PCT Value Research Articles

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.

DIAGNOSTIC VALUE OF PROCALCITONIN IN PREDICTING SEPSIS IN BURNS PATIENTS

Patients who have suffered from burns are at an increased risk of dying from sepsis. The combination of a systemic inammatory response and a recognised infection is what medical professionals call sepsis. If the infection is not treated, then it will lead to severe sepsis, which is characterised by organ dysfunction, low perfusion, and low blood pressure. The systemic inammatory response syndrome, often known as SIRS, may have an infectious or a noninfectious origin. When dealing with patients who have suffered serious trauma or burns, it is often difcult to determine whether SIRS is the consequence of the injury itself or whether it is related to a superimposed infection. In patients with SIRS, the majority of the clinical symptoms of infection, including fever, tachycardia, and leukocytosis, were also present. As a result, in order to circumvent this problem, the American Burns Association established a consensus panel, and criteria were drafted in order to dene sepsis in burns patients. In the past, a number of research have been carried out to determine the value of the PCT in both burns and non-burns related situations . Even in the absence of sepsis, the value of PCT may be modestly elevated due to the localised infection. Therefore, the diagnostic threshold for sepsis is quite low when using the cut off value that was examined in the earlier investigations. This study was carried out to determine the PCT value in burns patients and also to locate a threshold value that may be used to suspect sepsis in its early stages. We intend to incorporate this threshold value as a protocol into our existing set up

Legionella pneumophila Infections during a 7-Year Retrospective Analysis (2016-2022): Epidemiological, Clinical Features and Outcomes in Patients with Legionnaires' Disease.

Legionella pneumophila (LP) is one of the main causative agents of community-acquired pneumonia in Europe and its fifth bacterial cause in Italy (4.9%). We conducted a seven year retrospective analysis of LP infection serogroup 1 in Asti, Piedmont, between 2016 and 2022. Patients were included if they tested positive for the Legionella urinary antigen. Clinical, laboratory, and radiologic data were analyzed to describe the risk factors for mortality. Fifty patients with LD were collected, mainly male, with a median age of 69 years. The main comorbidities were cardiovascular diseases (50%), pulmonary diseases (26%), and neurological diseases (12%). The most common clinical presentations were fever, respiratory, gastrointestinal, and neurologic symptoms. Older age (p = 0.004), underlying cardiovascular diseases (p = 0.009), late diagnosis at admission (p = 0.035), and neurological symptoms at diagnosis (p = 0.046) were more common in the non-survivor group. Moreover, a septic-shock presentation or the need for non-invasive ventilation at admission were associated with a higher mortality. No considerable differences in the biochemical data were found between the two groups except for the median neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, and PCT value. We did not find any differences in mortality related to the choice of antibiotic regimen. Differences in outcome were associated with the median duration of treatment (p =< 0.001) but not to the choice of antibiotic regimen (mainly levofloxacin or azithromycin). In conclusion, early individuation of the wide spectrum of clinical characteristics of LP infection such as respiratory, cardiac, and neurological manifestations of the patient's comorbidities, and significant biochemical data should help clinicians flag high risk patients and potentially improve their outcome.

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.

Clinical features and risk factors of surgical site infections in HIV-negative patients with cryptococcal meningitis underwent ventriculoperitoneal shunt operations: a retrospective study

BackgroundTo investigate the clinical features and risk factors of ventriculoperitoneal shunt (VPS) associated surgical site infections (SSIs) in HIV-negative patients with cryptococcal meningitis (CM).MethodsWe retrospectively reviewed the medical records of HIV-negative patients with CM underwent VPS operation admitted to The Third Affiliated Hospital of Sun Yat-sen University in Southwest China over the past 7 years.Results193 patients were included, of whom 25 (12.95%) had SSIs in 6 (median duration, 1–48 days) days after operation. Compared with patients without SSIs, patient with SSIs tended to be shorter preoperative stay. 52% patients in SSIs group and 25% patients in no-SSIs group underwent VPS operations within 3 days after admission (p = 0.017). Although body temperature and infectious indicators slightly elevated postoperative in both groups. The patients with SSIs experienced more fever; more central nervous system symptoms; higher PCT value and lower cerebrospinal fluid (CSF) glucose in contrast to the no-SSIs group. Multivariate regression analysis found a 2.653 fold increase in the risk of infection for every 1 °C increase in postoperative body temperature. Among the 25 patients, 9 patients had positive culture results, three samples reported to be oxacillin resistant coagulase-negative Staphylococci.ConclusionsSSIs was one of the serious surgical complications after VPS operation. High body temperature, the occurrence of dizziness and headache, low postoperative hemoglobin are risk factors. Postoperative patients with high fever, high PCT and low CSF glucose should be paid more attention to.

Procalcitonin as a predictor of severity in acute pancreatitis

Background: Outcomes and severity of acute pancreatitis is a challenging condition to diagnose. However, multiple clinico-biochemical scores, imaging, radiological imaging, and biochemical markers are used. Aims: To evaluate procalcitonin as a predictor of severity in acute pancreatitis and to correlate the levels of procalcitonin to the CT Severity Index score. Materials and Methods: In 65 study subjects, prolactin levels, CRP, blood glucose, liver function tests, BUN, creatinine, urea, CBC, and radiological investigations including whole abdomen USG, X-ray abdomen-supine and erect, and chest X-ray PA view. Following 48-72 hours of admission, a CT abdomen was done on subjects with diagnostic dilemmas. In subjects where CECT was done, necrosis scores and Balthazar grading were used for grading the CT severity index. Results: For the cut-off PCT value of 1.77 ng/ml the sensitivity, specificity, PPV, NPV, accuracy, and likelihood ratio were 74.8, 76.88, 74.8, 76.94, 74, and 15.154 respective. In the PCT cut-off value of 3.29 ng/ml, the respective values of sensitivity, specificity, PPV, NPV, accuracy, and likelihood ratio were 66.65, 84.58, 79.8, 73.31, 74, and 14.426. BCTSI score of ≥4, the respective values of sensitivity, specificity, PPV, NPV, accuracy and likelihood ratio were 62.3, 65.36, 62.3, 65.36, 65, and 3.936.

The effect of preoperative urine culture and bacterial species on infection after percutaneous nephrolithotomy for patients with upper urinary tract stones

To study the relationship between preoperative urine culture, bacterial species and infection after percutaneous nephrolithotomy in patients with upper urinary tract stones, and summarize the clinical characteristics of different bacterial infections. From January 2014 and January 2020, 963 patients with upper urinary tract stones who underwent PCNL in the department of urology of Fujian provincial hospital were included in the study. Information included the patient’s age, gender, weight, diabetes, chronic disease history, urine routine, preoperative urine culture results, stone size, number of stones, hydronephrosis level, operation time, body temperature, heart rate, blood pressure, breathing rate, hemoglobin, serum creatinine, bilirubin, platelets and whether there was preoperative infection were recorded. 141 patients (14.6%) had a positive urine culture before surgery, and 7 of them had multiple bacterial infections. The most common pathogenic bacteria was Escherichia coli, followed by Enterococcus and Klebsiella pneumoniae. A total of 74 cases (7.7%) of 963 patients with infection after PCNL occurred, 24 cases (32.4%) of infected patients progressed to urinary septic shock. Univariate analysis shown that the probability of infection in patients with long operation time and positive urine culture was significantly higher, and the difference was statistically significant. Further multivariate logistic regression analysis shown that positive urine culture before operation and long operation time were independent risk factors for infection after PCNL. Among the 29 patients with septic shock, 18 cases (62.1%) had a positive urine culture before surgery. The incidence (43.9%) of postoperative infection in Escherichia coli positive patients was significantly higher than that in the negative group, and the difference was statistically significant. The rate of patients with Escherichia coli infection progressing to septic shock was 9 cases (60%). 2 patients with Enterococcus faecium infection and 2 patients with Klebsiella pneumoniae infection all progressed to septic shock. The age of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 58.53 ± 11.73 years, 76.5 years and 74 years.The body temperature of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 39.10 ± 0.25 °C, 39.45 °C and 38.65 °C. The highest pct value of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 80.62 ± 31.45 ng/mL, 24.32 ng/mL and 8.45 ng/mL. The nitrite positive rate of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 64.51%, 16.6% and 0. Postoperative infection of PCNL is significantly correlated with positive preoperative urine culture, and positive preoperative urine culture is an independent risk factor for postoperative infection. The most common pathogen of postoperative infection of PCNL is Escherichia coli, followed by Enterococcus and Klebsiella pneumoniae. Patients with Escherichia coli infection are often positive for nitrite before surgery, mainly manifested by high fever, and PCT is significantly increased (often exceeded 100 ng/ml). Enterococcus faecium and Klebsiella pneumoniae infections mostly occur in elderly patients and often progress to septic shock. Patients with Enterococcus faecium infection have a high fever, and the PCT value is significantly higher (often exceeded 20 ng/ml). Patients with Klebsiella pneumoniae infection have a moderate fever, and the PCT value generally does not exceeded 10 ng/ml. Long operation time is another independent risk factor for PCNL infection.

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

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

Fuel integrity evaluation method for BWR-6 plant Kuosheng during ATWS events

Abstract Anticipated Transients without Scram (ATWS) are evaluated to demonstrate that during ATWS the fuel’s integrity prevents fission product release, and that the safety features the BWR-6 plant is equipped with mitigate the ATWS event. For analyzing this scenario, a RETRAN-3D system model and hot channel model of Kuosheng NPP have been developed. From all possible events those are analyzed where the main steam isolation valves close (MSIVC) when the reactor is operating at rated power conditions. For cases with low core flows this results in higher peak cladding temperatures and thicker oxidation thicknesses. All results confirm the ATWS acceptance criteria. For sensitivity cases, increasing the boron concentration of standby liquid control system (SLCS) or injecting boron of SLCS earlier were investigated. The results show, that these measures cannot decrease the PCT value immediately, but can shorten the period of peak cladding temperature over 850 °C which results in smaller oxidation thickness.

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

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

Procalcitonin in myocarditis patients: role in aetiology identification and risk stratification

Abstract Background Procalcitonin (PCT) is an established predictor of bacterial infections and sepsis. However, PCT involvement in cardiovascular diseases has been scarcely investigated so far. In particular, no studies at all ever addressed the role of PCT in myocarditis patients. We aimed at evaluating PCT in myocarditis patients, as a potential biomarker of: a) aetiologic diagnosis; b) prognosis. Methods A cohort of 130 consecutive patients with a novel diagnosis of myocarditis confirmed by both endomyocardial biopsy and cardiac magnetic resonance were included in the study. Patients with known bacterial infections or bacterial myocarditis were excluded (n=5). PCT concentration was measured on admission in all patients. Prospective follow-up (FU) was performed every 6 months up to 5 years. Results Of 125 patients analyzed (mean age 45±15 years, males 62%, mean LVEF 48±15%), 22 (18%) had fulminant myocarditis (FM). The remaining 103 cases had non-fulminant myocarditis (NFM), including infarct-like presentation and non-malignant arrhythmias. Aetiology was viral or virus-negative in 23 and 102 patients, respectively. The mean PCT value was 0.44±0.18 mcg/ml, with no significant differences between viral and virus-negative myocarditis (0.43±0.19 vs. 0.44±0.18 mcg/ml, p=0.90). Baseline PCT concentration was significantly higher in FM patients (0.69±0.21 vs. 0.39±0.16 mcg/ml, p=0.07). Consistently, PCT was higher in patients with LVEF &amp;lt;60% (0.51±0.20 vs. 0.30±0.14 mcg/ml, p=0.03) and in those with elevated (&amp;gt;400 pg/mL) NT-proBNP (0.55±0.19 vs. 0.36±0.17 mcg/ml, p=0.03). As for inflammatory biomarkers, patients with high ESR (&amp;gt;20 mm/h) had also higher PCT values (0.56±0.20 vs. 0.37±0.16 mcg/ml, p=0.03). By converse, no association was found between PCT and CRP abnormal values (p&amp;gt;0.05). At univariate analysis, high PCT (≥0.20 mcg/ml) was predictive of heart failure recurrence (OR 2.77, 95% CI 1.18–6.48, p=0.02) or arrhythmic cardiac arrest (OR 3.22, 95% CI 1.19–8.71, p=0.02) by discharge, with overall hospitalization prolonged by 10±4 days (p&amp;lt;0.05). Furthermore, patients with high PCT were more prone to myocarditis recurrences (13/80 vs. 4/45, p=0.03) by 5-year FU. Conclusions In myocarditis patients, elevated PCT values at presentation are not associated with myocarditis aetiology. Nonetheless, PCT suggests a worse short-term clinical outcome, and also a higher risk of myocarditis recurrences at long-term FU. Funding Acknowledgement Type of funding source: None

Epidemiology of invasive early-onset neonatal infection in a French administrative district: A 10-year population-based study

BackgroundIn light of the pending update of the French guidelines for the management of neonatal infections, knowing the current epidemiology of early-onset neonatal infection (EONI) is essential. ObjectivesThe aim of this study was to assess the current epidemiology of a French administrative district population of proven EONI, including umbilical cord blood procalcitonin levels. MethodsWe conducted a retrospective population-based study in the Nantes metropolitan area. We included all infants treated for proven EONI in the maternity, neonatology, and intensive care wards between 1 January 2006 and 31 December 2015 in the Nantes University Hospital. ResultsAmong the 140,502 children born during the study period, 61 cases of EONI were documented. The overall incidence of confirmed EONI was 0.43/1000 live births, with 0.23/1000 GBS (group B streptococcus) infections and 0.08/1000 Escherichia coli infections. The majority of infected newborns were full-term or late-preterm infants (67% were≥34 weeks of gestation), 88% had symptoms of EONI in the first 24h of life, most of which were respiratory. The mortality rate was 8% (in premature infants). Available in 51% of the population, the cord blood PCT value could contribute to an earlier diagnostic screening in 10% of cases but with a very low sensitivity. ConclusionsThe incidence of confirmed EONI is low in this French district. The diagnostic value of PCT umbilical blood cord should be assessed based on further studies before confirming its value. We suggest that a national registry of these rare but serious cases of EONI could contribute to monitoring the epidemiological progression as well as to optimizing our diagnostic and therapeutic strategies.

Clinical Features, Laboratory Characteristics and Prognostic Factors of Severity in Patients with Rickettsiaceae at Two Military Hospitals, Northern Vietnam.

IntroductionRickettsioses are diseases caused by intracellular Gram-negative bacteria of the Rickettsiaceae family and transmitted through the bite of infected ticks or mites.Aim of StudyTo investigate the clinical and subclinical characteristics and prognostic severe factors of the disease caused by Rickettsiaceae.MethodsA prospective, descriptive cross-sectional study was conducted at Department of Infectious Diseases of two military hospitals in Northern Vietnam from May 2013 to June 2019, in which 88 adult febrile patients caused by Orientia tsutsugamushi (50 patients) or Rickettsia spp. (38 patients) were enrolled. We recorded information regarding epidemiological characteristics (age, geography, residence, occupation), medical history, clinical and subclinical findings, life-threatening complications during treatment, outcomes and some factors predicting serious life-threatening complications in a case record form.ResultsScrub typhus (ST) patients had eschar (70%), skin-conjunctiva congestion (60%) and lymphadenopathy (44%). Rickettsia patients had a higher rate of maculopapular rash (39.5%), no ulcers and no lymphadenopathy detected. The majority of patients had elevated PCT >0.05 ng/µL and increase in liver enzymes and thrombocytopenia. Major prognostic factors for severe complications included diffuse infiltrates on lung X-ray (OR: 19.5; p = 0.014), coarse crackles (OR: 18; p = 0.016), respiratory rate ≥25 cycles/minute (OR: 18; p = 0.016), shortness of breath (OR: 7.44; p = 0.003), pleural fluid (OR: 4.3; p = 0.035) and increase in AST ≥ 200 UI/l (OR: 4.42; p = 0.012). The PCT value is able to distinguish between the two groups with quite high reliability (the area under the ROC curve is 0.75).ConclusionEschar and peripheral lymphadenopathy were two valuable clinical symptoms for the diagnosis of scrub typhus and distinguishing 2 groups of diseases. Respiratory distress, increase in AST ≥ 200 UI/l and level of PCT were used as major prognostic factors in patients with Rickettsiaceae.

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).

Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive care unit-The PROSACAB study.

Introduction and objectiveChildren admitted to the pediatric intensive care unit after cardiovascular surgery usually require treatment with antibiotics due to suspicion of infection. The aim of this study was to assess the effectiveness of procalcitonin in decreasing the duration of antibiotic treatment in children after cardiovascular surgery.MethodsProspective, interventional study carried out in a pediatric intensive care unit. Included patients under 18 years old admitted after cardiopulmonary bypass. Two groups were compared, depending on the implementation of the PCT-guided protocol to stop or de-escalate the antibiotic treatment (Group 1, 2011–2013 and group 2, 2014–2018). This new protocol was based on the decrease of the PCT value by 20% or 50% with respect to the maximum value of PCT. Primary endpoints were mortality, stewardship indication, duration of antibiotic treatment, and antibiotic-free days.Results886 patients were recruited. There were 226 suspicions of infection (25.5%), and they were confirmed in 38 cases (16.8%). The global rate of infections was 4.3%. 102 patients received broad-spectrum antibiotic (4.7±1.7 days in group 1, 3.9±1 days in group 2 with p = 0.160). The rate of de-escalation was higher in group 2 (30/62, 48.4%) than in group 1 (24/92, 26.1%) with p = 0.004. A reduction of 1.1 days of antibiotic treatment (group 1, 7.7±2.2 and group 2, 6.7±2.2, with p = 0.005) and 2 more antibiotic free-days free in PICU in group 2 were observed (p = 0.001), without adverse outcomes.ConclusionsProcalcitonin-guided protocol for stewardship after cardiac surgery seems to be safe and useful to decrease the antibiotic exposure. This protocol could help to reduce the duration of broad-spectrum antibiotics and the duration of antibiotics in total, without developing complications or adverse effects.

Impact of Procalcitonin Levels Combined with Active Intervention on Antimicrobial Stewardship in a Community Hospital.

BackgroundProcalcitonin (PCT) guidance alone or in conjunction with antibiotic stewardship programs (ASPs) has been shown to reduce antibiotic utilization and duration of therapy without adversely affecting patient outcomes.MethodsIn a community hospital, we investigated the impact of PCT with ASP recommendations on length of stay (LOS), length of antimicrobial therapy (LOT) after ASP recommendation, and total LOT over a 1-year period. Adult patients with at least 1 PCT value and concomitant ASP recommendations were included. Patients were grouped by provider ASP compliance and further stratified by normal versus elevated PCT values. No specific PCT algorithm was utilized.ResultsA total of 857 patients were retrospectively analyzed. Physicians complied with 73.7% of ASP recommendations. There were no significant differences in LOS based on ASP compliance. Mean LOT after ASP recommendations and mean total LOT were significantly shorter (2.5 vs 3.9 days, P < .0001 and 5.1 vs 6.6 days, P < .0001, respectively) in the ASP complier group. When stratified by initial PCT levels, ASP compliers for patients with normal PCT levels had the shortest duration of therapy for all groups; among patients with elevated PCT levels, the duration of therapy was significantly shorter in the ASP compliant group (5.79 vs 7.12 days, P < .0111). When controlling for baseline differences in initial PCT levels, LOS was found to be marginally shorter in the ASP compliant group (P = .076).ConclusionsProcalcitonin-guided ASP physician recommendations, when accepted by providers, led to reduction in LOT in a community hospital. This benefit was extended across patient groups irrespective of initial PCT levels.

Procalcitonin in hemodialysis patients presenting with fever or chills to the emergency department.

We sought to assess the role of procalcitonin in discriminating severe bacterial infections requiring antibiotic treatment from non-bacterial causes of fever or chills in chronic dialysis patients. Chronic hemodialysis patients who were admitted to the emergency room due to fever and/or chills were recruited to the study. The presence or absence of bacterial infection was defined after recruitment conclusion by an infectious disease specialist who was blinded to procalcitonin results. Procalcitonin levels were compared between infected and non-infected patients. Out of 54 patients recruited, 22 (41%) patients eventually diagnosed with infection. Mean (± SD) procalcitonin values were 4.3 (± 5.5) ng/ml among cases, 1.0 (± 2.0) ng/ml among controls with no infection (p = 0.02). A cutoff PCT value of 1ng/ml or higher had 77% sensitivity and 59% specificity for the diagnosis of severe infection. Procalcitonin cannot usefully identify hemodialysis patient with bacterial infection.

Development of MELCOR thermal hydraulic model of AP1000 and its verification for a DECL break

The AP1000 is currently an advanced pressurized water reactor with emergency core cooling systems (ECCS) completely dependent on natural circulation. It is under construction in the USA and has been commissioned in China and is being considered by several countries to use this advanced technology for a power source. With this objective in mind, a representative MELCOR model (for the AP1000) has been developed to better understand the thermal hydraulics involved and to assess the performance of the safety systems for a design basis accident such as large break LOCA (LBLOCA) with availability of the safety systems. The results from these calculations were compared to those obtained using WCOBRA-TRAC, developed by Westinghouse Electric Company, which are reported in the AP1000 European Design Control Document.MELCOR was selected for the design assessment activities specifically because of its capabilities to model severe accident scenarios and features such as containment behaviour. It is one of the system thermal hydraulic codes, which are recommended for severe accident analysis in light water reactors. The aim of the current study is to assess the thermal hydraulic models and correlations in MELCOR against a specific code developed for a design basis accident such as a LBLOCA. This exercise will validate the input model for a LBLOCA and then use the input model for station blackout studies and the impact on the containment.A double ended cold leg (DELC) break in the loop containing the Core Makeup Tanks (CMT) is considered for this study. The calculated break flow, peak cladding temperature, accumulator, and CMT injection flow rates are compared to those reported. These calculated results are found to be satisfactory according to ECCS acceptance criteria for the temperature and hydrogen generation. This study has been further extended to analyse the containment behaviour during the accident. The calculations for the transient were extended to observe the behaviour of the Automatic Depressurization System (ADS) and IRWST injection capabilities which can effectively avoid core uncovery for a longer duration of the time. These systems can only work when the reactor system is depressurized. MELCOR calculated a PCT value (occurs just after the break) as 1242 K while the total hydrogen produced was calculated to be 2.216 kg which is only 0.61% of the total potential hydrogen production from oxidation.

Improvement in detecting sepsis using leukocyte cell population data (CPD).

Background The cell population data (CPD) parameters reported by XN analyzers (Sysmex Corporation, Kobe, Japan) reflect the size and internal structure of leukocytes. We explored whether CPD values could contribute to recognize those patients with fever at risk to develop sepsis. A profile of sepsis was developed combining CPD parameters and other markers. Methods We recruited 295 patients at the onset of fever, with infection confirmed by positive cultures. We studied the diagnostic performance of the CPD parameters in the differential diagnosis of sepsis vs. non-systemic bacterial infection using receiver operating characteristic (ROC) curve analysis. Additionally, the K-means unsupervised clustering method was applied. Once the clusters had been defined, the relationship between them and the CPD parameter values was assessed with the non-parametric Wilcoxon test. Lastly, the relationship between the clusters obtained and the categorical variables was examined with the χ2-test (or Fisher's exact test). Results ROC analysis demonstrated that NE-FSL, NE-WY, NE-WZ and MO-WZ had areas under the curve (AUCs) >0.700 for predicting sepsis. Using the K-means clustering algorithm, 80 patients (66.67%) were assigned to Cluster 1 and the others to Cluster 2. Out of 80 of patients in Cluster 1, 45 (56.25%) presented a PCT value ≥2 ng/mL, whereas almost 80% of Cluster 2 patients had a PCT <2 ng/mL. Cluster 1 was characterized by high NE-SFL, NE-WY, MO-X, MO-WX and MO-Z values (p<0.05). Conclusions CPD related to monocyte complexity and neutrophil activation were found to be significant, with high values suggesting sepsis.

Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acute bone infections like septic arthritis and osteomyelitis are a serious threat in management and diagnosis in the department of orthopaedics. Biochemical marker is needed with good sensitivity and specificity in diagnosing acute bone and joint infections. The aim of the present study was to study the role of PCT in conditions of septic arthritis and osteomyelitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A two year prospective study was done and cases were grouped into three group and laboratory parameters TC, ESR, CRP and PCT were measured. The sensitivity, specificity and predictive values were compared using SPSS software version 20.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 238 patients, (males- 154 &amp;amp; Females– 84) with mean age 34.1±8.20 years. Group-1 included 52 patients with raised PCT and MRSA and &lt;em&gt;Klebsiella&lt;/em&gt; as the common isolates. Group-2 with 89 patients and mean PCT in the study group was 4.99 ng/ml. Ninety seven were included in Group-3. The mean PCT value was 2.6 ng/ml. In group-1, the specificity of PCT (comparing Group-1 &amp;amp; 3) was 96.8 [95% CI, 94.2 -98.4], the sensitivity (26% [3.2-60.1], the PPV 16.1% [95% CI 2.3-48.3] and the NPV was 98% [95% CI, 95.5-99.8].&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; To conclude our study, highlights the role of PCT as a sensitive and specific marker in diagnosing cases of septic arthritis and Osteomyelitis. This opens a gateway to further research in evaluating the PCT effectiveness as a response marker to treatment. PCT is more sensitive than CRP in acute bone and joint bacterial infections and raises early and faster.&lt;/p&gt;