Value Of Procalcitonin Research Articles

Analysis of the diagnostic and prognostic value of serum PAD2 in patients with sepsis in the intensive care unit

BackgroundSepsis is a common disease in the intensive care unit (ICU). In recent years, the incidence rate and mortality rate remain high. Early diagnosis of sepsis is crucial for treatment and can effectively reduce mortality. So far, the ability of serum peptidylarginine deaminase 2 (PAD2) in the diagnosis and prognosis of sepsis patients is still unclear. We conducted this study to reveal the clinical value of PAD2 as a biomarker for sepsis patients. MethodsA prospective study method was used to select 207 patients in the ICU of Renmin Hospital of Wuhan University from May 2022 to May 2023. They were divided into the sepsis group (n = 135) and control group (n = 72), and data were collected within 24 h of hospitalization. Sepsis patients were divided into a survival group (n = 80) and a non-survival group (n = 55) based on their 28-day survival status. Using statistical methods to evaluate the diagnostic and prognostic value of PAD2 in sepsis. ResultsThe serum PAD2 concentrations in the sepsis group were significantly higher than in the control group (median 16.70 vs 35.32 ng/ml, P < 0.001). Multivariate logistic regression analysis showed that the Quick Sequential Organ Failure Assessment (qSOFA), C-reactive protein (CRP), procalcitonin (PCT), and PAD2 were independent risk factors for sepsis. The Receiver operating characteristic (ROC) curve showed that the combined diagnostic value of qSOFA, CRP, PCT, and PAD2 was the highest. The serum PAD2 concentrations in the non-survival group of patients with sepsis were significantly higher than those in the survival group (median 29.26 vs 50.08 ng/ml, P < 0.05). The COX regression analysis showed that PAD2, sequential organ failure score Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation (APACHE II) score were independent factors affecting the prognosis of sepsis patients. The ROC analysis showed that the combined prognostic value of PAD2, SOFA, and APACHE II scores was significantly higher than any single indicator. The Kaplan-Meier survival analysis showed that patients with PAD2 ≤ 48.62 ng/ml had a better prognosis. ConclusionThe significant increase in serum PAD2 concentrations in patients is an independent risk factor affecting the occurrence of sepsis and 28-day mortality. The combination of PAD2 and other indicators can further improve the diagnostic and prognostic value for ICU sepsis patients.

Persistently High Procalcitonin and C-Reactive Protein Are Good Predictors of Infection in Acute Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis.

Infected necrotizing pancreatitis (INP) is associated with an increased risk of organ failure and mortality. Its early recognition and timely initiation of antibiotic therapy can save patients' lives. We systematically searched three databases on 27 October 2022. In the eligible studies, the presence of infection in necrotizing pancreatitis was confirmed via a reference test, which involved either the identification of gas within the necrotic collection through computed tomography imaging or the examination of collected samples, which yielded positive results in Gram staining or culture. Laboratory biomarkers compared between sterile necrotizing pancreatitis and INP were used as the index test, and our outcome measures included sensitivity, specificity, the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Within the first 72 hours (h) after admission, the AUC of C-reactive protein (CRP) was 0.69 (confidence interval (CI): 0.62-0.76), for procalcitonin (PCT), it was 0.69 (CI: 0.60-0.78), and for white blood cell count, it was 0.61 (CI: 0.47-0.75). After the first 72 h, the pooled AUC of CRP showed an elevated level of 0.88 (CI: 0.75-1.00), and for PCT, it was 0.86 (CI: 0.60-1.11). The predictive value of CRP and PCT for infection is poor within 72 h after hospital admission but seems good after the first 72 h. Based on these results, infection is likely in case of persistently high CRP and PCT, and antibiotic initiation may be recommended.

Role of Serial change in Serum Procalcitonin Levels as a Marker to Predict 28th Day Mortality in Patients with Sepsis and Septic Shock

Objectives Worldwide, the estimated incidence of sepsis is &gt;30 million cases every year with approximately 6 million deaths annually. Studies have shown that procalcitonin can be a reliable marker for diagnosis and predicting mortality in sepsis patients. In this study, we have tried to determine the role of serial changes in procalcitonin levels in predicting 28th day mortality in patients with sepsis and septic shock. Methods A prospective observational study was conducted at ABVIMS and Dr RML Hospital from 1st November 2017 to 31st March 2019. Adults who were diagnosed with sepsis or septic shock and admitted to ICU, emergency or ward of the hospital were included. Sample for procalcitonin was taken at admission (day-1), and on day-5. Patients were followed telephonically to record final outcome at 28 days. Results Fifty-seven patients were enrolled in the study. 35(61.4%) patients had sepsis and 22 (38.6%) were in septic shock. 10 (17.54%) patients died over a period of 28 days follow up. The level of serum procalcitonin on day-1 was significantly higher in non survivors as compared to survivors (7.66±2.07 vs. 5.78±2.48, p-value-0.029). Percentage change in procalcitonin (ΔPCT) from day 1 to day 5 was significantly low among non survivors as compared to survivors (29.94 ± 38.29 vs 70.33±34.56, p- value-0.006). Of 10 patient who died, 8(32%) had ≤80% decrease in (ΔPCT) and only 2 (6.25%) had &gt;80%decrease in (ΔPCT) (p= 0.016). SOFA, q-SOFA and serum lactate were significantly higher among non survivors and were also significant in predicting mortality on univariate analysis. But multivariate analysis showed that only (ΔPCT) had significant correlation with mortality (OR: 0.972, p=0.022) and hence can hence can be used as an independent marker of mortality in sepsis patient. Conclusion This study determined that more than baseline values of procalcitonin, the change in serial procalcitonin (ΔPCT) was significant in predicting mortality in patients with sepsis and septic shock.

Procalcitonin and C-reactive protein as diagnostic biomarkers in COVID-19 and Non-COVID-19 sepsis patients: a comparative study

BackgroundThis study aimed to assess and compare procalcitonin (PCT) and C-reactive protein (CRP) levels between COVID-19 and non-COVID-19 sepsis patients. Additionally, we evaluated the diagnostic efficiency of PCT and CRP in distinguishing between Gram-positive (GP) and Gram-negative (GN) bacterial infections. Moreover, we explored the associations of PCT with specific pathogens in this context.MethodsThe study included 121 consecutive sepsis patients who underwent blood culture testing during the COVID-19 epidemic. PCT and CRP were measured, and reverse transcriptase-polymerase chain reaction (RT-PCR) was employed for the detection of COVID-19 nucleic acid. The Mann-Whitney U-test was used to compare PCT and CRP between the COVID-19 and non-COVID-19 groups. Receiver operating characteristic (ROC) curves were generated to compare PCT and CRP levels in the GN group versus the GP group for assessing the diagnostic efficiency. The kruskal-Wallis H test was applied to assess the impact of specific pathogen groups on PCT concentrations.ResultsA total of 121 sepsis patients were categorized into a COVID-19 group (n = 25) and a non-COVID-19 group (n = 96). No significant differences in age and gender were observed between the COVID-19 and non-COVID-19 groups. The comparison of biomarkers between these groups showed no statistically significant differences. The optimal cut-off values for PCT and CRP in differentiating between GP and GN infections were 1.03 ng/mL and 34.02 mg/L, respectively. The area under the ROC curve was 0.689 (95% confidence interval (CI) 0.591–0.786) for PCT and 0.611 (95% CI 0.505–0.717) for CRP. The diagnostic accuracy was 69.42% for PCT and 58.69% for CRP. The study found a significant difference in PCT levels among specific groups of pathogens (P < 0.001), with the highest levels observed in Escherichia coli infections. The frequency of Staphylococcus spp. positive results was significantly higher (36.0%) in COVID-19 compared to non-COVID-19 sepsis patients (P = 0.047).ConclusionSepsis patients with COVID-19 revealed a significantly higher culture positivity for staphylococcus spp. than the non-COVID-19 group. Both PCT and CRP showed moderate diagnostic efficiency in differentiating between GP and GN bacterial infections. PCT showed potential utility in identifying E. coli infections compared to other pathogens.

Comparison of platelet activation in patients undergoing coronary bypass surgery with conventional and mini extracorporeal systems

Aim: The aim of this study was to compare platelet activation in patients undergoing coronary bypass surgery with conventional and mini extracorporeal systems. Material and Methods: Our study is a retrospective study and a total of 116 patient data were obtained. Patients were divided into two groups as conventional extracorporeal and mini extracorporeal system bypass patients. Equal numbers of patients (n=58) were included in both groups. The data of patients who underwent coronary bypass surgery with conventional and mini extracorporeal systems between January 2022 and December 2022 were included in the study. Results: In our study, no significant difference was found between patients bypassed with conventional and mini extracorporeal system in terms of pump time and cross-clamp time. Although the duration of intensive care unit stay and total hospitalization were found to be shorter in patients bypassed with the mini-extracorporeal (MECC) system than those bypassed with the conventional method, the difference between the groups was not significant. As a result of our study, it was observed that postoperative ejection fraction (EF) values significantly increased and hematocrite (HTC), hemoglobin (Hb), platelet (PLT) and procalcitonin (PCT) values significantly decreased in both groups of patients who underwent bypass with conventional and MECC system, and no significant difference was found between pre- and postoperative mean platelet volume (MPV) and platelet distribution width (PDW) values. As a result of our study, postoperative PLT and PCT values in the MECC group were found to be significantly higher than those in patients who underwent bypass with the conventional method. Conclusion: Considering the results obtained in our study, it is seen that the values in patients bypassed with the MECC system are more favorable than those bypassed with the standard method, but more studies on the subject are needed.

Value of procalcitonin and presepsin in the diagnosis and severity stratification of sepsis and septic shock.

Value of procalcitonin and presepsin in the diagnosis and severity stratification of sepsis and septic shock.

Are C-reactive protein and procalcitonin safe and useful for antimicrobial stewardship purposes in patients with COVID-19? A scoping review.

The primary objectives of this study were to assess the usefulness of C-reactive protein (CRP) and procalcitonin (PCT) in the diagnosis of bacterial co-infections in coronavirus disease 2019 (COVID-19) and if their incorporation in antimicrobial stewardship (AMS) programs is safe and useful, stratified by severity of disease as level of care, intensive care unit (ICU) or non-ICU. Our secondary objectives were to identify cut-off values for antibiotic decision-making and identify reported results from low- and middle-income countries (LMICs). A scoping review of published literature, adhering to the PRISMA statement for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines. The last search was performed in January 2024. Fifty-nine studies were included in this scoping review: 20 studies reporting predictive values and/or sensitivity/specificity results for PCT, 8 reporting clear objectives on AMS, and 3 studies from LMICs. In the context of non-ICU hospitalized COVID-19 patients in high-income countries, a PCT value below 0.25mg/L can be a useful tool to rule out bacterial co-infection. The wide range of reported negative predictive values suggests that PCT should be interpreted in the context of other clinical findings. Our results do not support the use of CRP in the same manner as PCT. There is a clear need for more studies in LMICs.

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 &lt; 0.001) was revealed between the severity of pneumonia and PCT, and also a positive correlation (P &lt; 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.

The value of serum PCT/ALB and CRP/ALB ratios in evaluating the condition and prognosis of craniocerebral trauma.

The aim of the study was to explore the value of serum procalcitonin to albumin (PCT/ALB) and C-reactive protein to albumin (CRP/ALB) ratios in evaluating the condition and prognosis of craniocerebral trauma (CT). 158 patients with CT admitted to the emergency department of our hospital from January 2020 to June 2022 were selected as the study subjects. According to the Glasgow coma scale (GCS) score, 158 patients with CT were grouped in a mild group (GCS score 13-15 points, n = 68), a moderate group (GCS score 9-12 points, n = 61), and a severe group (GCS score 3-8 points, n = 29). Besides, according to the patient's Glasgow prognosis (GOS) score, 158 patients with CT were divided into a good prognosis group (GOS score 4-5 points, n = 110) and a poor prognosis group (GOS score 1-3 points, n = 48). Serum PCT/ALB and CRP/ALB levels of different groups were compared. The correlation between PCT/ALB and CRP/ALB ratios and the score of GCS and GOS was explored using Pearson correlation analysis. Prognosis-related influencing factors were found out through multivariate logistic regression. The value of serum PCT/ALB and CRP/ALB ratios in evaluating the condition and prognosis of CT was evaluated by the ROC curve. Patients in the moderate and severe groups had much higher ratios of PCT/ALB and CRP/ALB and sharply lower GCS scores than those in the mild group ( p < 0.001). Compared with the patients in the moderate group, those in the severe group had much higher PCT/ALB and CRP/ALB ratios and obviously lower GCS scores ( p < 0.001). Patients with poor prognosis had markedly higher PCT/ALB and CRP/ALB ratios and memorably lower GOS score than the patients with good prognosis ( p < 0.001). A negative correlation between PCT, CRP, PCT/ALB ratio, CRP/ALB ratio and GCS scores ( r = -0.821, -0.857, -0.750, -0.766, p < 0.001) and GOS scores ( r = -0.636, -0.628, -0.595, -0.628, p < 0.001) was revealed by Pearson correlation analysis. ALB was correlated positively with GCS score and GOS score ( r = 0.381, 0.413, p < 0.001). Multivariate logistic regression analysis exhibited that PCT/ALB ratio and CRP/ALB ratio were related to poor prognosis of CT patients ( p < 0.05). ROC curve analysis showed that the combined PCT/ALB ratio and CRP/ALB area under the curve (AUC) were 0.883 and 0.860, respectively, which were used to assess the severity and predict prognosis of patients with CT. PCT/ALB and CRP/ALB ratios were positively correlated with the severity and prognosis of patients with CT, and were risk factors for poor prognosis. Early determination of changes in PCT/ALB and CRP/ALB ratios had a certain clinical value for evaluating the condition and prognosis of CT patients.

COVID-19 Related Acute Respiratory Distress Syndrome versus Classical Acute Respiratory Distress Syndrome Patients: Inflammatory Biomarkers as Predictors of Mortality in Pulmonary Septic Shock.

Coronavirus disease-2019 (COVID-19)-related severe acute respiratory distress syndrome (ARDS) differs pathophysiological from other pulmonary septic shock-related ARDS. Thus, we assessed whether all-cause in-hospital mortality differs for severe COVID-19-related and classical severe ARDS and which inflammatory biomarkers can predict mortality among these patients. This single-center, retrospective, observational cohort study included pulmonary septic shock patients (n = 114) with COVID-19-related and classical severe ARDS admitted in the Intensive Care Unit. Patients with a mean age of 73 (IQR 62-82), predominantly male (63%), were divided into two groups based on outcomes: survivors (n = 50) and non-survivors (n = 64). COVID-19-related severe ARDS (n = 48) accounts for 75% of deaths. Present comorbidities like heart disease (p = 0.043), neurologic disorders (p = 0.018), and liver disease (p = 0.038) were associated with in-hospital mortality, as well. Regarding inflammatory biomarkers, the AUC/c-statistic was 0.656 (95% CI: 0.53-0.759) for leukocytes, 0.613 (95% CI: 0.509-0.717) C-reactive protein (CRP) and 0.651 (95% CI: 0.548-0.753) for procalcitonin in predicting all-cause in-hospital mortality among patients with pulmonary septic shock and severe ARDS. Patients with pulmonary septic shock and with COVID-19-related severe ARDS had a higher incidence of in-hospital mortality than those with classical severe ARDS. The high value of leukocytes, C-reactive protein, and procalcitonin were predictive for all-cause in-hospital mortality in patients with pulmonary septic shock and ARDS. Infection with COVID-19 was an independent predictor of in-hospital mortality in the presence of ARDS.

Cytokines and Other Laboratory Parameters of Hospitalized COVID-19 Patients that Predict Intensive Care Unit Admission.

This study aimed to investigate the roles of cytokines and other laboratory parameters in determining the need for intensive care in COVID-19 patients. This is a retrospective observational study. Demographic, clinical, and laboratory parameters of the patients were evaluated. Thirteen cytokines were measured along with baseline laboratory tests at admission and at 48-hour intervals: IL-1β, IFN-α, IFN-β, TNF-α, MCP-1, IL-6, IL -8, IL-10, IL-2p70, IL-17A, IL-18, IL-23, and IL-33. COVID-19 was confirmed by PCR in 116 hospitalized patients. The mean age was 55.3 ± 16.4 years. Seventy-four (63.8%) of the patients were male and 42 (36.2%) were female. Twenty-two (18.9%) patients (16 male, 6 female) were transferred to the intensive care unit. A significant increase in white blood cell (WBC), neutrophil (Neu) and lymphocyte (Lym) counts, Neu/Lym ratio (NLR), lactate dehydrogenase (LDH), INR (international normalized ratio), activated prothrombin time (aPTT), D-dimer (D-D), troponin (Trop), Pro-BNP (BNP), procalcitonin (PCT), ferritin (Fer), and alanine aminotransferase (ALT) values were observed in those requiring intensive care. A significant decrease was found in albumin (Alb) levels and Lym counts. Alb levels appeared to be protective against admission to intensive care. Except for IFN- α, IL-23, and IL-33, the baseline values of other cytokines were above the threshold values. MCP-1 and IL-6 were higher in patients requiring intensive care. High NLR and LDH and low Alb levels, especially with an increase in MCP-1 and IL-6, were found to be the best predictors of a serious COVID-19 infection.

Analysis of factors associated with postoperative systemic inflammatory response syndrome in patients with urine culture-positive stone lithotripsy.

Systemic inflammatory response syndrome (SIRS) is a significant postoperative complication following lithotripsy, particularly in patients with positive urine cultures. Understanding the factors that contribute to the development of SIRS in these patients is crucial for improving clinical outcomes and reducing morbidity. From 2022 to 2023, patients with preoperative positive urine culture who underwent minimally invasive uroscopic lithotripsy in Wuhan Union Hospital were retrospectively analyzed. A total of 393 patients with positive urine cultures underwent endoscopic lithotripsy, and 13.2% (52/393) were diagnosed with SIRS by relevant indicators after surgery. Multivariate logistic regression was used to study the risk factors for the occurrence of SIRS in patients postoperatively, which were preoperative positive WBC in urinalysis (OR = 5.685, p = 0.0051) and postoperative hemoglobin drop of greater than 5 g/L (OR = 2.180, p = 0.0145). Notably, preoperative upper urinary tract drainage was found to be a protective factor (OR = 0.4029, p = 0.0302), and postoperative C-reactive protein (CRP) value (OR = 1.025, p < 0.0001) and procalcitonin (PCT) value (OR = 1.066, p < 0.0001) were predictive factors. Besides, postoperative hemoglobin drop showed a weak correlation with surgical duration (r = 0.1589, p = 0.0016). In summary, our study identifies key factors affecting the occurrence of SIRS after lithotripsy for urine culture-positive stone: preoperative positive WBC in urinalysis, postoperative hemoglobin drop, and preoperative upper urinary tract drainage. And monitoring postoperative CRP and PCT levels helps to predict SIRS.

Evaluation of interferon gamma release assay to measure t-cell response in COVID-19 patients from intensive care units and inpatient departments.

Interferon gamma release assay (IGRA) is an in vitro blood test to measure interferon gamma (IFN-γ) released from antigen-specific Tcells after stimulation with pathogen-specific peptides. In this study, it was aimed to investigate the T-cell response using IGRA and to compare various laboratory values in Coronavirus Disease (COVID-19) patients hospitalized either in hospital inpatient departments or in intensive care units. Atotal of 100 patients (50+50) who were identified as positive for COVID-19 through the molecular method in Selcuk University Faculty of Medicine Infectious Diseases Service and Reanimation Intensive Care Unit were included in the study. IFN-γ levels in blood samples collected from patients were determined using the QuantiFERON Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) (QIAGEN, Germany) kit. The patients' gender, age, c-reactive protein (CRP), aspartate aminotransferase (AST), alanine transaminase (ALT), interleukin (IL)-6, lymphocyte count, procalcitonin, and D-dimer results were obtained from the hospital automation system. Thirty-eight of the IGRA test results were negative, 44 were positive and 18 were inconclusive. The age of patients with negative IGRA test results was significantly higher (p<0.001) compared to patients with positive results. There were no significant differences between patients' IGRA test results and gender, prognosis, IL-6, lymphocyte counts, CRP, AST, and ALT values.Age, death rates, D-dimer, CRP, procalcitonin, AST and ALT values of patients hospitalized in the intensive care unit were significantly higher (p<0.001) compared to the those hospitalized in the inpatient department, while conversely, the lymphocyte values were lower (p<0.001). The relatively higher IGRA negative results in the elderly, negative and intermediate results in intensive-care patients, and low lymphocyte levels in intensive-care patients indicate that the cellular immune response is diminished and/or absent. The death rates, D-dimer, CRP, procalcitonin, AST and ALT values of the patients hospitalized in the intensive care unit were higher compared to those from the in-patient department, indicating the severity of inflammation and signaling the development of organ failure. In the light of these findings, we suggest that IGRA tests may serve as aguide in immunomodulatory therapy (Tab. 2, Fig. 2, Ref.27). Text in PDF www.elis.sk Keywords: COVID-19, interferon gamma release assay test, Tcell response.

Эндотелиальная дисфункция сосудов как возможный предиктор тяжелого течения COVID-19

Objective. To study the role of the main marker of endothelial dysfunction VEGF-A as a possible predictor of severe COVID-19 formation. Patients and methods. On the basis of the clinic of the Republican Specialized Scientific and Practical Medical Center of Epidemiology, Microbiology, Infectious and Parasitic Diseases (RSSPMCEMIPD) and Samarkand Regional Specialized Medical Center, 210 patients with coronavirus infection were examined during 2020–2022. Patients were divided into 2 groups comparable by main characteristics: I consisted of 98 (47%) patients with a moderate form of COVID-19, II – 112 (53%) with a severe form of the disease. All patients were fully examined at admission to the hospital and at discharge from it. The level of medium molecular peptides (MMP) in blood plasma was determined by the method of N.I.Gabrielyan on spectrophotometer SF-46 in ultraviolet spectrum; the levels of vascular endothelial growth factor (VEGF-A) – in 163 patients – and interleukins 1 and 6 (IL-1, IL-6) in blood serum – by enzyme immunoassay (test systems of Cytokin LLC and Vector-Best JSC). The level of C-reactive protein (CRP) was determined using the immunoenzyme analyzer "MINDRAY MR-96A"; procalcitonin and D-dimer values were determined using an automatic ELISA analyzer mini-VIDAS. The obtained results were processed by methods of descriptive and variation statistics. Differences were considered reliable at (p &lt; 0.05). Results. The clinical picture of COVID-19 complicated by pneumonia was characterized by pronounced symptoms of intoxication, respiratory tract damage, respiratory failure. In group II patients, such comorbidities as ischemic heart disease (23.5 vs. 41.1%), arterial hypertension (9.2 vs. 25.4%), and diabetes mellitus (2.0 vs. 12.5%) were recorded significantly more often. In 119 (56.7%) cases (mostly in the group with severe coronavirus infection), there was a combination of several comorbidities. In 36 (17.1%) patients with elevated blood sugar level before hospitalization for COVID-19 neither clinical nor laboratory signs of diabetes ellitus were present; in group II stable elevated blood sugar level against the background of therapy of the main disease was recorded 2 times more often (23.2 vs. 10.2%, respectively). In the same group, the level of CPR was 1.5 times higher. A significant correlation (p &lt; 0.05) of elevated levels of CRP and D-dimer with the severity of COVID-19 course was established. In 163 patients the mean values of VEGF-A on admission were elevated; in patients from group II this index was significantly (p &lt; 0.01) higher: 303.02 ± 21.47 vs. 390.52 ± 29.05 pg/mL. At discharge, this index increased to 466.56 ± 37.59 pg/mL in group II patients and decreased to 237.60 ± 17.03 pg/mL in group I patients (differences were significant; p &lt; 0.01). In group I, this index returned to normal after 1 month, and in group II, it decreased to 205.05 ± 15.90 pg/mL only 2 months after discharge. A reliable correlation (p &lt; 0.05) of elevated levels of D-dimer, CRP, MMP with high VEGF-A levels, as well as with the severity of the disease and increasing respiratory failure was established. Positive results of bacteriologic study of upper respiratory tract secretions were found in 63 (64.3%) patients of group I and in 78 (69.6%) patients of group II; Staphylococcus aureus predominated in patients from group II (11.1 vs. 38.5%) and Candida spp (85.7 vs. 28.2%) from group I. Conclusion. The relationship between blood levels of VEGF-A and standard inflammatory markers allows us to propose this factor of endothelial dysfunction as a predictor of inflammation and disease progression, as well as to use it to assess the efficacy of therapy. Key words: bacterial pneumonia, novel coronavirus infection, procalcitonin, C-reactive protein, vascular endothelial growth factor, endothelial dysfunction

Comparative Diagnostic Value of Procalcitonin, C-Reactive Protein, and Lactate Measurements in Cerebrospinal Fluid for the Diagnosis of Central Nervous System Infections

Comparative Diagnostic Value of Procalcitonin, C-Reactive Protein, and Lactate Measurements in Cerebrospinal Fluid for the Diagnosis of Central Nervous System Infections

Prognostication of the development of septic complications in children with burn injuries.

Aim: To determine the prognostic criteria for the development of septic complications in children with thermal injury. Materials and Methods: A single-center retrospective-prospective cohort study included a retrospective analysis of 98 medical histories of children of different ages with severe burns who were treated from 2007 to 2017. A prospective study was conducted among children (n=63) from 1 to 5 years old, who received various degrees severity burn injury, according to an open comparative method in the period from 2018 to 2021. Results: Indicators of a high risk of developing sepsis were burns by flames of any etiology, damage severity index ≥75 units, total burn surface ≥25 %, deep burn area ≥ 5%. The threshold value of procalcitonin (PCT) ≥ 0.86 ng/ml on the 1st-3rd day and PCT > 0.51 ng/ml on the 7th day of burn disease, had a prognostic value for assessing the probability of sepsis. On the 1st day of hospitalization, the development of sepsis was predicted if the C-reactive protein (CRP) value was higher than 6.98 ng/ml, on the 3rd - the CRP level was above 7.43 ng/ml, on the 7th day - above 7.28 ng/ml. Conclusions: Based on the obtained data, we selected the criteria with the best prognostic characteristics, which allows us to predict and prevent the development of sepsis in the early stages of burn disease in children.

Serum procalcitonin as a marker of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD)

BackgroundNeonatal Intrahepatic Cholestasis (NICCD), as the early-age stage of Citrin deficiency involving liver dysfunction, lacks efficient diagnostic markers. Procalcitonin (PCT) has been identified as a biomarker for infection as well as various organ damage. This study aimed to explore the potential of PCT as a biomarker for NICCD. MethodsIn a single-center retrospective case-control study. Serum PCT concentrations before and after treatment of 120 NICCD patients, as the study group, were compared to the same number of cholestatic hepatitis patients, as the control group. The potential value of PCT to discriminate NICCD from control disease was further explored using Receiver Operating Characteristic (ROC) curve analysis and compared to those of other inflammatory markers. ResultsThere was a significantly higher level of PCT in NICCD patients than in the control group. PCT concentrations were only weakly correlated with neutrophil counts and CRP levels (p ˂ 0.05). At a cut-off value of 0.495 ng/mL, PCT exhibited a significantly higher diagnostic value compared to other inflammatory markers for discriminating NICCD from the control, with a sensitivity of 90.8 % and specificity of 98.3 %. ConclusionPCT might be used as an initial biomarker to discriminate children with NICCD from another hepatitis disease.

Применение полуколичественного экспресс-теста на прокальцитонин в диагностике внебольничной пневмонии у пациентов с ВИЧ-инфекцией

Timely diagnosis of community-acquired pneumonia (CAP) and optimal timing of initiation of antibiotic therapy are important for reducing mortality in patients with HIV infection. It is reported that the assessment of procalcitonin (PCT) levels in this category of patients can be a useful diagnostic tool. Aim. To determine the levels of a new semi-quantitative rapid test (RT) for PCT in patients with CAP depending on the presence or absence of HIV infection. Design. Cross-sectional comparative study. Material and methods. The study involved 123 patients hospitalized with a diagnosis of CAP. 15 (12.2%) patients, including 10 (66.7%) men and 5 (33.3%) women (average age 59.3 ± 22.4 years), were diagnosed with HIV infection 3th stage. The comparison group included 108 people (48 (44.4%) men and 60 (55.6%) women, average age 48.1 ± 20.5 years) who did not have HIV infection. Before starting antibacterial therapy, all patients underwent a general clinical examination, the concentration of PCT in plasma was determined quantitatively using the enzyme-linked immunosorbent assay, as well as using a new semi-quantitative ET method using a one-step immunochromatographic analysis. Results. In the group of patients with CAP without HIV infection, borderline values of PCT ET (0.5 to &lt; 2 ng/ml) were encountered 3.3 times more often than in patients with concomitant HIV infection (0.5 to &lt; 2 ng/ml) — 22.2% versus 6.7 %; p = 0.030. High levels of PCT ET (from 2 to &lt;10 ng/ml) were 7 times more likely to be detected in patients with CAP and HIV infection than without it - 13.3% versus 1.9%; p = 0.030. The quantitative content of PCT in the blood was also 4.5 times higher in patients with CAP in the presence of HIV infection (0.49 [0.11; 0.76] and 0.11 [0.01; 0.52] ng/ml; p = 0.038) relative to the comparison group. In the group of patients with CAP and HIV infection, a positive correlation was established between PCT RT and the degree of respiratory failure (r = 0.656; p = 0.008) and quantitative PCT (r = 0,453; р = 0,048), test negative correlations with the content of platelets (r = –0.542; p = 0.037), sodium (r = –0.700; p = 0.016 ) and saturation level (r = 0.335; p = 0.022). Conclusion. Patients with CAP and HIV infection in comparison with persons without HIV infection are characterized by higher PCT values determined by both classical quantitative and new semi-quantitative RT, which makes it possible to use the latter for rapid diagnosis of CAP in this group of patients. Key words: community-acquired pneumonia, HIV infection, diagnostics, procalcitonin, procalcitonin rapid test

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

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

Clinicoradiological Correlation of Serum Procalcitonin Values in Degenerative Lumbar Disc Disease

Introduction: Low back pain (LBP) as a result of prolapsed intervertebral disc is one of the common causes of the morbidity and disability in current population. We assessed any association of inflammatory marker serum procalcitonin in degenerative disc disease. Materials &amp; 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.