calca-protein--human and Acquired-Immunodeficiency-Syndrome

Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock.. A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU). Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6, interleukin-10 and TNF-α. Outcome measures were in-hospital and six-month mortality.. The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008). The main foci of infection in HIV-positive patients were pulmonary and abdominal (p=0.001). Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4%) and Gram-positive cocci (36.4%) (p=0.001). CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p=0.005, and 1.19 vs. 4.06 ng/mL p=0.04, respectively), with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p=0.005), with moderate accuracy for predicting death (area under receiver-operating characteristic curve =0.74). In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p=0.03, and 58.3 vs. 27.3% p=0.02, respectively).. The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and inflammatory characteristics.

Topics: Acquired Immunodeficiency Syndrome; Adult; Bacteremia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Fungemia; Humans; Male; Middle Aged; Prospective Studies; Protein Precursors; Sepsis; Survival Analysis; Treatment Outcome

The role of procalcitonin (PCT) in immunocompromised patients is still under investigation. This study evaluated the influence of immune deficiency on the value of PCT concentrations in the diagnosis of early stages of bacterial infections in human immunodeficiency virus (HIV)-infected patients compared with other inflammatory markers, such as C-reactive protein and white blood cell count. We analyzed major immunologic markers including CD4, CD8, and HIV-1 viral load. PCT concentrations in the early stages of bacterial infections correlated negatively with CD4 count in HIV-infected patients. However, a similar relation was not seen in patients with acquired immune deficiency syndrome. We support the recommendation to change the cutoff value ranges of PCT in patients with immune deficiency. PCT concentrations can be influenced by various factors and hence should be carefully analyzed, especially in immunocompromised patients.

Topics: Acquired Immunodeficiency Syndrome; Adult; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; CD4-CD8 Ratio; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; HIV-1; Humans; Immunocompromised Host; Male; Middle Aged; Poland; Predictive Value of Tests; Prospective Studies; Protein Precursors; ROC Curve; Viral Load