PCT Levels Research Articles

Acinetobacter spp. bloodstream infection in hematological patients: a 10-year single-center study

PurposeThis study investigated the clinical and antimicrobial characteristics of Acinetobacter spp. bloodstream infection (BSI) in hematological patients. Risk factors for 30-day mortality and carbapenem-resistant Acinetobacter spp. (CRA) BSI acquisition were also identified.MethodsWe reviewed forty hematological patients with Acinetobacter spp. BSI in a large Chinese blood disease hospital between 2013 and 2022. The remaining CRA isolates were subjected to whole-genome sequencing.ResultsThe 30-day mortality rate was high at 35%. Hematological patients with Acinetobacter spp. BSI often presented with severe conditions and co-infections at multiple sites. All strains were colistin-susceptible and 40.0% were CR. Multivariate analysis identified several risk factors associated with CRA BSI acquisition, including previous exposure to carbapenems within 30 days and CRA colonization. Very severe aplastic anaemia, tetracycline-resistant Acinetobacter spp. BSI, and unresolved neutropenia after infection were closely associated with 30-day mortality. Non-survivors often presented with higher median PCT and CRP levels and severe complications, such as intracranial infection, cardiac dysfunction, respiratory failure, and severe sepsis or septic shock. Our study also identified inappropriate empirical antibiotic therapy as an independent predictor of 30-day mortality (OR: 11.234, 95% CI: 1.261–20.086, P = 0.030). This study was the first to report A. oleivorans as a human pathogen, and to identify its unique oxacillinase, OXA-325.ConclusionAn environment-originated non-pathogenic species can become pathogenic when the body’s immunity is compromised. Our results also highlighted the importance of improving neutropenia after infection, treating severe organ dysfunction, and administering appropriate empirical antibiotic therapy to reduce mortality in this patient population.

Acute infections and inflammatory biomarkers in patients with acute pulmonary embolism

Abstract Background Although pneumonia is considered a common complication of acute pulmonary embolism (PE), the true incidence of infections after PE and the effect of infections on patient outcome are insufficiently studied. Purpose To investigate incidence and prognostic impact of acute infections and inflammatory biomarkers in patients with acute PE. Methods Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 02/2019 were studied. We excluded patients with (1) missing C-reactive protein (CRP) measurements at the time of PE diagnosis, (2) cardiopulmonary resuscitation as the presenting symptom, and (3) other acute cardiopulmonary or infectious disease responsible for the clinical presentation. We evaluated the incidence and impact of infections requiring antibiotic treatment and of inflammatory biomarkers (CRP and procalcitonin [PCT]) on the primary study outcome (hemodynamic insufficiency or in-hospital all-cause death) and the duration of the in-hospital stay. Results We analysed data from 749 patients (age 69 [interquartile range (IQR) 56-78] years). The primary study outcome occurred in 65 (8.7%) patients. Of 26 (3.4%) patients who died during the in-hospital stay, 17 (65.4%) deaths were due to PE and 6 (23.1%) due to infections. During the first 7 days after PE 347 (46.3%) patients required antibiotic treatment; in 79.6% due to pneumonia (Figure). On multivariate logistic regression analyses, antibiotic treatment increased the risk for the primary outcome with an OR of 3.12 (95% confidence interval [CI] 1.70-5.74), similar to an increase in one risk class of the ESC 2019 risk stratification algorithm (OR 3.45 [95% CI 2.24-5.30]). Furthermore, patients requiring antibiotic treatment had a longer duration of in-hospital stay compared to patients with no antibiotic treatment (11.0 vs. 7.0 days, p<0.001). At presentation, the majority of patients (86.4%) had CRP elevations above the upper limit of normal (median 33.5 [IQR 11.4-71.2] mg/l) and 34.2% had elevated PCT levels (median 0.05 [IQR 0.03-0.10] µg/l). CRP >124 mg/l and PCT >0.25 µg/l predicted the main study outcome with >90% specificity and odds ratios (OR) of 4.64 (95% CI 2.52-8.21) and 6.88 (95% CI 3.48-13.59), respectively. Furthermore, the predictive value associated with elevated inflammatory markers was independent of established risk factors for early mortality such as elevated troponin and the simplified Pulmonary Embolism Severity Index (sPESI). Conclusion Clinically relevant infections requiring antibiotic treatment occurred in almost half of patients with acute PE and carried a similar prognostic effect as an increase in one risk class of the ESC 2019 risk stratification algorithm. Furthermore, elevated levels of CRP and PCT were independent predictors of adverse outcome.Indications for antibiotic treatment

The immunomodulating activity of trimodulin (polyvalent IgM, IgA, IgG solution): a post hoc analysis of the phase II CIGMA trial

BackgroundThe phase II CIGMA trial performed in 160 patients with severe community-acquired pneumonia (sCAP) found treatment with trimodulin (human polyvalent immunoglobulin [Ig]: ~ 23% IgM, ~ 21% IgA, ~ 56% IgG) was associated with a lower mortality in those patients with elevated baseline serum levels of C-reactive protein (CRP) and/or subnormal IgM.MethodsIn this post hoc analysis, the pharmacodynamic effects of trimodulin treatment (182.6 mg/kg/day for 5 days) were investigated on Ig replenishment, cellular markers of inflammation (absolute neutrophil [ANC] and lymphocyte [ALC] count, neutrophil-to-lymphocyte ratio [NLR]), and soluble markers of inflammation (procalcitonin [PCT] and CRP). The impact of these pharmacodynamic effects on mortality was also evaluated.ResultsCompared with healthy subjects, baseline serum levels of IgM, IgG, and ALC were significantly lower, and ANC, NLR, PCT and CRP significantly higher in sCAP patients (p < 0.0001). Low Ig concentrations increased with trimodulin. Normalization of ANC (analysis of variance [ANOVA] p = 0.016) and PCT (ANOVA p = 0.027) was more rapid with trimodulin compared with placebo. These and other effects were more evident in patients with low baseline IgM levels. Normalization of PCT and CRP levels was both steadier and faster with trimodulin treatment. In patients with low baseline ALC, trimodulin was associated with a lower 28-day all-cause mortality rate (14.5% vs 32.1% in placebo, p = 0.043) and more ventilator-free days ([VFD]; median VFD: 3.5 vs 11 in placebo, p = 0.043). These numerical differences were greater if baseline IgM was also low (low ALC, low IgM: 8.1% mortality vs 34.1% placebo, p = 0.006; 3 VFD vs 15 VFD, p = 0.009, respectively). Results were consistent in patients with high baseline CRP (low ALC, high CRP: 10.9% mortality vs 34.1% placebo, p = 0.011).ConclusionsThis post hoc pharmacodynamic analysis of a blinded phase II trial suggests that trimodulin compensates for, and more rapidly modifies, the dysregulated inflammatory response seen in sCAP patients. Trimodulin was associated with significantly lower mortality and more VFD in subgroups with high CRP and low ALC. This effect was particularly marked in patients who also had low baseline IgM values. These findings require confirmation in prospective trials.

The Relationship Between the Expression of CRBN in Peripheral Blood and the Severity and Prognosis of Adult Sepsis.

To investigate the correlation between the expression of cereblon (CRBN) protein in peripheral blood and the severity and prognosis of sepsis. A total of 130 patients with sepsis admitted to our hospital were selected as the observation subjects (sepsis group). The patients were divided into mild group, moderate group and severe group according to their conditions. The patients were divided into survival group and death group according to their living conditions within 28 days after admission. 130 health individuals were selected as the control group. The levels of CRBN mRNA, CRP and PCT in peripheral blood were detected. The levels of serum CRBN mRNA, CRP, and PCT in patients with sepsis were higher than those in the control group (P<0.05); As the condition worsens, the levels of CRBN mRNA, CRP, and PCT gradually increase, and there are statistically significant differences among patients with mild, moderate, and severe sepsis; Correlation analysis showed that the expression of CRBN mRNA in sepsis patients was positively correlated with CRP, PCT levels, APACHE II score and SOFA score (P<0.05); the 28-day cumulative survival rate of patients with high CRBN mRNA expression was significantly lower than that of patients with low CRBN mRNA expression (P<0.05); compared with the survival group, the levels of serum CRBN mRNA, CRP and PCT in the death group were significantly higher (P<0.05); the AUC of death in sepsis patients diagnosed by CRBN mRNA, CRP and PCT was 0.961, the combined diagnostic efficacy was higher than that of single detection (P<0.05). The expression level of CRBN in the peripheral blood of patients with sepsis is increased, which is related to the severity and prognosis of the patients. The combination of CRP and PCT has certain diagnostic value for the death of sepsis patients.

Dynamics of organ dysfunction and inflammation markers in patients with septic shock during multimodal hemocorrection: a multicenter, randomized, controlled study

INTRODUCTION: Septic shock is the most serious complication in intensive care that associates with significant mortality. Extracorporeal hemocorrection may improve treatment of patients with septic shock. OBJECTIVE: Evaluation of the effect of hemocorrection with the multimodal adsorbent device Efferon LPS on the dynamics of organ dysfunction and inflammation markers in patients with septic shock. MATERIALS AND METHODS: A multicenter randomized controlled study was conducted in four clinical organizations in the city of Moscow from March 2021 to May 2022. The study included 58 patients (29 men and 29 women) with septic shock. Randomization was performed in a ratio of 2:1 (hemoperfusion: control). Within 24 hours of enrollment in the study, selective hemoperfusion procedures were performed or standard therapy was used. Hemosorption using Efferon LPS was performed twice, with an interval of 24.5 (23.3–26.0) hours. RESULTS: The use of the multimodal selective hemosorbent Efferon LPS significantly reduced the severity of multiple organ failure (MOF) in patients with septic shock from 7 to 3 points on the SOFA scale after 72 hours by improving hemodynamics, respiratory and renal function. In contrast to the control group, in the Efferon LPS group, the levels of CRP, PCT and IL-6 significantly decreased in 72 hours. The severity of MOF significantly correlated with the level of CRP and PCT (Spearman’s r = 0.346 and r = 0.444, respectively). The duration of hospitalization in survived patients was 16.1 days and 30.1 days in the Efferon LPS and control group, respectively (p = 0.032). The need for a renal replacement therapy (RRT) in survivors by the 3rd day was significantly reduced only in the Efferon LPS group — from 73.7 to 33.3 %. CONCLUSIONS: The use of the selective hemosorbent Efferon LPS resulted in significant decreases the hallmarks of systemic inflammation, MOF and requirements for RRT in patients with septic shock.

Role of procalcitonin in predicting newborn hospital-acquired sepsis: a case–control study

BackgroundNeonatal sepsis is a leading cause of newborn mortality in the developing world. Most of the newborn babies admitted to a neonatal ICU for different reasons acquire hospital-acquired infections. Early and optimal management is pivotal for successful outcomes. However, most of the places lack advanced automated culture facilities. Procalcitonin could potentially be used for early diagnosis of such infection.ObjectiveTo study the diagnostic role of serum procalcitonin in newborn hospital-acquired sepsis.Materials and methodsA case–control study was conducted in a tertiary care hospital in northern India.ResultsCulture-positive nosocomial sepsis group consisted of 59 patients and the control group of 41 patients. Gram-negative organisms were the most commonly isolated organisms (91.5%). The baseline median and interquartile range (IQR) serum PCT of the study population was 0.3 (0.18–.44) ng/ml. The median (IQR) serum PCT values at the time of clinical deterioration in the nosocomial sepsis and the sepsis-like illness groups are 4 (6.5) ng/ml and 1.2 (1.6) ng/ml, respectively (p = 000). The area under the ROC curve for the prediction of bacterial infection for PCT was 0.864. On the ROC curve, the PCT level that combined the greatest sensitivity and comparatively good specificity was 1.95 ng/ml, with a sensitivity of 88%, and specificity of 79%.ConclusionWe conclude that serum procalcitonin is a reliable marker for the diagnosis of neonatal nosocomial sepsis.

The effects of ultrasound-guided QLB and TAPB combined with opioid-free anesthesia (OFA) on clinical efficacy of the patients undergoing abdominal surgery

BackgroundAlthough opioids provide effective analgesia for abdominal surgery, they also present serious unwanted side effects. Ultrasound-guild quadratus lumborum block (QLB) and transversus abdominis plane block (TAPB) have been proven to offer long-lasting and efficient analgesia during abdominal surgery. However, the clinical efficacy of ultrasound-guided QLB and TAPB combined with opioid-free anesthesia (OFA) in abdominal surgery remains unclear. ObjectiveThis study aimed to investigate the impact of ultrasound-guided QLB and TAPB combined with opioid-free anesthesia (OFA) on the clinical efficacy of abdominal surgery. MethodsA total of 122 patients scheduled for abdominal surgery at People's Hospital of Wanning between March 2021 and April 2022 were enrolled in this study. Participants were randomly divided into two groups: the experimental group (QLB/TAPB + OFA, 62 patients) and the control group (opioid anesthesia, 60 patients). The clinical efficacy of the QLB/TAPB combined with OFA technique was evaluated by analyzing patients' vital signs, postoperative consciousness recovery time, numeric rating scale (NRS) score, and immune function in both groups. ResultsWe observed that systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in experimental group were significantly higher than those in control group after induction (p < 0.05). Heart rate (HR) in experimental group was significantly lower than in the control group at intraoperative 1h (p < 0.05). Additionally, bispectral index (BIS), state entropy (SE), and response entropy (RE) levels in the experimental group were significantly higher than those in the control group (p < 0.05). Furthermore, extubation and awakening time were significantly shorter in the experimental group compared to the control group (p < 0.05). The NRS scores in the experimental group were markedly lower than those in the control group. Moreover, IL-6 and CRP levels in the experimental group were obviously lower than in the control group after postoperative 1d (p < 0.05). Interestingly, IL-6 (p < 0.001), CRP (p < 0.001), and PCT (p = 0.037) levels in female patients of the experimental group were all significantly lower than those in the control group after postoperative 1d. ConclusionsUltrasound-guided QLB and TAPB combined with OFA technique can reduce pain intensity and enhance the patients’ immune function in abdominal surgery.

A-104 Clinical Validation of the VITROS® Immunodiagnostics Products B·R·A·H·M·S PCT Test Medical Decision Points and Prediction of Cumulative 28-Day All-Cause Mortality

Abstract Background Procalcitonin (PCT) is a biomarker for systemic bacterial infection and sepsis and may be used to aid in decision-making on antibiotic therapy for patients with suspected or confirmed lower respiratory tract infections (LRTI) and/or sepsis. Procalcitonin medical decision points have been established using the B·R·A·H·M·S PCT sensitive KRYPTOR assay. In this study, we compared the performance of the VITROS® Immunodiagnostic Products B·R·A·H·M·S PCT assay to the performance of the B·R·A·H·M·S PCT sensitive KRYPTOR assay at the established medical decision points. Percent change in PCT level over time can be used to aid in the prediction of cumulative 28-day mortality in patients diagnosed with severe sepsis and septic shock. The 28-day all-cause mortality prediction of the VITROS B·R·A·H·M·S PCT assay was also evaluated in the study. Methods Patient sample sets from the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) study conducted in 13 sites in the United States were used in this study. Blood samples were collected on Days 0, 1, 3 and 4 from subjects who were admitted to the ICU with severe sepsis or septic shock. Each patient’s vital status was verified at Day 28. The samples were tested on the VITROS B·R·A·H·M·S PCT assay and the B·R·A·H·M·S PCT sensitive KRYPTOR assay. Concordance analysis between the VITROS B·R·A·H·M·S PCT and the B·R·A·H·M·S PCT sensitive KRYPTOR assays was performed at the established clinical decision points of 0.100 ng/mL, 0.250 ng/mL, 0.500 ng/mL, 2.00 ng/mL and 10.0 ng/mL to determine overall agreement between the two assays. For prediction of cumulative 28-day all-cause mortality using the VITROS B·R·A·H·M·S PCT assay results, the change in PCT values (Δ PCT) from Day 0 to Day 4 and Day 1 to Day 4 was calculated and evaluated against 28-day-all-cause mortality. Results Overall agreements of 98.5%, 98.0%, 97.4%, 97.8% and 98.0% were observed at 0.100 ng/mL, 0.250 ng/mL, 0.500 ng/mL, 2.00 ng/mL and 10.0 ng/mL, respectively, with the B·R·A·H·M·S PCT sensitive KRYPTOR assay. Δ PCT decline &amp;gt;80% or ≤80% was significantly associated with 28-day-all-cause mortality (P = 0.006). Univariate Cox proportional hazards regression analysis showed a 1.93-fold increase in risk for mortality in subjects with a Δ PCT change ≤80%. Conclusion The VITROS B·R·A·H·M·S PCT assay demonstrated excellent agreement with the B·R·A·H·M·S PCT sensitive KRYPTOR assay at medical decision points used to aid in decision-making on antibiotic therapy for patients with suspected or confirmed LRTI and/or sepsis. Clinical performance shows ΔPCT information can be used to classify patients diagnosed with severe sepsis or septic shock as lower and higher risk for cumulative 28-day all-cause mortality.

Assessment of α9β1 ıntegrın as a new dıagnostıc and therapeutıc target ın Behcet's dısease.

This study aimed to investigate the roles of α9β1 integrin and its ligands in Behçet's disease (BD) by examining serum levels and gene expressions. 15 healthy controls and 30 BD patients (14 active and 16 inactive) were included in the study. Serum levels of ITGA9, ITGB1, TNC, OPN, VCAM-1, VEGF, TSP1, TGM2, Emilin-1, and vWF, were measured by ELISA. Gene expressions of α9β1 (ITGA9 and ITGB1) and its ligands (TNC and SPP1) were evaluated by RT-PCR. Laboratory findings (CRP, ESR, HGB, WBC, RBC, neutrophil, lymphocyte, PLT, RDW, MPV, PCT, and HLA-B51) were obtained from the electronic database. Active BD patients had higher serum levels of α9β1 integrin and its ligands than inactive patients and healthy controls. No significant difference was observed between healthy controls and inactive patients. Gene expressions of ITGB1 and SPP1 were increased in both patient groups compared to healthy controls. ITGA9 and TNC gene expression levels were lower in the active group than in the inactive group. No noticeable differences were found in ITGB1 and SPP1 gene expressions between the patient groups. BD patients exhibited elevated CRP, ESR, WBC, neutrophil, PLT, and PCT levels, while HGB, RBC, and RDW values were lower than healthy controls. Active patients had higher CRP, ESR, WBC, neutrophil, and PLT levels. Significant positive correlations were found between CRP, ESR, WBC, neutrophil, PLT, PCT and serum levels of α9β1 integrin and its ligands. Increased release of α9β1 integrin and its ligands is associated with BD, suggesting their potential as markers for disease severity.

Clinical characteristics and outcomes of acute kidney injury in patients with severe fever with thrombocytopenia syndrome.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis caused by a novel bunyavirus. Until recently, the SFTS related acute kidney injury (AKI) was largely unexplored. This study aimed to investigate the clinical characteristics and outcomes of AKI in patients with SFTS. The non-AKI and AKI groups were compared in terms of general characteristics, clinical features, laboratory parameters and cumulative survival rate. The independent risk factors for in-hospital mortality in patients with SFTS were analyzed by multivariate logistic regression to identify the population with poor prognosis. A total of 208 consecutive patients diagnosed with SFTS were enrolled, including 153 (73.6%) patients in the non-AKI group and 55 (26.4%) patients in the AKI group. Compared with patients without AKI, patients with AKI were older and had a higher frequency of diabetes. Among these laboratory parameters, platelet count, albumin and fibrinogen levels of patients with AKI were identified to be significantly lower than those of patients without AKI, while ALT, AST, ALP, triglyceride, LDH, BUN, uric acid, creatine, Cys-C, β2-MG, potassium, AMY, lipase, CK-MB, TnI, BNP, APTT, thrombin time, D-dimer, CRP, IL-6, PCT and ESR levels were significantly higher in patients with AKI. A higher SFTS viral load was also detected in the AKI patients than in the non-AKI patients. The cumulative survival rates of patients at AKI stage 2 or 3 were significantly lower than those of patients without AKI or at AKI stage 1. However, there was no significant difference in the cumulative survival rates between patients without AKI and those with stage 1 AKI. Univariate and multivariate binary logistic regression analyses demonstrated that stage 2 or 3 AKI was an independent risk factor for in-hospital mortality in patients with SFTS. AKI is associated with poor outcomes in patients with SFTS, especially patients at AKI stage 2 or 3, who generally have high mortality. Our findings support the importance of early identification and timely treatment of AKI in patients with SFTS.

Efficacy of TACE Combined with Lenvatinib Plus Sintilimab for Hepatocellular Carcinoma with Tumor Thrombus in the Inferior Vena Cava and/or Right Atrium.

To validate the safety and effectiveness of transarterial chemoembolization (TACE) combination with lenvatinib and sintilimab in treating hepatocellular carcinoma (HCC) patients with inferior vena cava (IVC) and/or right atrium (RA) tumor thrombosis (TT). This study retrospectively analyzed HCC patients with IVC and/or RA TT treated with TACE combined with lenvatinib plus sintilimab. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) were calculated to evaluate the anti-tumor efficacy. Treatment-related adverse events (TRAEs) were analyzed to assess the safety profiles. A total of 58 patients were screened for eligibility between March 2019 and May 2022. At the time of data collection, 48.2% of patients were still receiving treatment. The median follow-up was 23.5 months. The ORR was 48.3%, the DCR was 91.4%, the median OS was 17.3 months, and the median PFS was 13.0 months. The ORR for IVC/RA TT was 62.1%, DCR was 94.9%, and the median PFS was 14.3 months. 56.9% of patients experienced ≥ grade 3 TRAEs, such as hypertension (10.3%) and elevated liver enzymes (13.8%). No new safety signals were identified. Participants with low levels of serum PCT value had satisfactory prognoses. TACE combination with lenvatinib plus sintilimab is effective in treating HCC with IVC and/or RA TT. The toxicities were manageable, with no unexpected safety signals. The baseline levels of serum PCT might be the predictive biomarkers for the triple combination therapy.

Tobacco smoking and blood parameters in the kurdish population of Iran

ObjectiveThis study investigates the relationship between smoking and blood parameters in the Iranian Kurdish population.MethodThe current study was conducted based on the recruitment phase of the Ravansar Non-Communicable Disease (RaNCD) cohort study.ResultsCurrent smokers had higher levels of RBC count, HCT, HGB, MCV, MCH, MCHC, WBC count, and GR%, than in other groups significantly. Passive smokers had higher levels of PLT count and PCT statistically. The increasing exposure time of smoking positively affected WBC count, GR%, PLT count, PCT, and RDW in female passive smokers. In addition, heavy smokers, as well as participants with a higher duration time of smoking, had the same results for significantly lower levels of lymphocyte and monocyte and a higher level of RBC indices.ConclusionAccording to the present study, along with the current smokers, the intensity of smoking, as well as the duration time of the smoke, could have a positive correlation with blood parameters. Furthermore, passive smokers and specifically secondhand female smokers were more vulnerable to smoke.

Comparison of monocyte distribution width and Procalcitonin as diagnostic markers for sepsis: Meta-analysis of diagnostic test accuracy studies.

We aimed to perform a meta-analysis to find out whether PCT and MDW could be used as accurate diagnostic markers for sepsis. We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any observational or clinical trials that compared monocyte Distribution Width [MDW] with Procalcitonin [PCT] as diagnostic markers in a patient with sepsis. Case reports, editorials, conference abstracts, and animal studies were excluded. RevMan software [5.4] was used to perform the meta-analysis. After the complete screening, 5 observational studies were included in the meta-analysis. The total number of patients included in the meta-analysis in the sepsis group is 565 and 781 in the control group. The pooled analysis between the sepsis group and controls showed a statistically significant association between sepsis and increased levels of MDW and PCT [MD = 3.94, 95% CI = 2.53 to 5.36, p-value < 0.00001] and [MD = 9.29, 95% CI = 0.67 to 17.91, p-value = 0.03] respectively. Moreover, the subgroup analysis showed that the p-value of MDW levels [< 0.00001] is more significant than the p-value of PCT levels = 0.03, the p-value between the two subgroups [< 0.00001]. Additionally, the overall ROC Area for MDW [0.790] > the overall ROC Area for PCT [0.760]. Our study revealed a statistically significant association between sepsis and increased MDW and PCT levels compared with controls and the overall ROC Area for MDW is higher than the overall ROC Area for PCT, indicating that the diagnostic accuracy of MDW is higher than PCT.MDW can be used as a diagnostic marker for sepsis patients in the emergency department. More multicenter studies are needed to support our findings.

Diagnostic Value of PTX-3 Combined with PCT and CRP for Neonatal Sepsis

Aim: Neonatal sepsis is a critical illness among neonates and is the leading cause of neonatal death. In this study, we compared the changes in serum PTX-3 levels in neonates with sepsis and non-septicemia, as well as the diagnostic advantages and value of serum PTX-3 compared to traditional indicators such as WBC, CRP, and PCT. Methods: A total of 109 neonates were included in this study. Neonates were divided into three groups: 35 neonates were assigned to the sepsis group; 36 to the local infection group; and 38 assigned to the control group. Blood was collected to measure complete blood counts, CRP, PCT, liver and kidney function, lactate, and PTX-3 levels. Results: CRP, PCT, and PTX-3 in the sepsis group were significantly higher compared to the local infection group and non-infection group (P&lt;0.01 or P&gt;0.05). PCT and PTX-3 levels in the local infection group were significantly higher compared to the non-infection group (P&gt;0.05). The combination of WBC+CRP+PCT+PTX-3 was more sensitive for the diagnosis of neonatal infection. For the diagnosis of neonatal sepsis, CRP was the most sensitive index, with PTX-3 having the best specificity. The combination of WBC+CRP+PTX-3 was found to significantly improve the sensitivity and specificity of diagnosis. Conclusion: PTX-3 could be used as a new biomarker for neonatal sepsis, while the combination with WBC, CRP, and PCT could significantly improve the sensitivity and specificity for sepsis diagnosis.

Effectiveness and safety of normoxic allogenic umbilical cord mesenchymal stem cells administered as adjunctive treatment in patients with severe COVID-19

Inflammatory response in COVID-19 contributes greatly to disease severity. Mesenchymal Stem Cells (MSCs) have the potential to alleviate inflammation and reduce mortality and length of stay in COVID-19 patients. We investigated the safety and effectiveness of normoxic-allogenic umbilical cord (NA-UC)-MSCs as an adjunctive treatment in severe COVID-19 patients. A double-blind, multicentric, randomized, placebo-controlled trial involving severe COVID-19 patients was performed from January to June 2021 in three major hospitals across Java, Indonesia. Eligible participants (n = 42) were randomly assigned to two groups (1:1), namely the intervention (n = 21) and control (n = 21) groups. UC-MSCs dose was 1 × 106 /kg body weight on day D0, D3, and D6. The primary outcome was the duration of hospitalization. Meanwhile, the secondary outcomes were radiographical progression (Brixia score), respiratory and oxygenation parameters, and inflammatory markers, in addition to the safety profile of NA-UC-MSCs. NA-UC-MSCs administration did not affect the length of hospital stay of severe COVID-19 patients, nor did it improve the Brixia score or mMRC dyspnoea scale better than placebo. Nevertheless, NA-UC-MSCs led to a better recuperation in oxygenation index (120.80 ± 72.70 baseline vs. 309.63 ± 319.30 D + 22, p = 0.038) and oxygen saturation (97.24 ± 4.10% vs. 96.19 ± 3.75% in placebo, p = 0.028). Additionally, compared to the placebo group, the treatment group had a significantly smaller increase in PCT level at D + 22 (1.43 vs. 12.76, p = 0.011). No adverse effects, including serious ones, were recorded until D + 91. NA-UC-MSCs therapy is a very safe adjunct for COVID-19 patients. It improves the oxygenation profile and carries potential to suppress inflammation.

Clinical Value of Sampling Time of Metagenomic Next-Generation Sequencing in Patients with Severe Pneumonia.

Severe pneumonia is a common infectious disease with high morbidity and mortality. Early etiological diagnosis is crucial for improving the prognosis. The aim of this study is to evaluate the clinical value ofsamplingtime of mNGS in patients with severe pneumonia. This retrospective study enrolled 105 patients with severe pneumonia. mNGS was performed on bronchoalveolar lavage fluid (BALF). Patients were divided into the sampling time ≤ 72h vs sampling time >72h groups and survivors vs non-survivors groups according to their sampling time and prognosis. Clinical characteristics, the adjustment of antibiotics and clinical prognostic value were evaluated. Our study showed that, early sampling of mNGS can significantly shorten the mechanical ventilation time (p = 0.007) and hospitalization time (p = 0.004). In the non-survivors group, CURB-65, SOFA, and APACHE II scores were higher. Age (OR: 1.051, 95% CI: 1.004-1.100, p = 0.034), chronic respiratory diseases (OR: 4.639, 95% CI: 1.260-17.082, p = 0.021), immunosuppression (OR: 5.008, 95% CI: 1.617-15.510, p = 0.005) and SOFA score on the day of mNGS sampling (OR: 1.492, 95% CI: 1.212-1.837, p < 0.001) were independent risk factors of in-hospital mortality. The most common pathogens were Klebsiella pneumoniae and Human gammaherpesvirus 4. The proportion of appropriate and targeted antibiotics adjusted was significantly higher than that in the sampling time > 72h group, and the proportion of antifungal and antiviral agents adjusted was lower. In the early sampling group, it was significantly decreased in the CRP, PCT level and NEU% at discharge. This study demonstrated that early sampling of mNGS could shorten the time of mechanical ventilation and hospitalization of patients with severe pneumonia. Patients with higher SOFA score on the day of sampling had a poorer prognosis. It emphasizes that early sampling of mNGS has a positive value.

A study on the correlation between serumProcalcitonin level and the resistant bacterial strains isolated from meningitispatients in Bani- Suief governorate

Absract Meningitis is an inflammation of the membranes surrounding the brain, spinal cord and the intervening cerebrospinal fluid. Bacterial Meningitis can be quite severe and may result in brain damage, hearing loss, or learning disabilities. Viral Meningitis is less severe and will clear up with specific treatment. N.meningitides, S. pneumonia, H. influenza , M. tuberculosis are among the commonest bacterial causes.This study aimed to assess the diagnostic role of cerebrospinal LDH and serum procalcitonin (PCT-Q) in meningitis in Bani- suef governorate and to differentiate bacterial from viral meningitis. Patients were classified cases into three groups; group (I) for septic meningitis, group (II) for aseptic meningitis and group (III) for meningism along with 100 control patients. After clinical examination, CBC, ESR, CRP, blood sugar level, renal and hepatic functions. CSF LDH, serum PCT were assessed in some patients. CSF LDH was higher than normal in 100% of patients suffering from septic meningitis and in 98% of patients suffering from aseptic meningitis. Serum PCT was positive in all patients with septic meningitis whereas it was negative in 69(66%) patients. There is a correlation between elevated serum levels of PCT and presence of bacterial resistant strains in cases of septic meningitis.

Procalcitonin as a Sepsis Marker in Patients of Critical Care Unit

Introduction: The aim of this study was to observe the diagnostic role of procalcitonin to evaluate sepsis and assess the level of inflammation for the patients of Critical Care Unit of different departments. Methods: This cross sectional, prospective and observational study was conducted at Armed Forces Institute of Pathology on the patients at Critical Care Unit of Paediatric, Surgery, Gynae and Medicine department in a tertiary care hospital (Combined Military Hospital, Dhaka) from June, 2020 to May, 2021. Total 106 patients were enrolled in this study. As the study was conducted during corona pandemic, RT-PCR test for Corona virus disease 2019 (COVID-19) along with serum procalcitonin and bacterial culture and sensitivity tests for different samples were prescribed for all 106 patients. Result: Out of 106 patients, 30.2% (32) patients were found positive and 69.69% (74) were found negative for COVID- 19 and 14.15% (15) patients had clinical documentation of bacterial co-infection, confirmed by blood, respiratory, or urine culture. After PCT test, 20.75 % (22) samples were found with severe sepsis or septic shock, 7.54% (08) samples were found with systemic infection, 18.06% (20) samples were with possible systemic infection, 31.13 % (33) samples were with local infections and 21.69% (23) were found within normal ranges of PCT. Conclusion: This study supports the importance of the diagnostic role of PCT to assess the level of sepsis as well as presence of co-infection which suggests that PCT level is a good biomarker for early diagnosis, assessment and treatment of patients in CCU. J Bangladesh Coll Phys Surg 2023; 41: 198-204

The Analysis of MPV, Plateletcrit, Platelet Distribution Width, and Total Platelets in AKI

Patients with Acute Kidney Injury (AKI) who require hemodialysis had been reported to have a mortality rate of 50-70% in the last 30 years. Platelet and platelet index are two of the important hematological markers to be analyzed in AKI. This study aimed to analyze the levels of MPV, PCT, PDW, and total platelets in patients with AKI. A retrospective study using medical record data of 122 patients with AKI from January 2019 to December 2020 was conducted in Dr. Wahidin Sudirohusodo Hospital, Makassar. Patients were grouped based on disease outcomes and consisted of patients who died in the hospital and patients who recovered. Measurement of MPV, PCT, PDW, and platelet count was performed using a hematology analyzer. Mann-Whitney and independent T-tests were used for statistical analysis. The subjects of this study consisted of 80 AKI patients who died and 42 who recovered, the most affected age was &gt; 56 years old. The mean MPV was significantly higher in subjects who died in the hospital (10.31±1.53 fL) than in patients who recovered (9.5±1.39 fL) (p&lt;0.01). Mean PCT was higher in subjects who died in the hospital (0.85%) than in patients who recovered (0.18%), despite statistical insignificance (p&gt;0.05). Mean PDW was higher in subjects who died in the hospital (14.2 fL) than in patients who recovered (13.2 fL), despite statistical insignificance (p&gt;0.05). Mean platelet was lower in subjects who died in the hospital (174.3 x109L) than in patients who recovered (215.6 x109L), despite statistical insignificance (p&gt;0.05). Mean platelet volume levels were elevated in AKI patients with poor outcomes, possibly associated with the pathogenesis of more severe inflammation caused by hyperaggregation and peripheral destruction of platelets, which provide positive feedback to the bone marrow to produce larger and more active platelets. The MPV levels were significantly higher in AKI patients with poor outcomes, whereas PCT, PDW, and total platelet levels were not significant.

Clinico-demographic and microbiological profile of acute pyelonephritis in Azadi Teaching Hospital, Duhok province, Iraqi Kurdistan

The aims of this study were to identify the demographic and clinical characteristics of community associated acute pyelonephritis (CA-APN) or healthcare associated APN (HCA-APN), to determine risk factors linked with APN, and to identify the microbiological profile and its susceptibility patterns to antibiotics. A cross-sectional study was conducted from September to November 2022 at the nephrology unit of Azadi Teaching Hospital, Duhok, Iraqi Kurdistan. Urine and blood samples were collected from patients diagnosed with APN. These samples were investigated to identify the microbiologic profile of the infecting organisms and determine their antibiotic susceptibility results. From a total of 97 adult and elderly APN patients, 55 (56.7%) were classified as HCA-APN, while 42 (43.3%) were classified as CA-APN. In the univariate analysis, age ≥ 65, catheterization, chronic kidney disease, hemodialysis, diabetes mellitus (DM), cardiovascular disease (CVD), neurologic disease, chronic pulmonary disease, PCT level, and ANC were identified as significant risk factors for HCA-APN compared to CA-APN. Patients with catheterization and CVD history showed independent association in the multivariate analysis. The overall mortality rate was 11.3%, which was significantly associated with HCA-APN (P = 0.002). Considering the microbiological profile, Escherichia coli uropathogen (n=61) was the predominant isolated bacteria followed by Klebsiella pneumoniae (n=17). High antibiotic resistance rates were observed in fluoroquinolones and third generation cephalosporin classes among E. coli uropathogen in both CA-APN and HCA-APN patients, with a rate of 74.5 % and 63.9%, respectively. In conclusion, there is an increase in mortality rate regarding HCA-APN. The HCA-APN characteristics should be considered when prescribing empiric antibiotics. In our local setting, carbapenems are effective empiric therapies against enterobacteraceae uropathogens, for both HCA-APN and CA-APN. In order to prevent the emergence and spread of antibiotic resistance, implementing surveillance systems, infection prevention and control measures, and antimicrobial stewardship programs within our healthcare setting is crucial. Asian J. Med. Biol. Res. 2023, 9 (3), 59-69