Serum Procalcitonin Levels Research Articles

Dijagnostičko usaglašavanje presepsina, prokalcitonina, C-reaktivnog proteina i broja leukocita kod bolesnika kod kojih postoji sumnja na sepsu

Introduction/Aim. Agreement or disagreement of inflammatory parameters becomes important for making diagnosis when disparate values are encountered in a patient with suspected sepsis. The aim of our study was to test the agreement between the four commonly used tests for diagnosing systemic infection: white blood cell count (WBC), serum levels of C-reactive protein (CRP), procalcitonin and presepsin. Methods. This cross-sectional study included 479 adult patients hospitalized in the Clinical Center Kragujevac during 2019, who were suspected to have systemic infection and whose microbiological analyses were positive. Results. In a sample of hospital patients with isolated bacteria from the sites of suspected infection, the parameters of inflammation showed low agreement when used for diagnosing systemic infection. Only presepsin serum levels showed significant level of agreement with CRP and procalcitonin (Cohen's kappa = 0,257, p = 0,000Cohen's kappa = 0,169, p = 0,000, respectively, but also with low kappa values, while the agreement between CRP and procalcitonin was insignificant, as well as between the white cell count and the remaining three parameters. Conclusions. When disparate values of parameters of inflammation are encountered in a patient with suspected sepsis, a decision about antibiotic therapy should be based on either of the two pairs of parameters, presepsin/C-reactive protein or presepsin/procalcitonin.

Assessing the Predictive Accuracy of IL-6, CRP, PCT, and D-Dimer for Mortality in COVID-19 ICU Patients

Background: The COVID-19 pandemic has significantly impacted healthcare systems worldwide, particularly in intensive care units (ICUs) where mortality remains high. Biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), and D-dimer have been explored as predictors of disease severity and mortality in critically ill COVID-19 patients. Methods: This retrospective cohort study evaluated 325 COVID-19 ICU patients at IBN Sina Diagnostic Imaging Center, Dhaka, from September 2020 to December 2021. Serum levels of IL-6, CRP, PCT, and D-dimer were measured upon ICU admission. Mortality outcomes were recorded, and logistic regression models were used to assess the relationship between elevated biomarker levels and mortality. The predictive value of each biomarker was evaluated using receiver operating characteristic (ROC) curves. Results: Elevated IL-6 (≥30 pg/mL), CRP (≥100 mg/L), PCT (≥0.5 ng/mL), and D-dimer (≥1 µg/mL) were significantly associated with higher mortality (p<0.05). The cumulative mortality rate was 45.2%, with IL-6, CRP, PCT, and D-dimer showing odds ratios of 2.8, 2.1, and 3.2, respectively, for mortality risk. The combination of all four biomarkers yielded an area under the curve (AUC) of 0.87, indicating high predictive accuracy. Conclusion: IL-6, CRP, PCT, and D-dimer levels serve as important prognostic markers for mortality in critically ill COVID-19 patients. The combination of these biomarkers improves predictive accuracy, helping guide clinical decisions and optimize patient care in ICU settings.

Nomogram Based on Clinical Characteristics to Predict 28-Day Mortality Among Patients with CRAB-BSI.

The drug resistance of carbapenem-resistant Acinetobacter baumannii bloodstream infections (CRAB-BSI), especially hospital-acquired infections, has promoted their rapid and vast spread. It is necessary to use reliable methods to establish better prediction models. According to Cox proportional hazards regression, a nomogram was established. A retrospective cohort study among patients who were diagnosed with CRAB-BSI was performed from January 2020 to December 2022. Univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors regarding CRAB-BSI. Then, nomograms were used to calculate the area under the curve (AUC), C-index, and calibration curve to determine the predictive accuracy and dis-criminability. Decision curve analysis (DCA) was employed to further confirm the clinical effectiveness of the nomogram. A total of 98 cases were included in the comparison between the 28-day mortality group consisting of 32 patients and the 28-day survival group with 66 patients. The use of cefoperazone-sulbactam was significantly higher among patients who survived than among those who died. Univariable analysis revealed that factors such as primary diagnosis, time to inadequate antimicrobial therapy, and high serum creatinine and procalcitonin (PCT) levels were more prevalent in the mortality group. However, only primary diagnosis, time to inadequate antimicrobial therapy, and high PCT levels emerged as statistically significant risk factors for death in multivariate analysis and were used to construct the nomogram. The nomogram validation exhibited excellent performance. The nomogram was sufficiently accurate to predict the risk and prognostic factors of CRAB-BSI, allowing for individualized clinical decisions for future clinical work. The cefoperazone-sulbactam did have an effect, but more studies are needed to interpret it.

Can serum procalcitonin be used for severity identification and guiding treatment of children admitted with community-acquired pneumonia? – A cross-sectional study

Background: Community-acquired pneumonia (CAP) remains one of the leading causes of mortality and morbidity in children under 5 years of age. Early diagnosis and effective management remain the cornerstone to reduce complications and fatalities associated with CAP. Lately, C-reactive protein (CRP) and procalcitonin (PCT) have gained much attention as useful biomarkers in CAP. Recent data suggest that a very low PCT value has a high negative predictive value while identifying a population of children at low risk of typical bacterial infections. Hence, we propose to take up this study to assess the clinical utility of PCT in pediatric CAP. Aims and Objectives: The aim of this study was to study serum PCT level in children with the clinical diagnosis of CAP admitted at R.G Kar Medical College and Hospital, Kolkata, and its role in severity identification and contribution in the treatment of CAP. Materials and Methods: This cross-sectional hospital-based observational study was performed from January 2020 to June 2021 in the R.G Kar Medical College and Hospital, Kolkata, West Bengal, India. A total of 50 children were included within the age group of 2 months–5 years with CAP admitted in the Children’s ward and intensive care unit at our hospital. Clinical characteristics such as age, sex, symptoms such as history of fever, difficulty feeding or drinking, convulsion, lethargy, cyanosis, chest in-drawing, respiratory rates, auscultatory findings such as air entry of bilateral lungs, added sounds like-(inspiratory crept, bronchial breathing), and oxygen saturation were studied. Routine investigations such as complete blood count, serum CRP, blood culture, and chest radiograph sent along with serum PCT. Results: Out of 50 children diagnosed with CAP, 30 (60%) fell within the age range of 2–5 months of age. Among the study population, 70% of children displayed weakly positive and 20% strongly positive serum PCT values. A strong correlation (P < 0.001) was revealed between the severity of pneumonia and PCT, and also a positive correlation (P < 0.001) between clinical outcome and PCT. However, the role in contribution in early diagnosis could not be concluded. Conclusion: This study concluded that serum PCT may be used as a valuable indicator for assessing the severity and prognosis of CAP. All children with elevated PCT who were prescribed antibiotics did not experience further complications of CAP.

Serum procalcitonin levels elevate in association with egg yolk-associated FPIES reaction.

Serum procalcitonin levels elevate in association with egg yolk-associated FPIES reaction.

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.

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.

Serum Procalcitonin as a Biomarker for Diagnosing Neonatal Sepsis in a Tertiary Care Hospital of Eastern Nepal

Background: Sepsis is the main cause of morbidity and mortality in neonates. Early diagnosis and appropriate treatment can reduce the mortality rate. Blood culture is the gold standard for diagnosis of bacterial sepsis, but it requires 3-5 days for results. Since the disease may progress rapidly in neonates, a faster diagnostic test is needed. This study aimed to investigate and evaluate the role of serum procalcitonin as a marker for diagnosis of neonatal sepsis, aiming to enhance early detection and improve clinical outcomes.
 Materials and Methods: This was a hospital-based cross-sectional observational study carried out in 350 neonates admitted with suspicion of neonatal sepsis in Neonatal Intensive Care Unit (NICU) of Nobel Medical College Teaching Hospital (NMCTH), Biratnagar, Nepal during 1 year between October 2021 to September 2022.
 Results: The study included 350 cases, with a median age of 4days (1day to 4 days). Males made up the majority of cases (69.71%), as did Hindus (70.29%). Similarly, 78.86% of the cases had serum procalcitonin levels more than or equivalent to 0.5 ng/ml. Possible sepsis (43.43%) accounted for the majority of cases. The cases age, gender, and religion were shown to have a statistically significant relationship with serum procalcitonin.
 Conclusion: Therefore, we draw the conclusion that serum procalcitonin may not be the only diagnostic marker to diagnose neonatal sepsis in term/near term newborns, but it may be helpful when paired with other test indicators.

Comparison of CSF Lactate and Serum Procalcitonin in Diagnosing Pyogenic Meningitis

Background: Meningitis, a potentially life-threatening inflammation of the meninges, poses diagnostic challenges, particularly in differentiating bacterial meningitis (BM) from other forms. The identification of effective biomarkers is crucial for accurate diagnosis and treatment. Objective: This study aimed to evaluate the diagnostic utility of cerebrospinal fluid (CSF) lactate levels and serum procalcitonin (PCT) in distinguishing BM from tuberculous and viral meningitis. Methods: Conducted at the Neurology Department of Pak Emirates Military Hospital from February to May 2023, this observational study included 55 patients, with a mean age of 44.03 years. Patients were selected based on clinical signs and symptoms of meningitis, with those having received prior antibiotic treatment excluded. CSF and serum PCT levels were measured, and statistical analyses were performed to compare these biomarkers across different meningitis etiologies. Results: Of the 55 patients, 30 (54.50%) were diagnosed with BM, 15 (27.30%) with viral meningitis, and 10 (18.20%) with tuberculous meningitis. The mean CSF lactate level in BM patients was 9.36 ± 7.95 mmol/L, significantly higher than in non-bacterial cases. Similarly, serum PCT levels were markedly elevated in BM patients (24.05 ng/ml ± 39.82 ng/ml). The study found a strong correlation between elevated CSF lactate and serum PCT levels with the diagnosis of BM (P < 0.05). Conclusion: CSF lactate levels and serum PCT are reliable biomarkers for diagnosing BM. Their elevated levels in BM patients compared to those with tuberculous or viral meningitis can assist in accurate and timely diagnosis, contributing to improved patient outcomes and effective antibiotic stewardship.

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<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.

Effect of combining nano-silver dressing and vacuum sealing drainage with negative pressure treatment on patients with diabetic foot ulcers

This study investigates the efficiency of the combination of nano-silver dressing and vacuum sealing drainage (VSD) with negative pressure treatment on healing diabetic foot ulcers (DFU). A total of 100 patients with DFU admitted to our hospital between January 2022 and February 2023 were selected and randomly divided into a control group and an observation group, each consisting of 50 cases. Both groups received nano-silver dressings after debridement, but the observation group also underwent closed negative pressure drainage. Scores for wound granulation morphology and comfort were assessed before and after treatment. Efficacy rate, healing time, and clinical outcomes were evaluated before and after treatment. Serum levels of procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and cystatin C were measured before treatment and 30 days into treatment. After 10 days of treatment, the observation group showed a higher effective rate (96%) compared to the control group (88%). The observation group had better wound granulation morphology and comfort scores, shorter granulation and healing times, reduced hospitalization duration, and smaller wound areas than the control group. Both groups experienced decreased levels of IL-6, PCT, hs-CRP, and cystatin C after treatment. The observation group had lower levels of these markers compared to the control group. In conclusion, the combination of nano-silver dressing and VSD with negative pressure treatment improves the clinical efficacy of treating DFU. This approach reduces inflammation and promotes wound healing, as evidenced by improved wound scores, faster healing times, and reduced inflammatory marker levels.

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.

The Impact of Antimicrobial Stewardship in Treating Patients with Escherichia coli Bacteremia in a Small Single Center Community Hospital.

Purpose: There are many challenges that pharmacist led antimicrobial stewardship programs can encounter including lack of resources, costs, and inaccurate antimicrobial susceptibility testing (AST) results. The COVID-19 pandemic has led to increased resistance especially with gram negative infections. At a small single center community hospital, gram negative infections, particularly Escherichia coli infections, predominately occur. Therefore, this study aims to address gram negative bacteremia burden and its impact on antimicrobial stewardship efforts for combatting Escherichia coli and ESBL organisms with such barriers during the pandemic. Methods: In a retrospective cohort study, patients ≥ 18 years of age from a small community hospital were reviewed. Patients were excluded if their blood cultures were not positive for Escherichia coli and if antibiotics were not initiated during hospital stay. The primary endpoint was to determine the length of hospital stay. Critical secondary endpoints include antibiotic de-escalations, duration of antibiotics, time to definitive antibiotic therapy, serum procalcitonin levels, blood culture availabilities, MIC breakpoints, co-infection of COVID-19, and Clostridioides difficile occurrences. Results: Out of 74 patients with gram negative bacteremia, 41 patients specifically had Escherichia coli bacteremia. The primary endpoint results showed that patients with Escherichia coli bacteremia that stayed in the ICU had a length of stay of 13.6 days. Patients with Escherichia coli bacteremia in the Non-ICU setting has a length of stay of 7.3 days, and patients with ESBL bacteremia in the Non-ICU setting had a length of stay of 6.8 days. Conclusions: Despite the various challenges that antimicrobial stewardship programs (ASP) face in a single center small community hospital, the ASP at this small community hospital utilizes various policies and tools to increase appropriate antibiotic use and decrease hospital length of stay in patients with Escherichia coli bacteremia.

Perinatal asphyxia does not influence presepsin levels in neonates: A prospective study.

To compare Presepsin (presepsin) levels in plasma and urine of uninfected newborn infants with perinatal asphyxia with those of controls. In this prospective study, we enrolled 25 uninfected full-term infants with perinatal asphyxia and 19 controls. We measured presepsin levels in whole blood or urine. In neonates with perinatal asphyxia, we compared presepsin levels in blood and urine at four time points. In neonates with perinatal asphyxia, blood and urinary presepsin levels matched each other at any time point. At admission, the median presepsin value in blood was similar in both groups (p = 0.74), while urinary levels were higher in hypoxic neonates (p = 0.05). Perinatal asphyxia seemed to increase serum CRP and procalcitonin levels beyond normal cut-off but not those of presepsin. In uninfected neonates with perinatal asphyxia, median blood and urinary presepsin levels matched each other at any point in the first 72 h of life and seemed to be slightly affected by the transient renal impairment associated with perinatal hypoxia in the first 12 h of life. Perinatal asphyxia did not influence presepsin levels within the first 72 h of life, while those of CRP and procalcitonin increased.

Serum calprotectin as a marker of neonatal sepsis: a hospital-based cross-sectional diagnostic study

Background Despite significant advances in neonatal care, neonatal sepsis remains a major contributor to mortality, morbidity, and protracted hospitalization. The development of early possible diagnostic indicators for newborn sepsis is critical. Since calprotectin participates in major biological processes, it could be a diagnostic marker for infection/inflammation. This study aimed to estimate serum calprotectin in neonates with clinical sepsis. In addition, we compared serum calprotectin with standard sepsis markers and serum procalcitonin to evaluate its diagnostic accuracy. Methods A hospital-based cross-sectional diagnostic study of neonates identified with clinical sepsis using standard criteria was carried out. We compared estimated serum calprotectin levels to serum procalcitonin levels and conventional sepsis markers (leucocyte count, blood culture, immature to total neutrophil ratio, and C- reactive protein). We used SPSS version 25 to analyze the data. To examine diagnostic accuracy and determine a cut-off value for serum calprotectin, we used the receiver operating characteristics (ROC) curve. Results Of the 83 subjects included, 36.5% (30/83) had blood culture positive status, the median value of serum calprotectin being 0.93 ng/ml (0.67 to 1.3). Respiratory, cardiovascular, and gastrointestinal instabilities were present in 67.5% (56/83), 59% (49/83), and 50.1% (42/83) cases, respectively. The median values of serum calprotectin, procalcitonin, TLC, and I/T ratio between neonates withpositive blood culturesand negative culturesdid not differ significantly.. On ROC, calprotectin was not predictive for blood culture positivity (sensitivity: 50%; specificity: 44% at 0.83 ng/ml of serum calprotectin) and C-reactive protein (CRP) levels (sensitivity: 57%; specificity: 67% at serum calprotectin levels of 0.89 ng/ml). However, compared with serum procalcitonin, serum calprotectin at 1.2 ng/ml had sensitivity and specificity of 60% and 73%, respectively. Conclusions Serum calprotectin did not show a distinct advantage over the existing sepsis markers. Serum calprotectin level at 1.2 ng/ml had a sensitivity and specificity of 60% and 73%, respectively, compared to serum procalcitonin in detecting neonatal sepsis.

Procalcitonin as sepsis predictor in cardiovascular surgery with cardiopulmonary bypass

Cardiopulmonary bypass generates an exacerbated response that may lead to sepsis. To describe the association between procalcitonin levels and sepsis diagnosis in cardiovascular surgery subjects with cardiopulmonary bypass. A case-series study was conducted in 142 patients. Serum procalcitonin levels were measured at 24 hours and at 72 hours after surgery using a point of care testing based on quantitative immunochromatographic method. To assess association between procalcitonin levels and sepsis status, we calculated area under the curve (AUC) and sensitivity, specificity, and predictive values for the best cut-off point. From 142 patients studied, 7 developed sepsis after surgery (4.9%). For 24-hours procalcitonin levels AUC was 0.921 and best cut-off point was 3.8 ng/mL (sensitivity 0.857 and specificity 0.904). In the case of 72-hours procalcitonin levels, we observed a value of 0.868 for AUC and best cut-off point was 8.4 ng/mL (sensitivity 0.86 and specificity 0.97). Procalcitonin levels at 24 and 72 hours after cardiovascular surgery with cardiopulmonary bypass are associated with sepsis presence at cut-off points of 3.8 and 8.4 ng/mL respectively.

Evaluation of serum procalcitonin level as a biomarker for disease severity in Covid-19 patients: The experience of Mohammed VI University Hospital in Oujda.

The pandemic of coronavirus disease (Covid-19) has infected millions of individuals around the globe. The current study was aimed to evaluate the serum procalcitonin (PCT) level as a biomarker for bacterial co-infection and disease severity in Covid-19 patients. A total of 319 Covid-19 positive patients were examined in this study. Among the total individuals, 169 (53%) were male while 150 (47%) were female. Among the examined samples, 142 (44.5%) were hospitalized in Covid services, and 177(55.5%) were admitted in the intensive care unit (ICU). The mean PCT level for Covid-19 services patients was 0.58 ng/mL and for ICU patients was 7.84 ng/mL. The statistical analysis revealed that there was a significant association of PCT value and age (P<0,0001) while there was no association of gender and PCT value in COVID-19 patients (P=0.2745). Most Covid-19 patients have low PCT levels but elevated markers of inflammation such as C-reactive protein (CRP) on admission. It can be concluded that the serial PCT measurement could determine the prognosis of disease and presence of bacterial co-infection in Covid-19 patients. The main objective of our study is to determine the role of serum procalcitonin in the diagnosis and clinical management of patients with COVID-19 from Oriental Region of Morocco, also we evaluate the correlation between Procalcitonin and disease severity in COVID-19. We report the experience of the Moroccan Mohammed VI University Hospital of Oujda.

Diagnostic Value of Serum Procalcitonin and Diastolic Dysfunction for Evaluating the Mortality of Sepsis Patients Admitted in the Intensive Care

Background: Sepsis is a serious condition that can be fatal and has become more common in recent times. The impact of diastolic dysfunction on the early mortality rate of septic patients has not been extensively researched. This study aimed to assess the accuracy of serum procalcitonin (PCT) levels and diastolic dysfunction in predicting the mortality rate of patients diagnosed with sepsis and admitted to the intensive care unit.
 Methods: In this cross-sectional study, 40 sepsis patients admitted to the ICU were examined. Their characteristics were meticulously recorded using the APACHE II and SOFA score questionnaires, and only those who met the criteria underwent echocardiography. In order to evaluate the serum levels of PCT, it was required to take 40 ml of venous blood samples from the patients on the first and fifth days of admission. 
 Results: Out of 40 patients, the average age was 63±17 years. Of these patients, 23 (57.5%) were discharged, while 17 (42.5%) unfortunately passed away. Results showed a notable correlation between diastolic dysfunction, CRP, SOFA score on days 1 and 2, APACHE II score, and PCT on day 5 (P˂0.05). However, when analyzed using logistic regression, only PCT on day 5 showed a significant association with mortality.
 Conclusion: Based on our research, we found that PCT is an essential indicator in predicting the mortality rate of sepsis patients. While there was no significant correlation between diastolic dysfunction and mortality, it should still be considered a critical factor in determining the mortality rate.

Low monocytic HLA-DR expression in critically ill patients of sepsis: An indicator for antimicrobial and/or immunomodulatory intervention

BackgroundSepsis is a result of suppressed host immune response which leads to fatal multi-organ dysfunctionality. Low frequency of active monocytes or reduced expression of human leukocyte antigen (HLA)-DR on monocytes shows the suppressed immune response in sepsis patients. One of the well-studied markers in patients with sepsis is procalcitonin (PCT). The role of monocytic (m) HLA-DR expression has been monitored in sepsis and is being considered a marker of the severity of interim immuno-depression in these patients. The study describes the impact of HLA-DR expression on monocytes quantitatively using flow cytometry. MethodsIn this prospective study, we quantified monocytes and their HLA-DR expression in 20 patients of sepsis admitted to the Intensive Care Unit (ICU). Serum levels of PCT and interleukin (IL)-6 production were also measured in these patients, and the results were compared with those in healthy controls. ResultsMonocyte frequency calculated was higher in sepsis patients as compared to healthy controls, however, HLA-DR expressing monocytes were significantly reduced as was the mean fluorescence intensity (MFI) of HLA-DR. Contrastingly, IL-6 and PCT levels were significantly high in sepsis than controls. The results suggest that low HLA-DR expression, combined with PCT, is a better prognostic parameter in the early phase of sepsis. ConclusionPoor recovery of mHLA-DR may serve as an early guide for clinicians to assess the prognosis of sepsis patients and consider immunomodulatory therapy in its management.

Diagnostic usefulness of serum procalcitonin in patients with bacterial sepsis.

The Sequential Organ Failure Assessment (SOFA) score is used for the diagnosis of sepsis and involves clinical and laboratory parameters that may not be readily and/or timely available in most resource-poor settings. Procalcitonin (PCT) has its level changed in response to bacterial sepsis and its measurement costs only a fraction of the total cost of investigations required to calculate SOFA score. This study aims to determine the diagnostic usefulness of PCT in bacterial sepsis. Ninety-nine participants were studied, divided into three groups: apparently healthy volunteers, those with bacterial infection without sepsis (SOFA score <2), and patients with bacterial sepsis (positive culture and SOFA ≥2). PCT level of each participant was measured and median group levels compared. Pearson's correlation was used to determine the correlation between serum PCT levels and SOFA scores in the sepsis group using a significance level of 5 percent (P < 0.05). Diagnostic usefulness of PCT was assessed using receiver operating characteristic (ROC). Positive correlation was found between serum PCT levels and SOFA scores among patients with sepsis r = 0.42, P = 0.016. At a concentration of ≥4.25 ng/ml, serum PCT as a surrogate for SOFA score had a sensitivity and specificity of 57.60% and 84.80%, respectively, for indicating sepsis. The area under the ROC curve (AUC) was 0.74 (95% CI {0.62 to 0.86}, P = 0.001). Serum PCT concentration was significantly higher in bacterial sepsis compared to bacterial infection without sepsis and healthy state. PCT concentration demonstrated positive correlation with SOFA score in bacterial sepsis and can be used as surrogate for sepsis screening/monitoring in resource-poor settings.