Serum Procalcitonin Concentrations Research Articles

Serum procalcitonin as a diagnostic biomarker in dogs with bacterial respiratory diseases.

Procalcitonin (PCT) is a useful biomarker in humans in the identification of bacterial respiratory infections. The aim of this study was to investigate the utility of serum PCT measurements as a diagnostic biomarker in canine bacterial lower respiratory tract diseases. PCT concentrations were measured in serum samples with an ELISA method previously validated for dogs. All dogs underwent thorough clinical examinations, and the diagnosis of respiratory disease was based on clinical and laboratory findings, diagnostic imaging, as well as cytology and bacterial culture of respiratory samples. PCT concentrations between different cohorts of dogs were compared with an ANOVA-model. Sixty-two privately owned dogs with respiratory diseases, 25 with bacterial pneumonia (BP), 17 with bacterial bronchitis caused by Bordetella bronchiseptica (BB), and 20 with chronic bronchitis (CB) as well as 44 healthy controls were included in the study. Serum PCT concentrations in dogs with bacterial respiratory diseases (BP mean 51.8 ng/L ± standard deviation [SD] 40.6 ng/L and BB mean 61.4 ng/L ± SD 35.3 ng/L) were not significantly different when compared with dogs with a non-bacterial respiratory disease (CB mean 89.7 ± SD 73.5 ng/L) or healthy dogs (mean 51.0 ng/L ± SD 37.5 ng/L, p > .05 in all comparisons). These results indicate that despite being a valuable diagnostic, prognostic, and follow-up marker in humans with pneumonia, serum PCT concentrations are not elevated in dogs with bacterial respiratory diseases and, therefore, cannot be used as a diagnostic biomarker in dogs.

Procalcitonin, brain natriuretic peptide and albumin as markers to predict prognosis in hospitalized older Japanese patients with a risk of infection.

Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection. In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables. The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable-adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5-2 versus <0.5 ng/mL: 1.61(1.04-2.49), PCT 2-10 versus <0.5 ng/mL: 1.91(1.15-3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84-4.59), high BNP 1.26 (0.89-1.76) and low Alb 0.68 (0.52-0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased. Concentration-dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; ••: ••-••.

Immune profile of patients‑a new approach in management of sepsis and septic shock?

The present study was a prospective observational single center study, enrolling 102 patients with sepsis, admitted in the Intensive Care Unit of the County Emergency Clinical Hospital in Târgu Mureș (Mureș, Romania). The main goal of the present study was to compare the changes of the following parameters on day 1 compared with day 5, in sepsis compared with septic shock, as well as in survivors compared with non-survivors: Cell blood count parameters, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic inflammation index, C reactive protein (CRP), ferritin, procalcitonin (PCT), CD 3+ T cells, CD4+ T cells, CD8+ T cells, CD16+CD56+/CD3-NK cells and CD19+ B cells. The relationship between the subcategories of lymphocytes with the inflammatory markers was evaluated. The serum concentration of CRP and PCT was significantly lower on day 5 compared with day 1 and serum ferritin was significantly higher in patients with septic shock. The percentage of cytotoxic T lymphocytes was significantly decreased and the percentage of NK lymphocytes was significantly increased in patients who developed septic shock. The results indicated a negative significant correlation between the proportion of T lymphocytes and PCT concentration and a positive significant correlation between the proportion of B lymphocytes and PCT concentration.

Determination of Serum Procalcitonin Level in Kawasaki Disease

Background: The most frequent cause of coronary artery aneurysm in children is Kawasaki disease (KD). Recently, limited studies on procalcitonin (PCT) were performed to find a biomarker for the diagnosis or prognosis of children with KD. Objectives: This study aimed to compare serum PCT levels between complete and incomplete KD and testify to the predictive validity of PCT for intravenous immunoglobulin (IVIG) resistance and predicting coronary artery lesions (CALs). Methods: This cross-sectional study was conducted at Namazi hospital in Shiraz, Iran, in 2019. All KD patients admitted to the hospital were included, with parental consent obtained. Kawasaki disease patients were categorized as complete KD (cKD) or incomplete KD (iKD). Two-dimensional echocardiography was performed, and peripheral venous blood was examined for PCT levels and other markers. All patients received IVIG and aspirin as standard treatment. The presence of coronary artery abnormalities (CAAs) was determined based on coronary artery size and morphology. We used Stata software version 14.0 for data analysis. Logistic regression models identified predictive factors for coronary complications. This study determined the optimal PCT cut-off point for predicted coronary complications using receiver operating characteristic (ROC) curve analysis. Approval was obtained from the Research Ethics Committees of Shiraz University of Medical Sciences. Results: Procalcitonin values in 38 children hospitalized with acute KD ranged from 0.2 ng/mL to 10 ng/mL, with a mean of 2.65 ng/m. There was no correlation of PCT with patients’ age or gender, incomplete KD, or IVIG resistance. The serum PCT concentration was higher in patients with CAL (P = 0.009). The best PCT cut-off value for CAL prediction was 2.5 ng/mL (corresponding sensitivity = 81.8% and specificity = 68.7%), considering CAL prevalence as the studied group. Conclusions: Supplementary research is needed to determine the sensitivity and specificity of PCT for the diagnosis and prognosis of KD. Procalcitonin might be of value in predicting which children are at increased risk for CALs to intensify therapy.

Serum procalcitonin levels are associated with rhabdomyolysis following exertional heatstroke: an over 10-year intensive care survey.

Heatstroke has become a common emergency event in hospitals. Procalcitonin (PCT) is used as a biomarker of infection in the emergency department (ED), but its role in rhabdomyolysis (RM) following exertional heatstroke (EHS) remains unclear. A retrospective cohort study enrolled patients with EHS from the intensive care unit (ICU). We collected RM biomarkers, inflammation markers, critical disease scores at admission, 24 h, 48 h, and discharge, and 90-day mortality. Correlation analysis, linear regression and curve fitting were used to identify the relationship between PCT and RM. A total of 162 patients were recruited and divided into RM (n=56) and non-RM (n=106) groups. PCT was positively correlated with myoglobin (Mb), acute hepatic injury, disseminated intravascular coagulation (DIC), Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, with correlation coefficients of 0.214, 0.237, 0.285, 0.454, and 0.368, respectively (all P<0.05). Interestingly, the results of curve fitting revealed a nonlinear relationship between PCT and RM, and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of <4.6 ng/mL. Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases (P=0.0093). High serum PCT concentrations are associated with RM after EHS in critically ill patients. Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.

Novel Risk Models and Promising Biomarkers for Prognostic Prediction in T-Cell Lymphoma with Pleural Effusion

Introduction: T-cell lymphomas (TCLs), a cluster of lymphoproliferative diseases, display high heterogeneity of characteristics, and lack for accurate prognostic models and precision treatment at present. Pleural effusion (PE) is a relatively severe manifestation of lymphomas, which has been found to be associated with worse prognosis in tumor patients, posing more challenges for risk stratification in TCL patients. Methods: Entire of 472 new diagnosed TCL patients were included from Shandong Provincial Hospital (2010-2022), and 130 among them with PE were retrospectively investigated to evaluate the prognostic value of clinical factors. The study was performed with the approval of the Medical Ethical Committee of Shandong Provincial Hospital, and all samples were collected with informed consents. RNA sequencing datasets GSE5584, GSE58445 and GSE6338 from GEO database were applied for the identification and function analysis of PE-related genes (PERGs). LASSO Cox regression analysis was utilized to reveal the prognostic role of PERGs in TCL patients. Immunohistochemistry (IHC) was applied to explore the expression and prognostic significance of HIF1A in TCLs. Results: 130 TCL patients with PE were found to display worse prognosis compared to non-PE group (P &amp;lt; 0.0001). Three clinical variables were confirmed as independently prognostic factors in TCL patients with PE, including serum albumin concentration (ALB) &amp;lt; 40 g/L (HR = 0.346, P = 0.0452), PE volume (PEV) &amp;gt; 500ml (HR = 2.192, P = 0.0269) and serum procalcitonin concentration (PCT) &amp;gt; 0.05ng/ml (HR = 3.408, P = 0.0036). After addition of these three variables to NCCN IPI, we constructed NAPP prognostic model (NAPP score = 3 × NCCN IPI - ALB + 8 × PEV + 12 × PCT) in TCL patients with PE. With an Akaike information criterion (AIC) of 363.14 and concordance index (C-index) of 0.71, NAPP prognostic model obviously improved the prediction performance of NCCN IPI (AIC = 741.01 and C-index = 0.52). Then we used the “cutoff” package in R to choose optimum marginal value, patients with NAPP risk score &amp;lt; 41 were deemed as low risk while ≥ 41 were high risk. Kaplan-Meier survival curve clarified that there was significant discrepancy of OS between the two groups (Fig. 1A, P &amp;lt; 0.0001). The 1-, 3-, and 5-year AUC values of NAPP for OS were 0.70, 0.64 and 0.64. The point estimated value of AUC at each prediction time was above 0.60 (Fig. 1A), suggesting that NAPP score had obvious superiority in predictive ability than current NCCN IPI and prognostic index for PTCL-unspecified (PIT) risk models. Subsequently, based on GSE55846, we found 50 miRNAs were differentially expressed (|log 2FC| &amp;gt; 1.5 and P &amp;lt; 0.05) between TCL patients with and without PE. Then, 239 predicted target genes of the 50 differentially expressed miRNAs were selected as PERGs based on miRTarBase and TargetScanHuman 8.0 databases. GO and KEGG analysis revealed the tight relationship between PERGs and tumor immunity. Besides, we constructed a signature including 4 PERGs (HIF1A, FERMT2, NFACT1 and COL1A1) in GSE58445. The 1-year AUC value for OS in the cohort was 0.78, indicating that PERGs signature had reliable predictive ability for OS in TCL patients. Moreover, the expression of hypoxia inducible factor-1 alpha (HIF1A) was verified to be decreased in TCL patients with PE through IHC. TCL patients with low expression of HIF1A suffered obviously inferior prognosis (Fig. 1B, P &amp;lt; 0.0001), especially in PE group. In non-PE group, there were no statistical differences of OS between the two groups based on HIF1A expression (P = 0.48). These results indicated that HIF1A might serve as a promising prognostic biomarker in TCL patients with PE. Conclusions: A novel NAPP risk model was firstly constructed and demonstrated to achieve accurate risk stratification for TCL patients with PE. PERGs, especially HIF1A, were closely related to tumor immune, and could act as molecular predictors for prognosis in TCL patients. These findings have the promising potential to facilitate the identification of high-risk population and the establishment of individualized treatment in TCL patients with PE.

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.

Effect of protective lung ventilation during cardiopulmonary bypass on serum procalcitonin and interleukin- 6 concentrations in coronary artery bypass grafting patients

Objective: Evaluation of changes in serum Interleukin-6 and pro-calcitonin levels in patients who underwent coronary artery bypass grafting with and without protective lung ventilation during cardiopulmonary bypass.&#x0D; Methods: Randomised controlled trial. Eighty patients subjected to coronary bypass surgery were prospectively randomised to two groups: protective lung ventilation and no ventilation, during cardiopulmonary bypass. Serum interleukins - 6 levels were studied before and at6 hours, 24 hours, 48 hours and 72 hoursafter the cardiac surgery. Similarly, we also have measured serum procalcitonin (PCT) concentrations before and 24 hours after surgery.&#x0D; Results: The serum levels of Interleukin 6 (IL-6) increased with time, peaked six hours after cardiac surgery and levels were higher in the non-ventilated group when compared with the protective lung ventilation group at 6 hours (362,09 ± 91.52 vs 306,16 ± 73.99 ; p&lt;0.05) and 24 hours (256,5 ± 100,64 vs 204, 44 ± 52.59 ) after coronary artery bypass graft (CABG) operation. In addition, the secretion of pro-calcitonin after 24 hours surgery was significanly reduced in the ventilated patients compared to no ventilation patients (1.858 ± 4,205vs 4,302 ± 10,68; p&lt; 0.05).&#x0D; Conclusion: The protective mechanical ventilation during cardiopulmonary bypass may decrease serum  IL-6 and procalcitonin concentrations after CABG.

Extremely elevated serum procalcitonin concentration in a patient with stage IV non-small cell lung cancer.

Extremely elevated serum procalcitonin concentration in a patient with stage IV non-small cell lung cancer.

Clinical significance of serum S100 calcium-binding protein A12 concentrations in patients with community-acquired pneumonia.

This study aimed to investigate the clinical significance of serum S100 calcium-binding protein A12 (S100A12) concentrations in patients with community-acquired pneumonia (CAP). This was a case-control study. We selected 120 patients with CAP treated in Xichang People's Hospital from January to June 2022 as the case group. Sixty healthy adults without a history of basic diseases were selected as the control group. The patients in the case group were divided into the low S100A12 and high S100A12 subgroups. Serum S100A12, C-reactive protein (CRP), and procalcitonin (PCT) concentrations, the leukocyte count, and other study parameters were compared. Serum S100A12, CRP, and PCT concentrations and the leukocyte count were higher in the case group than in the control group. The baseline confusion, urea, respiratory rate, blood pressure, and age ≥ 65 score, baseline pneumonia severity index score, and 30-day mortality rate were higher in the high S100A12 subgroup than in the low S100A12 subgroup. Serum CRP and PCT concentrations and the leukocyte count were higher in the high S100A12 subgroup than in the low S100A12 subgroup. Patients with high serum S100A12 concentrations have more severe CAP, a more serious inflammatory reaction, and higher 30-day mortality.

The levels of cartonectin and procalcitonin in patients with chronic periodontitis and hypertension

Abstract Objectives This study aimed to examine the effects of chronic periodontitis and essential hypertension on serum and salivary cartonectin (CTRP3) and procalcitonin (ProCT) levels. Methods Sixty non-smokers were seperated into four groups as; 15 people with essential hypertension (EH) and chronic periodontitis (CP) (HT+ CP+), 15 with EH (HT+ CP−), 15 with CP (HT− CP+), 15 control (HT− CP−). PPD, CAL, PI and GI were measured. All groups had their serum and saliva samples collected. Serum and saliva procalcitonin (ProCT) were measured using an electroluminescence method, and cartonectin (CTRP3) levels were determined by enzyme-linked immunosorbent assay. Results When compared to the control group, serum and saliva cartonectin (CTRP3) levels were considerably lower in all groups (respectively p&lt;0.0001, p&lt;0.0001). The serum cartonectin (CTRP3) levels were substantially higher in the HT− CP+ group than in the HT+ CP− group (p=0.002). Serum procalcitonin (ProCT) concentrations were found to be lowest in the HT− CP− group and highest in the HT+ CP+ group. Serum ProCT concentrations did not vary significantly across groups (p=0.110). Salivary procalcitonin (ProCT) levels were below the detection limit in all groups. Conclusions When periodontitis coexist with hypertension in individuals, they may have adversely affect each other due to the same sathways in the pathogenesis of these two disorders. So we can suggest that, serum and saliva cartonectin (CTRP3) may play a role during hypertension and periodontal inflammation and represent a novel future therapeutic target.

Serum C-Reactive Protein, Procalcitonin and Ceruloplasmin Concentrations in Dogs with Naturally İnfected Ehrlichiosis

This study aimed to evaluate the concentrations of C-reactive protein (CRP), Procalcitonin (PCT), and ceruloplasmin (Cp), which are potential biochemical markers of the inflammatory process in dogs naturally infected with Ehrlichiosis. A total of 20 dogs, 8 clinically healthy (Healthy group) and 12 mono-infected with Ehrlichia spp. (Ehrlichia group) were included in the study. Dogs in the Ehrlichia group were selected from those showing clinical signs of active infection, and their diseases were diagnosed with commercial test kits. Serum CRP and PCT levels were analysed by commercially available test kits, and Cp concentration was determined by colourimetric methods. The CRP concentration in the Ehrlichia group was significantly higher compared to the healthy group. There was no significant difference between the groups in serum PCT and Cp concentrations. As a result, the increase in serum CRP concentration can be used for detecting inflammatory processes in dogs with Ehrlichiosis. In addition, this study showed that PCT and Cp concentrations are not clinically useful markers for determining inflammatory status in dogs with Ehrlichiosis.

[Predictive value of postoperative serum procalcitonin concentration for moderate to severe acute respiratory distress syndrome in patients undergoing cardiopulmonary bypass surgery].

To explore the changes of serum procalcitonin (PCT) level in patients with moderate and severe acute respiratory distress syndrome (ARDS) after cardiac surgery under cardiopulmonary bypass (CPB), and try to find out the best cut-off of PCT to predict the progression to moderate and severe ARDS. Medical records of patients undergoing cardiac surgery with CPB in Fujian Provincial Hospital from January 2017 to December 2019 were retrospectively analyzed. Adult patients who were admitted in intensive care unit (ICU) for more than 1 day and had PCT values on the first postoperative day were enrolled. Clinical data such as patient demographics, past history, diagnosis, and New York Heart Association (HYHA) classification, and the operation mode, procedure duration, CPB duration, aortic clamp duration, intraoperative fluid balance, calculation of 24 hours postoperative fluid balance and vasoactive-inotropic score (VIS); 24 hours postoperative C-reactive protein (CRP), N-terminal B-type natriuretic peptide precursor (NT-proBNP) and PCT levels were collected. Two clinicians independently made the diagnosis of ARDS according to the Berlin definition, and the diagnosis was established only in patients with a consistent diagnosis. The differences in each parameter were compared between patients with moderate to severe ARDS and those without or with mild ARDS. Analysis of the ability of PCT to predict moderate to severe ARDS was evaluated by receiver operator characteristic curve (ROC curve). Multivariate Logistic regression was conducted to determine the risk factors of the development of moderate to severe ARDS. 108 patients were finally enrolled, including 37 patients with mild ARDS (34.3%), 35 patients with moderate ARDS (32.4%), 2 patients with severe ARDS (1.9%), and 34 patients without ARDS. Compared with patients with no or mild ARDS, patients with moderate to severe ARDS were older (years old: 58.5±11.1 vs. 52.8±14.8, P < 0.05), with a higher proportion of combined hypertension [45.9% (17/37) vs. 25.4% (18/71), P < 0.05], longer operative time (minutes: 363.2±120.6 vs. 313.5±97.6, P < 0.05), and higher mortality (8.1% vs. 0, P < 0.05), but there were no differences in the VIS score, incidence of acute renal failure (ARF), CPB duration, aortic clamp duration, and intraoperative bleeding, transfusion volume, and fluid balance between the two groups. Serum PCT and NT-proBNP levels in patients with moderate to severe ARDS at postoperative day 1 were significantly higher than those in patients with no or mild ARDS [PCT (μg/L): 16.33 (6.96, 32.56) vs. 2.21 (0.80, 5.76), NT-proBNP (ng/L): 2 405.0 (1 543.0, 6 456.5) vs. 1 680.0 (1 388.0, 4 667.0), both P < 0.05]. ROC curve analysis showed that the area under the curve (AUC) for PCT to predict the occurrence of moderate to severe ARDS was 0.827 [95% confidence interval (95%CI) was 0.739-0.915, P < 0.05]. When PCT cut-off value was 7.165 μg/L, the sensitivity was 75.7% and the specificity was 84.5%, for differentiating patients who developed moderate to severe ARDS from who did not. Multivariate Logistic regression showed that age and the elevated PCT concentration were independent risk factors for the development of moderate to severe ARDS [age: odds ratio (OR) = 1.105, 95%CI was 1.037-1.177, P = 0.002; PCT: OR = 48.286, 95%CI was 10.282-226.753, P < 0.001]. Patients with moderate to severe ARDS undergoing CPB cardiac surgery have a higher serum concentration of PCT than patients with no or mild ARDS. Serum PCT level may be a promising biomarker to predict the development of moderate to severe ARDS, the cut-off value is 7.165 μg/L.

Procalcitonin as a biomarker for predicting bacterial infection in chimeric antigen receptor T-cell therapy recipients.

It is unknown whether serum procalcitonin (PCT) concentration monitoring can differentiate between bacterial infection or cytokine release syndrome (CRS) when chimeric antigen receptor T-cell (CAR-T) recipients present with a constellation of signs and symptoms that may represent both complications. The objective of the study was to assess the utility of serum PCT concentrations as a biomarker of bacterial infection in CAR-T recipients. This single-center, retrospective, medical record review evaluated patients prescribed CAR-T therapy until death or 30 days after infusion. Logistic regression modeling determined the association between elevated serum PCT concentrations within 48 h of fever onset and microbiologically confirmed infection. Secondary outcomes included clinically suspected infection, CAR-T toxicity rates, and broad-spectrum antibiotic usage. Predictive performance of PCT was assessed by area under the receiver operating characteristic curve (AUC). The 98 included patients were a median age of 63 (IQR: 55-69) years old, 47 (48%) were male, and 87 (89%) were Caucasian. Baseline demographics and clinical characteristics were similar between patients with and without a bacterial infection. Serum PCT >0.4 ng/mL within 48 h of fever was significantly associated with a microbiologically confirmed bacterial infection (OR: 2.75 [95% CI: 1.02-7.39], p= 0.045). Median PCT values in patients with and without confirmed infections were 0.40 ng/mL (IQR: 0.26, 0.74) and 0.26 ng/mL (IQR: 0.13, 0.47), respectively. The AUC for PCT to predict bacterial infection was 0.62 (95% CI 0.48-0.76). All patients experienced CRS of some grade, with no difference in CRS severity based on elevated PCT. Broad-spectrum antibiotics were used for a median of 45% and 23% of days in those with and without confirmed infection, respectively (p= 0.075). Elevated serum PCT concentrations above 0.4ng/mL at time of first fever after CAR-T infusion was significantly associated with confirmed bacterial infection. Furthermore, rigorous, prospective studies should validate our findings and evaluate serial PCT measurements to optimize antimicrobial use after CAR-T therapy.

The prognostic value of procalcitonin in critically ill cases of systematic inflammatory response syndrome in dogs.

Using markers for early diagnosis can help to reduce mortality and morbidity in systemic inflammatory response syndrome (SIRS). This study investigates the role of procalcitonin (PCT) as a prognostic value in dogs with SIRS in the intensive care unit. Fifty-five dogs were selected and studied. Blood samples were collected and investigated for PCT, white and red blood cells, iron, creatinine, platelet, glucose, albumin, urea, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), bandcell, body temperature, and hospitalized days and costs. The animals were grouped into survivors and deceased groups, and their results were compared. The results showed negative significant relations between PCT with hematocrit (r 2 = 0.294, P < 0.05) and the serum concentration of iron (r 2 = 0.280, P < 0.05) and also positive relation with IL-6 (r 2 = 0.456, P < 0.01) and TNF-α (r 2 = 0.391, P < 0.01). Significant relations were not seen between PCT with other parameters (P > 0.05). The results also showed a significant relation between glucose and albumin with body temperature (P < 0.05). The results showed that the serum concentrations of PCT, IL-6, and TNF-α were significantly higher in deceased dogs compared with survivors, while white blood cells, glucose, albumin, urea, lymphocyte, neutrophil, and body temperature were higher in survivors compared with others. PCT can be utilized as a prognostic value and helps early diagnosis in dogs with SIRS.

Relapsing and refractory peritoneal dialysis peritonitis caused by Corynebacterium amycolatum

BackgroundPeritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and mucosal contaminants, are a rare cause of PD-associated peritonitis and have been acknowledged in published guidelines for the diagnosis and treatment of PD peritonitis only over the last decade.Case-Diagnosis/TreatmentWe present two children with difficult-to-treat episodes of PD peritonitis due to Corynebacterium amycolatum. Episodes were associated with fever, abdominal pain and cloudy dialysate, high dialysate polymorphonuclear leukocyte counts, and elevated serum C-reactive protein and procalcitonin concentrations. Symptoms persisted beyond 5 days in 4 of 5 peritonitis episodes, and peritonitis relapsed despite in vitro sensitivity of the bacterial isolates to guideline-recommended antibiotics. C. amycolatum was cultured from the PD catheter tip despite 4 weeks of intraperitoneal glycopeptide therapy and clinical peritonitis resolution suggestive of efficient biofilm formation. Our systematic literature search identified three previous (adult) case descriptions of C. amycolatum peritonitis, all with repeat episodes by the same organism. The incidence of C. amycolatum as a cause of PD peritonitis has not yet been established but is likely underreported due to challenges in species differentiation.ConclusionsC. amycolatum is a rarely identified cause of refractory and/or relapsing PD peritonitis. Species differentiation of non-diphtheriae Corynebacterium isolates is critical, and prolonged antibiotic treatment, preferably with a glycopeptide antibiotic, is recommended, with a low threshold for PD catheter change or removal in case of repeat peritonitis.

Hepatocellular Damage and Severity of COVID-19 Infection in Iraqi Patients: A Biochemical Study.

Infection with COVID-19 can cause hepatic damages. Here, we aimed to examine the effect of COVID-19 infection on the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, and procalcitonin (PCT) concentrations as markers to evaluate the liver function. In this study, 56 patients infected with COVID- 19 and 28 healthy controls was recruited in Private Nursing Home Hospital of the Medical City, Baghdad. Patients were subdivided according to disease severity into severe and non-severe groups. The results showed that the mean±SD value of serum AST activity and serum PCT concentrations were elevated significantly in severe group in comparison to healthy control, (p< 0.01, p< 0.001) respectively. Also, the mean ±SD value of serum ALT activity was higher in severe group compared to the healthy subjects and non-severe ones, significantly (p< 0.0001, p< 0.003) respectively. While the mean value of serum albumin concentration of severe patients and non-severe group were significantly decreased compared to healthy subjects. The receiver operating characteristic curve (ROC) revealed that ROC value of albumin (0.992) differentiates between non-severe infected patients and healthy subjects, while the ROC value of serum ALT activity (0.735) differentiates between severe COVID-19 patients and non- severe ones. Changes of liver function parameters in COVID-19 patients were mild to moderate and measurement of serum ALT activity is the best biomarker in differentiation between non-severe patients and severe ones and albumin concentration is excellent in discrimination between patients and controls.

Serum procalcitonin and C-reactive protein concentrations in dogs with degenerative mitral valve disease and infective endocarditis

This study aimed to investigate the clinical significance of serum C-reactive protein (CRP) and procalcitonin (PCT) concentrations in dogs with degenerative mitral valve disease (DMVD) and infective endocarditis. It also aimed to evaluate whether there is a relationship between the degree of disease and serum PCT and CRP concentrations. A total of 100 dogs with MVD were prospectively recruited into the study. According to clinical/laboratory signs and echocardiography, the dogs were divided into infective and degenerative groups. The degenerative group was also classified into four stages based on the American College of Veterinary Internal Medicine (ACVIM) guidelines (Stages A-D). Serum PCT and CRP concentrations were determined with dog-specific commercial test kits. The serum CRP (P&lt;0.05) and PCT (P&lt;0.001) concentrations in the infective group were significantly higher than the degenerative group. In the degenerative group, the serum CRP concentration of stage D dogs was significantly higher than the other stages (P&lt;0.001), and the degree of disease correlated significantly positively with serum CRP concentration (r=0.531 P=0.000). In conclusion, serum CRP and PCT concentrations may aid traditional diagnostic techniques to differentiate infective and degenerative mitral valve disease. This study also demonstrated that serum CRP concentrations were elevated in Stage D dogs, and that there is a positive correlation between the degree of disease and serum CRP concentration. This can be useful in determining the severity of the inflammatory state in dogs with DMVD.

Procalcitonin for diagnosis of asymptomatic bacteriuria in kidney transplant recipients

Background and aim. Asymptomatic bacteriuria (ASB) is a frequent finding in allograft kidney transplant recipients and may be associated with a higher incidence of urinary tract infections in this population. We aimed to investigate the potential utility of serum procalcitonin (PCT) concentrations, an early marker of infection, for ASB diagnosis. We also compared its diagnostic performance with white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and highly sensitive C-reactive protein (hsCRP). Methods. In a single-center, cross-sectional study, 37 kidney transplant recipients with no clinical signs or symptoms of urinary tract infections were included. ASB was assessed by means of urine culture. Serum PCT concentrations were determined by the electrochemiluminescence immunoassay technique. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic performance of PCT and other classifiers. Results. Seventeen patients (46%) had ASB. Serum PCT concentrations were significantly higher in ASB+ patients (0.14 vs. 0.08 ng/ml, p=0.009). PCT concentrations significantly correlated with serum creatinine (r=0.408, p=0.012) and ESR (r=0.466, p=0.004). Of the four tested classifiers (PCT, WBC count, ESR, and hsCRP), only PCT was able to significantly distinguish between ASB+ and ASB- patients [area under the curve: 0.74, (95% CI: 057-0.91) p=0.012]. Adjustment of the ROC model for serum creatinine showed that the ability of PCT in classifying patients by ASB status is not affected by creatinine concentrations (crude vs. adjusted area under the curve: 0.74 vs. 0.72, test of AUC difference: p=0.891). A cut-point of 0.10 ng/ml of PCT correctly classified ASB+ patients with a sensitivity and specificity of 64.7% and 80.0%, respectively. Conclusion. PCT might be a useful surrogate marker for ASB diagnosis among kidney transplant recipients. Diagnostic performance of PCT is superior to that of WBC count, ESR, and hsCRP. Further, diagnostic ability of PCT appears to be independent of renal function.

Elevated Serum Procalcitonin to Predict Severity and Prognosis of Extensive Burns

Purpose To analyze the factors affecting the elevation of serum procalcitonin (PCT) in patients with extensive burns, and explore its potential value in evaluating the severity and prognosis. Methods Clinical data of 139 patients with extensive burns admitted to our burn center from January 2014 to December 2019 were retrospectively analyzed. Spearman’s Rank correlation coefficient was used to analyze the factors influencing the elevated PCT levels. The predictive power of PCT for death was evaluated by receiver operating characteristic (ROC) and multiple logistic regression analysis. Results 72 cases exhibited elevated serum PCT concentrations during the shock phase, but none of them had obvious signs of infection. PCT level in the shock phase was positively correlated with burn area, depth, degree of inhalation injury, delay in fluid resuscitation, APACHE II, and SOFA scores. The peak values of PCT during shock and infection phases were significantly higher in the non-survivors than in the survivors. The areas under the ROC curve for predicting death were 0.788 and 0.926, respectively, and 5.4 ng/mL (OR = 5.33) and 8.5 ng/mL (OR = 14.49) were the high-risk thresholds for death prediction. Conclusions Serum PCT level in the shock phase is a potential indicator for evaluating the severity of burns, while the PCT level during the infection period can be used as an early warning indicator for severe systemic infection. High levels of PCT peaks during the shock and infection periods indicate an increased risk of poor prognosis, and targeted treatment is required accordingly.