Serum Procalcitonin Concentrations Research Articles

Diagnostic Value of Serum Procalcitonin in Early Infection after Internal Fixation for Traumatic Fracture.

This study aimed to observe the changes of serum procalcitonin (PCT) and C-reactive protein (CRP) concentrations after internal fixation for traumatic fracture and to discuss the diagnostic value of these two indicators in early infection after internal fixation for traumatic fracture. Patients who received internal fixation for traumatic fracture at our hospital from June 2014 to December 2016 were included. They were divided into infection group (12 cases) and non-infection group (166 cases), depending on whether infection occurred. Venous blood samples were collected from cases in both groups on day 1, day 4, and day 9 after surgery. Changes in PCT and CRP levels were detected at different time points. As compared with the non-infection group, PCT and CRP levels were significantly increased at each time point after surgery in the infection group. The sensitivity of PCT combined with CRP in the detection of early infection after surgery was higher than that of either used alone. The serum PCT level can be used as an early diagnostic indicator of infection after internal fixation for traumatic fracture. The combined use of PCR and CRP levels can increase the sensitivity of detection.

Modified Fine-Needle Aspiration Biopsy for Calcitonin, Procalcitonin and Carcinoembryonic Antigen Levels in the Diagnosis of Thyroid Nodules With Medullary Thyroid Carcinoma

Background: The diagnostic tests have low sensitivities in detecting medullary thyroid cancer (MTC). We describe a modified fine-needle thyroid nodule biopsy (MFNB) technique that improved the diagnostic accuracy. MFNB was performed in three patients with MTC. Methods and results: A 41-year-old female presented with thyroid nodules and a family history of MTC. Fine-needle biopsy (FNB) of the thyroid nodules showed non-confirmatory cytology. MFNB established cytology more confirmatory of MTC. Additionally, intravenous administration of calcium-stimulated serum concentrations of procalcitonin (PCt) level, in addition to calcitonin (Ct) and MFNB, also confirmed elevated levels of Ct, PCt, and carcinoembryonic antigen (CEA) in the aspirate samples. The diagnosis of MTC was finally confirmed histologically after thyroidectomy. A 54-year-old female presented to our clinic for evaluation of a right thyroid nodule. An MFNB compared to standard FNB showed a more confirmatory MTC cytology along with markedly elevated levels of Ct, PCt, and CEA in the aspirated samples by the MFNB technique. Additionally, intravenous calcium administration increased PCt serum concentrations. The diagnosis of MTC was confirmed after surgery. A 65-year-old female reported to our clinic with a diagnosis of multinodular goiter and a family history of thyroid cancer. FNB showed atypical cells, although MFNB was more confirmatory for diagnosing MTC. Elevated serum PCt levels were also seen with calcium stimulation and MFNB aspirate samples also confirmed elevated levels of Ct, PCt, and CEA. MFNB of nodules in three patients with surgically confirmed benign thyroid confirmed low levels of Ct, PCt and CEA levels in the aspirate samples. Similar findings were confirmed in a patient with papillary thyroid cancer. Conclusion: MFNB was more confirmatory for diagnosing MTC than conventional FNB. Determining Ct, PCt, and CEA levels in MFNB aspirate samples may improve the diagnostic accuracy. J Endocrinol Metab. 2017;7(1):5-17 doi: https://doi.org/10.14740/jem371w

Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery.

Early recognition of patients who have developed anastomotic leakage (AL) after colorectal surgery is crucial for the successful treatment of this complication. The aim of this study was to assess the usefulness of the assessment of procalcitonin (PCT) and interleukin-6 (IL-6) levels in the prognosis of AL. This observational study included 157 patients who underwent major elective colorectal surgery. The most common indications for surgery were cancer and inflammatory bowel diseases. Serum samples were obtained directly before surgery (D0) and 1 day (D1) after surgery, and the relationships between the serum concentrations of PCT and IL-6 and development of AL were assessed. In total, 10.2% of patients developed post-surgical infections due to AL. PCT levels on D1 were significantly higher in patients who developed AL [2.73 (1.40-4.62)] than in those who recovered without complications [0.2 (0.09-0.44)]. The area under the ROC curve for PCT on D1 was 0.94, 95% CI (0.89-0.98). The sensitivity and specificity of the prediction of an infection were 87% and 87%, respectively, for PCT on D1, which was higher than 1.09 ng/mL. The increase in PCT concentration between D0 and D1 was significantly higher in patients with AL (p<0.001). Patients who developed AL had higher concentrations of IL-6 on D1, but the difference was not significant (p=0.28). This study confirms that surgical trauma increases serum PCT concentrations and that the concentration of PCT on D1 can predict AL after colorectal surgery. However, IL-6 is not a good early marker for developing AL.

Prognostic value of procalcitonin in patients after elective cardiac surgery: a prospective cohort study.

BackgroundProcalcitonin (PCT) is a well-known prognostic marker after elective cardiac surgery. However, the impact of elevated PCT in patients with an initially uneventful postoperative course is still unclear. The aim of this study was to evaluate PCT levels as a prognostic tool for delayed complications after elective cardiac surgery.MethodsA prospective study was performed in 751 patients with an apparently uneventful postoperative course within the first 24 h after elective cardiac surgery. Serum PCT concentration was taken the morning after surgery. All patients were screened for the occurrence of delayed complications. Delayed complications were defined by in-hospital death, intensive care unit readmission, or prolonged length of hospital stay (>12 days). Odds ratios (OR) [with 95% confidence interval (CI)] were calculated by logistic regression analyses and adjusted for confounders. Predictive capacity of PCT for delayed complications was calculated by ROC analyses. The cutoff value of PCT was derived from the Youden Index calculation.ResultsAmong 751 patients with an initially uneventful postoperative course, 117 patients developed delayed complications. Serum PCT levels the first postoperative day were significantly higher in these 117 patients (8.9 ng/ml) compared to the remaining 634 (0.9 ng/ml; p < 0.001). ROC analyses showed that PCT had a high accuracy to predict delayed complications (optimal cutoff value of 2.95 ng/ml, AUC of 0.90, sensitivity 73% and specificity 97%). Patients with PCT levels above 2.95 ng/ml the first postoperative day had a highly increased risk of delayed complications (adjusted OR, 110.2; 95% CI 51.5–235.5; p < 0.001).ConclusionsA single measurement of PCT seems to be a useful tool to identify patients at risk of delayed complications despite an initially uneventful postoperative course.

Severe pneumonia due to infection with Candida krusei in a case of suspected Middle East respiratory syndrome: A case report and literature review.

Candida krusei (C. krusei) pneumonia is a rare infection that is frequently associated with a poor outcome. The present study reports an unusual case of C. krusei pneumonia that was initially suspected to be a Middle East respiratory syndrome (MERS) case. A 64-year-old Saudi Arabian male patient was admitted to our hospital with complaints of cough and dyspnea that persisted for 6 days. The patient presented fever (oral temperature, 38.5°C) and slight tachypnea (25 respirations/min). A chest computerized tomography demonstrated unclear lung fields, diffuse pathological changes in the two lungs and multiple lymphadenectasis in the retrocaval and para-aortic arch area. The patient received 95-98% oxygen (6 l/min) for 24 h, as well as sulbactam sodium/cefoperazone sodium (1:1) injection (3.0 g) every 12 h, oral oseltamivir capsules (75 mg/time) twice a day, medaron injection (80 mg/time) and 750 ml fluid infusion; however, he succumbed to the disease on day 2 after admission. The infection was diagnosed by sputum smear and culture subsequent to patient mortality. A sputum smear showed a large fungal infection and sputum culture revealed the presence of C. krusei infection. Serum procalcitonin concentrations were 4.73 µg/l and 7.23 µg/l on days 2 and 3 after admission, respectively. In conclusion, the diagnosis of Candida pneumonia should be strongly considered in the presence of growth of Candida from a sputum culture and based on a suggestive computed tomography image. Tumescent diaphragmatic lymph nodes may also be an important symptom of Candida pneumonia. Treatment should be initiated immediately to improve tissue oxygenation, restore cardiovascular function and improve other organ functions.

Clinical Effect and Efficacy Factors of Modified Piperacillin-Tazobactam Dosing Regimens in Abdominal Tumor Patients with Post-Operative Pneumonia.

This study was conducted to observe the clinical efficacy of long-term piperacillin-tazobactam (TZP) infusion and identify the factors affecting its curative effect against pneumonia in patients who had undergone surgery for abdominal tumor. The 100 patients were divided into four clinical groups according to the severity of their infection: Simple pneumonia, pneumonia with pleural effusion, pneumonia and atelectasis, and severe pneumonia. Each group of patients was then divided into control and treatment groups using a completely random design. The control group received TZP as a regular infusion, and the treatment group received TZP as a long-term infusion. The cure time in the different groups was compared according to the administration regimen, and stratified analysis was carried out to identify the efficacy factors of long-term TZP infusion for patients with each kind of pneumonia. The average cure time for TZP differed significantly among the groups. In particular, the average cure times in the simple pneumonia, pneumonia with pleural effusion, pneumonia and atelectasis, and severe pneumonia groups were 6.800 ± 0.342, 7.320 ± 0.304, 10.840 ± 0.571, and 15.942 ± 0.973 d (p < 0.001). In each group, the usage time of antibiotics in the treatment groups was significantly shorter than in the control group (8.87 ± 0.64 vs. 15.95 ± 2.02 d; p < 0.001). The cure times (d) for simple pneumonia and pneumonia and atelectasis were conspicuously lower in the treatment groups than in the control group (5.667 ± 0.256 vs. 7.846 ± 0.451; p < 0.001; 9.667 ± 1.432 vs. 11.923 ± 0.947; p = 0.024). The factors associated with continuous treatment effectiveness were being male, age <70 years, Acute Physiology and Chronic Health Evaluation score ≥17 points, minimum inhibitory concentration of the pathogen 8 mcg/mL, oxygenation index >200 mm Hg, serum procalcitonin concentration >4 ng/mL, and serum albumin <25 g/L. Long-term TZP infusion exhibited better clinical efficacy than did traditional treatment in patients with pneumonia after abdominal tumor surgery.

ABSTRACTS 7th World Congress of Mountain & Wilderness Medicine A combined meeting of the International Society for Mountain Medicine and the Wilderness Medical Society July 30-August 4, 2016 Telluride, Colorado.

ABSTRACTS 7th World Congress of Mountain & Wilderness Medicine A combined meeting of the International Society for Mountain Medicine and the Wilderness Medical Society July 30-August 4, 2016 Telluride, Colorado.

Effect of procalcitonin-guided therapy on antibiotic usage in the management of patients with chronic obstructive pulmonary disease with acute exacerbation

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. In patients with COPD, the clinical manifestations of acute exacerbations due to infectious and noninfectious causes are similar. The differential diagnosis of these two conditions is very important for administering the correct treatment regimen and for avoiding unnecessary antibiotic use, thus reducing the morbidity, mortality, and care-related costs. The aim of this study was to evaluate the diagnostic role of procalcitonin (PCT) and its sensitivity as a marker of bacterial infection in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. A total of 53 patients with AECOPD and 30 apparently healthy individuals (control group) were studied. Serum PCT concentrations were measured, and Gram staining of the sputum and sputum culture were performed for the patients with AECOPD. The patients were classified into two subgroups: the bacterial group and the nonbacterial group. The bacterial group included patients with bacterial COPDAE (n=32) and the nonbacterial group included patients with nonbacterial AECOPD (n=21). The mean level of PCT in patients of the bacterial group (151.65±38.13) was significantly higher than that of the nonbacterial group (60.16±23.98) and control group (36.03 ±16.52) (P 0.05), and there was no significant correlation between serum PCT level and the studied parameters in the nonbacterial group (P> 0.05). Pulmonary function testing was done for the studied groups and included forced expiratory volume in 1 s (FEV1)/forced vital capacity (%) and FEV1. The association between serum PCT and FEV1% in the two studied group was not significant (P> 0.05). PCT can be used as a marker for differentiation between bacterial and nonbacterial COPDAE and could be used to guide antibiotic therapy and reduce antibiotic abuse in hospitalized patients with AECOPD.

Is procalcitonin a usefulbiomarker for the risk stratification of facial cellulitis?

Facial cellulitis is an infectious disease that may require emergency surgical drainage based on clinical assessment. To date, no biological marker has been reported to be useful for risk stratification. Procalcitonin (PCT) is a diagnostic and prognostic sepsis biomarker. We aimed to study the usefulness of PCT dosage for the risk-stratification of facial cellulitis. This was a monocentric prospective study conducted in a referral center for maxillofacial emergencies. Patients with a diagnosis of facial cellulitis were included and underwent a PCT measurement at admission. The main criterion was the requirement for surgical drainage. Seventy consecutive patients were included in a 7-months period, mean age 35±14 years. Surgical drainage was required for 48 patients (68%). Serum PCT concentrations were strictly negative in most patients (median [IQR]: 0.05μg/L [0.05; 0.10]). Only 6 patients (9%) had PCT values above the clinical threshold of 0.25μg/L. At a threshold of 0.1μg/L, PCT was 30% sensitive and 100% specific for surgical drainage requirement. PCT level usually remains in a low range in facial cellulitis and seems to have a limited added value for risk stratification.

Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia

Predicting the need for intensive care among adults with community-acquired pneumonia (CAP) remains challenging. Using a multicenter prospective cohort study of adults hospitalized with CAP, we evaluated the association of serum procalcitonin (PCT) concentration at hospital presentation with the need for invasive respiratory or vasopressor support (IRVS), or both, within 72h. Logistic regression was used to model this association, with results reported as the estimated risk of IRVS for a given PCT concentration. We also assessed whether the addition of PCT changed the performance of established pneumonia severity scores, including the pneumonia severity index and the American Thoracic Society minor criteria, for prediction of IRVS. Of 1,770 enrolled patients, 115 required IRVS (6.5%). Using the logistic regression model, PCT concentration had a strong association with IRVS risk. Undetectable PCT (<0.05ng/mL) was associated with a 4%(95%CI, 3.1%-5.1%) risk of IRVS. For concentrations< 10ng/mL, PCT had an approximate linear association with IRVS risk: for each 1ng/mL increase in PCT, there was a 1%to 2%absolute increase in the risk of IRVS. With a PCT concentration of 10ng/mL, the risk of IRVS was 22.4%(95%CI, 16.3%-30.1%) and remained relatively constant for all concentrations > 10ng/mL. When added to each pneumonia severity score, PCT contributed significant additional risk information for the prediction of IRVS. Serum PCT concentration was strongly associated with the risk of requiring IRVS among adults hospitalized with CAP and is potentially useful for guiding decisions about ICU admission.

Age-specific percentile-based reference curve of serum procalcitonin concentrations in Japanese preterm infants.

Procalcitonin (PCT) levels are elevated early after birth in newborn infants; however, the physiological features and reference of serum PCT concentrations have not been fully studied in preterm infants. The aims of the current study were to establish an age-specific percentile-based reference curve of serum PCT concentrations in preterm infants and determine the features. The PCT concentration peaked in infants at 1 day old and decreased thereafter. At 1 day old, serum PCT concentrations in preterm infants <34 weeks’ gestational age were higher than those in late preterm infants between 34 and 36 weeks’ gestational age or term infants ≥37 weeks’ gestational age. Although the 50-percentile value in late preterm and term infants reached the adult normal level (0.1 ng/mL) at 5 days old, it did not in preterm infants. It took 9 weeks for preterm infants to reach it. Serum PCT concentrations at onset in late-onset infected preterm infants were over the 95-percentile value. We showed that the physiological feature in preterm infants was significantly different from that in late preterm infants, even in those <37 weeks’ gestational age. To detect late-onset bacterial infection and sepsis, an age-specific percentile-based reference curve may be useful in preterm infants.

The association of serum procalcitonin level with the no-reflow phenomenon after a primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

The no-reflow phenomenon is associated with adverse outcomes in patients with acute ST-elevation myocardial infarction (STEMI) treated by a primary percutaneous coronary intervention (PPCI). Procalcitonin (PCT) is a marker of systemic inflammatory states and an elevated serum PCT concentration is related to an increased risk of cardiovascular events. We aimed to assess whether serum PCT level at admission is an independent predictor of no-reflow in patients with STEMI treated with PPCI. Between November 2012 and December 2014, 501 consecutive patients with STEMI who underwent PPCI within the first 12 h following the onset of symptoms were enrolled. Serum PCT levels were measured on admission. Patients (age: 59±13 years, 73.5% men) were divided into the two groups: no-reflow and reflow. The no-reflow phenomenon was defined as final Thrombolysis In Myocardial Infarction flow grade less than 3 after PPCI. No-reflow was diagnosed in 91 (18.2%) patients. PCT levels were significantly higher in patients who developed no-reflow than in those who did not [0.102 (0.063-0.247) vs. 0.042 (0.020-0.076) μg/l, P<0.001]. In receiver operating characteristics curve analysis, the cut-off value of PCT was 0.066 μg/l for the prediction of no-reflow (area under the curve: 0.776, 95% confidence interval: 0.720-0.831, P<0.001, sensitivity: 73%, specificity: 70%). On multivariate analysis, serum PCT (>0.066 μg/l) value was an independent predictor of no-reflow (odds ratio: 3.377, 95% confidence interval: 1.572-7.255, P=0.002), together with early patency of culprit artery (P=0.046), Killip class more than or equal to 2 at presentation (P=0.028), and total stent length (P=0.004). Increased admission PCT level is associated independently with no-reflow after PPCI in STEMI patients.

Prognostic and diagnostic value of procalcitonin in the post-transplant setting after liver transplantation.

IntroductionThe aim of the study was to assess the diagnostic accuracy of procalcitonin (PCT) as a marker for complications and as a prognostic factor for mortality after liver transplantation.Material and methodsLiver transplant patients between January 2007 and April 2011 were prospectively included in the study. Procalcitonin serum concentration was recorded before, 6 h after reperfusion and then daily. Postoperative clinical course was prospectively analyzed from admission to discharge. Main surgical data such as operating procedure, type of reperfusion, operating and ischemic times, high urgency (HU) status and MELD score at the time of transplantation were also recorded.ResultsSixteen patients with initial PCT > 5 ng/ml suffered ≥ 1 complication (p = 0.03). However, there was no association between the level of the 1st peak PCT and the further postoperative course or the occurrence of complications. Patients in whom a 2nd PCT peak occurred had a significantly higher risk for a complicated course, for a complicated sepsis course and for mortality (p < 0.0001). Warm ischemic time over 58 min, operating time over 389 min and HU status were significant independent factors for a complicated postoperative course (p < 0.001, p < 0.001 and p = 0.03 respectively).ConclusionsBased on our results, we believe that PCT course and the occurrence of a 2nd peak seem to possess important diagnostic and prognostic power in the post-transplant setting after liver transplantation.

A Fever in Acute Aortic Dissection is Caused by Endogenous Mediators that Influence the Extrinsic Coagulation Pathway and Do Not Elevate Procalcitonin.

Objective A fever is observed in approximately one-third of cases of acute aortic dissection (AAD); however, the causes remain unclear. We investigated the mechanism of a fever in AAD by measuring the serum concentrations of inflammatory markers, mediators of coagulation and fibrinolysis, and procalcitonin, a marker of bacterial infection. Methods We retrospectively studied 43 patients with medically treated AAD without apparent infection. Patients were divided into those with (Group A; n=19) and without (Group B; n=24) a maximum body temperature >38°C. We established which patients fulfilled the criteria for systemic inflammatory response syndrome (SIRS), and its relationship with a fever was examined. Mediators of inflammation, coagulation and fibrinolysis were compared by a univariate analysis. Factors independently associated with a fever were established by a multivariate analysis. Results The criteria for SIRS were fulfilled in a greater proportion of patients in Group A (79%) than in Group B (42%, p=0.001). There was no difference in the procalcitonin concentration between Groups A and B (0.15±0.17 ng/mL vs. 0.11±0.12 ng/mL, respectively; p=0.572). Serum procalcitonin concentrations lay within the normal range in all patients in whom it was measured, which showed that the fever was caused by endogenous mediators. On the multivariate analysis, there was a borderline significant relationship between a fever and the prothrombin time-International Normalized Ratio (p=0.065), likely reflecting the extrinsic pathway activity initiated by tissue factor. Conclusion Our findings suggest that a fever in AAD could be caused by SIRS, provoked by endogenous mediators that influence the extrinsic coagulation pathway without elevating the serum procalcitonin concentration.

Maternal serum copeptin, MR-proANP and procalcitonin levels at 11-13 weeks gestation in the prediction of preeclampsia.

We investigated the potential value of maternal serum copeptin, midregional proatrial natriuretic peptide (MR-proANP) and Procalcitonin (PCT) levels at 11-13 weeks' gestation in the prediction of preeclampsia (PE) in a case-control study. Maternal serum concentration of copeptin, MR-proANP and PCT were measured at 11-13 weeks' gestation in cases of PE (n = 35) and controls (n = 100). The PE group was divided into early-onset PE (EO-PE) and late-onset PE (LO-PE). From the regression model, the value in each case and control was expressed as a multiple of the expected median (MoM). The Mann-Whitney test was used to determine the significance of differences in the median MoM in each outcome group from that in the controls. In the PE group, compared to controls, maternal serum concentrations of copeptin, MR-proANP and PCT were not significantly different. The maternal serum copeptin, MR-proANP and PCT levels are higher in EO-PE and LO-PE patients, but the difference is not significant. Thus, their levels in first trimester are not proven to be effective markers to screen for PE.

P-070 – Néphropathie tubulointerstitielle aigue de l'enfant

Data on therapeutic drug monitoring of voriconazole in elderly patients are limited. Impaired liver function and an inflammatory state in elderly individuals are hypothesized to impact the voriconazole serum level.A total of 166 adult patients (317 trough concentrations) who underwent voriconazole therapeutic drug monitoring were enrolled. The voriconazole trough concentration, its associated covariates, and its correlation with adverse effects in 73 elderly (≥60 years) patients (116 trough concentrations) were analyzed and compared to those in 93 adult (<60 years) patients.The voriconazole trough concentration was 4.31 ± 3.03 μg/mL (range, 0.4–15.5 μg/mL) in the elderly patients, which was significantly higher than the 3.11 ± 2.13 μg/mL (range, 0.4–14.3 μg/mL) in the adult patients (P = 0.001). The proportion of voriconazole trough concentrations higher than 5 μg/mL was 35.3% in the elderly patients, which was also significantly higher than the 15.4% in the adult patients (P < 0.001). A stepwise multivariable linear regression model showed that procalcitonin and gamma-glutamyl transpeptidase were independently associated factors in the elderly patients (OR = 2.590, 95% confidence interval [CI] = 1.506–3.673, P = 0.001; OR = −0.016, 95% CI = −0.027 to −0.006, P = 0.005). Receiver operating characteristic (ROC) curve analysis indicated that procalcitonin concentrations of ≥1.31 ng/mL increased the incidence of a voriconazole trough concentration higher than 5 μg/mL (95% CI = 0.53–0.87 μg/mL) (P = 0.03). The incidence of decreased albumin concentrations was higher in the elderly cohort than that in the adult cohort independent of the voriconazole trough concentration (P < 0.05).The voriconazole trough concentrations in the elderly patients were significantly higher than those in the adult patients who received voriconazole therapy and were significantly affected by severe inflammation as evaluated by the procalcitonin concentration. Frequent monitoring of the voriconazole serum concentration and procalcitonin concentration during and after severe inflammation is critical to maintain the voriconazole serum concentration within the therapeutic range.

Vpliv vrste povzročitelja na porast koncentracije prokalcitonina pri bolnikih s sepso

AbstractTheoretical background: Procalcitonin (PCT) is diagnostic and prognostic biomarker of sepsis. The objective of this study was to evaluate the correlation between sepsis causative agent and serum PCT concentration, since it would influence the initial empirical antimicrobial therapy selection.Methods: This retrospective study included 96 patients with sepsis who were admitted to Intensive Care Unit of Department of Infectious Diseases and Febrile Illnesses of University Clinical Center Ljubljana from September of 2011 through March of 2013. Sepsis was established clinically and defined aetiologically by haemoculture growth. Statistical evaluation was conducted in 76 patients who had not received proper antimicrobial therapy prior to blood collection. ForPCT determination imunoluminometric method was used and concentrations above 5 mg/L were considered elevated. Results: Serum PCT concentration was significantly higher in Gram-negative sepsis (PCT median was 26,3 μg/L) compared to Gram-positive sepsis (PCT median was 11,2 μg/L) (p = 0,016). Differences in PCT concentrations between Gram-positive pathogens were not statistically significant (p = 0,09), however, S. aureus sepsis is linked to higher serum PCT concentration (median PCT 12,8 μg/L) than all other Gram-positive agents put together (median PCT of 5,9 μg/L) (p = 0,016). Difference in PCT concentration in E. coli sepsis (median PCT of 38,2 μg/L) compared to other enterobacteria (median PCT of 26,3 μg/L) is not statistically significant (p = 0,902). Conclusions: Causative agent has a significant effect on serum PCT concentration in patients with sepsis. Higher values were present in Gram-negative than in Gram-positive sepsis. Amongst Gram-positive pathogens, S. aureus caused greater rise in PCT than other Gram-positive bacteria put together.

Early diagnostic value of combined inflammatory cytokines in bloodstream infection with different organisms

Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP) , and endotoxin in bloodstream infection with different microorganisms, so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients. Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2±16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively. According to the results of blood culture, the microorganisms could be categorized into gram-negative bacteria, gram-positive bacteria and fungus groups, and the levels of serum CRP, PCT, and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission. Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18%) , 43 gram-positive strains (28.29%) , and 16 fungal strains (10.53%) . In the gram-negative strains, Klebsiella pneumoniae (n=29) , Acinetobacter baumannii (n=24) , Escherichia coli (n=23) , Burkholderia cepacia (n=9) and Pseudomonas aeruginosa (n=4) were the most common isolates. In the Gram-positive strains, 13 strains of Staphylococcus aureus were isolated. (2) In the gram-negative bacterial bloodstream infections group, there were 60 (64.52%) patients with endotoxin positive, and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections. The median levels of PCT were significantly different among the three groups [gram-negative strains group: 7.760 (3.365, 28.585) ng/mL, gram-positive strains group: 0.705 (0.265, 3.225) ng/mL, fungal infection group: 1.245 (0.543, 1.998) ng/mL]. In the fungal bloodstream infection group, the mean level of CRP was higher than that in other two groups [gram-negative strains group: (126.01 ± 66.53) mg/L, gram-positive strains group: (77.58±54.21) mg/L, fungal infection group: (140.14±71.21) mg/L]. (3) The receiver operating characteristic (ROC) curve of inflammatory cytokines was made for the diagnostic value in bloodstream infections. ROC curve used to distinguish between gram-positive bacterial bloodstream infections group and fungal group showed that AUCPCT+ CRP=0.791. When PCT cut-off value was 0.92 ng/mL, and CRP cut-off value was 68.00 mg/L, the sensitivity was 50% and the specificity was 95.5%. ROC curve used to distinguish between the gram-negative bacterial bloodstream infections group and fungal group showed that AUCPCT+ CRP+ LPS=0.947. When PCT cut-off value was 2.16 ng/mL and CRP cut-off value was 94.10 mg/L, and endotoxin was positive, the sensitivity was 82.8% and the specificity was 100% . ROC curve used to distinguish between gram-negative bacterial bloodstream infections group and gram-positive bacterial group showed that AUCPCT+ CRP+ LPS=0.947. When PCT cut-off value was 2.68 ng/mL, CRP cut-off value was 106.5 mg/L, endotoxin was positive, the sensitivity was 74.2% and the specificity was 97.7% . Conclusions Gram-negative bacteria were the most common microorganisms in bloodstream infections in ICU patients. Compared with single inflammatory cytokine, the serum concentrations of PCT, CRP and endotoxin used together could provide more sensitivity and specificity for the early diagnosis of bloodstream infection with different microorganisms. Key words: Bloodstream infection; Sepsis; Gram-negative bacteria; Gram-positive bacteria; Fungal; Procalcitonin; C-reactive protein; Endotoxin

Early monitoring of ventriculostomy-related infections with procalcitonin in patients with ventricular drains

Several factors are implicated in the increased vulnerability of multiple trauma victims to infection, especially in intensive care units. The incidence of EVD related infections ranges from 5 to 20%. To assess the accuracy of serum procalcitonin (PCT) in predicting central nervous system (CNS) infection in patients with EVDs. Thirty-six adult patients with severe head trauma were enrolled in this prospective study, after exclusion of other causes of fever; patients were subjected to sampling of C-reactive protein (CRP), PCT, and cerebrospinal fluid (CSF) cultures every other day. Five patients developed ventriculostomy-related infections, and all had an elevated serum PCT concentration. Patients with negative CSF cultures had mean serum PCT <2.0 ng/ml, while patients with positive culture had early elevation of serum PCT with mean of 4.18 ng/ml, CRP did not show similar early changes. Patients who acquire CNS infection had prolonged length of stay in hospital and length of ventilation. In absence of other nosocomial infections, early high serum PCT concentrations appear to be a reliable indicator of bacterial CNS infection in patients with EVD.

Choice of surgical treatment in patients with acute destructive pancreatitis

Medical and diagnostic algorithm in patients with pancreatic necrosis is developed. It takes into consideration features and expansion of necrotic process in retroperitoneal space, objective severity of patients' condition according to SAPS scale and inflammatory process according to serum procalcitonin concentration. Comparative analysis revealed that the use of developed algorithm improves results of treatment.