有统计学意义（P值均<0.05）。D-二聚体异常患者IL-2R、IL-8、TNF-α水平均较D-二聚体正常者增高，差异均有统计学意义（P值均<0.05）。8例预防性抗凝治疗患者D-二聚体、IL-2R、IL-6、IL-8抗凝治疗后比治疗前水平降低。结论COVID-19危重型患者存在更严重的凝血-免疫功能紊乱，动态监测D-二聚体、细胞因子水平有助于早期识别COVID-19危重型患者，抗凝治疗可能通过纠正凝血-免疫功能紊乱促进疾病好转。

Perioperative Procalcitonin in Predicting Infection in Children Undergoing Surgical Procedures

BackgroundProcalcitonin (PCT) is a biomarker of bacterial infections with more sensitivity and specificity than commonly used inflammatory markers. PCT can be particularly helpful in the postsurgical population where the surgery itself often leads to noninfectious inflammation. We aimed to examine the utility of perioperative profiles of PCT in predicting infection in two pediatric surgical populations. MethodsWe conducted a prospective observational study of perioperative PCT in children undergoing cardiac or neurosurgery. Consenting patients with no preoperative infection or immune deficiency were enrolled. We measured plasma PCT levels within 24 h preprocedure and 24-48 h postprocedure. Demographic, clinical, and laboratory data were collected from the medical records including clinical suspicion and confirmed infections. Perioperative PCT changes and their associations with these data are reported. ResultsWe enrolled 26 neuro and 15 cardiac surgery patients. There was postoperative clinical suspicion of infection in 3 neuro and 5 cardiac patients, and 1 neuro and 2 cardiac patients had subsequently confirmed infections. Cardiac patients had higher overall perioperative PCT increase than neuro cohort (P = 0.006). Neuro patient with infection had higher perioperative change in PCT (0.5 to 1.4 ng/mL) than noninfected neurosurgery patients. Cardiac patients with confirmed infections had higher postoperative levels which exceeded the previously described infection threshold of 2 ng/mL. ConclusionsPCT is a useful early biomarker of postoperative infection in pediatric patients undergoing cardiac and neurosurgery. Patients who underwent cardiac surgery have significantly higher perioperative PCT rise than patients who underwent neurosurgery, and all patients with subsequently confirmed infections had at least 2-fold perioperative PCT increase.

Can hematological and biochemical parameters fasten the diagnosis of COVID-19 in emergency departments?

INTRODUCTION: The primary aim of the study was to compare the laboratory and radiological parameters of COVID-19 positive and negative patients confirmed by Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), and Chest Computed Tomography (CCT) of patients admitting with the suspicion of COVID-19. The secondary purpose of the study was to find objective parameters to speed up the clinician for further examination, treatment or referral decision in COVID-19 suspicion. MATERIAL AND METHODS: A total of 61 COVID-19 suspected patients were evaluated in the study. Swab samples were taken for RT-PCR analysis. CCT was taken for 42 patients who described dyspnea. According to CCT and RT-PCR results, the patient population was divided into 2 groups as COVID-19 positive group (n = 32); and COVID-19 negative group (n = 29). Between two groups; demographic, clinical, laboratory and radiological parameters were compared. RESULTS: Male gender (p = 0.03), PLR value (p = 0.021) and CO-RADS scores were higher in the COVID-19 positive group. Oxygen saturation (SaO2) (p = 0.027) and PCT, WBC, Neutrophil count, Lymphocyte count values were significantly low in COVID-19 positive group (p = 0.03, p = 0.001, p = 0.017, p = 0.021, respectively). PLR showed a positive correlation with fever, CRP, neutrophil count and NLR, which are indicators of inflammation. CONCLUSIONS: SaO2, WBC, lymphocyte count, neutrophil count and low PCT levels, and PLR elevation showed a significant difference in COVID-19 patients in our retrospective cohort study examining the Turkish population. We believe that these results will allow clinicians to make quick decisions in patient management more simply.

A 5-Year Review of Invasive Fungal Infection at an Academic Medical Center.

Background: Invasive fungal infection (IFI) is one of the most common nosocomial infections. However, data on the epidemiology of IFI and susceptibility to antifungal agents in China are quite limited, and in particular, no current data exist on the microbiological, and clinical characteristics of IFI patients in Northeast China.Objectives: The purpose of this study was to provide a retrospective review of the clinical characteristics, laboratory test results, and risk factor predictions of inpatients diagnosed with IFI. Multivariate regression analysis was used to assess prognostic factors associated with the mortality of these patients.Methods: We retrospectively analyzed the results from 509 patients with IFI extracted from the First Hospital of China Medical University from January 2013 to January 2018.Results: Neutrophil numbers, total bilirubin, length of stay in the ICU, renal failure, use of immunosuppressants within the past 30 days, stomach tube placement and septic shock were risk factors for death from IFI. Recent surgery (within 2 weeks) and drainage tube placement did not increase mortality in these IFI patients. Increased serum levels of PCT (AUC 0.601, 95% CI 0.536–0.665, P = 0.003) and CRP (AUC 0.578, 95% CI 0.512–0.644, P = 0.020) provided effective predictors of 30-day mortality rates.Conclusions: We report for the first time epidemiological data on invasive fungal infections in Northeast China over the past 5 years. Despite the limited available clinical data, these findings will greatly aid clinical health care workers with regard to the identification, prevention, and treatment of IFI in hospitalized patients.

Diagnostic Value of ROC Curve Evaluating Serum Related Indexes for Bloodstream Infection in Patients with Hematopathy

Sixty hematopathy patients with bloodstream infection from July 2016 to June 2018 were selected and enroued in bloodstream infection group. Sixty-five patients with negative blood culture during the same period were selected and enrolled in non-bloodstream infection group. The ROC curves were drawn and used to eualuate the diagnostic value of above montioned indexes. The levels of PCT, CRP and SAA in the bloodstream infection group were higher than those in the non-bloodstream infection group (P<0.05). ROC curve showed that AUC values of PCT, CRP, SAA and the combined test detection were 0.868, 0.746, 0.678 and 0.900, respectively, there was no significant difference in AUC between combined test and PCT test (P>0.05). AUC of combined test and PCT test were higher than those of CRP and SAA test, and the difference was statistically significant (P<0.05), but there was no significant difference in AUC between CRP and SAA (P>0.05). The optimal PCT detection threshold was 0.49 ng/ml, the sensitivity and specificity were 75.0% and 83.1%, respectively. The optimal critical value for CRP detection was 15.76 mg/L, the sensitivity and specificity were 60.0% and 80.0% respectively. The optimal SAA detection threshold was 35.66 mg/L, the sensitivity and specificity were 81.7% and 53.8%, respectively. PCT, CRP and SAA detection have good diagnostic value for blood stream infection in patients with hematopathy. The diagnostic value of PCT is better than CRP and SAA, and there is no significant difference in diagnostic value between combined test and PCT test.

THE EFFECT OF VITAMIN D LEVELS ON INFLAMMATION IN PATIENTS WITH CHRONIC RENAL FAILURE

It is suggested that a number of environmental and genetic factors trigger the formation of progressive kidney damage and complications. One of these factors is inflammation, it occurs as a result of a series of mechanisms included within a number of cytokines. Vitamin-D, IL-6, PCT and hs-CRP are also valuable biomarkers in terms of mortality in dialysis patients in this sense. Vitamin D deficiency is common in patients with chronic kidney disease (CKD) and is associated with inflammation. In recent years, some randomized controlled trials have revealed the effect of Vitamin D on inflammation in CKD patients, but the results are conflicting. The aim of this study is to investigate the relationship between Vitamin D, high-sensitivity C Reactive Protein (hs-CRP), procalcitonin and IL-6, and to evaluate the relation of Vitamin D levels with inflammation in PD patients, HD patients and controls. This study was carried on with 40 patients receiving on hemodialysis treatment, 40 patients receiving peritoneal treatment with renal failure disease and with a control group consisting of 40 healthy individuals. Vitamin D levels were measured by HPLC, PCT and IL-6 levels were measured by chemiluminescent method, hs-CRP is measured by nephelometric method. For Vitamin D, there was no differences between the groups. For PCT, there was a significant difference between all groups. For IL-6, while there was no difference between peritoneal and hemodialysis groups, a significant difference was determined between the peritoneal dialysis and control groups. For hs-CRP, there was a significant difference among all groups. While correlation was found between serum PCT levels with IL-6 and hs-CRP, no correlations were found between serum PCT with Vitamin D levels. Although a correlation was found between serum IL-6 levels and hs-CRP, no correlation was detected between serum IL-6 and Vitamin D levels. No correlations were detected between Vitamin D andPCT, IL-6 and hs-CRP.

Diagnostic Value of sCD163 Combined with PCT and HS-CRP in Patients with Gynecological Malignant Tumors and Fever

To explore diagnostic values of sCD163 with PCT and HS-CRP in diagnosing infection among patients with gynecological malignant tumors and fever. Cross-sectional, observational study. Huzhou Maternity & Child Health Care Hospital, China, from May 2018 to February 2020. A total of 119 patients with gynecological malignant tumors and fever were divided into infected group (70 cases) and non-infected group (49 cases), according to the blood bacterial culture results and clinical symptoms. Serum PCT, HS-CRP, sCD163 level were compared. Pearson correlation was performed to analyse correlation of sCD163 with PCT and HS-CRP. The area under the curve (AUC) score was calculated from receiver operating characteristic curve (ROC). Serum sCD163, PCT and HS-CRP levels in infected group were all elevated compared to non-infected group (all p <0.001). Pearson correlation analysis showed that sCD163 was positively correlated with PCT and HS-CRP (r = 0.596, p <0.001; r = 0.744, p <0.001, respectively). The AUC of sCD163 + PCT + HS-CRP combined detection for predicting early infection in patients with gynecological malignant tumors and fever was 0.905 (95% CI: 0.855-0.956), which was greater than sCD163, PCT, and HS-CRP detected alone. Combined detection of sCD163 with PCT and HS-CRP has a high diagnostic efficiency for early infection in patients with gynecological malignant tumors and fever, which is better than that of sCD163, PCT or HS-CRP alone. It can be used as an effective auxiliary examination method and an indicator for differential diagnosis. Key Words: sCD163, PCT, HS-CRP; Gynecology, Tumor, Infection, Diagnosis.

Gender-associated difference following COVID-19 virus infection: Implications for thymosin alpha-1 therapy

Gender influences clinical presentations, duration and severity of symptoms, and therapy outcome in coronavirus disease 2019 (COVID-19) infection. Whether the immune response to Tα1 treatment for SARS-CoV-2 differs between the sexes, and whether this difference explains the male susceptibility to COVID-19, is unclear. This study aimed to investigate the efficiency and safety of Tα1 treatment and provide a basis for practically identifying gender differences characteristics and features of COVID-19. One hundred twenty-seven patients had COVID-19 symptoms and tested COVID19-positive (female 42.52%) in Wuhan union hospital were enrolled for medication. They were randomly divided into groups Control and Tα1 intervention. Seventy-eight patients received a subcutaneous injection of 1.6 mg Tα1, based on supportive treatment for 15 days. The control group included untreated 49 COVID19 patients closely matched for gender and age and received regular supportive treatment. In this retrospective analysis, we found that COVID-19-infected males reported more symptoms than COVID-19-infected females. A high degree of gender differences-related variability was observed in CRP and PCT levels and the cell counts of many lymphocyte subpopulations in the COVID-19 patients after Tα1 intervention. Levels of CRP and IL-6 were higher in Tα1-treated male group than Tα1-treated female group, while the level of PCT was significantly lower in Tα1-treated male group. Gender differences may be a factor in sustaining COVID-19 immunity responded to Tα1, male and female show statistically significant differences in relevance to cytokine production associated with the development of a more significant number of symptoms. This leaves the question of identifying gender-specific risk factors to explain these differences.

Characteristic of 523 COVID-19 in Henan Province and a Death Prediction Model.

Certain high-risk factors related to the death of COVID-19 have been reported, however, there were few studies on a death prediction model. This study was conducted to delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) of different degree and establish a death prediction model. In this multi-centered, retrospective, observational study, we enrolled 523 COVID-19 cases discharged before February 20, 2020 in Henan Province, China, compared clinical data, screened for high-risk fatal factors, built a death prediction model and validated the model in 429 mild cases, six fatal cases discharged after February 16, 2020 from Henan and 14 cases from Wuhan. Out of the 523 cases, 429 were mild, 78 severe survivors, 16 non-survivors. The non-survivors with median age 71 were older and had more comorbidities than the mild and severe survivors. Non-survivors had a relatively delay in hospitalization, with higher white blood cell count, neutrophil percentage, D-dimer, LDH, BNP, and PCT levels and lower proportion of eosinophils, lymphocytes and albumin. Discriminative models were constructed by using random forest with 16 non-survivors and 78 severe survivors. Age was the leading risk factors for poor prognosis, with AUC of 0.907 (95% CI 0.831–0.983). Mixed model constructed with combination of age, demographics, symptoms, and laboratory findings at admission had better performance (p = 0.021) with a generalized AUC of 0.9852 (95% CI 0.961–1). We chose 0.441 as death prediction threshold (with 0.85 sensitivity and 0.987 specificity) and validated the model in 429 mild cases, six fatal cases discharged after February 16, 2020 from Henan and 14 cases from Wuhan successfully. Mixed model can accurately predict clinical outcomes of COVID-19 patients.

Correlation of Redox Status with Procalcitonin and C-reactive Protein in Septic Patients

Based on the role of oxidative stress in the pathophysiological mechanisms of sepsis and the importance of PCT as a clinically applicable biomarker for early detection of inflammatory response initiation, we aimed this study at examining the correlation between PCT levels and oxidative stress parameters (prooxidants and antioxidants) in patients with sepsis. This study was designed as a case-series prospective clinical study which involved 103 critically ill patients and 17 healthy participants with diagnosis of sepsis/septic shock (over 18 years of age, both gender) admitted to the Intensive Care Unit (ICU) of Valjevo General Hospital in Serbia. All subjects were divided into patients who were operated on/underwent surgery before sampling and have sepsis (n = 24), patients who were operated on/underwent surgery before sampling and have septic shock (n = 25), patients who were not operated on/did not undergo surgery before sampling and have sepsis (n = 26), patients who were not operated on/did not undergo surgery before sampling and have septic shock (n = 28), and participants who are healthy (n = 17). PCT has confirmed a positive correlation with prooxidants and type of critical illness, and performing surgical intervention diminished oxidative stress in patients with septic shock. Prognosis in critically ill patients was strongly associated with PCT levels but not with nonspecifically C-reactive protein.