Serum PCT Levels Research Articles

Role of procalcitonin in viral and bacterial meningitis

Background: Meningitis is one of the most common central nervous system infections by bacteria, virus or fungus encountered in infants and children.Early diagnosis of meningitis and differentiation of bacterial from non-bacterial/ viral meningitis tends to play an important role in the emergency management of children with suspected meningitis. While cerebrospinal fluid analysis is popular, along with biomarkers: C-reactive protein and white blood cell count, serum procalcitonin seems to offer an even better specificity.Methods: A hospital based cross-sectional-study was conducted in department of neurology in collaboration with department of pathology, Medanta, Medicity, Gurugram, for a period of one year from March 2018 to 2019. 100 children aged 4 months to 12 years, with suspected meningitis were enrolled. The study group was further subdivided into two groups, based upon their bacteriological profile: bacterial meningitis and viral meningitis.Results: For both the groups, the common clinical presentations were fever (100% and 96.88%), convulsions (58.33% and 45.31%), vomiting (25% and 43.75%), The demographic and clinical profile of the 2 groups was largely comparable. Serum PCT levels were significantly higher in bacterial meningitis group compared to non-bacterial meningitis with p<0.001. The sensitivity of serum PCT was found to be 97% and superior to CRP in terms of accuracy in identification and to assess the severity. Procalcitonin is an ideal marker with highest accuracy for bacterial infections.Conclusions: Serum PCT can act as a more sensitive and specific diagnostic tool in early differentiation of bacterial from non-bacterial meningitis in children.

Elevated Serum C1q Levels in Children With Sepsis.

Objective: To analyze the serum complement C1q levels in children with sepsis, and explore the suggestive effect of serum C1q levels on the condition of children with sepsis.Methods: The clinical and laboratory data of children with sepsis (n = 95) and healthy children (n = 71) in Renmin Hospital of Wuhan University from January 2019 to October 2019 were collected, and each index of the two groups was compared. Then we divided children with sepsis into three subgroups based on the Pediatric Critical Illness Score (PCIS): non-critical group, critical group, and extremely critical group. The serum C1q and PCT levels of the three subgroups were analyzed, and the correlation analysis was carried out between the levels of serum C1q and PCT levels as well as PCIS among children with sepsis. Finally, we analyzed the serum C1q levels of septic children infected by different pathogens.Results: The serum C1q levels of children with sepsis were significantly higher than those of healthy children (median 198.4 vs. 186.2 mg/L, P < 0.001). In the analysis of subgroups, the serum C1q levels of non-critical group, critical group, and extremely critical group septic children were 182.80 (166.75, 195.85) mg/L, 219.90 (209.10, 246.40) mg/L and 249.95 (239.10, 272.25) mg/L, respectively, which were correlated with the severity of the disease. At the same time, we also found that serum C1q in children with sepsis was positively correlated with PCT levels (r = 0.5982, P < 0.001), and negatively correlated with PCIS score (r = −0.6607, P < 0.001). The serum C1q levels of septic children with bacterial infections, mycoplasma infections, viral infections, and co-infection were higher than those of the control group (P < 0.05).Conclusion: The serum levels of C1q in children with sepsis were increased and related to the severity of sepsis, suggesting that C1q may be involved in the occurrence and development of sepsis, which had reference value for the preliminary diagnosis and severity classification of sepsis.

Study on clinical, subclinical characteristics, serum immunoglobulins concentration during and after of acute exacerbation of chronic obstructive pulmonary disease

Objective: To describe the clinical, subclinical characteristics and serum immunoglobulin concentrations during and after of acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD). Subject and method: A prospective observational study. 127 cases were enrolled: 30 healthy persons in control group and 97 patients with AE of COPD, being treated at 103 Military Hospital from October 2015 to August 2017. Result: Severe and very severe dyspnea accounted for the highest proportion, average mMRC score of 3.2 ± 0.7. Life-threatening AE accounted for 43.3%. Increased number of leukocytes was 54.6%. Disorders of blood glucose and kidney function were common, increasing serum PCT levels by 54.6%, and CRP by 68%. Increased pCO2 was 47.4% and respiratory acidosis was 33% in arterial blood gas in AE. The serum concentration of IgG, IgG1 during and after of AE were lower than the control group. The serum concentration of IgA in COPD patients were higher than control group (p&lt;0.001). Conclusion: Severe clinical symptoms accounted for a high proportion in AE and life-threatening AE accounted for 43.3%. Leukocytosis, increased serum PCT and CRP levels were common in AE. Serum IgG concentrations during and after of AE were significantly lower than in the control group.

Moesin Is a Novel Biomarker of Endothelial Injury in Sepsis.

Objective Increased vascular permeability and inflammation are principal hallmark of sepsis. Moesin (MSN) is a membrane-associated cytoskeleton protein and crucial for the vascular endothelial function. This study is aimed at evaluating the role of MSN in endothelial injury during the process of sepsis. Methods Serum MSN in septic patients was measured by ELISA. BALB/c mice were injected with different doses of lipopolysaccharide (LPS) or underwent cecal ligation and single or double puncture (CLP) to mimic sublethal and lethal sepsis. After treatment, their serum MSN and PCT levels, wet to dry lung weights (W/D ratio), bronchoalveolar lavage fluid (BALF) protein concentrations, and lung injury scores were measured. The impact of MSN silencing on LPS-altered Rock1/myosin light chain (MLC), NF-κB, and inflammatory factors in human microvascular endothelial cells (HMECs), as well as monolayer HMEC permeability, was tested in vitro. Results Compared with healthy controls, serum MSN increased in septic patients and was positively correlated with SOFA scores and serum PCT levels in septic patients. LPS injection significantly increased serum the MSN and PCT expression, BALF protein levels, and W/D ratio, and the serum MSN levels were positively correlated with serum PCT, lung W/D ratio, and lung injury scores in mice. Similar results were obtained in the way of CLP modelling. LPS enhanced MSN, MLC, NF-κB phosphorylation, increased Rock1 expression, and inflammatory factors release in the cultured HMECs, while MSN silencing significantly mitigated the LPS-induced Rock1 and inflammatory factor expression, NF-κB, and MLC phosphorylation as well as the monolayer hyperpermeability in HMECs. Conclusions Increased serum MSN contributes to the sepsis-related endothelium damages by activating the Rock1/MLC and NF-κB signaling and may be a potential biomarker for evaluating the severity of sepsis.

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.

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.

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.

Study of the association of serum procalcitonin with leukocytosis in predicting complicated acute appendicitis

Background: Delay in the diagnosis of complicated appendicitis and its treatment results in an increased rate of postoperative morbidity, mortality and hospital stay. The diagnosis of appendicitis rests on a combination of signs of inflammation such as fever, pain and tenderness; leukocytosis, and elevated C-reactive protein levels, interleukin-6 (IL6) and procalcitonin. Raised level of serum procalcitonin in bacterial infection has been used to further improve the diagnosis of complicated AA.Methods: One-hundred ten patients of appendicitis confirmed by intra-operative findings and final pathologist report, who underwent appendectomy consisting 25 women (22.73%) and 85 men (77.27%) with a mean age of 25 years (age range 15-55 years) were included in this study. Serum procalcitonin value was measured by chemi E411 Cobas method (chemilumiscent immunoassay system) using the B.R.A.H.M.S PCT kit. Serum PCT level &gt;0.5 ng/ml was consider as risk for progression to severe systemic disease.Results: At a 0.5 ng/dl cut-off value of PCT, the sensitivity and specificity of PCT level measurement for acute complicated appendicitis prediction was 90% and 97.14% respectively. Association between WBC count and PCT value shows the sensitivity and specificity in 40 case of acute complicated appendicitis prediction was 86% and 75% respectively.Conclusions: Both the higher PCT values and leukocytosis correlates well with infectious post-operative complications for acute appendicitis and it can help to carry out timely surgical intervention which is highly recommended in complicated appendicitis(correlates PCT &gt;0.5 ng/dl).

Serum Procalcitonin Levels Predict Mortality Risk in Patients With Pulmonary Tuberculosis: A Single-Center Prospective Observational Study.

Globally, tuberculosis is the leading infectious cause of death; discovering biomarkers that predict a high mortality risk may improve treatment outcomes. We prospectively enrolled 252 pulmonary tuberculosis patients who were not coinfected with human immunodeficiency virus and initiated antituberculosis treatment, measured serum procalcitonin levels (PCT), and assessed mortality risk. PCT serum levels higher than 0.13 (day 0), 0.05 (day 7), 0.12 (day 14), or 0.06 (day 28) ng/mL predicted nonsurvivors with odds ratios of 7.9, 14.3, 20.0, and 7.3, respectively (P ≤ .005 for all), respectively. Therefore, serum PCT levels are a promising mortality risk indicator for patients with pulmonary tuberculosis. Main Point. For patients with pulmonary tuberculosis, a promising mortality risk indicator is the level of serum procalcitonin, which is weakly associated with sputum bacterial load and independent of radiographic findings.

Procalcitonin in special patient populations: Guidance for antimicrobial therapy.

Procalcitonin (PCT) is an endogenous hormone that increases reliably in response to bacterial infection, and measurement of serum PCT levels is recommended to help guide antimicrobial therapy. The utility of PCT assessment in special patient populations (eg, patients with renal dysfunction, cardiac compromise, or immunocompromised states and those undergoing acute care surgery) is less clear. The evidence for PCT-guided antimicrobial therapy in special populations is reviewed. In the presence of bacterial infection, nonneuroendocrine PCT is produced in response to bacterial toxins and inflammatory cytokines, resulting in markedly elevated levels of serum PCT. Cytokine induction in nonbacterial inflammatory processes activated by acute care surgery may alter the interpretation of PCT levels. The reliability of PCT assessment has also been questioned in patients with renal dysfunction, cardiac compromise, or immunosuppression. In many special populations, serum PCT may be elevated at baseline and increase further in the presence of infection; thus, higher thresholds for diagnosing infection or de-escalating therapy should be considered, although the optimal threshold to use in a specific population is unclear. Procalcitonin-guided antimicrobial therapy may be recommended in certain clinical situations. Procalcitonin may be a reliable marker of infection even in special populations with baseline elevations in serum PCT. However, due to unclear threshold values and the limited inclusion of special populations in relevant clinical trials, PCT levels should be considered along with clinical criteria, and antibiotics should never be initiated or withheld based on PCT values alone. Procalcitonin measurement may have a role in guiding de-escalation of antibiotic therapy in special populations; however, the clinician should be aware of disease states and concomitant therapies that may affect interpretation of results.

Effectiveness of Cefoperazone-sulbactam alone and Combined with Tigecycline in the Treatment of Multi-drug Resistant Acinetobacter Baumannii Pulmonary Infection.

The aim of this study was to compare the effectiveness of cefoperazone-sulbactam alone and combined with tigecycline in the treatment of multi-drug resistant acinetobacter baumannii pulmonary infection. It was an experimental study carried out from April 2016 to September 2018. One hundred and fourteen patients with multi-drug resistant acinetobacter baumannii pulmonary infection were randomly divided into group A and group B with 57 cases in each group. Group A was treated with cefoperazone-sulbactam sodium alone, and group B was treated with cefoperazone-sulbactam combined with tigecycline. After 14 days of treatment, serum levels of PCT, CRP, TNF-a and IL-6 in group B were lower than those in group A (all p <0.001); APACHE II scores of group B were lower than those of group A (p <0.001). Compared with cefoperazone-sulbactam sodium alone, cefoperazone-sulbactam combined with tigecycline can effectively reduce the inflammatory response of patients with multi-drug resistant acinetobacter baumannii pulmonary infection; and thus a better prognosis can be obtained.

Evaluation of Acute and Sub-acute Toxicity of the Aqueous Extract from the Fruit of Solanum indicum Linn. (Solanaceae) in Rats

Aim: The fruit of Solanum indicum Linn have been reported traditionally to have anti-hypertensive and diuretic properties. This study was undertaken to evaluate the toxicological potential of S. indicum fruits aqueous extract through the acute and sub-acute toxicity tests in rats.&#x0D; Methodology: For acute toxicity evaluation, a single oral dose of 5000 mg/kg of the plant extract was administrated in 60 days old female albino Wistar rats. Then, the animals were observed for 14 days. Sub-acute toxicity studies were conducted with 50 adult rats of both gender that orally received during 28 days, increasing doses of the plant extract. Their body weight and food intake were weekly collected. At the end of the experiment, biochemical and hematological parameters as well as histological analysis of organs (liver, kidneys and spleen) were undertaken.&#x0D; Results: Single oral administration of 5000 mg/kg dose of the fruit plant aqueous extract produced no mortality or signs of toxicity. During sub-acute test, no variations in body weight and food intake of both animals gender were observed. An important decrease in male’s rat liver weight were obtained at the dose 25 mg/kg; serum urea, total cholesterol, TAG, ALP and AST levels were significantly lowered in male especially at the dose 50 mg/kg, but this decrease was noticed only in serum urea, ALP and ALT in female rats. Furthermore, a significant decrease in platelets number, serum PCT, MPV and PDW levels were recorded in all treated male rats except those receiving the highest extract dose. No structural changes in treated animal organs section histology were observed when compared to controls.&#x0D; Conclusion: The fruits aqueous extracts of S. indicum is safe when administered acutely and for 28 days in rats. However, alterations on their hematological and biochemical parameters were not closely related with the dose, implying caution on its use.

Effects of levofloxacin combined with heparin on serum PCT and CRP levels in hemodialysis patients with catheter infection

Objective To investigate the effect of levofloxacin combined with heparin on serum PCT and CRP levels in hemodialysis patients with catheter infection. Methods 82 hemodialysis patients with catheter infection admitted to our hospital from January 2017 to January 2018 were selected and were randomly divided into two groups. The control group was treated with levofloxacin, and the study group was treated with heparin on the basis of the control group. The incidence of adverse reactions, WBC and CRP levels, PCT and ESR levels, and inflammatory factors levels were compared between the two groups. Results There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). There were no statistically significant differences in WBC and CRP levels between the two groups before treatment (P>0.05). After treatment, the WBC and CRP levels in the study group [(4.1±2.2)×109/L, (5.1±2.3)mg/L] were lower than those in the control group (P 0.05). After treatment, the PCT and ESR levels in the study group [(0.8±0.2)μg/L, (19.3±3.2)mm/h] were lower than those in the control group (P 0.05). After treatment, the TNF-α, IL-6, and TG levels in the study group [(16.1±6.3)μg/L, (35.1±8.5)ng/L, (4.5±2.3)mmol/L] were significantly lower than those in the control group (P<0.05). Conclusion Levofloxacin combined with heparin can significantly improve WBC and CRP levels, PCT and ESR levels in hemodialysis patients with catheter infection, which can reduce inflammatory factors levels, improve safety, and improve patients’ prognosis. Therefore, levofloxacin and heparin should be further promoted and applied. Key words: Levofloxacin; Heparin; Hemodialysis; Catheter infection; Serum PCT level; Serum CRP level

DIAGNOSTIC SIGNIFICANCE OF PROCALCITONIN IN SEPSIS

Background: Sepsis is a global healthcare problem, characterized by whole body inflammation in response to microbial infection, which leads to organ dysfunction. It is a frequent complication in hospitalized patients. Despite the use of available treatment modalities mortality in sepsis remains high, often due to delayed diagnosis and treatment.&#x0D; .Objective: To study the efficacy of procalcitonin as a diagnostic marker for sepsis.&#x0D; Design: This was a cross-sectional study.&#x0D; Duration: One year i.e. from January 2017 to January 2018.&#x0D; Setting: Nimra Institute of Medical Sciences, Vijayawada, Andhra Pradesh, India.&#x0D; Participants: 100 Patients aged above 18 years presenting with acute sepsis to the Department Of Medicine, Nimra Institute of Medical Sciences, Vijayawada, Andhra Pradesh, India.&#x0D; Methods: Sepsis was confirmed clinically and/or by positive blood culture. Serum PCT was assayed semi-quantitatively by rapid immunochromatographic technique (within 2 hours of sample receipt). The patients were classified into groups. PCT and various other relevant factors were measured in all study subjects. PCT levels of less than 0.1 ng/ml were considered negative; all other levels were considered positive. Data were presented in the form of statistical Tables and charts. SPSS software version 20 was used for statistical analysis.&#x0D; Results: PCT proved to be an excellent indicator of sepsis. Serum PCT levels predicts mortality in the present study.&#x0D; Conclusion: The PCT assay was found to be a useful biomarker of sepsis in this study. The assay could be performed and reported rapidly and provided valuable information before availability of culture results. This might assist in avoiding unwarranted antibiotic usage.&#x0D; Keywords: Sepsis, Procalcitonin, Marker, Diagnosis.

Correlation between the serum procalcitonin level and the extension and severity of coronary artery disease in patients with non-ST-segment elevation myocardial infarction.

In this prospective cross-sectional study, the serum PCT level was measured 48 h after hospital admission in 131 patients with a diagnosis of NSTEMI. All the patients underwent selective coronary angiography, and the severity and extension of their CAD was evaluated with the Gensini score. The study population was assigned to two groups on the basis of the median of the Gensini score: those with a score higher than the median and those with a score lower than the median. There was no statistically significant difference with regard to the serum PCT level between the two groups (P = 0.511). In the multivariable logistic regression analysis, after adjustment for the potential confounders, the serum PCT level was not a determinant of the Gensini score (P = 0.502). The second 24-h postadmission serum PCT level was not correlated with the severity and extension of CAD according to the Gensini score in our patients with NSTEMI.

Procalcitonin levels in candidemia versus bacteremia: a systematic review

BackgroundProcalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia.MethodsPubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia.ResultsWe included 16 studies for a total of 45.079 patients and 785 cases of candidemia. Most studies claimed to report data relating to the use of PCT values for differentiating between candidemia and bacteremia in septic patients in the intensive care unit. However, the studies identified were all retrospective, except for one secondary analysis of a prospective dataset, and clinically very heterogeneous and involved different assessment methods. Most studies did show lower PCT values in patients with candidemia compared to bacteremia. However, the evidence supporting this observation is of low quality and the difference seems insufficiently discriminative to guide therapeutic decisions. None of the studies retrieved actually studied guidance of antifungal treatment by PCT. PCT may improve diagnostic performance regarding candidemia when combined with other biomarkers of infection (e.g., beta-d-glucan) but more data is needed.ConclusionsPCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence.

ESTIMATION OF RISK FACTORS OF EARLY POSTOPERATIVE MORTALITY IN ELDERLY PATIENTS WHO ARE SUBJECTED TO GASTRIC SURGICAL PROCEDURES

The use of screening programms in elderly population (age ≥65 years) comprises an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The aim was to determine the intra-hospital mortality rate in elderly patients undergoing gastric surgical procedures. 108 elderly patients (≥65 years old) were examined, divided into two groups: deceased and surviving surgical patients, treated for diseases (benign and malignant) of the stomach. The patients were divided into four age groups and five ASA groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administered transfusion and the occurrence of surgical complications during hospitalization. The mortality rate among elderly patients was 28.7%. The significant risk factors for mortality were: emergency surgery (p &lt; 0.001), bleeding gastric ulcer operations (p = 0.042), lung (p = 0.003), kidney (p &lt; 0.001), heart (p = 0.025) diseases, ASA score of 4 or higher (p &lt; 0.001), serum levels (higher after two times measurement) of creatinine, haemoglobin, CRP, PCT and glycemia (p &lt; 0.001). In order to improve medical treatment, the determination of independent validated risk indicators for mortality in elderly patients might lead to developing a dedicated scoring system.

The clinical value of brain natriuretic peptide and soluble urokinase plasminogen activator receptor in the diagnosis and prognosis of bloodstream infection in the patients of Intensive Care Unit

Objective To study the clinical value of brain natriuretic peptide (BNP) and soluble urokinase plasminogen activator receptor (suPAR) in the diagnosis and prognosis of bloodstream infection. Methods Totally 165 patients suspected of bloodstream infection admitted in intensive care unit (ICU) of the Second Hospital Affiliated to Suzhou University were enrolled in this study. According to the diagnosis standard of bloodstream inflection, patients were divided into the bloodstream infection group and non-bloodstream infection group. According to the prognosis of the patients, the bloodstream infection group was further divided into the survival group and the death group. Serum levels of suPAR, BNP, CRP, PCT, and chronic health evaluation Ⅱ acute physiology score (APACHE Ⅱ ), and mortality of the patients were analyzed, and the possible relation of the above indexes between the two groups were compared. Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC), the early diagnostic value of suPAR, BNP, CRP, PCT, and APACHE Ⅱ score in the bloodstream infection patients was determined. Results Serum levels of suPAR, BNP, CRP, PCT and APACHE II score in the bloodstream infection group were higher than those in the non-bloodstream infection group (P<0.05); Serum levels of suPAR, BNP, CRP, PCT and APACHE Ⅱ score in the death group were higher than those in the survival group (P<0.05). There was a positive correlation between serum suPAR, BNP, PCT and APHCHE Ⅱscore in patients of bloodstream infection(r=0.503, 0.548, 0.781,all P<0.05). The levels of suPAR, BNP, PCT and APACHE Ⅱ in the patients of blood stream infection were related to significant the prognosis (P<0.05). And these indexes can provide good evaluation on the prognosis of the patients. Conclusion Detection of serum suPAR, BNP can evaluate the severity of bloodstream infection and preliminarily determine the prognosis of patients with bloodstream infection. Therefore, the method is worth applying in the clinical field. Key words: Bloodstream infection; Soluble urokinase plasminogen activator receptor; Brain natriuretic peptide; APACHE Ⅱ score

Procalcitonin as an early marker of invasive bacterial infection in febrile children aged 1 month to 5 years of age

Objectives: To evaluate the role of serum procalcitonin as a marker of invasive bacterial infection in febrile children between 1 month to 5 years of age. METHOD: Febrile Children aged between 1 month to 5 years with temperature at admission of ≥ 38 0C (100.4 0F) and with no prior antibiotic use during the current febrile illness were studied prospectively. Results: At a cutoff value of 2 ng/ml for serum PCT levels the sensitivity of 90%, specificity 76%, positive predictability value 78%, negative predictability value of 88%, area under curve (AUC) of 0.935 with standard error of 0.0221 and 95% confidence interval of 0.892 to 0.979 was obtained. The optimum sensitivity and specificity was 86% and 84% respectively at PCT level of ≥ 2.27 ng/ml. Conclusions: Considering this high sensitivity and significant area under curve (AUC) it could be concluded that Serum PCT levels could serve a reliable early biomarker of invasive bacterial infection.