PCT Levels Research Articles

Distinguishing Early Infections from CRS with Routine and Exploratory Serum Proteomics and the HT10 Score Following CD19 CAR-T for Relapsed/Refractory B-NHL

Background: Early fever after CAR-T therapy can reflect both an infection or CRS. Distinguishing both etiologies in these commonly neutropenic patients represents an unresolved clinical challenge. Accordingly, the vast majority of patients receive empiric broad-spectrum antibiotics, which can promote antibiotic resistance and negatively influence the gut microbiome, which has recently been linked to inferior CAR-T outcomes (Smith et al, Nature Medicine 2022). Here, we aimed to characterize infection- vs. CRS-specific differences in routine and exploratory serum proteomics, and to develop a clinical tool that reliably discriminates between both. Methods: Early fever events (day 0-30) were retrospectively characterized as CRS vs. infection in 62 patients treated with standard-of-care CD19 CAR-T for r/r B-NHL (23 Axi-cel, 30 Tisa-cel, 9 Brexu-cel). Severe infections were defined as requiring IV anti-infectives and/or hospitalization in the presence of microbiologic evidence or distinct clinical signs of infection; CRS was graded according to ASTCT criteria. Cumulative incidence curves were calculated as time-to-event-analysis for CRS 1°, ≥2° and severe infections (day of event = index event). Serum inflammatory markers (CRP, interleukin-6 [IL-6], procalcitonin [PCT]) were measured daily from CAR infusion until discharge and on subsequent outpatient visits. Inflammatory markers were tested using binary logistic regression for severe infection vs. CRSonlyindex events. Discriminatory thresholds were determined from receiver operating characteristic (ROC) curves by optimizing the Youden J statistic. Longitudinal plasma proteomics was performed in 52 patients across four time points (day 0, 4, 14, 28) using a 92-protein multiplex proximity extension assay (Olink Proteomics). We applied a linear mixed model (LMM) accounting for both infection vs. CRS status and time effects. Results: The cumulative 30-day incidence of CRS 1°, CRS ≥2° and severe infections was 47%, 43%, and 25%, respectively. Five patients had neither CRS nor an infection, and were subsequently excluded from further analysis. Tocilizumab was applied in the majority of CRS patients (1°: 90%, ≥2°: 100%). We did not find a significant correlation between CRS grade and severe infections (G2 = 0.13, p = n.s.). Median onset of CRS and infection was 3 and 8 days, respectively. Most events (54%) occurred in the setting of coincident severe neutropenia (ANC <500/µl). While event-day CRP was comparable between infection and CRS (median 1.8 vs. 3.4 mg/dL, n.s.), we noted increased serum IL-6 (median 2243 vs. 64 pg/mL, p=0.03) and particularly high PCT levels (median 1.6 vs. 0.3 µg/L, p<0.0001) in the infection cohort. For PCT, an optimal discriminatory threshold of 1.5 µg/L was established (AUCROC 0.78). In previous work, we demonstrated that a CAR-HEMATOTOX (HT) score ≥2 identifies patients with a high infection risk (Rejeski et al, JITC 2022). Indeed, the infection cohort displayed higher baseline HT scores (median 5 vs. 2, p=0.002). By incorporating day-of-fever PCT levels with the HT score, the discriminatory capacity for severe infection events was improved. On ROC analysis, the 'HT10 score' (addition of 10 points to the patient-specific HT score in case event-day PCT ≥1.5 µg/L) exhibited superior discrimination for severe infections (AUC 0.92, p<0.0001, sens. 80%, spec. 91%, Fig. 1A). Additionally, we identified protein-level differences between the infection (n=13) vs. CRSonly (n=39) cohorts from the Olink dataset. On day 0, we noted marked upregulation of the angiogenetic factor TNFRSF12A in the infection cohort (q=4.8E-05). Notably, we observed progressive endothelial dysfunction and immune dysregulation in the patients developing severe infections (day 28, Fig. 1B). This included an increased ANG2/1 ratio and dysregulated CD40/CD40L axis. Consistent with a response to microbial exposure, the innate immune regulators CXC3L1, CCL20, and CXCL13 were upregulated in the infection group. Conclusions: The high discriminatory capacity of the HT10 score for infections highlights the advantage of dynamic risk-assessment and emphasizes the utility of procalcitonin in routine inflammatory panels. If validated prospectively, the score will enable more patient-individual decisions on antibiotic use. Finally, the identified Olink candidate markers may further refine the discriminatory capacity of the HT10 score. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Bacterial Aspiration Pneumonia in Generalized Convulsive Status Epilepticus: Incidence, Associated Factors and Outcome.

Suspicion of bacterial aspiration pneumonia (BAP) is frequent during generalized convulsive status epilepticus (GCSE). Early identification of BAP is required in order to avoid useless antibiotic therapy. In this retrospective monocentric study, we aimed to determine the incidence of aspiration syndrome and BAP in GCSE requiring mechanical ventilation (MV) and factors associated with the occurrence of BAP. Patients were older than 18 years and had GCSE requiring MV. To distinguish BAP from pneumonitis, tracheal aspirate and quantitative microbiological criterion were used. Out of 226 consecutive patients, 103 patients (46%) had an aspiration syndrome, including 54 (52%) with a BAP. Staphylococcus aureus represented 33% of bacterial strains. No relevant baseline characteristics differed, including serum levels of CRP, PCT, and albumin. The median duration of treatment for BAP was 7 days (5-7). Patients with BAP did not have a longer duration of MV (p = 0.18) and ICU stay (p = 0.18) than those with pneumonitis. At 3 months, 24 patients (44%) with BAP and 10 (27%) with pneumonitis had a poor functional outcome (p = 0.06). In conclusion, among patients with GCSE, half of the patients had an aspiration syndrome and one-quarter suffered from BAP. Clinical characteristics and biomarkers were not useful for differentiating BAP from pneumonitis. These results highlight the need for a method to rapidly differentiate BAP from pneumonitis, such as polymerase-chain-reaction-based techniques.

Clinical Implications of Postoperative Hyperamylasemia after Partial Pancreaticoduodenectomy

Introduction: The present study aimed to examine the clinical implications of postoperative hyperamylasemia (POH) after partial pancreaticoduodenectomy (PD). Methods: Data from all consecutive patients undergoing PD were obtained from a prospectively maintained database and reviewed. POH was defined as an elevation of serum pancreatic amylase above the upper limit of normal (53 U/L) on postoperative days 0–2. Clinically relevant POH (cr-POH) was defined as POH in patients with clinically relevant (Clavien-Dindo ≥ III) postoperative complications. Results: POH occurred in 61 of 170 (35.9%) and cr-POH in 24 of 170 (14.1%) patients. Patients with POH had higher rates of clinically relevant postoperative pancreatic fistula (cr-POPF) (44.3 vs. 3.7%, p < 0.001) and clinically relevant postoperative complications than those without POH (39.3 vs. 21.1%, p = 0.001). Patients with cr-POH had higher C-reactive protein (CRP, milligrams per liter) levels on third (257.7 vs. 187.85 mg/L, p = 0.016) and fourth (222.5 vs. 151, p = 0.002) postoperative day (POD) than those with POH alone. Serum procalcitonin (PCT, micrograms per liter) levels on POD 2 (1.2 vs. 0.4 μg/L, p = 0.028) and POD 3 (0.85 vs. 0.4 μg/L, p = 0.001) were also higher in patients with cr-POH. Rates of cr-POPF in patients with cr-POH were higher than in those with POH alone (70.8 vs. 27%, p = 0.001). POH (OR 0.011, 95% CI: 0.001–0.097, p < 0.001) was an independent predictor of cr-POPF in the multivariable analysis. A high-risk pathology, defined as nonadenocarcinoma/nonchronic pancreatitis pathology (OR 0.277, 95% CI: 0.106–0.727, p = 0.009), and a small duct diameter (OR 0.333, 95% CI: 0.139–0.796, p = 0.013) were independent predictors of POH in the multivariable analysis. Conclusion: POH is a frequent, but not always clinically relevant, finding after partial PD. Serum CRP and PCT levels in the early postoperative period can be used to identify patients with cr-POH. POH is an independent risk factor for increased postoperative morbidity, including cr-POPF, after partial PD.

Analysis of the impact of various risk factors on short-term and long-term outcomes in patients with COVID-19 on maintenance hemodialysis

Patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis (MHD) belong to a group of particularly high risk of infection and the course of COVID-19. The new coronavirus infection also has a great impact on long-term outcomes.Materials and methods: A retrospective observational study included 510 patients on MHD, hospitalized from April 1, 2020 to April 01, 2021. The outcome of hospitalization was chosen as the primary endpoint of the study: discharge or 28day mortality. Death within 6 months after discharge and the development of complications related to COVID-19 during this period were considered as secondary endpoints. Data collection was carried out by analyzing electronic and archival medical records. Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used.Results: average age 57.8±14 years, men – 59.5%, average bed day 17.6±10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-ofhospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P&lt;0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78; 95% CI 33.4-616.2; p=0.0001), on ventilator (OR 57.96; 95% CI 23.1-144.5; p=0.0001), the presence of septic complications (OR 26.4; 95% CI 13.8-50; p=0.0001), the course of the disease is defined as severe (OR 25; 95% CI 12.9-48.2; p=0.0001), the course of the disease is defined as complicated (OR 11.6; 95% CI 6.8-19.7; p=0.0001), the presence of gastrointestinal complications (OR 6.5; 95% CI 2.28-18.4; p=0.0007), the presence of obesity (OR 2.57; 95% CI 1.0-6.5; p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P&lt;0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7; 95% CI 1.0-57.7; p=0.03), the initial LDH blood level of 622 units /l (OR 4.7; 95% CI 1.63-13.63; p=0.0086), the course of the disease defined as complicated (OR 4.05; 95% 1.97-8.33; p=0.003), the course of the disease is defined as severe (OR 2.4; 95% CI 1.17-5.0; p=0.03).Conclusions: gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. During the first year of the epidemic, therapy remained largely supportive and aimed at preventing complications, the main isolated treatment regimens showed no significant differences in the impact on the outcomes of COVID-19.

Postoperative Serum Procalcitonin to Predict Clinically Relevant Pancreatic Fistula after Pancreatoduodenectomy

INTRODUCTION: Early detection of postoperative pancreatic fistula (POPF) is crucial for clinical and oncologic outcomes of patients who undergo pancreaticoduodenectomy (PD). The role of inflammation on post-PD morbidity is still controversial. Here, we aimed to assess the value of postoperative serum procalcitonin (PO-PCT) in predicting the onset of POPF, with particular regard to the clinically relevant POPF (CR-POPF). METHODS: A prospectively maintained database of patients who underwent PD between January 2012 and January 2020 has been retrospectively analyzed. Receiving operator characteristic analyses have been performed to identify the optimal postoperative cutoff values of PCT in predicting POPF and CR-POPF. RESULTS: A total of 124 PDs with available PO-PCT levels have been considered. PCT levels on postoperative day (POD) 3 >0.47 ng/mL were significantly associated with POPF (odds ratio [OR] 2.078; p < 0.017). Regarding CR-POPF, patients with POD 5 PCT levels >0.5 ng/mL have been found to be significantly at higher risk of developing this complication (OR 2.251; p < 0.046; area under the ROC curve of 0.680; Fig. 1). POD 5 PCT was significantly associated with severe postoperative complication (p = 0.006) and mortality (p = 0.005).CONCLUSION: POD 3 and POD 5 PCT may represent simple and useful tools to predict POPF, CR-POPF, severe complication, and mortality in patients undergoing PD.

Sepsis Due to Bacterial Infection: An Analysis based on Ratio Count of Neutrophil – Lymphocyte

Sepsis due to bacterial infection is a serious medical emergency and requires prompt and proper handling. Various parameters such as white blood cells count, CRP, and PCT level are used as a marker of sepsis due to bacterial infection. Sepsis is a condition of systemic inflammation with infection. Physiological response to systemic inflammation involves an increased level of neutrophils and a reduction of lymphocyte count; therefore, combining both parameters seems logical, and NLCR could be a simple and even better marker in predicting sepsis. This research aimed to determine the sensitivity and specificity of the NLCR test in patients with sepsis due to bacterial infection. This research was conducted by observing 70 sepsis patients aged 14-70 years at a private hospital in Bekasi and UKI general hospital in July-September 2015 through medical records. This research was an observational study with a cross-sectional design. The result of this research showed ROC curve for NLCR test with sensitivity 97.8 % , specificity 84.0 % , and cut off ≥ 6,4 (AUC: 0,94, p-value &lt;0,05). In conclusion, the NLCR is an ideal and efficient marker to diagnose sepsis due to bacterial infection with good sensitivity and specificity tests.&#x0D; Keywords: Sepsis, NLCR, Sensitivity, Specificity.

Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study.

BackgroundWe assessed the outcomes and characteristics of culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in pediatric intensive care unit (PICU).MethodsWe performed a retrospective study on the data of children admitted to the PICU due to septic shock between January 2018 and December 2021. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay (LOS) of hospital, the need for mechanical ventilation (MV) and continue renal replacement therapy (CRRT).ResultsOverall, 238 patients were enrolled. 114 patients (47.9%) had positive cultures (60 blood samples, 41 sputum samples, 17 pus samples, and 19 others), 18 of whom were cultured positive at two sites, 1 at three sites, and 3 had two different types of bacteria at same site. The in-hospital mortality was 47.1%. There were no significant differences in the in-hospital mortality (47.6% vs. 46.5%, P = 0.866), PRISM-III score (10 vs. 12, P = 0.409), PIM-3 score (0.08 vs. 0.07, P = 0.845), pSOFA score (10 vs. 10, P = 0.677) or the need for MV (64.5% vs. 68.4%, P = 0.524) and CRRT (29.8% vs. 34.2%, P = 0.470) between the CNSS group and the CPSS group. The Procalcitonin (8.89 ng/ml vs. 28.39 ng/ml, P = 0.001) and C-reactive protein (28 mg/L vs. 58 mg/L, P = 0.001) levels were significantly lower in the CNSS group than in the CPSS group, while WBC count (9.03 × 109/L vs. 5.02 × 109/L, P = 0.002) and serum sodium (137 mmol/L vs. 132 mmol/L, P = 0.001) was significantly higher in CNSS. The LOS of hospital was significantly longer (16 days vs. 11 days, P = 0.011) in the CPSS group than in the CNSS group, while the LOS of PICU (5 days vs. 4 days, P = 0.094) stay was not significantly different.ConclusionCompared with children with CNSS, children with CPSS had higher PCT and CRP levels, but lower WBC count. Children with CPSS had longer LOS of hospital. However, positive or negative culture results were not associated with in-hospital mortality, the LOS of PICU, the need for MV or CRRT in children with septic shock.

C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis.

Objective The aim of the study is to analyze the clinical characteristics, pathogen distribution, and drug sensitivity information of adult sepsis, and to provide reference for empirical clinical use; to explore the relationship between C-reactive protein (CRP) and calcitonin (PCT) The clinical value in the diagnosis of adult sepsis. Methods We collected 455 cases of hospitalized patients with positive blood culture, including 352 cases with sepsis and 103 cases without sepsis; 1609 cases of hospitalized patients with suspected infection and negative blood culture, including 287 cases of sepsis, and 518 cases of non-infectious systemic inflammatory response syndrome (SIRS) and 804 cases of local infection. Age, gender, route of admission, admission status, CRP, PCT, and white blood cell (WBC) levels were collected from the patients. The differences between the factors were statistically analyzed, and the receiver operating characteristic curve (ROC curve) was plotted to obtain the optimal cut-off values of CRP and PCT and their area under the curve (AUC), and to compare the CRP, PCT and PCT, and the CRP + PCT tandem to diagnose sepsis sensitivity and specificity. Results (1) 387 pathogenic strains were isolated from blood cultures of patients with sepsis, 71.06% Gram-negative, 26.87% Gram-positive and 2.07% fungi. (2) Among Gram-positive bacteria, Staphylococcus aureus was 87.5% resistant to penicillin and sensitive to vancomycin, milantropine, and teicoplanin; among Gram-negative bacteria, Escherichia coli was resistant to piracillin The resistance rate was 73.1%, fully susceptible to viraemia (100%) and resistant to imipenem, amikacin, and lacillin/tazole. (3) Among patients with positive blood cultures, CRP and PCT levels were higher in patients with sepsis than in those without sepsis. Pairwise comparison of ROC curves showed that the diagnostic value of PCT was greater than that of CRP (P=0.016). Conclusion CRP and PCT have a good reference value for diagnosis of sepsis patients and determination of the degree of infection in septic patients, especially PCT is more valuable for diagnosis of sepsis.

What does the Procalcitonin Level Tell us in Patients with Acute Pancreatitis?

To determine the factors affecting the procalcitonin level, and its association with the severity of pancreatitis in patients with acute pancreatitis (AP). Cross-sectional analytical study. Division of Gastroenterology, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital and Department of Gastroenterology, Dicle University School of Medicine, Diyarbakır, Turkey, between April 2017 and June 2021. The study included 214 patients diagnosed with AP according to Atlanta criteria. By checking the PCT and CRP values of the patients in the first 12 hours, the relationship with these scales that predict the severity of pancreatitis was statistically examined. Hundred and fifty-two patients (71.0%) had mild, while 62 patients (29.0%) had severe pancreatitis. According to the Atlanta criteria, the mean PCT level of patients with mild pancreatitis was 1.4±0.7 ng/mL, while the mean PCT level of patients with severe pancreatitis was 9.0±12.3 ng/mL (p<0.001). The diagnostic performance of PCT was better for predicting severe AP. For the 0.94 ng/mL cut-off, PCT had 86.9% sensitivity and 50.7% specificity. (AUC=0.731[95% CI: 0.669-0.811]; p<0.001; LR: 1.7). In patients with severe pancreatitis, the PCT level was 4.7±18.5 ng/mL in patients without concomitant infection and 15.8±8.1 ng/mL in patients with concomitant infection (p<0.001). High PCT value measured at the time of the first admission to the hospital may predict severe pancreatitis. In addition, a high PCT value at the time of admission to the hospital in patients with pancreatitis may indicate another concomitant infection. Acute pancreatitis, Coinfection, Procalcitonin, Severity of pancreatitis.

Elevated Serum Procalcitonin Levels in Chronic Kidney Diseases Patients Undergoing Renal Therapy

Introduction: Inflammation is an established mortality risk factor in chronic kidney disease patients and particularly in patients on dialysis. Objectives: The main objective of the study is to find the role of procalcitonin in chronic kidney diseases patients undergoing renal therapy. Material and methods: This cross sectional study was conducted Holy Family Hospital, Rawalpindi during November 2021 to June 2022. The data was collected with the permission of ethical committee of hospital. Baseline characteristics of patients were collected, including age, gender, BMI, history of diseases and time of dialysis. Results: The data was collected from 200 patients. There were 88 (44.0%) male and 112 (57.0%) female patients. The mean age for male was 45.9 ± 11.7 years and for female 49.8 ± 14.1 years. The PCT level in CKD patients (0.45 ± 0.70 ng/mL) was significantly higher as compared to reference value of healthy control subjects. Significance increase in the value of BUN, Na, K, CRP and BUN is also observed in CKD patients. Practical implication: PCT must be measured in CKD patients especially for dialysis patients. Conclusion: It is concluded that PCT levels were significantly high in CKD patients, thus PCT is a valuable marker for early diagnosis of CKD or patients undergoing HD. Keywords: CKD, PCT, CRP, Inflammation, Dialysis, Diagnosis

P409 Study of epidemiology, risk factors and antifungal sensitivity pattern of fungal pneumonia in critically ill cirrhotics

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesLiver cirrhosis causes immune dysregulation and increased susceptibility to fungal infections. We studied the epidemiology and risk factors, and compared the rapid diagnostic methods and biomarkers for fungal pneumonia in critically ill cirrhotics.MethodsSingle-center, prospective cohort study of 100 critically ill cirrhotics with fungal pneumonia between January to September 2021. Comparative analysis was done for culture, realtime PCR and biomarkers, bronchoalveolar lavage and serum Galactomannan, and serum procalcitonin measured on days 1, 3, and 7. The final outcome considered was mortality within 1 month after diagnosis or discharge.Results Aspergillus flavus was the most common species (70/100,70%). Risk factors were, neutropenia (P .03), steroids prior to ICU admission (P .02), prolonged hospitalizations ˃21 days (P .05), and culture positivity was 80%. The culture was not inferior to realtime PCR for the diagnosis of fungal pneumonia. BAL Galactomannan was an early prognostic marker with a median rise above ˃ 3.5 index value. The Median PCT level was higher from day 1in the fungal pneumonia non-survivor group (3.29 vs. 0.8 ng/ml) with higher 30-day mortality (72%). Higher PCT was associated with bacterial co-infection (48%), antibiotic (74%), antifungal therapy, and renal failure and mortality.ConclusionFungal pneumonia complicates cirrhotics with neutropenia, prolonged hospitalization, and steroids as risk factors. Aspergillus flavus predominate in consensus with Asian epidemiology. Culture methods are reliable and a combination of molecular tests with BAL Galactomannan is useful for rapid diagnosis. Serum PCT is raised in patients with fungal pneumonia and is associated with higher mortality. In our study the baseline PCT at admission to ICU was higher in the non-survivor group, and levels on D3 and D7 were persistently higher. High serum procalcitonin level is an independent prognostic biomarker of mortality risk in fungal pneumonia.

Multimorbidity and Frailty Are the Key Characteristics of Patients Hospitalized with COVID-19 Breakthrough Infection during Delta Variant Predominance in Italy: A Retrospective Study.

The aims of this study were to describe the characteristics of patients hospitalized with delta SARS-CoV-2 breakthrough infection, and to identify factors associated with pneumonia on chest Computed Tomography (CT) and mortality. The clinical records of 229 patients (105 F), with a median age of 81 (interquartile range, IQR, 73–88) years old, hospitalized between June and December 2021 after completion of the primary vaccination cycle, were retrospectively analyzed, retrieving data on comorbidities, Clinical Frailty Scale (CFS), clinical presentation and outcomes. Multimorbidity (91.7% with ≥2 chronic illnesses) and frailty (61.6% with CFS ≥ 5) were highly prevalent. CFS (OR 0.678, 95% CI 0.573–0.803, p < 0.001) and hypertension were independently associated with interstitial pneumonia. Mortality was 25.1% and unrelated with age. PaO2/FiO2 on blood gas analysis performed upon admission (OR 0.986, 95% CI 0.977–0.996, p = 0.005), and CFS (OR 1.723, 95% CI 1.152–2.576, p = 0.008) were independently associated with mortality only in subjects < 85 years old. Conversely, serum PCT levels were associated with mortality in subjects ≥ 85 years old (OR 3.088, 95% CI 1.389–6.8628, p = 0.006). In conclusion, hospitalization for COVID-19 breakthrough infection mainly involved geriatric patients, with those aged ≥ 85 more characterized by decompensation of baseline comorbidities rather than typical COVID-19 respiratory symptoms.

Retrospective Analysis of D- Dimer and Procalcitonin as the Predictor of DIC in Patients with COVID 19

Background: COVID 19 causes growing numbers of severe diseases with systemic abnormalities like organ dysfunction, thrombosis, and mortality. Disseminated Intravascular Coagulation or DIC is associated with the development of systemic fibrin, which may cause due to increased thrombin expression, concomitant physiological anticoagulant suppression and dysfunctional fibrinolysis. Methods: This study was a retrospective study that was conducted at the department of Clinical Pathology. The study was carried out during the period of September 2021-February, 2022. The total sample size for this study was 50. Result: Most of the respondents 12(24%) were aged from 50-59 years. Most of the respondents 35(70%) were female and 15(30%) were male. D-Dimer findings of most of the patients (44%) were severe. PCT test findings were normal for 34% of the participants, mild for 6%, moderate for 26%, and the remaining 40% had severe PCT levels. Among the 50 cases, both PCT and D-Dimer values were in the normal range for 26% of the participants, while 62% of the participants had raised values (mild, moderate, or severe) in both PCT and D-Dimer tests. Conclusion: From this study, it can be said that levels of D-dimer and PCT are directly linked to the disease severity among the patients with COVID 19.

Diagnostic and Prognostic Value of Interleukin-6 in Emergency Department Sepsis Patients.

PurposeThe objective of this study was to explore the diagnostic and prognostic value of interleukin-6 (IL-6) in sepsis patients presenting to the emergency department.Patients and MethodsA total of 128 patients who visited the emergency department of West Hospital of Beijing Chaoyang Hospital, affiliated to Capital Medical University, from November 2021 to February 2022 were subjected to this study. According to Sepsis-3.0 diagnostic criteria for sepsis, patients were divided into non-sepsis group (65 cases) and sepsis group (63 cases). Demographic data and clinical characteristics of the two patient groups were compared. Serum levels of biomarkers including IL-6, blood urea nitrogen (BUN), and lactic acid (Lac) were compared with Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Scale (GCS) scores. Logistic regression was used to analyze independent risk factors and Receiver Operating Characteristic Curve (ROC) method was used to analyze the Area Under the Curve (AUC) to determine the diagnostic and prognostic value of markers.ResultsCompared with non-sepsis patients, levels of IL-6, PCT, CRP and BUN were significantly higher in sepsis patients (10.84 (4.41–27.01): 92.22 (21.53–201.12), 0.03 (0.01–0.1):0.49 (0.08–3.1), 8.3 (0.5–31.8):39.8(10.3–98.6), 7.01 (4.90–11.74):13.03 (6.93–25.99), all p = 0.001). IL-6, BUN and mean arterial pressure (MAP) were independent risk factors for sepsis diagnosis. AUC values of IL-6, BUN, MAP and IL-6+BUN+MAP were 0.764, 0.696, 0.685, and 0.848, respectively. Lactate, age and SOFA score were independent risk factors for 28-day mortality in sepsis patients. The AUC of Lac, age, SOFA score and Lac+age+SOFA score to predict 28-day death in sepsis patients was 0.679, 0.626, 0.747, and 0.819, respectively.ConclusionIL-6 is an independent predictor of sepsis diagnosis, and the combination of blood BUN and MAP has superior diagnostic performance. Lac, age, and SOFA score could effectively predict clinical outcomes in patients with sepsis.

Systemic inflammation is linked to liver fibrogenesis in patients with advanced chronic liver disease.

Experimental evidence indicates that systemic inflammation (SI) promotes liver fibrogenesis. This study investigated the potential link between SI and fibrogenesis in patients with advanced chronic liver disease (ACLD). Serum biomarkers of SI (CRP, IL-6, procalcitonin [PCT]) and extracellular matrix (ECM) turnover (i.e., fibrogenesis/fibrolysis) were analysed in 215 prospectively recruited patients with ACLD (hepatic venous pressure gradient [HVPG] ≥6 mm Hg) undergoing hepatic vein catheterization. Patients with non-elective hospitalization or bacterial infection were excluded. Histological alpha-smooth muscle actin (α-SMA) area was quantified on full biopsy scans by automated morphometric quantification in a subset of 34 patients who underwent concomitant transjugular liver biopsy. Histological α-SMA proportionate area correlated with enhanced liver fibrosis (ELF) score (Spearman's ρ= 0.660, p< .001), markers of collagen formation (PRO-C3, ρ= 0.717, p< .001; PRO-C6, ρ= 0.526, p= .002) and tissue inhibitor of metalloproteinases-1 (TIMP1; ρ= 0.547, p< .001), indicating that these blood biomarkers are capable of reflecting the dynamic process of ECM turnover. CRP, IL-6 and PCT levels correlated with ELF, biomarkers of collagen synthesis/degradation and TIMP1, both in compensated and decompensated patients. Multivariate linear regression models (adjusted for HVPG) confirmed that CRP, IL-6 and PCT were independently linked to markers of liver fibrogenesis and ECM turnover. Systemic inflammation is linked to both liver fibrogenesis and ECM turnover in ACLD and this association is not confounded by the severity of liver disease, as evaluated by HVPG. Our study confirms experimental data on the detrimental impact of SI on ECM deposition and fibrosis progression in a thoroughly characterized cohort of patients with ACLD.

A retrospective observational study of biomarker levels and severity assessment in pediatric community-acquired pneumonia.

Multiple studies have investigated the role of biomarkers in predicting pneumonia severity in adults but minimal conclusive research exists for children. This study aimed to determine if the following biomarker levels, collected within 72 hours of hospital arrival: white blood cell count (WBC), platelet count, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-lymphocyte ratio, neutrophil count, or band count associated with community-associated pneumonia (CAP) severity in children.Methods:A retrospective chart review was conducted on children (aged 60 days to 18 years) diagnosed with CAP, and admitted to a regional, tertiary hospital (Charleston, WV, USA) for 3 years (2015–2018). Patients were stratified into 2 severity cohorts, mild (no ICU care), and moderate/severe (required ICU care). Biomarker values were then compared between the severity cohorts and area under the curve (AUC), and cut-off values and performance characteristics were calculated.Results:A total of 108 patients met inclusion criteria with 46% having moderate/severe CAP. Elevated levels of CRP (51.7 mg/L in mild vs. 104.8 mg/L in moderate/severe, P = .003, PCT (0.29 ng/ml in mild vs. 4.02 ng/mL in moderate/severe, P = .001) and band counts (8% in mild vs. 15% moderate/severe, P = .009) were associated with increased pneumonia severity. In predicting moderate/severe CAP, PCT had the highest AUC of 0.77 (P = .001) followed by bands AUC of 0.69 (P = .009) and CRP AUC of 0.67 (P = .003). Cut-off for PCT of 0.55 ng/mL had a sensitivity of 83% and a specificity of 65%. Cut-off level of 53.1 mg/L for CRP had a sensitivity of 79% and specificity of 52%. Cut off level of 12.5% bands had a sensitivity of 61% and specificity of 71%. In a multivariable model controlled for patient demographics and other biomarker levels, only PCT levels significantly predicted moderate/severe CAP (adjusted odds ratio: 1.40 [95% CI, 1.14–1.73], P = .002).Conclusion:Biomarkers, in particular PCT, obtained early in hospitalization may perform as possible predictors for CAP severity in children and be beneficial in guiding CAP management. However, biomarkers in pneumonia should not drive severity assessment or patient management independent of clinical presentation.

Prognostic Value of Serum Procalcitonin Based Model in Moderate to Severe Traumatic Brain Injury Patients.

ObjectiveProcalcitonin (PCT) is an acknowledged marker of systemic inflammatory response. Previous studies have not reached agreement on the association between serum PCT and outcome of traumatic brain injury (TBI) patients. We designed this study to confirm the prognostic value of PCT in isolated TBI and those with extracranial injury, respectively.MethodsPatients hospitalized in our hospital for moderate-to-severe TBI between March 2015 and December 2019 were included. Logistic regression analysis was performed to validate the association between PCT and in-hospital mortality in these patients. AUC (area under the receiver operating characteristics curve) of PCT and constructed model were calculated and compared.ResultsAmong the included 211 patients, 81 patients suffered a poor outcome, with a mortality rate of 38.4%. Non-survivors had a higher level of serum PCT (2.73 vs 0.72, p<0.001) and lower GCS (5 vs 7, p<0.001) on admission than survivors. AUC of single PCT for predicting mortality in isolated TBI and those with extracranial injury were 0.767 and 0.553, respectively. Multivariate logistic regression showed that GCS (OR=0.744, p=0.008), glucose (OR=1.236, p<0.001), cholesterol (OR=0.526, p=0.002), and PCT (OR=1.107, p=0.022) were independently associated with mortality of isolated TBI. The AUC of the prognostic model composed of GCS, glucose, cholesterol, and PCT was 0.868 in isolated TBI.ConclusionPCT is an efficient marker of outcome in isolated moderate-to-severe TBI but not those with extracranial injury. A prognostic model incorporating PCT is useful for clinicians to make early risk stratification for isolated TBI.

Association between Chorioamnionitis Severity and Procalcitonin Levels in Umbilical Venous Blood

Background: Procalcitonin can effectively differentiate between bacterial sepsis and a systemic inflammatory response syndrome of noninfectious origins in the adult. However, the usefulness of procalcitonin in perinatal field is not determined. Thus, the purpose of this study was to determine whether procalcitonin levels in the umbilical blood reflect the severity of chorioamnionitis and to assess their correlation with perinatal outcomes. Methods: A retrospective study was conducted in 145 pregnant women with singleton pregnancies and their neonates at a tertiary center between September 2010 and March 2013. Procalcitonin levels in the umbilical blood were measured by an immunoluminometric assay. The severity of chorioamnionitis was classified by the histological stage and grade for maternal and fetal inflammatory responses. Procalcitonin levels were evaluated according to the severity of chorioamnionitis; and the association with neonatal sepsis, intraventricular hemorrhage (IVH), neonatal death within 28 days of life, and periventricular leukomalacia was investigated. Results: In total, 28 women (19%) had chorioamnionitis, of which 21 (75%) delivered at less than 34 weeks of gestation. Fetal response in those with chorioamnionitis was correlated with maternal response. Procalcitonin levels in the group with fetal stage 2 and 3 or grade 2 responses were significantly higher than those infants with any other stage or grade. The frequency of neonatal sepsis, IVH stage III or IV, and neonatal death significantly increased (p &lt; 0.01), when a Procalcitonin level of ≥2 ng/mL was obtained. Conclusions: Procalcitonin levels in the umbilical blood reflect the severity of chorioamnionitis and are associated with neonatal outcomes such as neonatal sepsis, neonatal death, and severe IVH. When PCT level in umbilical venous blood show the high value of ≥2 ng/mL, it might be required that antibiotics therapy is initiated immediately after birth.

The Impact of Glycemic Control on Procalcitonin Level in Patients with Type II Diabetes

Background: Diabetes mellitus is a chronic condition characterized by hyperglycemia that can lead to serious complications. It results from a defect in insulin secretion, insulin resistance, or both. Type 2 diabetes mellitus (T2DM) is the most common type of diabetes and mainly affects adults. It is associated with insulin resistance and low-grade chronic inflammation in the adipose tissue, muscles, and liver. Measurement of hemoglobin A1c (HbA1c) is one of the most widely used tests to monitor diabetes. The aim of this study was to shed light on the effect of glycemic control of type 2 diabetes on procalcitonin (PT) levels in order to prevent future complications. Materials and Methods: This case-control study included 68 patients with type 2 diabetes mellitus. At Biochemistry Department, College of Medicine, and University of Baghdad and at Al-Sadiq Teaching Hospital in Al-Hilla City, during the period from July 2020 to October 2020. Hemoglobin A1C (HbA1c) was estimated by using an affinity chromatography assay. These patients were divided according to HbA1c level into bad control group (HbA1c &gt; = 7%) which included 36 patients, and good control group (HbA1c &lt;7%) which included 32 patients. Another group of 32 nondiabetic apparently healthy subjects (HbA1c &lt;5.7%) served as control group. Patients with type 1 diabetes mellitus (T1DM), gestational diabetes, insulin-treated type 2 diabetes, history of recent infection, diabetic foot, ischemic heart disease, cerebrovascular disease, or recent trauma or surgery were excluded. PCT of each participant was estimated using an enzyme-linked immunosorbent assay (ELISA). Results: The mean PCT values of bad control group, good control group, and control groups were 871.3776, 834.5005, and 208.5313 pg/mL, respectively. The study showed that there was no significant difference in mean PCT between good control and bad control groups (P &gt; 0.05). In addition, there was no significant correlation between PCT and HbA1c among diabetic patients (r = 0.072, P &gt; 0.05). However, there is a significant differences in mean of PCT values between diabetic patients and control group (P &lt; 0.05). Conclusion: There was no effect of glycemic control on PCT level in patients with T2DM. However, the level of PCT was increased in comparison with non-diabetic healthy subjects.

Outcome of Patients with Sepsis Admitted in Intensive Care Unit of a Tertiary Care Hospital in India

Introduction: Sepsis has a death rate of ∼25% globally and its clinical treatment presents an important clinical challenge. The rapid progression of sepsis requires correspondingly swift adjustments in therapy, and accurate identification of disease severity is therefore vitally important for predicting prognosis, treatment, preventing complications, reducing complication and mortality. With this background, the present research is aimed to study the relation of serum procalcitonin levels in cases with sepsis, to calculate APACHE II scores and to correlate the levels of serum PCT levels with APACHE II Score with the outcome.&#x0D; Methodology: This was a prospective observational non interventional cohort study was conducted in the Clinic of Intensive Care unit of a tertiary care hospital and medical college in western India from May 2020 to December 2020.&#x0D; Results: A total of 75 patients, admitted to the ICU with the diagnosis of sepsis, were included in this prospective observational study. Of them 47 (62.7%) were males and highest cases were aged between 60 to 69 years. Of the total 75 patients, 47 (62.7%) patients were survivors. Age, gender and involvement of system were not associated with mortality while lower APACHE II score and presence of co-morbidities were significantly associated with mortality.&#x0D; Conclusion: From this study we conclude that the lower APCHE II score and presence of co-morbidity significantly increases the mortality in ICU patients admitted with sepsis.