Value Of Procalcitonin Research Articles

Procalcitonin Levels for Prognosis of Scrub Typhus Patients: A Retrospective Observational Analysis from a Tertiary Care Centre in Northern India

Introduction: Scrub typhus is a major cause of acute febrile illness in India. It presents with various clinical features that vary from fever to multiorgan dysfunction. Similar symptoms and presentations cause difficulty in diagnosis. Therefore, it is important to have early and prompt diagnosis with better prognostic markers to decrease morbidity and mortality. Aim: To determine the prognosis of scrub typhus patients based on the Procalcitonin (PCT) levels. Materials and Methods: This retrospective observational study was conducted in the Microbiology Department of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India, from January 2022 to January 2023. A total of 120 patients admitted to the hospital, who tested positive for Scrub typhus IgM by ELISA during this period and had a negative blood culture, were included in this study. Data analysis was conducted from February 2023 to April 2023. PCT levels of all these patients at the time of admission were recorded. The demographic information, laboratory parameters, and treatment regimen of these patients were also compiled. Statistical analysis was performed, and p-value was used to determine statistical significance. Results: The majority of the patients belonged to the age group of 21-40 years. Among these, elevated PCT values (ranging from 0.05-89.4 ng/mL) were observed in 112 (93.33%) patients. Twelve (10%) patients died during the study period, and all of them had elevated PCT levels. Among these, six developed septic shock with Multiple Organ Dysfunction Syndrome (MODS). Increased leukocyte values, elevated liver enzymes such as Aspartate Aminotransferase (SGOT/AST) and Alanine Transferase (SGPT/ALT), abnormal coagulation profile, and abnormal renal profile with elevated urea and uric acid levels were found to be significantly associated with scrub typhus patients with elevated PCT values. Conclusion: There is a need to address the role of prognostic markers in the management of scrub typhus patients. This may lead to breakthroughs in the field of diagnostic research and help improve the prognosis of these patients.

Clinicoradiological Correlation of Serum Procalcitonin Values in Degenerative Lumbar Disc Disease

Introduction: Low back pain (LBP) as a result of prolapsed intervertebral disc is one of the common causes of the morbidity and disability in current population. We assessed any association of inflammatory marker serum procalcitonin in degenerative disc disease. Materials & Methods: A prospective analytical study carried out at our tertiary care institute over one year from Dec 2021 to Dec 2022 after clearance from institute ethical committee. Total of 68 patients aged 18 to 65 years with low back pain with lumbar disc herniation on MRI imaging were included in the study. Serum procalcitonin levels were assessed using electrochemiluminescence technique on e411 Elecsys 2010. Results: The median values of serum procalcitonin were higher in early phase of disease tends to stabilising with chronicity of symptoms. There was a positive correlation between mean VAS scores and procalcitonin levels, those patients with higher procalcitonin values clinically had positive straight leg raising test and in the long run required more operative interventions. Conclusions: Lumbar degenerative disc disease has a strong inflammatory basis and serum values of procalcitonin can be useful objective marker to predict extent of inflammation with prediction of possible clinical course of disease.

Diagnostic Value of CRP, H-FABP, PCT, Lp-PLA2 and Cytokines in Stable Angina

Coronary artery disease (CAD) is a significant cause of worldwide mortality and morbidity. This study aims to evaluate the levels of serum H-FABP (fatty acid-binding protein), hs-CRP (high sensitivity- CPR), Lp-PLA2 (lipoprotein PLA2), PCT (procalcitonin) and cytokines, in addition to routinely used diagnostic tests, Troponin I (Trop I), Myoglobin (MYO) and Creatine kinase MB (CK-MB) in patients with stable angina to determine their sensitivity in diagnosing stable angina and facilitating faster decision-making in the emergency unit. The current study was performed on 86 patients complaining stable angina, at Nasiriyah Heart Center from October 2021 to October 2022. Eighty-six, healthy subjects (age-matched) were taken as a control group. Blood samples were collected in the emergency department. Serum levels of hs CRP, H-FABP, CK-MB, Trop I, MYO, Lp-PLA2 and PCT were determined using electro-chemiluminescence immunoassay. Blood sugar and serum total cholesterol, triglycerides, LDL, VLDL and HDL were determined using Cobas C311 photometric assays. Serum IL-6 was determined by using electro-chemiluminescence immunoassay, while, IL-9, IL-1β and TNF-α were assayed by ELISA. The study showed that the level of troponin I didn’t significantly change in patients with stable angina. However, compared with healthy controls, patients showed a significant increase in serum levels of CK-MB, myoglobin, hs-CRP, H-FABP, Lp-PLA2 and PCT. Significantly elevated levels of serum IL-6, IL1β, IL-9 and TNF-α were also recorded in patients with stable angina compared to healthy controls. The results also revealed that patients with stable angina had significantly elevated serum levels of serum triglycerides, total cholesterol, LDL and VLDL with a significant decline of serum HDL compared to healthy controls. We can concluded that, in addition to cTnI, CK-MB and MYO, other biomarkers such as hs-CRP, H-FABP, Lp-PLA2 and PCT are sensitive; and can serve as diagnostic indicators of stable angina pectoris for fast treatment. Furthermore, the detection of inflammatory biomarkers was found to be an additional diagnostic parameter in stable angina.

Toplumdan Kazanılmış Pnömoni Hastalarında Prokalsitonin, C-Reaktif Protein, Kan Beyaz Küre Sayılarının ve Hemogram Alt Parametrelerinin Karşılaştırılması

Aims: Pneumonia is a clinically and radiologically detected inflammation of the lungs. Most of the pneumonia patients are community-acquired pneumonia cases. Hemogram and C-reactive protein (CRP) are commonly used to support diagnosis and follow-up of treatment. Procalcitonin is less accessible and expensive. And the use of hemogram subparameters is not very common. The aim of this study was to research the relationship between procalcitonin, CRP, White Blood Cell count (WBC) and hemogram subparameters in patients with CAP and the efficacy of new hematologic rates in differential diagnosis.
 Methods: Patients who were diagnosed with community acquired pneumonia by applying to the chest diseases outpatient clinic of our hospital were retrospectively analyzed. 67 patients who were clinically and radiologically diagnosed without noticing male or female were included in our study. Anamnesis data and co-morbidities of the cases were questioned. Procalcitonin, CRP and hemogram (platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) were calculated and WBC value was examined) were recorded. The obtained data were evaluated statistically and compared in terms of variables. 
 Results: The mean age of our patients was 57 (18-71) years; there were 41 (61.19%) female and 26 (38.81%) male patients. 36 (53.73%) of our patients had chronic diseases; 21 (31.34%) had heart disease, 23 (34.32%) had diabetes, and 6 (8.95%) had kidney failure. Patients; 48 (71.64%) procalcitonin, 56 (83.58%) CRP, 38 (56.71%) WBC, 52 (77.61%) NLR, 34 (50.74%) PLR and 38 (56.71%) MLR values were high. Procalcitonin, CRP and NLR values were significantly higher than other subparameters. The CRP and NLR values of patients with an additional chronic disease were higher than patients without co-morbidities. In the correlation analyses, there was a strong correlation between procalcitonin, CRP and NRL, but the correlation between the others was not significant. (p

Value of C-Reactive Protein and Procalcitonin in Assessing the Severity of Acute Pancreatitis

Amaç: Şiddetli AP'nin erken tespiti için pek çok skorlama sistemi geliştirilmiştir, ancak birçok parametreyi içerdikleri için AP'nin ciddiyetini tahmin etmede uygun değildirler. Son zamanlarda, C-reaktif proteinin rolü, inflamatuar ve enfektif durumların ciddiyetinin değerlendirilmesinde incelenmiştir. Biyokimyasal belirteç olan serum prokalsitonin , AP'nin ciddiyetini tahmin etmek için nispeten doğru ve uygun bir yöntemdir ve kolayca ölçülür. Çalışmamızda kullanılmakta olan ciddiyet skorlarından BISAP, BCTSI skorlarının ve PCT ve CRP değerlerinin akut pankreatitin ciddiyetini öngördürmedeki değerliliğini RAS ile karşılaştırılması amaçlanmıştır.
 
 Gereç ve Yöntemler: Çalışmaya 18 yaş üstü AP şüphesi olan ve aydınlatılmış onam veren tüm hastalar dahil edilmiştir. Hastalar kabul edilen standart AP yönetimi kullanılarak tedavi edildi. Başvuru sırasında PCT ve CRP için kan örnekleri toplandı ve diğer skorlama sistemleri için biyokimyasal testler başvuru sırasında (0. gün) yapıldı. Ranson, BISAP, SIRS puanları kaydedildi. BCTSI skoru için; Kontrastlı BT, başvuru esnasında yapıldı ve semptomların kötüleşmesi durumunda tekrarlandı ve sonuçları kayıt altına alındı.
 
 Bulgular: Hastaların 100'ü Erkek, 75'i kadındı. Ortalama hasta yaşı 53 yıldı. Atlanta kriterlerine göre 136 hasta hafif, 19 hasta orta, 20 hasta ise ağır AP olarak sınıflandırıldı. Yaşa göre anlamlı fark varken(p

Procalcitonin Levels in Identifying Bacterial Infections in Children with and without COVID-19.

Elevated procalcitonin levels have been associated with bacterial infection in children. Observational studies reported high procalcitonin values in COVID-19. Data on bacterial coinfections in pediatric COVID-19 is sparse; small studies suggest a low coinfection rate. In this study, we aimed to quantify the positive predictive value (PPV) of procalcitonin in identifying bacterial infection in children with and without COVID-19. A retrospective chart review was performed for 215 children <21 years admitted to our tertiary children's hospital between February 1, 2013, and July 15, 2020, who had procalcitonin levels measured within 48 hours of admission. Confirmed bacterial infection was defined as positive blood, urine, or cerebrospinal fluid (CSF) culture, positive endotracheal culture with evidence of leukocytosis on Gram stain, or pneumonia by chest radiograph. Suspected bacterial infection was defined as confirmed bacterial infection or administration of antibiotics for >48 hours. Of the 215 patients, 73 were admitted for COVID-19 (66% multisystem inflammatory syndrome in children [MIS-C], 34% acute COVID-19). The PPV of an elevated procalcitonin level >1.0 ng/mL in identifying suspected bacterial infections for those with MIS-C was 6.3% (95% CI=0-15), in acute COVID-19 was 29% (95% CI=0-62%), and in the non-COVID-19 cohort was 75% (95% CI=62-88%). For identification of confirmed bacterial infection, PPV of an elevated procalcitonin level was 0% in MIS-C, 14% (95% CI=0-40%) in acute COVID-19, and 55% (95% CI=40-69%) in the non-COVID-19 cohort. We found a low PPV of elevated procalcitonin level above 1 ng/mL in identifying either culture-confirmed or presumed bacterial infection in children hospitalized with COVID-19-related illness.

No Drain, No Problem: Serum-Based Marker Prediction of Clinically Relevant Postoperative Pancreatic Fistula.

Postoperative day (POD) 1 drain amylase concentration (DAC) is considered the most accurate predictor for the development of a clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). Recent studies have associated drain placement with negative postoperative outcomes. This study aims to evaluate multiple biochemical markers and their associations with CR-POPF development in order to identify a reliable, non-drain dependent alternative to DAC. This is a review of 53 consecutive PD patients between 2021 and 2022. Albumin, C-reactive protein (CRP), C-reactive protein-to-albumin ratio (CAR), DAC, white blood cell count, and procalcitonin values were compared by CR-POPF status. The discriminatory abilities of CAR, CRP, and DAC for CR-POPF were compared using receiver operating characteristic (ROC) curves. Six of 51 included patients developed a CR-POPF. Receiver operating characteristic curve analysis produced an area under the curve of .977 for POD 1 DAC (cut-off 5131.0 IU/L, sensitivity 100%, specificity 95.5%), .858 for POD 1 CRP (cut-off 52.5mg/L, sensitivity 100%, specificity 72.7%), and 1.000 for POD 3 CAR (cut-off 99.2, sensitivity and specificity 100%). POD 3 CAR produced a positive and negative predictive value of 100%. The CAR and CRP provide early and accurate identification of patients with post-PD CR-POPFs. These markers offer a method of safe CR-POPF detection, when the gold standard DAC is unavailable, ultimately allowing for early intervention and patient rescue.

Profil Paramater Inflamasi Albumin Dan Prokalsitonin Pada Kasus Pasien Covid-19

Patients with COVID-19 have increased serum levels of Procalcitonin and decreased albumin, a key inflammatory marker associated with a high risk of organ injury and death. This study aims to determine the profile of inflammatory parameters albumin and procalcitonin in covid-19 patient cases. The type of research used is retrospective with a cross sectional approach. The research data were taken using a simple random sampling technique. Analysis for albumin with severity in COVID-19 positive patients in this study used an optimal limit or cut-off value of 3.5 g/dL. The optimal limit or cut off value for Procalcitonin in this study was 0.05 µg/L. The results of research from 30 patient data showed that there was a decrease in albumin levels in moderate and severe patients by 60% and an increase in procalcitonin levels &gt; 0.05 µg/L by 96%. The conclusion of this study is that there was a decrease in albumin levels and an increase in procalcitonin levels in COVID-19 case patients, which indicates inflammation due to SARS-COV2 virus infection.

Relationship between serum procalcitonin values and clinical course in patients diagnosed with neonatal sepsis

Procalcitonin is considered to be one of the markers of bacterial infections in critically ill patients, as well as a diagnostic and prognostic aid in severe sepsis. Neonatal sepsis is still among the main causes of mortality among newborns worldwide. Objective: To relate serum procalcitonin values and factors such as: sex, use of vasoactive drugs, use of glucocorticoids at supra physiological doses and clinical evolution, in neonates diagnosed with sepsis. Admitted to the neonatal intensive care unit in the period between October 2018 and January 2019. Methodological design: Descriptive, retro prospective design. Results: Direct relationship was demonstrated between serum procalcitonin values &gt;2 ng/ml, the use of both vasoactive drugs and steroids, with high mortality among the patients studied. Conclusions: Both male sex, as well as the use of the drugs reviewed significantly increase mortality when presenting procalcitonin values &gt;10 ng/ml. An early diagnosis together with an integral treatment provides a better prognosis in newborns with sepsis in the neonatal period.

To Study Correlation between MOD Score and Biomarker Values for Early Prediction of MODS in Suspected Cases of Sepsis Cases in Hospital

Background: Utility of biomarkers in early prediction of multiple organ dysfunction syndrome (MODS) in suspected cases of sepsis presenting to the Emergency Department (ED). Aim and Objectives: To correlate the biomarker values (Pro-calcitonin (PCT), C-reactive protein (CRP), NT-pro BNP and Neutrophil gelatinase associated lipocalin (NGAL) with multiple organ dysfunction (MOD) score and to evaluate their role in early prediction of MODS in suspected sepsis patients presenting to ED. Methods: This is a prospective observational study conducted on 65 patients with suspected sepsis. Patients of 18-65 years presented in the ED with triage complaints of fever, respiratory, urinary and abdominal infections, who were sepsis screen positive on arrival and admitted, were enrolled in the study. They were categorized into two groups: Group 1 (MODS score Positive at 48 or 72 hours) and Group 2 (MOD score Negative). Biomarker values in both the groups and its correlation with MOD score was analyzed. Results: At 48 hours, 40 (61.5%) patients were MODS positive with PCT (Sensitivity 100%, OR-12.6, CI-0.6-255.04, p=0.098), CRP (Sensitivity 100%, OR-27.0, CI-1.44-504.0, p=0.027), NTpro BNP (Sensitivity 82.5%, OR-7.07, CI-2.55-22.16, p=0.0008) and NGAL (Sensitivity 77.5%, OR-82.9, CI-9.7-698.16, p=0.0001) with PPV of NGAL (96.88%) and NT-pro BNP (76.74%) and 100% NPV for PCT and CRP. Conclusion: This study established a good correlation of NT-pro BNP and NGAL with positive MODS score suggestive of and highly predictive of developing MODS in suspected cases of sepsis. The normal value of PCT and CRP on arrival in patients with suspected sepsis rules out MODS even at 72 hours during their hospital stay.

Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Obtaining blood cultures (HC) is performed in 15% of the patients treated with suspicion of infection in the Hospital Emergency Services (ED) with a variable diagnostic yield (2-20%). The 30-day mortality of patients with bacteremia is two or three times higher than the rest with the same process. Procalcitonin (PCT) is a biomarker that has been used as a tool to help predict bacteremia in HEDs. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT in predicting true bacteraemia in adult patients treated with clinical suspicion of infection in the ED, as well as to identify a specific PCT value as the most relevant from the clinical decision diagnostic point of view that can be recommended for decision making. A systematic review was performed following the PRISMA guidelines in the PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov databases from January 2010 to May 31, 2023 without language restrictions and using a combination of MESH terms: "Bacteremia/ Bacteraemia/ Blood Stream Infection", "Procalcitonin", "Emergencies/ Emergency/ Emergency Department" and "Adults". Observational cohort studies and partially an systematic review were included. No meta-analysis techniques were performed, but the results were compared narratively. A total of 1,372 articles were identified, of which 20 that met the inclusion criteria were finally analyzed. The included studies represent a total of 18,120 processed HC with 2,877 bacteraemias (15.88%). Ten studies were rated as high, 9 moderate and 1 low quality. The AUC-COR of all the studies ranges from 0.68 (95% CI: 0.59-0.77) to 0.98 (95% CI: 0.97-0.99). The PCT value >0.5 ng/ml is the most widely used and proposed in up to ten of the works included in this systematic review, whose estimated mean yield is an AUC-COR of 0.833. If only the results of the 6 high-quality studies using a cut-off point (PC) >0.5 ng/mL PCT are taken into account, the estimated mean AUC-COR result is 0.89 with Se of 77.6% and It is 78%. PCT has a considerable diagnostic accuracy of bacteraemia in patients treated in EDs for different infectious processes. The CP>0.5 ng/ml has been positioned as the most suitable for predicting the existence of bacteraemia and can be used to reasonably rule it out.

INTRA-ABDOMINAL HYPERTENSION AND INCREASED SERUM PROCALCITONIN LEVELS ARE IMPORTANT PROGNOSTIC MARKERS IN CRITICALLY ILL SURGICAL PATIENT’S OUTCOME: A PROSPECTIVE OBSERVATIONAL STUDY

Objective: The objective of the study is to determine the clinical value of procalcitonin (PCT) levels and in recognizing surgical complications, morbidity and mortality in a heterogeneous group of general surgical patient population admitted in casualty ward and intensive care unit (ICU). Methods: A prospective, observational study was conducted on 100 patients by purposive sampling for blood and ascites in the peritoneal cavity, bowel distension and edema, high-volume resuscitation and massive transfusion, damage control surgery in traumatic patients, excessive tension after abdominal closure, post-operative ileus, circumferential abdominal eschar in burn patients, and hemodilution with severe sepsis were enrolled within 24 h of admission to the ICU or casualty ward in the Department of General Surgery, J.L.N. Medical College and Hospital, Ajmer, from August 2021 to December 2022. Results: The mean age of the overall patient population for the study is 52.29 years and it ranges between 16 years and 84 years. 79% of the patients presented with intra-abdominal hypertension (IAH), and mean serum PCT level in the IAH group is 4.47±7.49 which is higher than that in the non- IAH group (p&lt;0.05). The mean serum PCT levels among the group having peritonitis as the cause of sepsis is 5.69 ng/mL and having pneumonitis as the cause of sepsis is 6.74 ng/mL (p=0.033). Conclusion: Serum PCT, a new serum biomarker for infection and inflammation, that has been found to be more sensitive and specific for the same, is also an indicator for patient mortality and morbidity, and also correlates with patient’s length of hospital stay can be said to have an important role in prediction of critically ill surgical patient’s outcome.

Impact of Anti-Thymocyte Globulin on Procalcitonin Levels Comparison during Fever in Allogeneic Stem Cell Transplantation Conditioning

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a complex medical procedure that offers hope for patients with various hematological disorders. However, one of the significant challenges associated with allo-HSCT is the risk of infection, which remains a major contributor to non-relapse mortality. Detecting and managing infectious diseases in febrile patients during the pre-transplant conditioning phase is of utmost importance to ensure successful transplantation outcomes. In this context, procalcitonin (PCT) has emerged as a valuable diagnostic tool, serving as an auxiliary marker for severe infections. Additionally, PCT has shown promise as a predictor of infections in patients undergoing allo-HSCT. Its ability to aid in early detection and subsequent intervention has made it an attractive biomarker for clinicians. However, the interpretation of PCT levels in patients receiving anti-thymocyte globulin (ATG) as part of their pre-transplant conditioning has posed specific challenges. ATG, a commonly used immunosuppressive agent in allo-HSCT, plays a vital role in reducing the risk of graft rejection and graft-versus-host disease. However, ATG administration is not without its drawbacks, as it can lead to various side effects such as fever and hypotension. These ATG-induced symptoms must be carefully distinguished from infectious diseases to ensure appropriate treatment decisions. One particular concern in this regard is the potential impact of ATG administration on PCT levels. Unfortunately, there is a paucity of data on PCT levels in febrile patients who have received ATG, making it difficult for clinicians to interpret the results accurately. Furthermore, a comprehensive analysis comparing the increase in PCT levels during the conditioning phase for allo-HSCT and its associated risk factors in ATG and non-ATG regimens is lacking. Understanding how ATG affects PCT levels during febrile episodes and whether PCT can effectively discriminate between infections and ATG-related symptoms is crucial for optimizing patient care. To address these gaps in knowledge, we conducted a retrospective analysis involving 76 patients who developed febrile episodes during the pre-transplant conditioning phase, and their PCT levels were measured and compared in our institution. Our study aimed to elucidate whether ATG administration could lead to increased PCT levels during febrile episodes in the context of pre-transplant conditioning and whether PCT could serve as a reliable marker for distinguishing infections during this critical period. The findings of our analysis shed light on the complex relationship between ATG administration, PCT levels, and infectious diseases. Notably, ATG administration was identified as the sole significant factor contributing to increased PCT positivity during fever (p = 0.01). In contrast, the presence of infectious diseases did not significantly impact PCT positivity in the ATG group (p = 0.24). Intriguingly, bloodstream infection emerged as a significant risk factor for PCT positivity in patients who received non-ATG regimens (p &amp;lt; 0.01). These results underscore the importance of considering ATG administration when interpreting PCT levels in febrile patients undergoing pre-transplant conditioning for allo-HSCT. The administration of ATG can confound the interpretation of PCT levels during febrile episodes, potentially leading to inaccurate diagnoses of infectious diseases. Clinicians must exercise caution and be aware of this confounding factor when incorporating PCT values into the diagnostic workup, particularly in patients receiving ATG regimens. In conclusion, our study highlights the complexity of using PCT as a diagnostic marker in febrile patients undergoing pre-transplant conditioning for allo-HSCT. While PCT shows promise as a valuable tool for predicting and detecting infections, its interpretation must be approached with caution in patients receiving ATG regimens. Future research is warranted to further elucidate the intricacies of PCT dynamics in the context of allo-HSCT, enabling clinicians to optimize its use and improve patient outcomes in this challenging and high-stakes medical procedure.

Early diagnosis of candidemia with explainable machine learning on automatically extracted laboratory and microbiological data: results of the AUTO-CAND project

Background Candidemia is associated with a heavy burden of morbidity and mortality in hospitalized patients. The availability of blood culture results could require up to 48–72 h after blood draw; thus, early treatment decisions are made in the absence of a definite diagnosis. Methods In this retrospective study, we assessed the performance of different supervised machine learning algorithms for the early differential diagnosis of candidemia and bacteremia in adult patients on a large dataset automatically extracted within the AUTO-CAND project. Results Overall, 12,483 episodes of candidemia (1275; 10%) or bacteremia (11,208; 90%) were included in the analysis. A random forest classifier achieved the best diagnostic performance for candidemia, with sensitivity 0.98 and specificity 0.65 on the training set (true skill statistic [TSS] = 0.63) and sensitivity 0.74 and specificity 0.57 on the test set (TSS = 0.31). Then, the random classifier was trained in the subgroup of patients with available serum β-D-glucan (BDG) and procalcitonin (PCT) values by exploiting the feature ranking learned in the entire dataset. Although no statistically significant differences were observed from the performance measures obtained by employing BDG and PCT alone, the performance measures of the classifier that included the features selected in the entire dataset, plus BDG and PCT, were the highest in most cases. Conclusions Random forest classifiers trained on large datasets of automatically extracted data have the potential to improve current diagnostic algorithms for candidemia. However, further development through implementation of automatically extracted clinical features may be necessary to achieve crucial improvements.

Efficacy of curcumin gel as an adjunct to scaling and root planing on salivary procalcitonin level in the treatment of patients with chronic periodontitis: a randomized controlled clinical trial

The aim of the studyTo evaluate the effect of curcumin gel combined with scaling and root planing (SRP) on salivary procalcitonin in periodontitis treatment.Materials and methodsseventy patients were selected from the Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, and sixteen patients were excluded. Patients in groups II and III included stage II grade A periodontitis. The participants were classified into three groups: group I as a negative control group (individuals with healthy gingiva), group II (SRP) were treated with SRP, and group III (curcumin gel) which was applied weekly for four weeks after SRP. Clinical indices (plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing depth (PD)) and saliva samples for procalcitonin (PCT) assessment using an enzyme-linked immunosorbent assay (ELISA) test were collected and measured at both baselines and after six weeks.ResultsThis randomized controlled clinical trial registered on ClinicalTrials.gov (NCT05667376) and first posted at 28/12/2022 included Fifty-four patients (20 male; 34 female). Regarding the age and sex distribution, there was no statistically significant difference between the three studied groups (p > 0.05). There was no significant statistical difference regarding PI, GI, PPD, and CAL between group II and group III at baseline p (> 0.05). However, there was a significant statistical difference regarding the clinical parameters at baseline of both group II and group III as compared to group I (p ≤ 0.05). At six weeks after treatment, group III showed greater improvement in the PI, PD, and CAL as opposed to group II (p ≤ 0.05). Regarding PCT values, at baseline, there wasn’t a statistically significant difference between group II and group III (p > 0.05). However, there was a significant statistical difference between group II, group III, and group I (p ≤ 0.05). At six weeks after treatment, there was a statistically significant decrease in PCT levels of both group II and III (p ≤ 0.05).ConclusionThe application of curcumin gel was found to have a significant effect on all clinical indices as opposed to SRP.

Procalcitonin in the Post-Operative Burn Patient.

Serum procalcitonin (PCT) is a biomarker used to diagnose sepsis and infection. Following invasive bacterial infection, PCT is detectable in peripheral blood. The aim of our study was to determine if there is a relationship between serum PCT post-burn wound debridement and burn-related sepsis. In total, 34 participants were recruited from 1 November 2019 to 31 July 2020. Serum PCT levels were drawn on days 0, 1, 2, and 3, with day 0 being the day of the surgery. Blood culture samples were drawn on days 0 and 3. Statistical analyses were performed using STATA©. Descriptive statistics were presented as the median for continuous data and frequencies for categorical data. A two-sample Wilcoxon-Mann-Whitney test was performed to assess the correlation between the PCT values and blood culture positivity. In all, 33 burn debridement procedures were completed, and 1 patient demised before surgery. The median age was 35.5 years; 61.8% were male. Four patients had comorbidities. There was a trend of higher PCT values from day 0 to day 3. The median PCT on day 0 was 3.30 µg/L (IQR 0.78-15.10), compared to day 3 PCT which was 5.15 µg/L (IQR 1.35-18.55). The median values for serum PCT for days 0 to 3 were above the normal threshold regardless of BC positivity. There was a statistically significant difference in the PCT levels between positive and negative BC, with a p value of 0.0087 for day 3 serum PCT. The findings indicate an association of a high serum PCT level with a positive blood culture in a burn patient post-debridement surgery. A higher numerical threshold/cut-off of serum PCT should be used for this cohort of patients, to aid in the diagnosis of sepsis. A cut-off value could not be determined due to the small sample size.

Serum procalcitonin has no significance in the diagnosis of periprosthesis joint infection before total hip and knee replacement.

Currently, there is no "gold standard" for early diagnosing PJI. The diagnosis of periprosthetic joint infection (PJI) is a challenging problem in the clinic. As we know, many serum markers have been used in the early diagnosis of PJI. The aim of this study was to validate the value of PCT in the diagnosis of PJI. A retrospective review of 77 patients with revision arthroplasties from January 2013 to July 2020 was conducted. PJI was defined using the modified Musculoskeletal Infection Society (MSIS) criteria combined with follow-up results. Besides medical history, clinical and laboratory data was gathered. Preoperative blood was taken for serum PCT and other biomarkers measurement. Receiver operating characteristic (ROC) curves were generated to evaluate the biomarkers' diagnostic performance and optimal cut-off value. Forty-one patients were identified as the PJI group (27 hips and 14 knees), while thirty-six patients were identified as the aseptic loosening (AL) group (33 hips and 3 knees). The AUCs for C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Platelets (PLT), Fibrinogen (FIB), and Procalcitonin (PCT) were 0.845 (95% CI 0.755-0.936, p < 0.001), 0.817 (95% CI 0.718-0.916, p < 0.001), 0.728 (95% CI 0.613-0.843, p < 0.001), 0.810 (95% CI 0.710-0.910, p < 0.001) and 0.504 (95% CI 0.373-0.635, p = 0.950), respectively. Higher Area under the Curve (AUC) values were obtained for the combinations of PCT and CRP (AUC = 0.870) (95% CI, 0.774-0.936), PCT and ESR (AUC = 0.817) (95% CI, 0.712-0.896), PCT and PLT (AUC = 0.731) (95% CI, 0.617-0.825), PCT and FIB (AUC = 0.815) (95% CI, 0.710-0.894). The serum PCT indicated a sensitivity of 19.51% and a specificity of 83.33% for diagnosing PJI. When the optimal cut-off value for PCT was set as 0.05 ng/ml, its positive and negative likelihood ratios were 57.1% and 47.6%, respectively. In conclusion, serum PCT appeared to be no reliable biomarker in differentiating PJI from aseptic loosening before revision arthroplasties. However, PCT combined with other biomarkers further increases the diagnostic accuracy.

Comparative Characterization of Procalcitonin (Sensitivity, Specificity, Predictability, and Cut-Off Reference Values) as a Marker of Inflammation in Odontogenic Abscesses of the Head and Neck in the Female Population.

Introduction Odontogenic abscesses of the head and neck can lead to serious complications and even end in death. This requires healthcare professionals to have a good knowledge of all the markers of inflammation that can be used in their diagnosis and treatment. Such markers that we use in our daily medical practice are leukocytes (WBC), neutrophils (Neu), and C-reactive protein (CRP). Somehow, in the background is procalcitonin (PCT), which has not been studied in detail in this type of purulent infection. The aim of the present study is to investigate and analyze PCT in odontogenic purulent infections of the head and neck in the female population and to compare it with already proven markers of inflammation such as CRP, WBC, and Neu. For the first time in the literature, as per our knowledge, the sensitivity, specificity, and predictability of PCT were determined when using it as an independent indicator of inflammation, and its cut-off reference values were determined in women with odontogenic abscesses of the head and neck. Materials and methods This is a prospective study, in which the CRP, WBC, Neu, and PCT of 30 women with odontogenic abscesses of the head and neck with a mean age of 47 (18-81) years were examined and analyzed. As a control group, we included 30 healthy women with a mean age of 48 (18-80) years, in whom there was no anamnestic and physical evidence of the presence of any infection in the last three months. The four markers were measured for the control group too. Results In the clinical group of women with odontogenic abscesses of the head and neck, the average values of CRP, WBC, Neu, and PCT were significantly higher (p<0.0001) compared to the same in the control group of healthy women; CRP: 95.46±76.41 mg/l vs. 0.63±0.37 mg/l, WBC: 10.44±2.97x103/L vs. 6.5±1.49x103/L, Neu: 7.92±2.93x103/L vs. 4.03±1.07x103/L, PCT: 0.74±0.69 ng/ml vs. 0.14±0.08 ng/ml. Discussion PCT, as well as CRP, WBC, and Neu, increases its plasma concentration in women with odontogenic abscesses of the head and neck and is extremely well positively correlated with them, with a high correlation with CRP and a significant correlation with WBC and Neu. In addition, PCT has a number of advantages over the other markers; it begins to increase its plasma concentration faster, reaches its maximum plasma concentration faster, normalizes its concentration faster after the infection subsides, and increases its blood level only in bacterial infection genesis. Conclusions PCT as a marker of inflammation not only positively correlates well with CRP, WBC, and Neu but also, with its advantages over them, it appears to be the most accurate indicator in the diagnosis, treatment, and follow-up of odontogenic head and neck abscessesin the near future; not only in women but also in the male and children's population. Its sensitivity, specificity, and predictability as an independent indicator of inflammation are 80%, 76.7%, and 83%, respectively, and its cut-off value of 0.225 ng/ml is lower than the generally accepted 0.5 ng/ml.

Fever with Significant Procalcitonin Increase Following Gemtuzumab Ozogamicin Infusion in Hematologic Malignancy Patients without Evidence of Infection

In patients diagnosed with hematologic malignancies, including acute myeloid leukemia (AML), infections remain a major cause of non-relapse mortality. The accurate detection and management of infections during the treatment of these diseases are crucial for successful outcomes. Procalcitonin (PCT) has been proposed as a valuable tool for identifying severe bacterial infections, even in patients with hematologic malignancies. Gemtuzumab ozogamicin (GO), a humanized anti-CD33 monoclonal antibody conjugated to calicheamicin, is used in certain subsets of AML patients, such as core binding factor (CBF) leukemia and AML with favorable-risk, as well as in cases of refractory AML. However, GO administration comes with its own set of risks, including liver dysfunction, veno-occlusive disease (VOD), bone marrow suppression, bleeding, and infusion reactions. Among these reactions, those causing high fever and shivering can be particularly challenging to differentiate from sepsis or severe infections. Nevertheless, there have been no reports evaluating the utility of PCT in discriminating infections during GO-induced infusion reactions. To shed light on the impact of GO administration on PCT levels, we undertook a retrospective analysis. Over the period between 2014 and 2022, we administered GO (3.0 mg/sqm per dose) to 42 patients with hematologic malignancies, a total of 97 times (median 2 doses per patient, range 1-6 doses per patient). Of the recipients, 23 had undergone allogeneic stem cell transplantation, while 19 were non-transplant patients. Prior to GO administration, all patients received premedication comprising corticosteroids, antihistamines, and acetaminophen. Among the 97 instances of GO administration, 40 (41.2%) resulted in fever (≥37.5 ℃) within 24 hours. For 19 cases, we conducted a complete set of PCT measurements and blood cultures within 24 hours of GO administration and analyzed the PCT levels and clinical parameters. These 19 cases corresponded to 19 individual patients, of whom nine had CBF leukemia, including t(8;21) AML or inv(16) AML, and ten had non-CBF leukemia. Out of these patients, 12 experienced fever (≥37.5 ℃), while seven did not. The findings indicated that patients with fever (≥37.5 ℃) exhibited significantly higher PCT levels compared to afebrile patients (p=0.018). Furthermore, PCT levels showed a significant positive correlation with C-reactive protein levels (p=0.003). However, among the 19 patients, only one patient with a positive PCT result had a documented infection identified through blood cultures or imaging studies.Other factors, such as patient gender (p=0.467), underlying disease (p=0.224), disease remission status at GO administration (p=0.492), transplant status (p=0.556), and the number of GO administrations (p=0.906), did not significantly influence PCT levels. It is essential to acknowledge that this analysis is based on a limited number of cases from a single institution. Nevertheless, approximately 40% of patients experienced fever within 24 hours of GO administration, despite receiving premedication.Furthermore, the presence of fever after GO administration was associated with a significant increase in PCT levels, even in the absence of identifiable infection. This raises the possibility of false positives for PCT in the context of GO-induced infusion reactions, underscoring the need for cautious interpretation of PCT values for infection differentiation in patients undergoing regimens that include GO. Further research with larger patient cohorts is warranted to validate these findings and improve our understanding of the implications of PCT measurements in this clinical setting.

Can mean platelet volume be a prognosis predictor in viral infections: An example of Covid-19

PurposeThis study revealed the utility of mean platelet volume (MPV) as a mortality marker in SARS-CoV-2 infection, as well as its connection with other inflammatory indicators such as procalcitonin (PCT) and neutrophil-lymphocyte ratio (NLR). MethodsA total of 1528 patients (853 males and 653 females; mean age: 64.33 ± 16.36 years; range, 18–100 years) were hospitalized with COVID-19 between March 2020 and December 2022. The patients' demographic and clinical information, including ward and critical care data, were gathered from their medical records. On the first and last days, the PCT, NLR, and MPV values of the patients, who were divided into groups based on their hospitalization and outcomes, were analyzed. ResultsWhen the relevant laboratory data from the first and last days were compared, each group was statistically significant (p < 0.05). There was a moderate association between the final MPV values and the PCT and NLR values of the patients admitted to the ward (r = 0.448 and r = 0.397, respectively, where p < 0.01). There was also a substantial and moderate correlation between the final MPV levels and the PCT and NLR values of patients admitted to the intensive care unit (r = 0.613 and r = 0.361, respectively, p < 0.01). When compared to the patients' outcomes, the MPV had greater specificity and AUC values than the PCT and NLR (94.4 %, 0.968, 80.6 %, 0.923, 81 %, 0.845, respectively). ConclusionIn patients hospitalized with COVID-19, the specificity of MPV values at the point of sickness severity and outcome was shown to be greater than PCT and NLR values, and MPV values may be a more accurate predictor of mortality than PCR and NLR.