calca-protein--human and Acute-Disease

Whether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predict adverse clinical outcome in a large ARI population.. We analysed data from 14 trials and 4,211 ARI patients to study associations of admission procalcitonin levels and setting specific treatment failure and mortality alone at 30 days. We used multivariable hierarchical logistic regression and conducted sensitivity analyses stratified by clinical settings and ARI diagnoses to assess the results' consistency.. Overall, 864 patients (20.5%) experienced treatment failure and 252 (6.0%) died. The ability of procalcitonin to differentiate patients with from those without treatment failure was highest in the emergency department setting (treatment failure area under the curve (AUC): 0.64 (95% confidence interval (CI): 0.61, 0.67), adjusted odds ratio (OR): 1.85 (95% CI: 1.61, 2.12), P <0.001; and mortality AUC: 0.67 (95% CI: 0.63, 0.71), adjusted OR: 1.82 (95% CI: 1.45, 2.29), P <0.001). In lower respiratory tract infections, procalcitonin was a good predictor of identifying patients at risk for mortality (AUC: 0.71 (95% CI: 0.68, 0.74), adjusted OR: 2.13 (95% CI: 1.82, 2.49), P <0.001). In primary care and intensive care unit patients, no significant association of initial procalcitonin levels and outcome was found.. Admission procalcitonin levels are associated with setting specific treatment failure and provide the most prognostic information regarding ARI in the emergency department setting.

Topics: Acute Disease; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Emergency Service, Hospital; Female; Humans; Intensive Care Units; Male; Middle Aged; Predictive Value of Tests; Prognosis; Protein Precursors; Respiratory Tract Infections; Treatment Failure

Persistent organ failure and infected pancreatic necrosis are major determinants of mortality in acute pancreatitis, but there is a gap in the literature assessing the best available predictors of these two determinants. The purpose of this review was to investigate the utility of predictors of persistent organ failure and infected pancreatic necrosis in patients with acute pancreatitis, both alone and in combination.. We performed a systematic search of the literature in 3 databases for prospective studies evaluating predictors of persistent organ failure, infected pancreatic necrosis, or both, with strict eligibility criteria.. The best predictors of persistent organ failure were the Japanese Severity Score and Bedside Index of Severity in Acute Pancreatitis when the evaluation was performed within 48h of admission, and blood urea nitrogen and Japanese Severity Score after 48h of admission. Systemic Inflammation Response Syndrome was a poor predictor of persistent organ failure. The best predictor of infected pancreatic necrosis was procalcitonin.. Based on the best available data, it is justifiable to use blood urea nitrogen for prediction of persistent organ failure after 48h of admission and procalcitonin for prediction of infected pancreatic necrosis in patients with confirmed pancreatic necrosis. There is no predictor of persistent organ failure that can be justifiably used in clinical practice within 48h of admission.

Topics: Acute Disease; Blood Urea Nitrogen; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Disease Progression; Humans; Multiple Organ Failure; Necrosis; Pancreas; Pancreatitis, Acute Necrotizing; Predictive Value of Tests; Protein Precursors; Severity of Illness Index; Systemic Inflammatory Response Syndrome

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Protein Precursors; Respiratory Tract Infections

Urinary tract infections (UTIs) are common childhood bacterial infections that may involve renal parenchymal infection (acute pyelonephritis [APN]) followed by late scarring. Prompt, high-quality diagnosis of APN and later identification of children with scarring are important for preventing future complications. Examination via dimercaptosuccinic acid scanning is the current clinical gold standard but is not routinely performed. A more accessible assay could therefore prove useful. Our goal was to study procalcitonin as a predictor for both APN and scarring in children with UTI.. A systematic review and meta-analysis of individual patient data were performed; all data were gathered from children with UTIs who had undergone both procalcitonin measurement and dimercaptosuccinic acid scanning.. A total of 1011 patients (APN in 60.6%, late scarring in 25.7%) were included from 18 studies. Procalcitonin as a continuous, class, and binary variable was associated with APN and scarring (P < .001) and demonstrated a significantly higher (P < .05) area under the receiver operating characteristic curve than either C-reactive protein or white blood cell count for both pathologies. Procalcitonin ≥0.5 ng/mL yielded an adjusted odds ratio of 7.9 (95% confidence interval [CI]: 5.8-10.9) with 71% sensitivity (95% CI: 67-74) and 72% specificity (95% CI: 67-76) for APN. Procalcitonin ≥0.5 ng/mL was significantly associated with late scarring (adjusted odds ratio: 3.4 [95% CI: 2.1-5.7]) with 79% sensitivity (95% CI: 71-85) and 50% specificity (95% CI: 45-54).. Procalcitonin was a more robust predictor compared with C-reactive protein or white blood cell count for selectively identifying children who had APN during the early stages of UTI, as well as those with late scarring.

Topics: Acute Disease; Adolescent; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Cicatrix; Confidence Intervals; Disease Progression; Female; Follow-Up Studies; Humans; Incidence; Likelihood Functions; Male; Odds Ratio; Predictive Value of Tests; Protein Precursors; Pyelonephritis; Risk Assessment; Severity of Illness Index; Urinary Tract Infections

The aim was to evaluate the diagnostic value of procalcitonin, C-reactive protein (CRP) and white blood cell count (WBC) in uncomplicated or complicated appendicitis by means of a systematic review and meta-analysis.. The Embase, MEDLINE and Cochrane databases were searched, along with reference lists of relevant articles, without language restriction, to September 2012. Original studies were selected that reported the performance of procalcitonin alone or in combination with CRP or WBC in diagnosing appendicitis. Test performance characteristics were summarized using hierarchical summary receiver operating characteristic (ROC) curves and bivariable random-effects models.. Seven qualifying studies (1011 suspected cases, 636 confirmed) from seven countries were identified. Bivariable pooled sensitivity and specificity were 33 (95 per cent confidence interval (c.i.) 21 to 47) and 89 (78 to 95) per cent respectively for procalcitonin, 57 (39 to 73) and 87 (58 to 97) per cent for CRP, and 62 (47 to 74) and 75 (55 to 89) per cent for WBC. ROC curve analysis showed that CRP had the highest accuracy (area under ROC curve 0·75, 95 per cent c.i. 0·71 to 0·78), followed by WBC (0·72, 0·68 to 0·76) and procalcitonin (0·65, 0·61 to 0·69). Procalcitonin was found to be more accurate in diagnosing complicated appendicitis, with a pooled sensitivity of 62 (33 to 84) per cent and specificity of 94 (90 to 96) per cent.. Procalcitonin has little value in diagnosing acute appendicitis, with lower diagnostic accuracy than CRP and WBC. However, procalcitonin has greater diagnostic value in identifying complicated appendicitis. Given the imperfect accuracy of these three variables, new markers for improving medical decision-making in patients with suspected appendicitis are highly desirable.

Topics: Acute Disease; Adult; Appendicitis; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Humans; Leukocyte Count; Protein Precursors; ROC Curve; Sensitivity and Specificity

Procalcitonin algorithms may reduce antibiotic use for acute respiratory tract infections (ARIs). We undertook an individual patient data meta-analysis to assess safety of this approach in different ARI diagnoses and different clinical settings.. We identified clinical trials in which patients with ARI were assigned to receive antibiotics based on a procalcitonin algorithm or usual care by searching the Cochrane Register, MEDLINE, and EMBASE. Individual patient data from 4221 adults with ARIs in 14 trials were verified and reanalyzed to assess risk of mortality and treatment failure-overall and within different clinical settings and types of ARIs.. Overall, there were 118 deaths in 2085 patients (5.7%) assigned to procalcitonin groups compared with 134 deaths in 2126 control patients (6.3%; adjusted odds ratio, 0.94; 95% confidence interval CI, .71-1.23)]. Treatment failure occurred in 398 procalcitonin group patients (19.1%) and in 466 control patients (21.9%; adjusted odds ratio, 0.82; 95% CI, .71-.97). Procalcitonin guidance was not associated with increased mortality or treatment failure in any clinical setting or ARI diagnosis. Total antibiotic exposure per patient was significantly reduced overall (median [interquartile range], from 8 [5-12] to 4 [0-8] days; adjusted difference in days, -3.47 [95% CI, -3.78 to -3.17]) and across all clinical settings and ARI diagnoses.. Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARIs was effective in reducing antibiotic exposure across settings without an increase in the risk of mortality or treatment failure. Further high-quality trials are needed in critical-care patients.

Topics: Acute Disease; Adult; Aged; Algorithms; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Protein Precursors; Randomized Controlled Trials as Topic; Regression Analysis; Respiratory Tract Infections

Acute respiratory infections (ARIs) comprise a large and heterogeneous group of infections including bacterial, viral and other aetiologies. In recent years, procalcitonin - the prohormone of calcitonin - has emerged as a promising marker for the diagnosis of bacterial infections and for improving decisions about antibiotic therapy. Several randomised controlled trials (RCTs) have demonstrated the feasibility of using procalcitonin for starting and stopping antibiotics in different patient populations with acute respiratory infections and different settings ranging from primary care to emergency departments (EDs), hospital wards and intensive care units (ICUs).. The aim of this systematic review based on individual patient data was to assess the safety and efficacy of using procalcitonin for starting or stopping antibiotics over a large range of patients with varying severity of ARIs and from different clinical settings.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to May 2011) and EMBASE (1974 to May 2011) to identify suitable trials.. We included RCTs of adult participants with ARIs who received an antibiotic treatment either based on a procalcitonin algorithm or usual care/guidelines. Trials were excluded if they exclusively focused on paediatric patients or if they used procalcitonin for another purpose than to guide initiation and duration of antibiotic treatment.. Two teams of review authors independently evaluated the methodology and extracted data from primary studies. The primary endpoints were all-cause mortality and treatment failure at 30 days. For the primary care setting, treatment failure was defined as death, hospitalisation, ARI-specific complications, recurrent or worsening infection, and patients reporting any symptoms of an ongoing respiratory infection at follow-up. For the ED setting, treatment failure was defined as death, ICU admission, re-hospitalisation after index hospital discharge, ARI-associated complications, and recurrent or worsening infection within 30 days of follow-up. For the ICU setting, treatment failure was defined as death within 30 days of follow-up. Secondary endpoints were antibiotic use (initiation of antibiotics, duration of antibiotics and total exposure to antibiotics (total amount of antibiotic days divided by total number of patients)), length of hospital stay for hospitalised patients, length of ICU stay for critically ill patients, and number of days with restricted activities within 14 days after randomisation for primary care patients.For the two co-primary endpoints of all-cause mortality and treatment failure, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable hierarchical logistic regression. The hierarchical regression model was adjusted for age and clinical diagnosis as fixed-effect. The different trials were added as random-effects into the model. We fitted corresponding linear regression models for antibiotic use. We conducted sensitivity analyses stratified by clinical setting and ARI diagnosis to assess the consistency of our results.. We included 14 trials with 4221 participants. There were 118 deaths in 2085 patients (5.7%) assigned to procalcitonin groups compared to 134 deaths in 2126 control patients (6.3%) (adjusted OR 0.94, 95% CI 0.71 to 1.23). Treatment failure occurred in 398 procalcitonin group patients (19.1%) and in 466 control patients (21.9%). Procalcitonin guidance was not associated with increased mortality or treatment failure in any clinical setting, or ARI diagnosis. These results proved robust in various sensitivity analyses. Total antibiotic exposure was significantly reduced overall (median (interquartile range) from 8 (5 to 12) to 4 (0 to 8) days; adjusted difference in days, -3.47, 95% CI -3.78 to -3.17, and across all the different clinical settings and diagnoses.. Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARI was not associated with higher mortality rates or treatment failure. Antibiotic consumption was significantly reduced across different clinical settings and ARI diagnoses. Further high-quality research is needed to confirm the safety of this approach for non-European countries and patients in intensive care. Moreover, future studies should also establish cost-effectiveness by considering country-specific costs of procalcitonin measurement and potential savings in consumption of antibiotics and other healthcare resources, as well as secondary cost savings due to lower risk of side effects and reduced antimicrobial resistance.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cause of Death; Humans; Protein Precursors; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Treatment Failure

Procalcitonin (PCT) levels are below the detection level in healthy subjects, while pre-procalcitonin mRNA is over expressed in human medullar thyroid carcinoma, in small cell lung tumor, and occasionally in other rare neuroendocrine tumors such as phaeochromocytoma. PCT is known as a sensitive and specific biomarker for bacterial sepsis, being produced by extra-thyroidal parenchymal tissues, mainly hepatocytes. The increase in plasma level correlates with the severity of infection and the magnitude and the time course of its increase can be strictly related to the patient's outcome, and to the bacterial load. So far, data on serum PCT levels in patients with cardiogenic shock and in those with acute coronary syndromes (ACS) are scarce and controversial. While some studies report that PCT levels are increased in ACS patients on admission, other investigations document that plasma PCT concentrations are in the normal range. We recently reported that the degree of myocardial ischemia (clinically indicated by the whole spectrum of ACS, from unstable angina to cardiogenic shock following ST-elevation myocardial infarction) and the related inflammatory-induced response are better reflected by C-reactive protein (which was positive in most acute cardiac care patients of all our subgroups) than by PCT, which seems more sensitive to a higher degree of inflammatory activation, being positive only in patients with cardiogenic shock. Few studies investigated the dynamics of PCT in cardiac acute patients, and, despite the paucity of data and differences in patients' selection criteria, an increase in PCT values seems to be associated with the development of complications. In acute cardiac patients, the clinical values of procalcitonin rely not on its absolute value, but only on its kinetics over time.

Topics: Acute Coronary Syndrome; Acute Disease; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Protein Precursors; Sepsis; Shock, Cardiogenic

The use of biomarkers has been demonstrated useful in many acute diseases both for diagnosis, prognosis and risk stratification.. The purpose of this review is to analyze several biomarkers of potential use in patients referring to Emergency Department with acute dyspnea.. The role of natriuretic peptides has a proven utility in the diagnosis, risk stratification, patient management and prediction of outcome in acute and chronic heart failure (HF). New immunoassays are available for the detection of mid-region prohormones in patients with acute dyspnea such as Mid-region pro-adrenomedullin (MR-proADM) and Mid-region pro-atrial natriuretic peptide (MR-proANP). Also procalcitonin, copeptin and D-dimer, which are markers of inflammation, bacterial infections and sepsis, seem to be useful in the differential diagnosis of dyspnea. Conventional and high-sensitivity troponins are fundamental, not only in the diagnosis of acute coronary syndromes, but also as indicators of mortality in patients with acute decompensated heart failure.. Further studies with randomized controlled clinical trials will be needed to prove the theoretical clinical advantages offered by a shortness of breath biomarkers in terms of diagnostic, prognostic, cost effective work-up and management of patients with acute dyspnea.. A multimarker pannel approach performed by rapid and accurate assays could be useful for emergency physicians to promptly identify different causes of dyspnea thus managing to improve diagnosis, treatment and risk stratification.

Topics: Acute Disease; Adrenomedullin; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Dyspnea; Fibrin Fibrinogen Degradation Products; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Troponin T

Topics: Acute Disease; Calcitonin; Calcitonin Gene-Related Peptide; Child; Fever; Humans; Pediatrics; Protein Precursors; Pyelonephritis; Urinary Tract Infections

Acute dyspnea is one of the leading causes of emergency hospitalization of elderly patients. Clinical diagnostic procedures are difficult in this geriatric population. Acute heart failure is the most frequent cause of acute dyspnea in geriatric patients. The use of plasma B natriuretic peptide (BNP) assays in the general population has profoundly improved its medical management. There has also been progress recently for other frequent causes of dyspnea in the elderly, including infection and venous thromboembolic disease. Procalcitonin assays may be useful as a prognostic factor for infectious disease. Nevertheless, the real value of BNP assays in geriatric populations must be clarified by interventional studies.

Topics: Acute Disease; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Dyspnea; Emergencies; Emergency Service, Hospital; Female; Fibrin Fibrinogen Degradation Products; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Patient Admission; Pneumonia; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Thromboembolism; Troponin

Serum amylase remains the most commonly used biochemical marker for the diagnosis of acute pancreatitis, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism. Urinary trypsinogen-2 is convenient, of comparable diagnostic accuracy, and provides greater (99%) negative predictive value. Early prediction of the severity of acute pancreatitis can be made by well validated scoring systems at 48 hours, but the novel serum markers procalcitonin and interleukin 6 allow earlier prediction (12 to 24 hours after admission). Serum alanine transaminase >150 IU/l and jaundice suggest a gallstone aetiology, requiring endoscopic retrograde cholangiopancreatography. For obscure aetiologies, serum calcium and triglycerides should be measured. Genetic polymorphisms may play an important role in "idiopathic" acute recurrent pancreatitis.

Topics: Acute Disease; Alanine Transaminase; Amylases; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Interleukin-6; Isoenzymes; Lipase; Pancreatitis; Protein Precursors; Sensitivity and Specificity; Time Factors; Trypsinogen

The evaluation and management of urinary tract infections in infants and children is undergoing changes due to the impact of evidence-based studies and new technology.. The uncircumcised male infant is at increased risk for a urinary tract infection, but there is marked difference in the frequency of circumcision carried out to lower the risk of infection in the United States compared with Europe. Commentaries presenting different interpretations of the current data make for interesting reading and present the many sides of this issue. Vesicoureteric reflux, previously viewed as the major risk factor for acquired renal damage, now shares this role with nonreflux nephropathy. Procalcitonin has been evaluated as a biochemical tool to identify patients at risk for kidney damage, with dimercaptosuccinic acid scintigraphy as the reference method to detect renal scarring.. The previously accepted concept that vesicoureteric reflux as detected radiologically is almost always the key factor in acquired renal injury secondary to a urinary tract infection is no longer accepted. Current studies show that nonreflux nephropathy occurs as often as reflux nephropathy. There is now a question of the value of imaging studies designed to identify vesicoureteric reflux and of the use of suppressive antibiotics for vesicoureteric reflux. There exist useful evidence-based studies for antibiotic therapy for upper and lower tract urinary tract infections, but no such data are available for guidance in selecting imaging studies for the infant or child with a first febrile urinary tract infection.

Topics: Acute Disease; Calcitonin; Calcitonin Gene-Related Peptide; Child; Circumcision, Male; Female; Fever; Glycoproteins; Humans; Kidney; Male; Protein Precursors; Risk Factors; Ultrasonography; Urinary Tract Infections; Vesico-Ureteral Reflux

Approximately 15-20% of cases of acute pancreatitis are categorized as severe. There is a lack of accurate predictors of disease severity. Several studies have evaluated the usefulness of procalcitonin as a marker of severe disease. Reports regarding the diagnostic accuracy of procalcitonin are conflicting.. The present meta-analysis was carried out to evaluate the relevance of procalcitonin as a predictor of disease severity.. Two investigators working independently attempted to locate eligible studies by electronic and manual means. Studies in which at least one of the markers of disease severity was procalcitonin were included for analysis. For all the studies included, the following parameters were calculated: true positive, false negative, false positive and true negative. A summary receiver operating characteristic (SROC) curve was generated from these parameters.. Four studies were finally included in the analysis. The unweighted regression line parameters b and i were 3.633 and 1.399, respectively. The values for b and i for weighted regression line were 3.637 and 1.428. The SROC curve generated demonstrated that procalcitonin is not a good predictor of the severity of acute pancreatitis.. The available data indicates that procalcitonin cannot be considered a good marker for assessing the severity of pancreatitis.

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Data Interpretation, Statistical; Disease Progression; Humans; Pancreatitis; Predictive Value of Tests; Protein Precursors; Regression Analysis; Severity of Illness Index

A large array of parameters has been proposed for the biochemical stratification of severity and prediction of complications in acute pancreatitis. However, the number of accurate and readily available variables for routine application is still limited.. The literature was reviewed for laboratory markers of acute pancreatitis with special regard to their clinical usefulness and test performance for stratifying severity and monitoring disease progression.. Several parameters, such as trypsinogen and procarboxypeptidase B activation peptide, PMN-elastase, interleukin-6 (IL-6) and 8 (IL-8), serum amyloid A (SAA), and procalcitonin (PCT), can differentiate between mild and severe acute pancreatitis within 48 h of disease onset with favorable diagnostic accuracy. Because fully automated assays have become available, IL-6, IL-8, PCT, and SAA are the most interesting parameters in this respect. For monitoring disease progression beyond 48 h, acute-phase proteins, IL-6, IL-8, and PCT are valuable markers. PCT is the first biochemical variable for predicting severe pancreatic infections and overall prognosis throughout the course of acute pancreatitis with high sensitivity and specificity.. Among all the biochemical variables available, C-reactive protein is still the standard for a fast, reliable, and cost-effective assessment of severity in acute pancreatitis. PCT substantially contributes to an improved stratification of patients at risk to develop major complications and deserves routine application.

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Carboxypeptidase B; Disease Progression; Humans; Interleukins; Oligopeptides; Pancreatic Juice; Pancreatitis; Protein Precursors; Serum Amyloid A Protein; Severity of Illness Index

In daily routine diagnosis, there are few parameters available to monitor critically ill patients and to control the course of therapy in severe inflammations. There are also few reliable parameters differentiating acute bacterial infection from other types of inflammation. Most of the presently used indicators of the inflammatory response, like body temperature, white cell count, erythrocyte sedimentation rate or C reactive protein are unspecific parameters with changing reliability. Procalcitonin is a diagnostic parameter of bacterial infections with systemic reaction of the organism. It is an innovative diagnostic parameter with feature different from other presently available indicators of the inflammatory response. The incidence of noninfectious systemic inflammatory response syndrome associated with coronary artery bypass surgery and the potential role of several inflammatory parameters as early markers of pulmonary dysfunction induced by cardiopulmonary bypass were investigated. Procalcitonin seems to be appropriate parameter indicating the early development of severe noninfectious systemic inflammatory response syndrome and for predicting pulmonary dysfunction secondary to cardiopulmonary bypass. Hence, the review of the data of different authors may lead to the conclusion that because of wide spectrum of indications procalcitonin concentration can be used for differential diagnosis of bacterial versus non-bacterial inflammation, as monitoring parameter in critically ill patients, the course of disease, treatment control evaluating the effectiveness of antibacterial treatment, for evaluation of high risk patients to see if there are no postoperative bacterial complications as a prognostic indicator.

Topics: Acute Disease; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Coronary Artery Bypass; Critical Care; Critical Illness; Diagnosis, Differential; Humans; Inflammation; Lung Diseases; Monitoring, Physiologic; Protein Precursors; Risk Factors; Systemic Inflammatory Response Syndrome; Time Factors

Bacterial infections in patients hospitalized with acute heart failure are related to worse prognosis, but they can be difficult to diagnose. In this study we evaluated the prevalence, clinical correlates and association with outcomes of significantly elevated procalcitonin levels in patients hospitalized for acute heart failure without clear signs of bacterial infection.. 1781 patients from the PROTECT trial were included. Patients with a body temperature >38°C, sepsis or active infection requiring IV antibiotics were excluded. Significant elevation of procalcitonin was considered present when levels exceeded 0.20 ng/mL. In-hospital and post-discharge outcomes were compared between groups of patients with and without elevated procalcitonin levels.. Procalcitonin ≥ 0.20 ng/mL was seen in 6.0% of patients (N=104). This group of patients had lower serum albumin, lower hemoglobin, higher leukocyte count, higher C-reactive protein, higher blood urea nitrogen, higher heart rate and more pulmonary rales. Interestingly, no significant differences were observed between the two groups in terms of severity of heart failure evidenced by left ventricular ejection fraction (LVEF) or B-type natriuretic peptide (BNP) levels. Patients with significantly elevated procalcitonin levels were more often classified as treatment failure or unchanged status, and had an increased risk of 30-day all-cause mortality even after adjustment for established prognosticators; HR=2.3 (95% CI, 1.3-4.2), (P=0.005).. Patients with acute heart failure and significantly elevated procalcitonin levels, indicating probable undiagnosed/untreated bacterial infection, had poorer in-hospital and post-discharge outcomes, despite similar severity of heart failure.

Topics: Acute Disease; Aged; Aged, 80 and over; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Double-Blind Method; Female; Heart Failure; Humans; Male; Middle Aged; Mortality; Patient Discharge; Protein Precursors; Risk Factors

This study was designed to investigate the effect of N-acetylcysteine (NAC), as a potent and safe antioxidant, on inflammatory biomarkers of acute pyelonephritis in pediatric patients.. Children (< 15 years old) admitted with a diagnosis of pyelonephritis were recruited in a randomized placebo-controlled trial. They were randomly allocated to 2 groups and recieved placebo or NAC effervescent tablets with daily dose based on their weight, for 5 days. The children were evaluated for serum procalcitonin level, leukocyte count, C-reactive protein (CRP), serum creatinine, and clinical symptoms on the 1st and the 5th days.. Seventy patients, 35 in each group, with a mean age of 5.54 ± 3.10 years completed the study. There was no significant difference between the two groups in the amount of changes in procalcitonin levels after 5 days (P = .90). Within-group analysis confirmed CRP reduction in both groups (P < .001); however, between-group analysis did not show significant difference in CRP reductions, either (P = .65). No significant differences were found between the two groups in the day of resolving pyuria (P = .46), day of resolving bacteriuria (P = .81), or reductions in leukocyte count (P = .64) and neutrophil count (P = .49).. A short period of NAC administration with the recommended doses could not lead to a significant decrease in inflammation biomarkers. Studies on higher doses and longer duration of NAC administration along with evaluation of the long-term effects of the intervention by tools such as renal scntigraphy are suggested.

Topics: Acetylcysteine; Acute Disease; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Creatinine; Double-Blind Method; Female; Free Radical Scavengers; Humans; Inflammation; Leukocyte Count; Male; Protein Precursors; Pyelonephritis

Rapid diagnosis of acute pyelonephritis is important because of its association with long-standing complications. This study was conducted to compare the reliability of serum procalcitonin (PCT) and interleukin-1 beta (IL-1β) with conventional laboratory parameters for diagnosis of acute pyelonephritis in children. Seventy nine children with urinary tract infection were divided into two groups based on the result of Tc-99m dimercaptosuccinic acid renal scan: acute pyelonephritis (n=33) and lower UTI (urinary tract infection) (n=46) groups. White blood cell (WBC) count, neutrophil count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), PCT and IL-1β concentrations of both groups were measured and compared. WBC count, neutrophil count, ESR, serum CRP, PCT and IL-1β concentrations were higher in acute pyelonephritis patients than in the lower UTI group (P<0.05). The sensitivity and specificity of serum PCT and IL-1β for diagnosis of acute pyelonephritis were 31, 84.7% and 27.2, 90% respectively (using a cut-point value of 0.5 ng/ml for PCT and 6.9 pg/ml for IL-1β). The sensitivity of PCT and IL-1β for diagnosis of acute pyelonephritis was less than that of conventional markers such as ESR and CRP. This study revealed that serum PCT and IL-1β are not good biologic markers for differentiating acute pyelonephritis from lower UTI. It seems that conventional inflammatory markers such as ESR and CRP besides the clinical findings are more reliable for the diagnosis of acute pyelonephritis in children.

Topics: Acute Disease; Biomarkers; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Cross-Sectional Studies; Diagnosis, Differential; Female; Humans; Infant; Interleukin-1beta; Leukocyte Count; Male; Neutrophils; Prospective Studies; Protein Precursors; Pyelonephritis; Sensitivity and Specificity; Urinary Tract Infections

Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment. We aimed to determine whether serum procalcitonin (PCT) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma.. In this randomized controlled trial, a total of 216 patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and 169 completed the 12-month follow-up visit. Patients were randomized to either PCT-guided (PCT group) or standard (control group) antimicrobial therapy. In the control group, patients received antibiotics according to the attending physician's discretion; in the PCT group, patients received antibiotics according to an algorithm based on serum PCT levels. The primary end point was antibiotic exposure; secondary end points were clinical recovery, length of hospital stay, clinical and laboratory parameters, spirometry, number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma.. PCT guidance reduced antibiotic prescription (48.9% versus 87.8%, respectively; P < 0.001) and antibiotic exposure (relative risk, 0.56; 95% confidence interval, 0.44 to 0.70; P < 0.001) compared to standard therapy. There were no significant differences in clinical recovery, length of hospital stay or clinical, laboratory and spirometry outcomes in both groups. Number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma were similar during the 12-month follow-up period.. A PCT-guided strategy allows antibiotic exposure to be reduced in patients with severe acute exacerbation of asthma without apparent harm.. Chinese Clinical Trial Register ChiCTR-TRC-12002534 (registered 26 September 2012).

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Asthma; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Drug Utilization; Female; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Protein Precursors; Treatment Outcome

To quantify the diagnostic accuracy of selected inflammatory markers in addition to symptoms and signs for predicting pneumonia and to derive a diagnostic tool.. Diagnostic study performed between 2007 and 2010. Participants had their history taken, underwent physical examination and measurement of C reactive protein (CRP) and procalcitonin in venous blood on the day they first consulted, and underwent chest radiography within seven days.. Primary care centres in 12 European countries.. Adults presenting with acute cough.. Pneumonia as determined by radiologists, who were blind to all other information when they judged chest radiographs.. Of 3106 eligible patients, 286 were excluded because of missing or inadequate chest radiographs, leaving 2820 patients (mean age 50, 40% men) of whom 140 (5%) had pneumonia. Re-assessment of a subset of 1675 chest radiographs showed agreement in 94% (κ 0.45, 95% confidence interval 0.36 to 0.54). Six published "symptoms and signs models" varied in their discrimination (area under receiver operating characteristics curve (ROC) ranged from 0.55 (95% confidence interval 0.50 to 0.61) to 0.71 (0.66 to 0.76)). The optimal combination of clinical prediction items derived from our patients included absence of runny nose and presence of breathlessness, crackles and diminished breath sounds on auscultation, tachycardia, and fever, with an ROC area of 0.70 (0.65 to 0.75). Addition of CRP at the optimal cut off of >30 mg/L increased the ROC area to 0.77 (0.73 to 0.81) and improved the diagnostic classification (net reclassification improvement 28%). In the 1556 patients classified according to symptoms, signs, and CRP >30 mg/L as "low risk" (<2.5%) for pneumonia, the prevalence of pneumonia was 2%. In the 132 patients classified as "high risk" (>20%), the prevalence of pneumonia was 31%. The positive likelihood ratio of low, intermediate, and high risk for pneumonia was 0.4, 1.2, and 8.6 respectively. Measurement of procalcitonin added no relevant additional diagnostic information. A simplified diagnostic score based on symptoms, signs, and CRP >30 mg/L resulted in proportions of pneumonia of 0.7%, 3.8%, and 18.2% in the low, intermediate, and high risk group respectively.. A clinical rule based on symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough performed best in patients with mild or severe clinical presentation. Addition of CRP concentration at the optimal cut off of >30 mg/L improved diagnostic information, but measurement of procalcitonin concentration did not add clinically relevant information in this group.

Topics: Acute Disease; Adult; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cough; Cross-Sectional Studies; Decision Support Techniques; Female; Humans; Likelihood Functions; Logistic Models; Lung; Male; Medical History Taking; Middle Aged; Physical Examination; Pneumonia; Prevalence; Primary Health Care; Protein Precursors; Radiography; Risk Assessment; ROC Curve; Severity of Illness Index; Single-Blind Method

Predicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED.. We conducted a prospective study of women with APN presenting to the ED. The authors measured inflammatory biomarkers, and the severity of pyelonephritis was assessed by 4 severity of disease classification system and stage of sepsis. We performed an analysis to assess the value of PCT for the prediction of 28-day mortality and disease severity.. A total of 240 female patients with APN are included. Patients were divided into 4 groups on the basis of systemic inflammatory response syndrome criteria, organ dysfunction, and persistent hypotension. The median PCT level was higher in the septic shock group compared with other groups. Of the other inflammatory markers, only white blood cell count was significantly different among the groups, whereas high-sensitivity C-reactive protein level and erythrocyte sedimentation rate revealed no differences. The area under the curve for PCT in predicting 28-day mortality was 0.68. For predicting mortality, a cutoff value of 0.42 ng/mL had a sensitivity of 80% and a specificity of 50%. However, the disease classification systems were demonstrated to be superior to PCT in predicting 28-day mortality.. Relative to other classic markers of inflammation, by distinguishing the severity of sepsis related to APN, PCT levels can provide additional aid to clinicians in disease severity classification and their decision of treatment at ED.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Decision Support Techniques; Emergency Service, Hospital; Female; Humans; Middle Aged; Outcome Assessment, Health Care; Prognosis; Prospective Studies; Protein Precursors; Pyelonephritis; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Systemic Inflammatory Response Syndrome

This randomized controlled trial aimed to evaluate whether the serum procalcitonin (PCT) level can be utilized to guide the use of antibiotics in the treatment of acute exacerbations of asthma.. A total of 293 consecutive patients with suspected asthma attacks from February 2005 to July 2010 participated in this study. 225 patients completed the study. Serum PCT levels, and other inflammatory biomarkers of all patients were measured. In addition to the standard treatment, the control group received antibiotics according to the attending physicians' discretions, while the patients in the PCT group were treated with antibiotics according to serum PCT concentrations. Antibiotics usage was strongly discouraged when the PCT concentration was below 0.1 μg/L; discouraged when the PCT concentration was between 0.1 μg/L and 0.25 μg/L; or encouraged when the PCT concentration was above 0.25 μg/L. The primary endpoint was the determination of antibiotics usage. The second endpoints included the diagnostic accuracy of PCT and other laboratory biomarkers the effectiveness of asthma control, secondary ED visits, hospital re-admissions, repeated needs for steroids or dosage increase, needs for antibiotics, WBC count, PCT levels and FEV1%.. At baseline, two groups were identical regarding clinical, laboratory and symptom score. Probability of the antibiotics usage in the PCT group (46.1%) was lower than that in the control group (74.8%) (χ2 = 21.97, p < 0.001. RR = 0.561, 95% CI 0.441-0.713). PCT and IL-6 showed good diagnostic significance for bacterial asthma (r = 0.705, p = 0.003). The degrees of asthma control in patients were categorized to three levels and were comparable between the two groups at the six weeks follow-up period (χ2 = 1.62, p = 0.45). There were no significant difference regarding other secondary outcomes (p > 0.05).. The serum PCT concentration can be used to effectively determine whether the acute asthma patients have bacterial infections in the respiratory tract, and to guide the use of antibiotics in the treatment of acute asthma exacerbations, which may substantially reduce unnecessary antibiotic use without compromising the therapeutic outcomes.. ICTRP ChiCTR-TRC-12002534.

Topics: Acute Disease; Adult; Aged; Anti-Bacterial Agents; Asthma; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Drug Monitoring; Female; Humans; Interleukin-6; Male; Middle Aged; Protein Precursors; Treatment Outcome; Young Adult

To confirm whether oral antibiotic treatment is as efficacious as sequential intravenous/oral antibiotic treatment in the prevention of renal scarring in children with acute pyelonephritis and scintigraphy-documented acute lesions.. In a prospective multicenter trial, children aged 1 to 36 months with their first case of acute pyelonephritis, a serum procalcitonin concentration ≥0.5 ng/mL, no known uropathy, and a normal ultrasound exam were randomized into 2 treatment groups. They received either oral cefixime for 10 days or intravenous ceftriaxone for 4 days followed by oral cefixime for 6 days. Patients with acute renal lesions detected on early dimercaptosuccinic acid scintigraphy underwent a follow-up scintigraphy 6 to 8 months later.. The study included 171 infants and children. There were no significant differences between the 2 groups in any clinical characteristic. Initial scintigraphy results were abnormal for 119 children. Ninety-six children were measured for renal scarring at the follow-up scintigraphy (per protocol analysis population). The incidence of renal scarring was 30.8% in the oral treatment group and 27.3% for children who received the sequential treatment.. Although this trial does not statistically demonstrate the noninferiority of oral treatment compared with the sequential treatment, our study confirmed the results of previously published reports and therefore supports the use of an oral antibiotic treatment of primary episodes of acute pyelonephritis in infants and young children.

Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Cefixime; Ceftriaxone; Child, Preschool; Drug Administration Schedule; Escherichia coli Infections; Female; Humans; Infant; Infusions, Intravenous; Male; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging

To investigate the clinical usefulness of procalcitonin (PCT) for guiding duration of antibiotic therapy in patients with severe acute pancreatitis (SAP).. A total of 71 patients with confirmed severe acute pancreatitis from March 2009 to September 2011 in the Department of Critical Care Medicine of Huizhou Municipal Central Hospital, Guangdong, China were enrolled in this study. Procalcitonin was measured daily by a semi-quantitative immunoassay in the study group. Patients were randomly assigned into 2 groups including a PCT-guided group (study group) and a prophylactic antibiotic therapy (control group). Antibiotic therapy in the study group was not applied until clinical signs and symptoms of infection appeared (PCT value was >0.5ng/ml). We discontinued the antibiotic therapy if clinical signs and symptoms of infection improved and PCT was <0.5ng/ml over 3 days. In the control group, antibiotic therapy was administrated for 2 weeks, or antibiotic therapy was continued because of confirmed infection until clinical signs and symptoms of infection disappeared over 3 days.. In the study group (35 patients), the duration of antibiotic therapy and hospitalization was significantly shorter than the control group (36 patients) (10.89+/-2.85 versus 16.06+/-2.48 days, p<0.001, and 16.66+/-4.02 days versus 23.81+/-7.56 days, p<0.001) without negative clinical effects and the cost of hospitalization was significantly lower.. Procalcitonin is a helpful and safe tool for guiding duration of antibiotic treatment in patients with severe acute pancreatitis.

Topics: Acute Disease; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Pancreatitis; Prospective Studies; Protein Precursors

Acute respiratory tract infections are the most common reason for antibiotic therapy in primary care despite their mainly viral etiology. A laboratory test measuring procalcitonin levels in blood specimens was suggested as a tool to reduce unnecessary prescribing of antibiotics. We consider whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restrictions experienced by patients by more than 1 day.. Fifty-three primary care physicians recruited 458 patients, each patient with an acute respiratory tract infection and, in the physician's opinion, in need of antibiotics. Patients were centrally randomized to either a procalcitonin-guided approach to antibiotic therapy or to a standard approach. For patients randomized to procalcitonin-guided therapy, the use of antibiotics was more or less strongly discouraged (procalcitonin level, < or =0.1 or < or =0.25 microg/L, respectively) or recommended (procalcitonin level, >0.25 microg/L). Follow-up data were collected at 7 days by treating physicians and at 14 and 28 days by blinded interviewers.. Adjusted for baseline characteristics, the mean increase at 14 days in days in which activities were restricted was 0.14 with procalcitonin-guided therapy (95% confidence interval [CI], -0.53 to 0.81 days), which met our criterion of an increase in days in which activities were restricted by no more than 1 day. With procalcitonin-guided therapy, the antibiotic prescription rate was 72% lower (95% CI, 66%-78%) than with standard therapy. Both approaches led to a similar proportion of patients reporting symptoms of ongoing or relapsing infection at 28 days (adjusted odds ratio, 1.0 [95% CI, 0.7-1.5]).. As an adjunct to guidelines, procalcitonin-guided therapy markedly reduces antibiotic use for acute respiratory tract infections in primary care without compromising patient outcome. In practice, this could be achieved with 1 to 2 procalcitonin measurements in patients for whom the physician intends to prescribe antibiotics.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Glycoproteins; Humans; Male; Middle Aged; Primary Health Care; Protein Precursors; Respiratory Tract Infections; Retrospective Studies; Treatment Outcome

Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations. We evaluated the efficacy and safety of procalcitonin guidance compared to standard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD.. A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were randomized at the index exacerbation to procalcitonin-guided or standard antibiotic therapy. Patients receiving procalcitonin-guided therapy were treated with antibiotics according to serum procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician. The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months. Secondary outcomes were clinical recovery, symptom scores, length of hospitalization, ICU stay, death, lung function, exacerbation rate, and time to next exacerbation.. At the index exacerbation, procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy. Moreover, procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p = 0.004). Clinical outcome and improvement in FEV(1) at 14 days and 6 months did not differ between groups. Within 6 months, the exacerbation rate (0.62 vs 0.64, respectively), the rehospitalization rate (0.21 vs 0.24, respectively), and mean (+/- SD) time to the next exacerbation (70.0 +/- 46.1 vs 70.4 +/- 51.9 days, respectively; p = 0.523) were similar in both groups.. Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; Spirometry; Statistics, Nonparametric; Treatment Outcome

Appendicitis clinical diagnosis in children is difficult and the acute inflammatory markers hyperleucocytis and CRP do not contribute to it.. To study the predictive value of procalcitonin (PCT) and to assess variations of its serum level according to inflammatory lesions in paediatric appendicitis.. Among 101 children aged two and 15, hospitalized for painful abdominal syndromes, 70 underwent operation for acute appendicitis and appendiceal peritonitis, 31 had no operation. PCT was evaluated in all children, normal serum concentration was <0,5 microg/L. Every appendicectomy part has been examined through histological analysis to confirm the diagnosis and the histological lesions have been classified into three categories according to their severity.. Out of 70 appendix analysed at histology, 68 (97%) were healthy and 2 (3%)were unhealthy. Among the 68 cases of healthy appendix, 19 had a PCT higher than 0,5 microg/L and among 33 cases of unhealthy appendix 4 had a PCT higher than 0,5 microg/L. The PCT mean of healthy children was not significantly different from unhealthy appendix population, appendicitis prevalence was 0,67, PCT sensitivity 28%: IC 95% [18-40], specificity 88%: IC 95% [72-97], positive predictive value 83%: IC 95% [61-95], and negative predictive value 37%: IC 95% [26-49]. PCT mean increases with the severity of inflammatory lesions of the appendix (P=0,0051).. PCT has not a good predictive value in acute paediatric appendicitis but remains a good indicator of severity in paediatric appendicitis.

Topics: Abdominal Pain; Acute Disease; Adolescent; Appendicitis; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Severity of Illness Index

The aim of this study was to describe the change in serum procalcitonin levels during treatment for community-acquired acute bacterial meningitis.. Out of 50 consecutive patients presenting with bacterial meningitis and infection at no other site, and who had received no prior antibiotic treatment, 48 had a serum procalcitonin level above 0.5 ng/ml on admission and were enrolled in the study.. The mean age of the patients was 55 years, and mean Glasgow Coma Scale score on admission was 13. The time from symptom onset to admission was less than 24 hours in 40% of the patients, 24-48 hours in 20%, and more than 48 hours in 40%. The median (interquartile) interval between admission and initial antibiotic treatment was 160 min (60-280 min). Bacterial infection was documented in 45 patients. Causative agents included Streptococcus pneumoniae (n = 21), Neisseria meningitidis (n = 9), Listeria monocytogenes (n = 6), other streptococci (n = 5), Haemophilus influenzae (n = 2) and other bacteria (n = 2). The initial antibiotic treatment was effective in all patients. A lumbar puncture performed 48-72 hours after admission in 34 patients showed sterilization of cerebrospinal fluid. Median (interquartile) serum procalcitonin levels on admission and at day 2 were 4.5 (2.8-10.8) mg/ml and 2 (0.9-5.0) mg/ml, respectively (P < 0.0001). The corresponding values for C-reactive protein were 120 (21-241) mg/ml and 156 (121-240) mg/ml, respectively. Five patients (10%) died from noninfectious causes during their hospitalization.. Serum procalcitonin levels decrease rapidly with appropriate antibiotic treatment, diminishing the value of lumbar puncture performed 48-72 hours after admission to assess treatment efficacy.

Topics: Acute Disease; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Humans; Meningitis, Bacterial; Meningitis, Pneumococcal; Middle Aged; Prospective Studies; Protein Precursors; Survival Analysis; Time Factors; Treatment Outcome

Lower respiratory tract infections are often treated with antibiotics without evidence of clinically relevant bacterial disease. Serum calcitonin precursor concentrations, including procalcitonin, are raised in bacterial infections. We aimed to assess a procalcitonin-based therapeutic strategy to reduce antibiotic use in lower respiratory tract infections with a new rapid and sensitive assay.. 243 patients admitted with suspected lower respiratory tract infections were randomly assigned standard care (standard group; n=119) or procalcitonin-guided treatment (procalcitonin group; n=124). On the basis of serum procalcitonin concentrations, use of antibiotics was more or less discouraged (<0.1 microg/L or <0.25 microg/L) or encouraged (> or =0.5 microg/L or > or =0.25 microg/L), respectively. Re-evaluation was possible after 6-24 h in both groups. Primary endpoint was use of antibiotics and analysis was by intention to treat.. Final diagnoses were pneumonia (n=87; 36%), acute exacerbation of chronic obstructive pulmonary disease (60; 25%), acute bronchitis (59; 24%), asthma (13; 5%), and other respiratory affections (24; 10%). Serological evidence of viral infection was recorded in 141 of 175 tested patients (81%). Bacterial cultures were positive from sputum in 51 (21%) and from blood in 16 (7%). In the procalcitonin group, the adjusted relative risk of antibiotic exposure was 0.49 (95% CI 0.44-0.55; p<0.0001) compared with the standard group. Antibiotic use was significantly reduced in all diagnostic subgroups. Clinical and laboratory outcome was similar in both groups and favourable in 235 (97%).. Procalcitonin guidance substantially reduced antibiotic use in lower respiratory tract infections. Withholding antimicrobial treatment did not compromise outcome. In view of the current overuse of antimicrobial therapy in often self-limiting acute respiratory tract infections, treatment based on procalcitonin measurement could have important clinical and financial implications.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Bacterial Infections; Bronchitis; Calcitonin; Calcitonin Gene-Related Peptide; Drug Utilization Review; Female; Humans; Male; Middle Aged; Pneumonia; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; Single-Blind Method; Treatment Outcome

Febrile urinary tract infection (UTI) is a common problem among children. The diagnosis and management of acute pyelonephritis is a challenge, particularly during infancy. The distinction between acute pyelonephritis and UTI without renal involvement is very important, because renal infection may cause parenchymal scarring and thus requires more aggressive investigation and follow-up monitoring. However, this distinction is not easy among children, because common clinical findings and laboratory parameters are nonspecific, especially among young children. In an attempt to differentiate acute pyelonephritis from febrile UTI without renal lesions in a group of 100 children, we measured serum levels of procalcitonin (PCT), a new marker of infection. The objective of the study was to determine the accuracy of PCT measurements, compared with C-reactive protein (CRP) measurements, in diagnosing acute renal involvement during febrile UTI and in predicting subsequent scars, as assessed with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy.. Serum CRP levels, erythrocyte sedimentation rates, leukocyte counts, and PCT levels were measured for 100 children, 1 month to 13 years of age, admitted for suspected febrile UTI (first episode). Renal parenchymal involvement was evaluated with DMSA scintigraphy within 5 days after admission. The DMSA study was repeated 6 months later if the initial results were abnormal.. The mean PCT level was significantly higher in acute pyelonephritis than in UTI without renal lesions (4.48 +/- 5.84 ng/mL vs 0.44 +/- 0.30 ng/mL). In these 2 groups, the mean CRP levels were 106 +/- 68.8 mg/L and 36.4 +/- 26 mg/L, mean erythrocyte sedimentation rates were 79.1 +/- 33 mm/hour and 58.5 +/- 33 mm/hour, and leukocyte counts were 18 492 +/- 6839 cells/mm3 and 16 741 +/- 5302 cells/mm3, respectively. For the prediction of acute pyelonephritis, the sensitivity and specificity of PCT measurements were 83.3% and 93.6%, respectively; CRP measurements had a sensitivity of 94.4% but a specificity of only 31.9%. Positive and negative predictive values for prediction of renal involvement with PCT measurements were 93.7% and 83% and those with CRP measurements were 61.4% and 83.3%, respectively. When inflammatory markers were correlated with the severity of the renal lesions, as assessed with DMSA scintigraphy, a highly significant correlation with both PCT and CRP levels was found. However, when the 2 parameters were correlated with renal scarring in follow-up scans, a significant positive association was found only for PCT levels.. Serum PCT levels may be a sensitive and specific measure for early diagnosis of acute pyelonephritis and determination of the severity of renal parenchymal involvement. Therefore, this measurement could be useful for the treatment of children with febrile UTIs, allowing prediction of patients at risk of permanent parenchymal renal lesions.

Topics: Acute Disease; Adolescent; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Kidney; Male; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Ultrasonography; Urinary Tract Infections; Urography

The diagnostic significance of procalcitonin concentrations in lower respiratory tract infections and tuberculosis is not known. A prospective analysis was, therefore, performed in patients with acute exacerbation of chronic bronchitis (AECB), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and tuberculosis and their procalcitonin levels compared with those of patients with noninfectious lung diseases (controls). In addition, standard inflammatory parameter data were collected. A prospective clinical study was performed with four different groups of patients and a control group that consisted of patients with noninfectious lung diseases. A total of 129 patients were included: 25 with HAP, 26 CAP, 26 AECB, 27 tuberculosis, and 25 controls. C-reactive protein level, blood cell counts and procalcitonin concentration were evaluated on the first day after onset of clinical and inflammatory symptoms prior to treatment. The median procalcitonin concentrations in HAP, CAP, AECB and tuberculosis were not elevated in relation to the cut-off level of 0.5 ng x mL(-1). In the HAP group, in four of five patients who subsequently died, procalcitonin concentrations of >0.5 ng x mL(-1) were found. In acute lower respiratory infections, such as HAP, CAP and AECB, significantly elevated levels were found in comparison to the control group, but below the usual cut-off level. No differences were observed between tuberculosis and the control group. Relative to the current cut-off level of 0.5 ng x mL(-1), procalcitonin concentration is not a useful parameter for diagnosis of lower respiratory tract infections. However, compared to the control group, there were significantly elevated levels in patients with hospital-acquired pneumonia, community-acquired pneumonia and acute exacerbation of chronic bronchitis below the current cut-off level, which should be further investigated.

Topics: Acute Disease; Aged; Blood Cell Count; Bronchitis, Chronic; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Cross Infection; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Protein Precursors; Reproducibility of Results; Sensitivity and Specificity; Tuberculosis, Pulmonary

We aimed to compare the prognostic value of various predictors and complex scoring systems for prediction of severe acute pancreatitis (SAP) according to the revised Atlanta classification.. C-reactive protein (CRP) and procalcitonin were obtained on admission, and CRP level 24 hours after admission (CRP2) was measured. Various scoring systems including Ranson, Acute Physiology and Chronic Health Examination (APACHE II), the Bedside Index for Severity in Acute Pancreatitis, and Computed Tomography Severity Index (CTSI) were calculated.. There were 146 patients with acute pancreatitis (mean age, 50.6 ± 18.3 years; 63% male), of which 43 patients (29.5%) received a diagnosis of moderately severe AP, and 17 patients (11.6%) received a diagnosis of SAP. In patients with moderately severe acute pancreatitis to SAP, CTSI (odds ratio [OR], 10.46; 95% confidence interval [CI], 4.3-25.43; P < 0.001), APACHE II (OR, 3.87; 95% CI, 1.18-12.64; P = 0.025), and CRP2 (OR, 4.5; 95% CI, 1.53-13.1; P = 0.006) were strongly related to moderately severe acute pancreatitis and SAP. In patients with SAP compared with mild to moderately severe AP, procalcitonin (OR, 4.36; 95% CI, 1.01-18.96; P = 0.049) was the only factor strongly associated with SAP.. Procalcitonin was the best predictor for patients with SAP; CTSI, APACHE II, and CRP2 were valuable predictors for patients with moderately severe acute pancreatitis and SAP.

Topics: Acute Disease; Adult; Aged; APACHE; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Decision Support Techniques; Female; Health Status; Health Status Indicators; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Pancreatitis; Predictive Value of Tests; Prospective Studies; Protein Precursors; Reproducibility of Results; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed

Septic arthritis is a common and serious problem. Early detection and prompt treatment improve outcomes.. To evaluate serum procalcitonin for diagnosis of acute bacterial septic arthritis and to compare its diagnostic utility with synovial white blood cells (WBC), erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hs-CRP).. A prospective cross-sectional study was performed in 78 Thai patients with acute arthritis. Patients with concomitant infections were excluded. Twenty-eight patients were diagnosed with acute bacterial septic arthritis and 50 patients were diagnosed with acute inflammatory arthritis. Blood samples were collected for complete blood count, ESR, hs-CRP, procalcitonin and hemoculture. Synovial fluid was sent for cell count, Gram stain, crystals identification and culture. The diagnostic accuracy by area under receiver operating characteristic (ROC) curve was calculated.. Patients with acute bacterial septic arthritis had higher procalcitonin levels than in acute inflammatory arthritis (mean ± SD = 1.48 ± 2.30 vs. 0.44 ± 0.92 ng/mL, P = 0.032). The cut-off level of procalcitonin was 0.5 ng/mL for which sensitivity, specificity and accuracy for diagnosis of bacterial septic arthritis were 59.3%, 86% and 75.3%, respectively. The ROC curve analysis showed that procalcitonin had a good diagnostic performance (area under the curve = 0.78, 95% CI 0.69-0.89). The area under the curve of hs-CRP and synovial fluid WBC were 0.67 (95% CI 0.55-0.79) and 0.821 (95% CI 0.720-0.923), respectively. Combining procalcitonin with other markers did not provide better sensitivity or specificity than procalcitonin alone.. Serum procalcitonin has a potential role in diagnosing acute bacterial septic arthritis, especially if arthrocenthesis cannot be performed.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Area Under Curve; Arthritis, Infectious; Bacteria; Bacteriological Techniques; Biomarkers; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cross-Sectional Studies; Diagnosis, Differential; Early Diagnosis; Female; Humans; Inflammation Mediators; Leukocyte Count; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; ROC Curve; Up-Regulation

Whether or not antibiotic stewardship protocols based on procalcitonin levels results in cost savings remains unclear. Herein, our objective was to assess the economic impact of adopting procalcitonin testing among patients with suspected acute respiratory tract infection (ARI) from the perspective of a typical US integrated delivery network (IDN) with a 1,000,000 member catchment area or enrollment.. To conduct an economic evaluation of procalcitonin testing versus usual care we built a cost-impact model based on patient-level meta-analysis data of randomized trials. The meta-analytic data was adapted to the US setting by applying the meta-analytic results to US lengths of stay, costs, and practice patterns. We estimated the annual ARI visit rate for the one million member cohort, by setting (inpatient, ICU, outpatient) and ARI diagnosis.. In the inpatient setting, the costs of procalcitonin-guided compared to usual care for the one million member cohort was $2,083,545, compared to $2,780,322, resulting in net savings of nearly $700,000 to the IDN for 2014. In the ICU and outpatient settings, savings were $73,326 and $5,329,824, respectively, summing up to overall net savings of $6,099,927 for the cohort. RESULTS were robust for all ARI diagnoses. For the whole US insured population, procalcitonin-guided care would result in $1.6 billion in savings annually.. Our results show substantial savings associated with procalcitonin protocols of ARI across common US treatment settings mainly by direct reduction in unnecessary antibiotic utilization. These results are robust to changes in key parameters, and the savings can be achieved without any negative impact on treatment outcomes.

Topics: Acute Disease; Anti-Bacterial Agents; Blood Chemical Analysis; Calcitonin; Calcitonin Gene-Related Peptide; Cost-Benefit Analysis; Delivery of Health Care; Humans; Inpatients; Length of Stay; Meta-Analysis as Topic; Protein Precursors; Respiratory Tract Infections; United States

Traditionally, procalcitonin (PCT) is considered a diagnostic marker of bacterial infections. However, slightly elevated levels of PCT have also been found in patients with heart failure. In this context, it has been suggested that PCT may serve as a proxy for underrecognized infection, endotoxemia, or heightened proinflammatory activity. Nevertheless, the clinical utility of PCT in this setting is scarce. We aimed to evaluate the association between PCT and the risk of long-term outcomes.. We measured at admission PCT of 261 consecutive patients admitted for acute heart failure (AHF) after excluding active infection. Cox and negative binomial regression methods were used to evaluate the association between PCT and the risk of death and recurrent rehospitalizations, respectively. At a median follow-up of 2years (IQR: 1.0-2.8), 108 deaths, 170 all-cause rehospitalizations and 96 AHF-rehospitalizations were registered. In an adjusted analysis, including well-established risk factors such as natriuretic peptides and indices of renal function, the logarithm of PCT was associated with a higher risk of death (HR=1.43, CI 95%: 1.12-1.82; p=0.004), all-cause rehospitalizations (IRR=1.22, CI 95% 1.02-1.44; p=0.025) and AHF-rehospitalizations (IRR=1.28, CI 95%: 1.02-1.61; p=0.032). The association with these endpoints persisted after adjustment for other inflammatory biomarkers such as white blood cells, C-reactive protein and interleukins.. In patients with AHF and no evidence of infection, PCT was independently and positively associated with the risk of long-term death and recurrent rehospitalizations.

Topics: Acute Disease; Aged; Aged, 80 and over; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Cytokines; Endotoxins; Female; Heart Failure; Hospitalization; Humans; Longitudinal Studies; Male; Middle Aged; Natriuretic Peptide, Brain; Patient Readmission; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies; Protein Precursors; Risk Factors

To elucidate the prognostic role of procalcitonin (PCT) in patients with acute decompensated heart failure (ADHF) without clinical signs of infection at admission.. Serial measurements of PCT and NT-proBNP were performed in 168 patients, aged 68 ± 10 years with ADHF followed by 3-month outcome evaluation.. Cox regression analysis demonstrated significant predictive value of baseline PCT for all-cause death/hospitalization (area under the curve: 0.67; p = 0.013) at 90th day. The patients with persistently elevated PCT or with an increase during the first 72 h of hospitalization had the worst prognosis (p = 0.0002).. Baseline and serial in-hospital measurements of PCT have significant prognostic properties for 3-month all-cause mortality/hospitalization in patients with ADHF without clinical signs of infection at admission.

Topics: Acute Disease; Aged; Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Heart Failure; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Proportional Hazards Models; Protein Precursors; ROC Curve

Acute cholangitis and cholecystitis (AC) often progress to severe septic conditions. We evaluated the endotoxin activity assay (EAA) for assessment and prediction of the severity of AC.. We retrospectively reviewed 98 patients diagnosed with AC. We divided them into low (<0.4) and high (≥0.4) groups based on EAA values.. Endotoxin levels showed no correlation with EAA values. Serum C-reactive protein (8.57 vs. 5.23 mg/dl, P = 0.02), procalcitonin (2.45 vs. 0.48 ng/ml, P = 0.004), and the positive culture rate of blood (50% vs. 15%, P < 0.001) were significantly higher in the high group than in the low group. Platelet counts were significantly lower in the high group than in the low group (23.9 vs. 13.5 10(4) /ml, P = 0.004). The ratio of patients with a Japanese Association for Acute Medicine disseminated intravascular coagulation score ≥4 (32% vs. 14%, P = 0.032) was significantly higher in the high group than in the low group. There was a significantly higher percentage of patients with a severe grade of AC in the high group than patients with a mild or moderate grade (32% vs. 15%, P = 0.05).. Endotoxin activity assay is useful for assessment and early prediction of septic conditions due to AC.

Topics: Acute Disease; Aged, 80 and over; Blood; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cholecystitis; Endotoxins; Female; Forecasting; Humans; Male; Middle Aged; Platelet Count; Protein Precursors; Retrospective Studies

Brain natriuretic peptide (BNP) is well established in detecting acute decompensation of heart failure (ADHF). The role of BNP at discharge in predicting mortality is less established. Accumulating evidence suggests that inflammatory cytokines play an important role in the development of heart failure. We aimed to examine the contribution of BNP, interleukin 6, and procalcitonin to mortality in ADHF.. A cohort of 33 patients with ADHF was identified between March 2009 and June 2010 at Rambam Health Care Campus, Haifa, Israel. The cohort was followed up for all-cause mortality during 6 months after hospital discharge. Cox proportional hazard model was used to assess the association between BNP, interleukin-6 and procalcitonin and all-cause mortality.. As compared to BNP at admission, BNP at discharge was more predictive for all-cause mortality. The area under the curve for BNP at admission and discharge was 0.810 (P=.004) and 0.864 (P=.001) respectively. Eleven patients (33.3%) patients who died during the follow-up period had higher BNP levels, median 2031.4 (IQR, 1173.4-2707.2), than those who survived; median 692.5 (IQR, 309.9-1159.9), (P = .001). On multivariate analysis, BNP remained an independent predictor for 6 month all-cause mortality HR 9.58 (95% CI, 2.0-45.89) for levels above the median compared to lower levels, (P=.005). Albumin, procalcitonin and interleukin 6 were not associated with all-cause mortality.. BNP at discharge is an independent predictor for all-cause mortality in patients with ADHF. Compared with BNP at admission, BNP at discharge has slightly higher predictive accuracy with regard to 6-month all-cause mortality.

Topics: Acute Disease; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Female; Heart Failure; Humans; Interleukin-6; Male; Natriuretic Peptide, Brain; Patient Discharge; Predictive Value of Tests; Proportional Hazards Models; Protein Precursors

Two clinical trials suggest that procalcitonin-guided antibiotic therapy can safely reduce antibiotic prescribing in outpatient management of acute respiratory tract infections (ARTIs) in adults. Yet, it remains unclear whether procalcitonin testing is cost-effective in this setting.. To evaluate the cost-effectiveness of procalcitonin-guided antibiotic therapy in outpatient management of ARTIs in adults.. Cost-effectiveness model based on results from two published European clinical trials, with all parameters varied widely in sensitivity analyses.. Two hypothetical cohorts were modeled in separate trial-based analyses: adults with ARTIs judged by their physicians to require antibiotics and all adults with ARTIs.. Procalcitonin-guided antibiotic therapy protocols versus usual care.. Costs and cost per antibiotic prescription safely avoided.. We estimated the health care system willingness-to-pay threshold as $43 (range $0–$333) per antibiotic safely avoided, reflecting the estimated cost of antibiotic resistance per outpatient antibiotic prescribed. In the cohort including all adult ARTIs judged to require antibiotics by their physicians, procalcitonin cost $31 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored compared to usual care was 58.4 % in a probabilistic sensitivity analysis. In the analysis that included all adult ARTIs, procalcitonin cost $149 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored was 2.8 %.. Procalcitonin-guided antibiotic therapy for outpatient management of ARTIs in adults would be cost-effective when the costs of antibiotic resistance are considered and procalcitonin testing is limited to adults with ARTIs judged by their physicians to require antibiotics.

Topics: Acute Disease; Adult; Ambulatory Care; Animals; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Child; Cohort Studies; Cost-Benefit Analysis; Disease Management; Humans; Models, Economic; Protein Precursors; Respiratory Tract Infections

The aim of this study was to conduct a preliminary analysis of serum procalcitonin (PCT) to predict bacterial coinfection in infants with acute bronchiolitis.. Retrospective cohort chart review of 40 infants admitted with acute bronchiolitis to the pediatric intensive care unit. Logistic regression models were used to determine the association of PCT and white blood count with presence of bacterial coinfection defined by either positive culture or chest radiograph result.. Fifteen (38%) of 40 patients had a diagnosis of bacterial coinfection by positive culture (9/15) or chest radiograph (6/15). Procalcitonin (P < 0.0001) was significantly associated with bacterial coinfection. A cutoff value of 1.5 ng/mL had sensitivity of 0.80, specificity of 1.00, and area under the operating curve of 0.88. White blood count (P = 0.06) was borderline significant with sensitivity of 0.33, specificity of 0.96, and area under the operating curve of 0.67. Three of 15 patients were later found to have bacterial coinfection with initial PCT of less than 1.5 ng/mL. None had follow-up PCT measurements taken. Thirty-five of 40 were prescribed empiric antibiotic therapy, including 20 of 25 patients without evidence of bacterial coinfection. None had a PCT of greater than 1.5 ng/mL. If a PCT cutoff of greater than 1.5 ng/mL had been used, 57% fewer patients would have received antibiotics with a 45% reduction in antimicrobial charges.. An elevated PCT may assist clinicians in determining presence of bacterial coinfection at admission in infants with acute bronchiolitis. Implementation of a PCT cutoff of 1.5 ng/mL at admission may prevent unnecessary antibiotic use with associated cost savings. Serial PCT levels may increase sensitivity. Further validation is warranted.

Topics: Acute Disease; Bacteremia; Biomarkers; Bronchiolitis; Calcitonin; Calcitonin Gene-Related Peptide; Coinfection; Diagnosis, Differential; Female; Follow-Up Studies; Glycoproteins; Humans; Infant; Intensive Care Units, Pediatric; Male; Predictive Value of Tests; Prognosis; Protein Precursors; Retrospective Studies; ROC Curve

Early recognition of bacterial infections is crucial for their proper management, but is particularly difficult in children with severe acute malnutrition (SAM). The objectives of this study were to evaluate the accuracy of C-reactive protein (CRP) and procalcitonin (PCT) for diagnosing bacterial infections and assessing the prognosis of hospitalized children with SAM, and to determine the reliability of CRP and PCT rapid tests suitable for remote settings.. From November 2007 to July 2008, we prospectively recruited 311 children aged 6 to 59 months hospitalized with SAM plus a medical complication in Maradi, Niger. Blood, urine, and stool cultures and chest radiography were performed systematically on admission. CRP and PCT were measured by rapid tests and by reference quantitative methods using frozen serum sent to a reference laboratory.. Median CRP and PCT levels were higher in children with bacteremia or pneumonia than in those with no proven bacterial infection (P < .002). However, both markers performed poorly in identifying invasive bacterial infection, with areas under the curve of 0.64 and 0.67 before and after excluding children with malaria, respectively. At a threshold of 40 mg/L, CRP was the best predictor of death (81% sensitivity, 58% specificity). Rapid test results were consistent with those from reference methods.. CRP and PCT are not sufficiently accurate for diagnosing invasive bacterial infections in this population of hospitalized children with complicated SAM. However, a rapid CRP test could be useful in these settings to identify children most at risk for dying.

Topics: Acute Disease; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child Nutrition Disorders; Child, Preschool; Female; Humans; Infant; Male; Prognosis; Prospective Studies; Protein Precursors; Reproducibility of Results; Severity of Illness Index

Procalcitonin is a reliable and specific marker of bacterial infections such as urinary tract infection. Some authors suggest measurement of serum procalcitonin as a predictor of vesicoureteral reflux (VUR). We investigated this association in children admitted because of acute pyelonephritis.. Forty-eight children with the first febrile urinary tract infection were included. Twelve patients had low-grade VUR, 9 patients had high-grade VUR, and 27 patients did not have any VUR in their imaging assessment.. There was a significant association between high-grade VUR and higher levels of procalcitonin (P = .04). The sensitivity of a procalcitonin level of 0.31 ng/mL or greater was 90% and the specificity was 32% for diagnosis of high-grade VUR.. We concluded that serum procalcitonin concentration is a sensitive and promising predictor of high-grade VUR.

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Female; Humans; Infant; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Pyelonephritis; Risk Factors; Severity of Illness Index; Up-Regulation; Vesico-Ureteral Reflux

Hemodialysis patients have a greater risk of infection than individuals not on dialysis. Procalcitonin has been shown to rise in bacterial from but widely studied in hemodialysis patients. The present study evaluates procalcitonin as an early predictor of infection in this population.. A historical cohorts study was made of 211 prevalent hemodialysis patients (median age 73 years [range 60-80], 58% males) covering the period 2005-2012. Serum samples were thawed and patients were followed-up on for 40±25 months (0-84). Demographic and laboratory test (including inflammatory values) data were recorded at baseline. During follow-up, all infections were documented and analyzed.. During follow-up, 112 patients (53.3%) suffered acute infection. A positive correlation was established for procalcitonin and C-reactive protein (σ=0.482, p<0.0001). Procalcitonin was the only inflammatory marker capable of predicting infection at one month (p=0.023) in a model with all the studied inflammatory markers. C-reactive protein was the best predictor of infection over global follow-up (p=0.003), after adjusting for all the studied factors.. Procalcitonin is an early predictor of infection in the first 30 days in hemodialysis patients. However, in relation to the long-term prognosis, C-reactive protein is the most important independent predictor of infection.

Topics: Acute Disease; Aged; Aged, 80 and over; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Protein Precursors; Renal Dialysis; Retrospective Studies

Acute appendicitis is the commonest surgical emergency, but its diagnosis can be elusive with a negative appendicectomy rate of 20%. The aims of this study were to investigate the potential value of the markers of acute inflammation, serum amyloid A (SAA), and serum procalcitonin (ProCT), in the diagnosis of acute appendicitis in adults and to compare that with the commonly used serum C-reactive protein (CRP).. Adult patients presenting with acute right lower abdominal pain and a clinical suspicion of acute appendicitis were included. Blood samples were obtained within 6 hours of admission for rapid serum CRP assay and for end-of-recruitment batch analysis of SAA and serum ProCT concentrations.. A total of 147 patients (81 males) with a mean (±SD) age of 36 (±17) years were recruited. Appendicitis was confirmed histologically in 61 of 72 patients (84.7%) who underwent appendicectomy. A post hoc analysis revealed a diagnostic sensitivity and specificity for SAA of 92% and 72%, ProCT of 85% and 74%, and CRP of 75% and 72%, respectively. The receiver operator characteristics for the area under the curves showed that SAA (P=0.011) and ProCT (P=0.037) significantly exceeded CRP in the prediction of acute appendicitis on admission.. The measurement of SAA and serum ProCT on admission in patients with clinically suspected acute appendicitis seems to outperform serum CRP in aiding that diagnosis.

Topics: Acute Disease; Adult; Appendicitis; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Humans; Leukocyte Count; Male; Predictive Value of Tests; Protein Precursors; ROC Curve; Serum Amyloid A Protein

It is important to identify biomarkers for sepsis and organ damage in acute cholangitis patients. We investigated the usefulness of procalcitonin (PCT) as a biomarker of inflammation based on the Tokyo Guidelines 2013 (TG13).. A total of 110 acute cholangitis patients were categorized based on TG13, and the PCT levels and common laboratory inflammatory markers were measured. The cases undergoing hemoculture (n = 72) at the time of diagnosis also correlated with the PCT levels.. The PCT and C-reactive protein levels were significantly higher in grade III cases versus grade I. The mean PCT levels for positive hemoculture cases (8.6 ng/ml) were significantly higher than those for negative cases (0.7 ng/ml). In hemoculture positive cases or when purulent bile was obtained from the duodenal papilla, i.e., cases clearly requiring emergency biliary drainage and necessitating categorization as grade III, three cases were categorized as grade I and 13 as grade II. Only PCT showed statistically significant increases in severe cases underestimated as grade I or II despite them being fundamentally grade III cases.. Acute cholangitis with high PCT levels can signify the need to perform emergency biliary drainage and institute intensive care even if categorized by TG13 as not being severe cases.

Topics: Acute Disease; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Diagnostic Imaging; Drainage; Emergencies; Female; Humans; Liver Function Tests; Male; Middle Aged; Protein Precursors; Severity of Illness Index; Treatment Outcome

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Female; Heart Failure; Humans; Male; Middle Aged; Protein Precursors

Topics: Acute Disease; Adolescent; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Emergency Service, Hospital; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Viral; Protein Precursors

There is no hematological marker that reliably differentiates between bacterial and nonbacterial acute gastroenteritis (AGE). The objective of this study is to evaluate procalcitonin (PCT) as a marker for bacterial AGE and analyze its relationship with hospital admission.. A prospective study of children diagnosed with AGE was conducted at the emergency room during a period of seven months, which required blood and stool samples. Epidemiological, clinical and analytical variables were analyzed. Patients with chronic digestive disease, prolonged diarrhea, immunodeficiency or prior antibiotic treatment were excluded. The study was approved by the Ethics Committee and an informed consent was requested.. 45 patients were analyzed. Children with bacterial GEA were older (p=0.027) and presented higher median PCT and C-reactive protein concentrations (CRP) (p=0.001). The PCT and CRP values that best discriminated bacterial infection were PCT≥0.05 mg/L (sensibility 64.3%, specificity 83.9%, positive probability coefficient (PPC): 4), and CRP≥3 mg/dL (sensibility 78.6%, specificity 90.3%, PPC: 8). No association between the elevation of these markers and higher hospitalization probability was found.. Procalcitonin, like CRP, is elevated in bacterial gastroenteritis (p=0.001), but these markers are not a predictor of hospitalization.

Topics: Acute Disease; Adolescent; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Gastroenteritis; Hospitalization; Humans; Infant; Male; Prospective Studies; Protein Precursors; Sensitivity and Specificity

To evaluate the diagnostic and prognostic usefulness of procalcitonin (PCT) in patients admitted to the Emergency Department (ED) with signs of infections and to assess the prognostic value of repeated measurements in predicting hospital mortality.. A prospective, observational study was conducted in our 400-bed General Teaching Hospital. 261 patients arriving in ED with signs/symptoms of infection were enrolled. PCT was performed upon arrival in the ED (T0), and 5 days after antibiotic therapy (T5). Blood cultures were performed in all patients upon arrival in the ED.. Mean T0 PCT value was 7.1±17.9 ng/ml, and at T5 3±9.1 ng/ml (p < 0.0001). Mean PCT in septic non-survivors was increased at T5 compared to T0 but not significantly. The PCT increase at T5 was an independent factor of mortality (OR = 1.29, p < 0.02) in septic patients. Compared to baseline mean delta % PCT decrease at T5 was 28%. Patients with a decrease delta % PCT > 28% showed a lower number of deaths, with a statistical significant difference if compared to those patients with a < 28% decrease (p < 0.004). ROC curve of delta % PCT for prediction of death has an AUC = 0.82 (p < 0.03).. PCT is a useful marker for diagnosis of systemic and local infections, and for prognostic stratification in patients with acute infectious diseases at their arrival in ED. PCT variations after antibiotic therapy are highly predictive for in-hospital mortality. PCT normalization during antibiotic therapy suggests a good response to infection possibly leading to less infection-related deaths.

Topics: Acute Disease; Aged; Aged, 80 and over; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Communicable Diseases; Emergency Service, Hospital; Female; Hospital Mortality; Hospitals, General; Hospitals, Teaching; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Patient Admission; Predictive Value of Tests; Prospective Studies; Protein Precursors; Risk Factors; ROC Curve; Rome; Sepsis; Time Factors; Treatment Outcome

The aim of the present study was to examine the usability of procalcitonin (PCT) for severity assessment in patients with acute cholangitis (AC).. Serum PCT concentrations were measured on admission in patients with AC. Patients were classified with mild, moderate, or severe AC based on severity assessment guidelines.. We included 159 treatment-naïve patients with AC (95 males, 64 females) in this study. The median PCT concentrations were 0.08 ng/mL (interquartile range (IQR) 0.04 - 0.18 ng/mL), 0.37 ng/mL (IQR 0.15 - 1.85 ng/mL), and 5.56 ng/mL (IQR 3.59 - 25.89 ng/mL) in patients with mild, moderate and severe AC, respectively. PCT concentrations were significantly higher in patients with severe AC than in patients with moderate AC (p < 0.0001), and in patients with moderate AC than in patients with mild AC (p < 0.0001). The areas under the receiver operating characteristic curves for PCT to discriminate patients with moderate and severe AC were 0.84 (95% CI 0.77 to 0.92, p < 0.001) and 0.86 (95% CI 0.78 to 0.92, p < 0.001), respectively.. Serum PCT concentrations were elevated in patients with AC and may be a useful parameter for the severity assessment of AC.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Female; Humans; Male; Middle Aged; Protein Precursors; Retrospective Studies; ROC Curve; Severity of Illness Index

Hyperglycemia is a common complication of diabetes melitis (DM) and in the absence of metabolic decompensation is a common finding in the Emergency Department (ED). We aimed to evaluate the 25 OH Vit D [25(OH)D] and procalcitonin (PCT) levels during hyperglycemia and after normalization of blood glucose.. The study included 88 patients over the age of 18 years who presented with acute hyperglycemia at the Hacettepe University Department of Emergency Medicine. Euglycemia was obtained within 6-12 hours and serum samples were taken from patients on admission and 6 hours after normalization of blood glucose. Along with plasma glucose, plasma 25(OH)D and PCT levels were measured using ELISA.. There were 88 (45 males) patients, with a median age of 60.0±13.9 years. Serum 25(OH)D levels increased in all patients after normalization of blood glucose, and serum PCT levels decreased in the whole group. This decrease was independent of type of diabetes or presence of infection.. We demonstrated an increase in 25(OH)D after normalization of blood glucose, and a decrease in PCT in patients with hyperglycemia. This effect was independent of the type of diabetes and presence of infection. Further studies are needed to evaluate the faster link between metabolic abnormalities, vitamin D, PCT, and inflammation.

Topics: Acute Disease; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Hyperglycemia; Insulin; Male; Middle Aged; Protein Precursors; Vitamin D

Serious bacterial illness (SBI) presents a diagnostic challenge in febrile infants. History, clinical signs, and laboratory information combined with experiential knowledge affects decisions to admit and treat.. To assess the utility of serum procalcitonin and the Acute Infantile Observation Score (AIOS) performed at emergency department presentation in predicting (a) confirmed serious bacterial illness and (b) illness severity.. Sensitivity, specificity, and likelihood ratios were calculated for C-reactive protein, white cell count, serum procalcitonin, and AIOS.. Forty-six infants were recruited. Seven had a diagnosis of SBI, 28 were moderately ill with length of stay >24 hours, and 12 were severely ill with length of stay >96 hours. The positive likelihood ratios for confirmed SBI were C-reactive protein = 5.3, procalcitonin = 0.43, white cell count = 1.9, and AIOS = 1.5.. Procalcitonin and the AIOS do not modify the diagnostic uncertainty of the ED physician assessing the febrile infant with respect to admission or antibiotic treatment above standard laboratory investigations.

Topics: Acute Disease; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Female; Fever of Unknown Origin; Humans; Infant; Infections; Lymphocyte Count; Male; Predictive Value of Tests; Protein Precursors; Sensitivity and Specificity; Severity of Illness Index

Analysis of the examination and treatment results was conducted in 92 patients, suffering the obturation jaundice syndrome. There was elaborated a diagnostic program, in which the existing diagnostic standard for obturation jaundice and its complicated forms, an acute cholangitis and biliary sepsis, was added by determination of the blood procalcitonin level, microbiological investigation of the blood and bile, the bile microscopy, the analysis of the system inflammatory response syndrome signs and the organs dysfunction (according to SOFA scale). The program introduction have permitted to perform differential diagnosis of uncomplicated--in 30 (32.6%) patients, and complicated--in 42 (45.7%) obturation jaundice in an acute cholangitis and in 20 (21.7%)--in biliary sepsis. The treatment program is characterized by differentiated approach, depending on the disease kind, and includes the conduction of urgent decompression and sanation of biliary ducts. The method and volume of complex conservative therapy have differed essentially in patients, suffering obturation jaundice, an acute cholangitis and biliary sepsis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bile; Bile Ducts; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Decompression, Surgical; Diagnosis, Differential; Disease Management; Female; Humans; Jaundice, Obstructive; Male; Microscopy; Middle Aged; Minimally Invasive Surgical Procedures; Protein Precursors; Sepsis

Acute pyelonephritis (APN) is one of the most common community-acquired infections and frequently accompanies bacteremia. The purpose of this study was to investigate the diagnostic role of procalcitonin in predicting bacteremia in patients with APN.. We conducted a retrospective study of patients with APN who visited the emergency department (ED) at Samsung Medical Center, Seoul. Predictors of bacteremia were analyzed and receiver operating characteristics (ROC) curves were plotted for procalcitonin, C-reactive protein (CRP), and leukocytes.. During the study period, a total of 147 patients who had microbiologically proven APN and available initial procalcitonin concentrations were identified. Of these, bacteremia was present in 84 patients. Multivariate analysis showed that age, hypotension, and higher procalcitonin concentrations independently predicted the presence of bacteremia. Procalcitonin had better discriminative power than CRP, as reflected by area under the ROC curve analysis (0.746 [95% CI, 0.667-0.826] vs. 0.602 [95% CI, 0.509-0.694], p = 0.02). At a cut-off value of 1.63 μg/L, procalcitonin predicted bacteremia with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 61.9, 81.0, 81.3, 61.4 and 70.1%, respectively.. Procalcitonin concentration could be used as a reliable marker to predict bacteremia in patients with APN in the ED.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Area Under Curve; Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Protein Precursors; Pyelonephritis; Retrospective Studies; ROC Curve

Early diagnosis of Acute Osteomyelitis (OM) and Septic Arthritis (SA) is of vital importance to avoid devastating complications. There is no single laboratory marker which is sensitive and specific in diagnosing these infections accurately. Total Count, ESR and CRP are not specific as they can also be elevated in non pyogenic causes of inflammation. Pus Culture and sensitivity is not a true gold standard due to its varied positivity rates (40 - 70%). Serum Procalcitonin (PCT), at 0.5 ng/ml is found to be an accurate marker for pyogenic infections. The objectives of this study were to show that PCT is an accurate marker in differentiating Acute Osteomyelitis and Septic Arthritis from viral and non infective inflammatory bone and joint conditions.. Patients of all age groups (n = 82) with suspected Acute Osteomyelitis and Septic Arthritis were prospectively included in this study. All patients were subjected to TC, CRP, PCT, IgM Dengue, IgM Chikungunya, pus and blood culture and sensitivity. At the end of the study, patients were classified into 3 groups: Group 1 = Confirmed Pyogenic (n = 27); Group 2 = Presumed Pyogenic (n = 21); Group 3 = Non - infective inflammatory (n = 34).. Group 1 has higher mean PCT levels than Group 2 and 3 (p < 0.05). PCT, at 0.4 ng/ml, was 85.2% sensitive and 87.3% specific in diagnosing Septic Arthritis and Acute Osteomyelitis. In comparison, PCT at conventional cut - off of 0.5 ng/ml is 66.7% sensitive and 91% specific.. Serum Procalcitonin, at a cut - off of 0.4 ng/ml, is a sensitive and specific marker in the diagnosis of Septic Arthritis and Acute Osteomyelitis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Arthritis, Infectious; Biomarkers; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Diagnosis, Differential; Early Diagnosis; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Young Adult

Urinary tract infection (UTI) is a common bacterial infection in children that can result in permanent renal damage. This study prospectively assessed the diagnostic performance of procalcitonin (PCT) for predicting acute pyelonephritis (APN) among children with febrile UTI presenting to the paediatric emergency department (ED).. Children aged ≤10 years with febrile UTI admitted to hospital from the paediatric ED were prospectively studied. Blood PCT, C reactive protein (CRP) and white blood cell (WBC) count were measured in the ED. Sensitivity, specificity, predictive values, multilevel likelihood ratios, receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess quantitative variables for diagnosing APN.. The 136 enrolled patients (56 boys and 80 girls; age range 1 month to 10 years) were divided into APN (n=87) and lower UTI (n=49) groups according to (99m)Tc-dimercaptosuccinic acid scan results. The cut-off value for maximum diagnostic performance of PCT was 1.3 ng/ml (sensitivity 86.2%, specificity 89.8%). By multivariate regression analysis, only PCT and CRP were retained as significant predictors of APN. Comparing ROC curves, PCT had a significantly greater area under the curve than CRP, WBC count and fever for differentiating between APN and lower UTI.. PCT has better sensitivity and specificity than CRP and WBC count for distinguishing between APN and lower UTI. PCT is a valuable marker for predicting APN in children with febrile UTI. It may be considered in the initial investigation and therapeutic strategies for children presenting to the ED.

Topics: Acute Disease; Age Factors; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Emergency Service, Hospital; Female; Humans; Leukocyte Count; Logistic Models; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Pyelonephritis; Sensitivity and Specificity

Clinical diagnosis of pneumonia is difficult and chest radiographs often indeterminate, leading to incorrect diagnoses and antibiotic overuse.. To determine if serum procalcitonin (ProCT) could assist in managing patients with respiratory illness and indeterminate radiographs.. Subjects were prospectively enrolled during 2 consecutive winters.. A 520-bed hospital in Rochester, NY.. Five hundred twenty-eight adults admitted with acute respiratory illness were enrolled.. Serum ProCT, admission diagnoses, and chest radiographic findings were used to derive receiver operating characteristics curves to assess predictive accuracy of ProCT for the presence of infiltrates.. Subjects with pneumonia had higher ProCT (median 0.27 ng/ml) than those with exacerbations of chronic obstructive pulmonary disease (0.08 ng/ml), acute bronchitis (0.09 ng/ml), or asthma (0.06 ng/ml). ProCT had moderate accuracy for the presence of infiltrates (area under curve [AUC] 0.72), when indeterminate radiographs were independently classified as infiltrates by a pulmonologist evaluating patients.. ProCT may be useful in diagnosing pneumonia when chest radiographs are indeterminate.

Topics: Acute Disease; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Hospitalization; Humans; Male; Middle Aged; Prospective Studies; Protein Precursors; Radiography, Thoracic; Respiratory Tract Infections

Acute exacerbation (AE) of interstitial pneumonia (IP) is defined as a life-threatening deterioration of IP without identifiable cause. We evaluated the diagnostic and prognostic role of serum procalcitonin (PCT) in AE-IP.. Twenty consecutive patients admitted for AE-IP between May 2010 and April 2012 were evaluated. Controls consisted of 13 consecutively admitted patients with acute respiratory distress syndrome (ARDS) due to bacterial pneumonia (BP) and 24 with bacterial pneumonia with stable IP ('BP with IP'). Serum PCT was measured at baseline, at days 2, 4 and 8 in patients with AE-IP, and at baseline in controls.. Serum PCT levels in AE-IP were significantly lower than in BP-ARDS (mean ± standard deviation, 0.62 ± 1.30 vs 30.14 ± 22.76 ng/mL; P < 0.0001) or 'BP with IP' (mean ± standard deviation, 0.62 ± 1.30 vs 8.31 ± 14.83 ng/mL; P < 0.05). Thus, serum PCT discriminated well between AE-IP and BP-ARDS, or 'BP with IP' (area under the curve 0.99 and 0.85, respectively). However, there were no significant differences in serum PCT between 30-day survivors or non-survivors. Serum PCT tended to be reduced in both patient groups.. Serum PCT is a useful marker for discriminating between AE-IP and BP. However, serum PCT is not useful as a prognostic marker for survival.

Topics: Acute Disease; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Disease Progression; Female; Follow-Up Studies; Glycoproteins; Humans; Japan; Lung Diseases, Interstitial; Male; Prognosis; Protein Precursors; Reproducibility of Results; Retrospective Studies; Survival Rate

To determine if B cell activating factor of the tumor necrosis factor family (BAFF) acts as an acute phase reactant and predicts severity of acute pancreatitis.. 40 patients with acute pancreatitis were included in this single center cohort pilot study. Whole blood and serum was analyzed on day of admission and nine consecutive days for BAFF, c-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and leucocyte numbers. Different severity Scores (Ranson, APACHE II, SAPS II, SAPS III) and the clinical course of the patient (treatment, duration of stay, duration ICU) were recorded.. Serum BAFF correlates with CRP, an established marker of severity in acute pancreatitis at day of admission with a timecourse profil similar to IL-6 over the first nine days. Serum BAFF increases with Ranson score (Kruskal-Wallis: Chi2 = 10.8; p = 0.03) similar to CRP (Kruskal-Wallis: Chi2 = 9.4; p = 0.05 ). Serum BAFF, IL-6, and CRP levels are elevated in patients that need intensive care for more than seven days and in patients with complicated necrotizing pancreatitis. Discriminant analysis and receiver operator characteristics show that CRP (wilks-lambda = 0.549; ROC: AUC 0.948) and BAFF (wilks-lambda = 0.907; ROC: AUC 0.843) serum levels at day of admission best predict severe necrotizing pancreatitis or death, outperforming IL-6, PCT, and number of leucocytes.. This study establishes for the first time BAFF as an acute phase reactant with predictive value for the course of acute pancreatitis. BAFF outperforms established markers in acute pancreatitis, like IL-6 and PCT underscoring the important role of BAFF in the acute inflammatory response.

Topics: Acute Disease; Adult; Aged; B-Cell Activating Factor; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Interleukin-6; Male; Middle Aged; Pancreatitis; Prospective Studies; Protein Precursors

The aim of this study was to evaluate the use of procalcitonin (PCT) and C-reactive protein (CRP) on admission as predictors of the severity of appendicitis in children.. We prospectively studied 111 consecutive patients admitted with a diagnosis of acute appendicitis between July 2009 and February 2010 and recorded the following variables: age, sex, time since diagnosis, laboratory data, complications (abscess, intestinal obstruction), presence of hemodynamic instability, mortality, length of stay, and need for admission to the pediatric intensive care unit. Patients were divided into 2 groups according to the diagnosis confirmed during surgery (group 1, appendicitis; group 2, localized or generalized peritonitis).. Group 1 comprised 69 patients, and group 2 comprised 42 patients. Procalcitonin and CRP values were significantly lower in group 1 than in group 2 (0.15 vs 4.95 ng/mL [P < 0.001] and 3 vs 14.3 mg/dL [P < 0.001]). For a diagnosis of peritonitis, a PCT cutoff of 0.18 ng/mL gave a sensitivity of 97%, specificity of 80%, positive predictive value of 72%, and negative predictive value of 89.3%. The equivalent values for a CRP cutoff of 3 mg/dL were 95%, 74%, 68%, and 96.2%. Complications and the need for admission to the pediatric intensive care unit were more common in patients with peritonitis.. On admission, CRP and PCT predict the outcome of pediatric patients with appendicitis. Children with CRP greater than 3 mg/dL and/or PCT greater than 0.18 ng/mL have a greater risk of complications; thus, intervention should be early, and patients should be monitored closely.

Topics: Acute Disease; Adolescent; Appendicitis; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Infant; Male; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Severity of Illness Index

Early assessment of severity and continuous monitoring of patients are the key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the value of procalcitonin (PCT) and Bedside Index for Severity in Acute Pancreatitis (BISAP) scoring system as prognostic markers in early stages of AP with comparison to other established indicators such as C-reactive protein (CRP) and Acute Physiology and Chronic Health Evaluation (APACHE) II score.. This prospective study included 51 patients (29 with severe AP). In the first 24 h of admission in all patients the APACHE II score and BISAP score, CRP and PCT serum concentrations were determined. The values of PCT serum concentrations and BISAP score were compared with values of CRP serum concentrations and APACHE II score, in relation to the severity and outcome of the disease.. Values of PCT, CRP, BISAP score and APACHE II score, measured at 24 h of admission, were significantly elevated in patients with severe form of the disease. In predicting severity of AP at 24 h of admission, sensitivity and specificity of the BISAP score were 74% and 59%, respectively, APACHE II score 89% and 69%, respectively, CRP 75% and 86%, respectively, and PCT 86% and 63%, respectively. It was found that PCT is highly significant predictor of the disease outcome (p < 0,001).. In early assessment of AP severity, PCT has better predictive value than CRP, and similar to the APACHE II score. APACHE II score is a stronger predictor of the disease severity than BISAP score. PCT is a good predictor of AP outcome.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; APACHE; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Pancreatitis; Prognosis; Protein Precursors; Sensitivity and Specificity; Severity of Illness Index; Young Adult

The objective of this study was to determine the ability of various parameters commonly used for the diagnosis of acute meningitis to differentiate between bacterial and viral meningitis, in adult patients with a negative direct cerebrospinal fluid (CSF) examination.. This was a prospective study, started in 1997, including all patients admitted to the emergency unit with acute meningitis and a negative direct CSF examination. Serum and CSF samples were taken immediately on admission. The patients were divided into two groups according to the type of meningitis: bacterial (BM; group I) or viral (VM; group II). The CSF parameters investigated were cytology, protein, glucose, and lactate; the serum parameters evaluated were C-reactive protein and procalcitonin. CSF/serum glucose and lactate ratios were also assessed.. Of the 254 patients with meningitis with a negative direct CSF examination, 35 had BM and 181, VM. The most highly discriminative parameters for the differential diagnosis of BM proved to be CSF lactate, with a sensitivity of 94%, a specificity of 92%, a negative predictive value of 99%, a positive predictive value of 82% at a diagnostic cut-off level of 3.8 mmol/L (area under the curve (AUC), 0.96; 95% confidence interval (CI), 0.95 to 1), and serum procalcitonin, with a sensitivity of 95%, a specificity of 100%, a negative predictive value of 100%, and a positive predictive value of 97% at a diagnostic cut-off level of 0.28 ng/ml (AUC, 0.99; 95% CI, 0.99 to 1).. Serum procalcitonin and CSF lactate concentrations appear to be the most highly discriminative parameters for the differential diagnosis of BM and VM.

Topics: Acute Disease; Adolescent; Adult; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cerebrospinal Fluid; Cerebrospinal Fluid Proteins; Diagnosis, Differential; Female; Glucose; Humans; Lactic Acid; Male; Meningitis, Bacterial; Meningitis, Viral; Middle Aged; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Young Adult

The aim of this study was to assess the use of neutrophil distribution width (NDW) and to compare it to C-reactive protein (CRP) and procalcitonin (PCT), in the detection of early sepsis in the intensive care unit.. Subjects (N = 166) were divided into 4 groups: healthy, acute inflammatory non-infectious (AINI), localized infection, and systemic infection, according to clinical history and cultures. NDW, CRP, and PCT were compared among the different groups using multivariate analysis of variance (MANOVA). Diagnostic efficacy was assessed using receiver operating characteristic curves and areas under the curves (AUC).. The lowest mean(NDW) was found in the healthy group (n = 41), followed by the AINI (n = 20), localized infection (n = 55), and systemic infection (n = 50) groups. AUC(NDW) was 0.877 for infected (localized + systemic) vs non-infected (healthy + AINI) groups, and 0.965 for systemic infection vs non-infected groups. A cut-off of 21.9 resulted in 90% sensitivity, 92% specificity, 90% positive predictive value, and 92% negative predictive value (AUC(NDW) = 0.965, 95% confidence interval 0.935-0.995). According to MANOVA, only NDW was able to differentiate an acute inflammatory process from early infection in postoperative patients, but not healthy from AINI subjects.. NDW had the highest diagnostic accuracy and is available with the complete blood count with differential (CBC). It may be a promising parameter to aid in the diagnosis of acute infection in adults, provided the possibility of haematological disorders is first ruled out.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Analysis of Variance; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Leukocyte Count; Male; Middle Aged; Neutrophils; Protein Precursors; Reproducibility of Results; Retrospective Studies; ROC Curve; Sepsis; Serologic Tests; Temperature

The aim of this study is to assess serum procalcitonin (PCT) for early prediction of severe acute pancreatitis compared with multiple scoring systems and biomarkers.. Forty-four patients with acute pancreatitis confirmed by radiological evidences, laboratory assessments, and clinical manifestation were prospectively enrolled. All blood samples and image studies were obtained within 24 hours of admission.. Acute pancreatitis was graded as severe in 19 patients and mild in 25 patients according to the Atlanta criteria. Levels of serum PCT were significantly higher in severe acute pancreatitis (p=0.001). The accuracy of serum PCT as a predicting marker was 77.3%, which was similar to the acute physiology and chronic health examination (APACHE)-II score, worse than the Ranson score (93.2%) and better than the Balthazar CT index (65.9%). The most effective cut-off level of serum PCT was estimated at 1.77 ng/mL (AUC=0.797, 95% CI=0.658-0.935). In comparision to other simple biomarkers, serum PCT had more accurate value (77.3%) than C-reactive protein (68.2%), urea (75.0%) and lactic dehydrogenase (72.7%). Logistic regression analysis revealed that serum PCT has statistical significance in acute severe pancreatitis. Assessment of serum PCT levels and length of hospital stay by simple linear regression analysis revealed effective p-value with low R square level, which could make only possibilty for affection of serum PCT to admission duration (r2=0.127, p=0.021).. Serum PCT was a promising simple biomarker and had similar accuracy of APACHE-II scores as predicting severity of acute pancreatitis.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; APACHE; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; L-Lactate Dehydrogenase; Length of Stay; Logistic Models; Male; Middle Aged; Pancreatitis; Predictive Value of Tests; Protein Precursors; Radiography; Severity of Illness Index; Urea

We assessed the usefulness of procalcitonin as a biological marker in diagnosing acute pyelonephritis and for predicting subsequent renal scarring in young children with a first febrile urinary tract infection.. Children 2 years old or younger with a first febrile urinary tract infection were prospectively studied. Renal parenchymal involvement was assessed by (99m)Tc-dimercaptosuccinic acid scan within 5 days of admission and after 6 months. Serum samples from all patients were tested for procalcitonin, C-reactive protein and white blood cell count measurements.. The 112 enrolled patients (age range 24 days to 24 months old) were divided into acute pyelonephritis (76) and lower urinary tract infection (36) groups according to the results of (99m)Tc-dimercaptosuccinic acid scans. Median values of procalcitonin, C-reactive protein and white blood cell count at hospitalization were significantly higher in patients with acute pyelonephritis than in those with lower urinary tract infection. The area under receiver operating characteristic curves showed that procalcitonin was superior to C-reactive protein and white blood cell count as a marker for diagnosing acute pyelonephritis. Initial and post-antibiotic treatment procalcitonin values were significantly higher in children with renal scarring than in those without scarring (p <0.001). Procalcitonin values at hospitalization and after treatment were independent predictors of later renal scarring on logistic regression analysis.. Our results indicate the superior diagnostic accuracy of procalcitonin for predicting acute pyelonephritis in children 2 years old or younger. Higher initial and posttreatment procalcitonin values are independent risk factors for later renal scarring.

Topics: Acute Disease; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glycoproteins; Humans; Infant; Infant, Newborn; Logistic Models; Male; Protein Precursors; Pyelonephritis; Radiopharmaceuticals; ROC Curve; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections

Urinary tract infection (UTI) is a common problem in children. The aim of this study was to determine the usefulness of the procalcitonin (PCT) rapid test in the diagnosis of renal involvement in children with urinary tract infection.. Through a case series study, PCT and C-reactive protein rapid tests were measured in children with proven UTI at the Tehran Children's Medical Center, Iran. One-hundred patients aged 1 month-14 years old (19 boys and 81 girls) with documented UTI were enrolled in the study.. Of 100 children, 62 patients (62%) had renal involvement on the basis of abnormal Tc-dimercaptosuccinic acid scintigraphy and 38 patients (38%) had infection restricted to the lower urinary tract. There were no differences related to age or gender among the groups. The sensitivity and specificity of PCT were 77% and 89%, respectively, in prediction of renal involvement, whereas C-reactive protein had a sensitivity of 80% and a specificity of 65%.. We concluded that a rapid determination of PCT concentration could be useful for the management of children with febrile UTI in the emergency room.

Topics: Acute Disease; Adolescent; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Emergency Service, Hospital; Female; Humans; Infant; Male; Protein Precursors; Pyelonephritis; Time Factors; Urinary Tract Infections

The aim of this study was to evaluate the usefulness of procalcitonin (PCT) as a marker of renal scars in infants and young children with a first episode of acute pyelonephritis. Children aged 7 days to 36 months admitted for first febrile urinary tract infection (UTI) to a pediatric emergency department were prospectively enrolled. The PCT concentration was determined at admission. Acute (99m)Tc-dimercaptosuccinic acid (DMSA) scintigraphy was performed within 7 days of admission and repeated 12 months later when abnormal findings were obtained on the first scan. Of the 72 children enrolled in the study, 52 showed signs of acute pyelonephritis (APN) on the first DMSA scan. A follow-up scintigraphy at the 12-month follow-up performed on 41 patients revealed that 14 (34%) patients had developed renal scars; these patients also presented significantly higher PCT values than those without permanent renal lesions [2.3 (interquartile range 1-11.6) vs. 0.5 (0.2-1.4) ng/mL; p = 0.007]. A comparison of the PCT concentration in patients with febrile UTI without renal involvement, with APN without scar development and with APN with subsequent renal scarring revealed a significant increasing trend (p = 0.006, Kruskal-Wallis test). The area under the ROC curve for scar prediction was 0.74 (95% confidence interval 0.61-0.85), with an optimum statistical cut-off value of 1 ng/mL (sensitivity 78.6%; specificity 63.8%). Based on these results, we suggest that serum PCT concentration at admission is a useful predictive tool of renal scarring in infants and young children with acute pyelonephritis.

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Cicatrix; Cohort Studies; Female; Fever; Follow-Up Studies; Humans; Infant; Infant, Newborn; Kidney; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Succimer; Time Factors; Ultrasonography; Urinary Tract Infections

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Protein Precursors; Respiratory Tract Infections; Risk Assessment; Sensitivity and Specificity; Treatment Outcome; Virus Diseases

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Primary Health Care; Protein Precursors; Respiratory Tract Infections; Sensitivity and Specificity; Treatment Outcome; Virus Diseases

Topics: Acute Disease; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Glycoproteins; Humans; Primary Health Care; Protein Precursors; Respiratory Tract Infections; Treatment Outcome

The distinctions and interrelationship were established between acute cholangitis and biliary sepsis. Patients with hyperbilirubinemia were divided into four groups according to the developed criteria of inclusion and of using a new strategy of treatment for each group. It determined the result of treatment, i.e. resulted in lower lethality, shorter stay at hospital, less cost of treatment. One of the main criteria for the inclusion into a certain group was considered to be the index of blood plasma procalcitonin.

Topics: Acute Disease; Bile Ducts; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cholangitis; Decompression, Surgical; Follow-Up Studies; Glycoproteins; Humans; Protein Precursors; Retrospective Studies; Sepsis

Query-fever (Q-fever) is a zoonotic infection caused by the intracellular Gram-negative coccobacillus Coxiella burnetii. A large ongoing outbreak of Q-fever has been reported in the Netherlands. We studied various markers of infection in inpatients (hospitalised) and outpatients (treated by a general physician) with acute Q-fever in relation to disease severity.. Leukocyte counts, C-reactive protein (CRP) and procalcitonin (PCT) concentrations were measured in 25 inpatients and 40 outpatients upon presentation with acute Q-fever. Chest X-rays, if available, were analysed and confusion, urea, respiratory rate, blood pressure-age 65 (CURB-65) scores, indicating severity of pneumonia, were calculated.. CRP was the only marker that significantly differentiated between inpatients and outpatients. It was increased in all patients from both groups. Leukocyte counts and PCT concentrations did not differ between inpatients and outpatients. Overall, only 13/65 patients had an increased leukocyte count and only 11/65 patients presented with PCT concentrations indicative of possible bacterial respiratory tract infection. Infiltrative changes on the chest X-ray were observed in the majority of patients. CURB-65 score was 0+/-1 (mean+/-SD).. Acute Q-fever, a relatively mild pneumonia with low CURB-65 scores, specifically induces a response in CRP, while PCT concentrations and leukocytes are within the normal range or increased only marginally.

Topics: Acute Disease; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Inpatients; Leukocyte Count; Outpatients; Pneumonia; Protein Precursors; Q Fever; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index

Strategies aiming at reducing antibiotic use are required in the intensive care unit (ICU). Although antibiotic treatment is recommended in patients with severe exacerbation of chronic obstructive pulmonary disease (COPD), a bacterial etiology is found in only a half of these patients.. The aim of this study was to determine factors predicting bacterial isolation in severe acute exacerbations of COPD.. All patients with severe acute exacerbation of COPD requiring intubation and mechanical ventilation were included in this prospective observational cohort study. At ICU admission, information on endotracheal aspirate purulence and hyperthermia was collected. In all patients, Gram stain and quantitative endotracheal aspirate culture (positive at 10(6) cfu/ml) were performed. In addition, leukocyte count, C-reactive protein and procalcitonin (PCT) levels were measured.. Ninety-eight severe acute exacerbations of COPD requiring intubation and mechanical ventilation were studied. Forty-nine bacteria were isolated at significant threshold in 40 exacerbations. Streptococcus pneumoniae (16%), methicillin-sensitive Staphylococcus aureus (16%) and Hemophilus influenzae (14%) were the most frequently isolated bacteria. PCT >0.5 ng/ml and positive Gram stain of endotracheal aspirate were independently associated with bacterial isolation in severe acute exacerbation of COPD. Positive Gram stain and PCT >0.5 ng/ml had a negative predictive value >95%. Similar results were found after excluding patients with prior antibiotic treatment.. Positive Gram stain of endotracheal aspirate and PCT >0.5 ng/ml are independently associated with bacterial isolation in severe acute exacerbation of COPD. These results could be helpful for future interventional studies aiming at reducing antibiotic use in these patients.

Topics: Acute Disease; Aged; Algorithms; Bronchoalveolar Lavage Fluid; Calcitonin; Calcitonin Gene-Related Peptide; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Multivariate Analysis; Predictive Value of Tests; Prospective Studies; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Respiration, Artificial; Sensitivity and Specificity

Of patients with acute pancreatitis (AP), 20% develop severe attacks that need early and intensive therapy. Yet, to administer such treatment, it is important to classify early on the patients with mild and severe pancreatitis. The aim of this study was to evaluate the role of serum amyloid A, C-reactive protein, procalcitonin, and routinely measured parameters in the early prediction of the course of AP.. A total of 40 consecutive patients with AP confirmed by computed tomography were prospectively enrolled in the study-29 were graded as mild and 11 were graded as severe. Blood samples were obtained on admission and 24 hours thereafter.. Procalcitonin concentration in both measurements was significantly higher in patients with severe pancreatitis, and the cutoff level was estimated at 0.5 ng/mL. Although serum amyloid A and C-reactive protein levels rose significantly during the period of observation, these were not differentiated between both groups. Among the routinely measured parameters, a prognostic value was found for total calcium concentration, lactic dehydrogenase activity, and glucose concentration.. The best efficiency in the early prediction of severe AP would be achieved with the measurement of procalcitonin, total calcium level, and lactic acid dehydrogenase activity immediately after admission to the ward.

Topics: Acute Disease; Biomarkers; Blood Glucose; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Calcium; Disease Progression; Female; Humans; L-Lactate Dehydrogenase; Male; Middle Aged; Pancreatitis; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Serum Amyloid A Protein; Severity of Illness Index; Time Factors; Tomography, X-Ray Computed

To validate procalcitonin (PCT) level as the best biological marker to distinguish between bacterial and aseptic meningitis in children in the emergency department.. Secondary analysis of retrospective multicenter hospital-based cohort studies.. Six pediatric emergency or intensive care units of tertiary care centers in 5 European countries.. Consecutive children aged 29 days to 18 years with acute meningitis.. Univariate analysis and meta-analysis to compare the performance of blood parameters (PCT level, C-reactive protein level, white blood cell count, and neutrophil count) and cerebrospinal fluid parameters (protein level, glucose level, white blood cell count, and neutrophil count) quickly available in the emergency department to distinguish early on between bacterial and aseptic meningitis.. Of 198 patients analyzed, 96 had bacterial meningitis. Sensitivity of cerebrospinal fluid Gram staining was 75%. The PCT level had significantly better results than the other markers for area under the receiver operating characteristic curve (0.98; 95% confidence interval, 0.95-0.99; P = .001). At a 0.5-ng/mL threshold, PCT level had 99% sensitivity (95% confidence interval, 97%-100%) and 83% specificity (95% confidence interval, 76%-90%) for distinguishing between bacterial and aseptic meningitis. The diagnostic odds ratio between high PCT level and bacterial meningitis was 139 (95% confidence interval, 39-498), without significant heterogeneity between centers.. The PCT level is a strong predictor for distinguishing between bacterial and aseptic meningitis in children in the emergency department. Its combination with other parameters in an effective clinical decision rule could be helpful.

Topics: Acute Disease; Adolescent; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Confidence Intervals; Diagnosis, Differential; Europe; Female; Follow-Up Studies; Glycoproteins; Humans; Incidence; Infant; Infant, Newborn; Male; Meningitis, Aseptic; Meningitis, Bacterial; Odds Ratio; Protein Precursors; Retrospective Studies; ROC Curve

The present study attempted to identify the diagnostic significance of procalcitonin (PCT) in acute abdominal conditions as well as the range of concentrations relating to diagnosis of abdominal sepsis.. This was prospective clinical study. The study included 98 consecutive patients with acute abdominal conditions, divided in sepsis and systemic inflammatory response syndrome (SIRS) group.. PCT concentrations on admission were significantly higher in the sepsis group than in the SIRS group (median [interquartile range] 2.32 [7.41] vs 0.45 ng/ml [2.62]). A cutoff value of 1.1 ng/ml yielded 72.4% sensitivity and 62.5% specificity. In a group of patients with abdominal symptoms lasting for more than 24 h, a cut-off value of 1.1 ng/ml yielded higher sensitivity (82.9%) and higher specificity (77.3%).. Our results suggest that PCT measurements may be useful for early, preoperative diagnosis of abdominal sepsis.

Topics: Acute Disease; Adult; Aged; APACHE; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Peritonitis; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The myeloid-related proteins 8 and 14 exist as a dimeric complex (MRP 8/14) and serve as early and highly specific markers for inflammatory processes, such as allograft rejection and non-viral (bacterial or fungal) infections. An elevated procalcitonin (PCT) concentration in serum also serves as a diagnostic indicator of non-viral infection. Therefore, by measuring both MRP 8/14 and PCT serum concentrations, one may be able to distinguish between acute allograft rejection and non-viral infections in non-rejection transplant recipients. Here, we investigated whether MRP 8/14 and PCT can function as prognostic (Study I) or diagnostic (Study II) markers for allograft rejection in renal transplant recipients. In Study I, the serum concentrations of MRP 8/14 and PCT during the first 2 weeks after transplantation did not differ between patients who did and did not suffer organ rejection within 1 year post-transplantation; these findings suggest that the MRP 8/14 and PCT parameters are not valid prognostic markers. However, in Study II, patients with acute rejection or non-rejection/non-viral infection groups displayed a significant increase in serum MRP 8/14 concentration, and non-rejection patients with non-viral infections only had elevation in the PCT serum concentrations. These results indicate that the combined use of MRP 8/14 and PCT serum concentrations can allow one to distinguish between allograft rejection and other inflammatory processes, such as infection.

Topics: Acute Disease; Adolescent; Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Calgranulin A; Calgranulin B; Female; Graft Rejection; Humans; Kidney Transplantation; Male; Middle Aged; Prognosis; Protein Precursors

The aim of this study was to evaluate the usefulness of serum procalcitonin (PCT) to differentiate between septic and nonseptic acute arthritis.. Thirty-three patients who presented to our outpatient clinics with the symptoms of acute arthritis of unknown origin were enrolled in this study. We determined the serum concentrations of PCT and C-reactive protein and performed a white blood cell count. The definitive diagnosis was determined by microbiologic examination of a joint aspirate.. Microbiologic cultures showed that 15 patients had septic arthritis. In these patients the PCT levels were significantly increased compared with those in the 18 patients with nonseptic arthritis (mean +/- SD, 1.18 +/- 1.66 ng/mL v 0.078 +/- 0.073 ng/mL; P = .001). On the basis of the normal range (<0.5 ng/mL), the test sensitivity in our series was 53.3% with a specificity of 100%. C-reactive protein levels in patients with septic arthritis were also significantly elevated compared with the nonseptic group. Because in either group no value was within the normal range (<0.5 mg/dL), the specificity was 0%.. In this study serum PCT levels of patients with septic arthritis were significantly higher than those of patients with nonseptic arthritis (P = .001). However, the sensitivity when referencing the normal upper limit of PCT (0.5 ng/mL) is not high enough to establish a diagnosis based exclusively on serum parameters. This reflects the results of other studies examining localized infections without generalized bacteremia. The data suggest that a specific PCT cutoff level for localized infections could be helpful in the future.. Level III, diagnostic study of nonconsecutive patients without consistently applied reference gold standard.

Topics: Acute Disease; Arthritis, Infectious; Arthroscopy; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Leukocyte Count; Male; Osteoarthritis; Predictive Value of Tests; Protein Precursors; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric

To assess the diagnostic utility of combining measurement of blood procalcitonin (PCT) concentrations with the presence of a biphasic transmittance waveform (BPW) from the activated partial thromboplastin time (aPTT) to identify sepsis in critically ill patients.. Prospective observational study.. Thirty-one-bed university hospital department of medico-surgical intensive care.. Two hundred consecutive adult patients admitted to the department during a 3-month period.. aPTT waveform analysis was performed on admission and daily throughout the intensive care unit (ICU) stay. Receiver operating characteristic curves were created to determine the best threshold values of BPW and PCT for prediction of sepsis. Of the 200 patients, 63 (32%) had sepsis during the ICU stay; 29 (15%) patients were diagnosed with sepsis at admission. Using a threshold value of BPW slope_1 = -0.075%T/sec, 37 patients (19%) had a BPW at ICU admission and 84 (42%) at some time during the ICU stay. At this threshold, 23 of the patients (62%) with a BPW at admission and 51 (61%) with a BPW during the ICU stay were diagnosed with sepsis. Using a cut-off value of 1 ng/ml, 60 patients (30%) had abnormal PCT at admission, and 86 during the ICU stay. At this threshold, 24 of the patients (40%) with abnormal PCT at admission and 52 (60%) with abnormal PCT during the ICU stay were diagnosed with sepsis. Thirty patients had a BPW and an abnormal PCT, and 23 (77%) of these had sepsis. Of the other 170 patients, only six patients (4%) had sepsis. Hence, the sensitivity of the combination of BPW and PCT at admission was 79% and specificity 96%; the negative predictive value was 96%.. aPTT waveform analysis is an easy and rapid method for identification of sepsis; its combination with PCT increases its specificity.

Topics: Acute Disease; Aged; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Humans; Middle Aged; Partial Thromboplastin Time; Prospective Studies; Protein Precursors; Sepsis

Methods for lipopolysaccharide (LPS) (endotoxin) reduction have been proposed as one way to improve the treatment of Gram-negative sepsis. Here we present a case with severe Gram-negative sepsis, treated with a novel device for LPS adsorption (Alteco LPS Adsorber, Alteco Medical AB, Lund, Sweden). After LPS adsorption, the level of LPS in the patient's bloodstream was almost eliminated: from 1.44 EU/ml before treatment to 0.03 EU/ml post treatment). The procalcitonin level and inflammatory cytokines were concurrently reduced. Also, an obvious improvement in the status of the patient's hemodynamics was seen. Forty-five days after treatment the patient is still alive. In conclusion, LPS adsorption may represent a significant improvement in the treatment of Gram-negative sepsis and further studies are planned.

Topics: Abdomen; Acute Disease; Adsorption; Adult; Anticoagulants; Calcitonin; Calcitonin Gene-Related Peptide; Cholecystectomy; Hemoperfusion; Hemorrhage; Heparin; Humans; Lipopolysaccharides; Male; Multiple Organ Failure; Pancreatitis, Acute Necrotizing; Protein Precursors; Pseudomonas aeruginosa; Renal Insufficiency; Respiratory Insufficiency; Sepsis; Severity of Illness Index; Treatment Outcome

The endogenous inhibitor of nitric oxide synthase (NOs) asymmetrical dimethyl-arginine (ADMA) has been implicated as a possible modulator of inducible NOs during acute inflammation. We examined the evolution in the plasma concentration of ADMA measured at the clinical outset of acute inflammation and after its resolution in a series of 17 patients with acute bacterial infections.. During the acute phase of inflammation/infection, patients displayed very high levels of C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin and nitrotyrosine. Simultaneous plasma ADMA concentration was similar to that in healthy subjects while symmetric dimethyl-arginine (SDMA) levels were substantially increased and directly related with creatinine. When infection resolved, ADMA rose from 0.62 +/- 0.23 to 0.80 +/- 0.18 micromol/l (+29%, P = 0.01) while SDMA remained unmodified. ADMA changes were independent on concomitant risk factor changes and inversely related with baseline systolic and diastolic pressure. Changes in the ADMA/SDMA ratio were compatible with the hypothesis that inflammatory cytokines activate ADMA degradation.. Resolution of acute inflammation is characterized by an increase in the plasma concentration of ADMA. The results imply that ADMA suppression may actually serve to stimulate NO synthesis or that in this situation plasma ADMA levels may not reflect the inhibitory potential of this methylarginine at the cellular level.

Topics: Acute Disease; Arginine; Bacterial Infections; Biomarkers; Blood Pressure; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chromatography, High Pressure Liquid; Creatinine; Disease Progression; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Glycoproteins; Humans; Inflammation; Interleukin-6; Male; Middle Aged; Nitric Oxide Synthase; Protein Precursors; Severity of Illness Index; Tyrosine

Predicting medical outcomes for pyelonephritis in women is difficult, leading to unnecessary hospitalization. Unlike other serious infectious diseases, high procalcitonin (PCT) level has never been associated with 28-d adverse medical outcomes in women with pyelonephritis. Therefore, we sought to determine the accuracy of PCT in discriminating between pyelonephritis with adverse medical outcome (PAMO) and pyelonephritis without adverse medical outcome (PWAMO).. Adult women with pyelonephritis presenting to the emergency department of a French tertiary care hospital were consecutively included. Those patients who developed adverse medical outcomes during a 28-d follow-up period were identified as having PAMO. Baseline characteristics and PCT level were compared between patients with PAMO and PWAMO.. Eleven women (19.0%) had PAMO and 47 (81%) had PWAMO. The median PCT level was higher in PAMO compared with PWAMO 0.51 ng/ml (IQR: 0.04-3.8) and 0.08 ng/ml (IQR: 0.01-1.0), but this difference was not statistically significant (p=0.07). We failed to find a threshold value for PCT that discriminated between PAMO and PWAMO (ROC, AUC=0.67 [95%CI, 0.51-0.86]). All but one subject with PAMO had either a PCT level >0.1 ng/ml or an underlying genitourinary abnormality by radiographic testing.. A single PCT level was a poor predictor of 28-d adverse medical outcomes in women with pyelonephritis treated in the emergency department. Prediction based on underlying genitourinary abnormality by radiographic testing in addition to the PCT level should be investigated in future studies.

Topics: Acute Disease; Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Hospitalization; Humans; Middle Aged; Protein Precursors; Pyelonephritis; Risk Factors; Sensitivity and Specificity

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic; Respiratory Tract Infections

The aim of this study is to determine the relation of high-sensitive serum C-reactive protein (hsCRP) and procalcitonin with presence and severity of coronary artery disease and early prognosis in patients with acute coronary syndrome (ACS).. Procalcitonin and hsCRP levels were measured at admission and after 48 hours in 50 patients (41 men, 9 women) with ACS. The patients were assigned to three groups according to their clinical diagnosis: unstable angina pectoris (UAP) (Braunwald III-B), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Incidences of adverse cardiac events were recorded in a 3-month follow-up. Coronary angiography was performed to evaluate presence and severity of coronary artery disease. In the groups of STEMI, NSTEMI and UAP, procalcitonin (P = 0.01 3, P = 0.045 and P = 0.000 1, respectively) and hsCRP (P = 0.000 1, P = 0.01 and P = 0.00 1, respectively) levels were significantly increased. No significant correlation was found between these markers and the presence and severity of coronary artery disease. There was no correlation between procalcitonin and hsCRP levels at admission and after 48 hours and primary end points after 3 months except in the group of UAP with revascularization procedure. In the group of UAP, hsCRP levels at 48 hours were found higher in the patients with a revascularization procedure (P = 0.04).. In conclusion, levels of hsCRP and procalcitonin are increased in patients with ACS but failed to correlate with severity of coronary disease and early prognosis.

Topics: Acute Disease; Adult; Aged; Analysis of Variance; Angina, Unstable; Angioplasty, Balloon, Coronary; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Creatine Kinase, MB Form; Female; Follow-Up Studies; Humans; Inflammation Mediators; Male; Middle Aged; Myocardial Infarction; Prognosis; Protein Precursors; Research Design; Severity of Illness Index; Syndrome; Treatment Outcome; Troponin I; Turkey

Procalcitonin (PCT) is an established marker for severe systemic bacterial infection and sepsis in blood. Here we measured PCT by immunoassay in CSF and matched serum/plasma samples of controls and patients with different primary dementia disorders and acute neuroinflammation. PCT in CSF was significantly increased in patients with probable Alzheimer's disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia and acute neuroinflammation (encephalitis, meningitis) compared to non-demented controls. In contrast, PCT levels in matched plasma samples were normal in dementia groups, but elevated in meningitis/encephalitis. Our results indicate a central production of PCT and suggest PCT as a valuable marker candidate for the monitoring of dementia and acute neuroinflammation.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Analysis of Variance; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Dementia; Encephalitis; Female; Humans; Male; Middle Aged; Neurogenic Inflammation; Protein Precursors; ROC Curve

To evaluate the diagnostic value of serum procalcitonin levels in patients with acute or chronic liver disease, with or without bacterial infections and to correlate the results with the clinical outcome and the laboratory findings for these patients.. One hundred and six consecutive hospitalized patients with liver disease were evaluated for procalcitonin levels on admission. Fifteen of them (14.2%) had acute alcoholic hepatitis on cirrhotic background (group A), 20 (18.9%) had alcoholic cirrhosis without hepatitis and/or bacterial infection (group B), 16 (15.1%) had decompensated cirrhosis with proved bacterial infection (group C), 42 (39.6%) had uncomplicated viral hepatitis-related cirrhosis (group D) and 13 (12.3%) had acute icteric viral hepatitis (group E). Serum procalcitonin levels were measured using an immunoluminometric assay. Statistical analysis was based on Student's t-test and the non-parametric Kruskall-Wallis test (P<0.05).. Serum procalcitonin levels were significantly higher in cirrhotic patients with bacterial infection (9.80+/-16.80 ng/ml) than in those without bacterial infection (0.21+/-0.13 ng/ml, P=0.001), whereas they were within normal range (<0.5 ng/ml) in all patients with uncomplicated cirrhosis, irrespective of the cause of cirrhosis. Seven of 15 group A patients (46.2%) and 4/13 group E patients (30.8%), all of them cirrhotics, had procalcitonin levels higher than 0.5 ng/ml on admission, without established bacterial infection.. Serum procalcitonin levels remain below the threshold of 0.5 ng/ml in all patients with uncomplicated cirrhosis, irrespective of the cause of the disease, while they are significantly elevated when bacterial infection complicates the course of the disease. A significant proportion of patients with acute alcoholic hepatitis on a cirrhotic background as well as of patients with acute on chronic viral hepatitis, without bacterial infection, exhibit serum procalcitonin levels above 0.5 ng/ml, suggesting that this cut-off value is probably not enough to discriminate between patients with or without bacterial infection within these subgroups of patients with liver disease.

Topics: Acute Disease; Adolescent; Adult; Aged; Alanine Transaminase; Aspartate Aminotransferases; Bacterial Infections; Bilirubin; Blood Cell Count; Calcitonin; Calcitonin Gene-Related Peptide; Female; Hemoglobins; Hepatitis; Hepatitis, Alcoholic; Hepatitis, Viral, Human; Humans; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Prospective Studies; Protein Precursors; Prothrombin Time; Serum Albumin; Urinary Tract Infections

This prospective study aimed to investigate the diagnostic value of serum procalcitonin levels in children with acute pyelonephritis documented by Tc-dimercaptosuccinic acid (DMSA) scintigraphy.. We compared the symptoms and laboratory findings of fever, vomiting, abdominal/flank pain, leukocyte count, serum C-reactive protein and procalcitonin levels with the results of the DMSA scan obtained within the first 72 h after referral in children who were diagnosed as having acute pyelonephritis. Thirty-three children (31 female and two male) aged 1-11 years (mean 4.42 years) were enrolled in this prospective study.. Twenty-one of 33 patients (64%) had positive DMSA scans. On the scans obtained after 6 months, five of 21 patients (23.8%) had renal scars. No correlation was found between clinical and laboratory parameters, alone or combined with each other, and positive DMSA scans. Serum procalcitonin levels were 0.767+/-0.64 and 1.23+/-1.17 ng . ml in children with normal and positive DMSA scans, respectively. The cut-off value for procalcitonin using receiver operating characteristic analysis was 0.9605 ng . ml, while sensitivity and specificity were 86.4% and 36.4%, respectively. However, if the cut-off value was chosen as 2 ng . ml, the sensitivity increased to 100% while specificity did not change markedly.. The serum procalcitonin test, like other commonly used laboratory parameters, e.g. serum C-reactive protein and white blood cell count, was inadequate in distinguishing renal parenchymal involvement in acute febrile urinary tract infections.

Topics: Acute Disease; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Humans; Infant; Kidney; Leukocyte Count; Male; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Dimercaptosuccinic Acid

This study was designed to evaluate the diagnostic accuracy of serum procalcitonin (PCT) for the diagnosis of severity in acute pancreatitis (AP), compared with routine clinical, biochemical, radiological, and combination severity scoring systems.. Quantitative meta-analysis was performed on prospective studies, comparing serum PCT, against validated scoring systems for diagnosing severe AP. The sensitivity, specificity, and diagnostic odds ratio were calculated for each study. Summary receiver operating characteristic (SROC) curves and subgroup analysis were undertaken. Study quality and heterogeneity were evaluated. Meta-regression meta-analysis was used to evaluate the effect of using serum PCT in the diagnostic accuracy severity scoring in AP.. Summary receiver operating characteristic analysis of nine studies showed an overall sensitivity and specificity of 74% (range: 66%-81%) and 83% (range: 79%-87%), respectively. Overall unweighted area under the curve (AUC) was 0.91 (DOR = 16.26 95% CI: 5.68-46.60), demonstrating significant heterogeneity (Q-value = 25.32; P = 0.001). When high-quality studies alone were evaluated, there was an increase in the overall sensitivity (89%); however, specificity was similar (82%), with an overall unweighted AUC of 0.94 (DOR 41.46, 95% CI: 17.95-95.80), with no significant heterogeneity. Meta-regression analysis confirmed the significant effect of study quality on the diagnostic accuracy of severity scoring using serum PCT (P = 0.025).. The use of PCT for severity scoring in AP has a moderate sensitivity but higher specificity. However, the overall accuracy for predicting severity in AP is high. The prognosis of severity, especially early on (<48 hours from onset of symptoms), and the evaluation of potential infectious complications of AP may be the most useful factors to assess in subsequent clinical trials to identify its exact application in clinical practice in the management of AP.

Topics: Acute Disease; Area Under Curve; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Pancreatitis; Prognosis; Protein Precursors; ROC Curve; Sensitivity and Specificity; Severity of Illness Index

To analyse the mid region of plasma N-terminal pro-atrial natriuretic peptide (MR-proANP) levels in patients with lower respiratory tract infections to evaluate its prognostic use for the severity of disease and outcome.. Prospective observational study. Setting. Emergency department of a university hospital.. A total of 545 consecutive patients with lower respiratory tract infections and 50 healthy controls. Interventions. MR-proANP was measured in serum from all patients using a new sandwich immunoassay.. MR-proANP levels (median [IQR], in pmol L(-1)) were significantly higher in patients with lower respiratory tract infections when compared with controls (138.0 [74.1-279.0] vs. 72.7 [62.5-89.5], P < 0.001), with highest levels in patients with community-acquired pneumonia (CAP). MR-proANP, but not C-reactive protein (CRP) levels, gradually increased with increasing severity of CAP, classified according to the pneumonia severity index (PSI) score (P < 0.001). On admission, MR-proANP levels were significantly higher in nonsurvivors when compared with survivors (293.0 [154.0-633.0] vs. 129.0 [71.4-255.0], P < 0.001). In a receiver operating characteristic (ROC) analysis for the prediction of survival of patients with CAP the area under the ROC curve (AUC) for MR-proANP was 0.69, similar when compared with the PSI (AUC 0.74, P = 0.31), and better when compared with other biomarkers, i.e. procalcitonin (AUC 0.57, P = 0.08), CRP (AUC 0.52, P = 0.02), and leucocyte count (AUC 0.56, P = 0.07).. MR-proANP levels are increased in lower respiratory tract infections, especially in CAP. Together with other clinical, radiographic and laboratory findings, MR-proANP levels might be helpful for the risk stratification in CAP.

Topics: Acute Disease; Aged; Atrial Natriuretic Factor; Biomarkers; Bronchitis; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chronic Disease; Community-Acquired Infections; Female; Humans; Leukocyte Count; Male; Pneumonia; Prognosis; Prospective Studies; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; ROC Curve; Severity of Illness Index

Early assessment of the severity and the etiology is crucial in the management of acute pancreatitis. To determine the value of procalcitonin (PCT) as a prognostic marker and as an indicator of biliary etiology in the early phase of acute pancreatitis.. In a prospective study, 75 consecutive patients were included (severe pancreatitis in 12 patients, biliary etiology in 42 cases). The value of PCT as a prognostic marker was compared to C-reactive protein (CRP), hematocrit (HCT), acute physiology and chronic health evaluation (APACHE) II score, and Ranson score. The value of PCT as an indicator of biliary etiology was compared to alanine aminotransferase (ALT) and alkaline phosphatase (AP). The area under the receiver operating characteristic curve (AUC) was applied as a measure of the overall accuracy of the single markers and multiple scoring systems.. The most accurate prediction of severe disease was provided by the APACHE II score on the day of admission (AUC: APACHE II, 0.78; CRP, 0.73; HCT, 0.73; and PCT, 0.61), and by CRP after 48 h (AUC: CRP, 0.94; Ranson score, 0.81; PCT, 0.71; APACHE II score, 0.69; and HCT, 0.46). ALT was the most accurate indicator of biliary pancreatitis (AUC: ALT, 0.83; AP, 0.81; and PCT, 0.68).. PCT is of limited additional value for early assessment of severity and etiology in acute pancreatitis. CRP is found to be a reliable prognostic marker with a delay of 48 h, while ALT is validated as the best indicator of biliary etiology.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Alanine Transaminase; APACHE; Biliary Tract Diseases; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Pancreatitis; Prognosis; Prospective Studies; Protein Precursors

This prospective study, performed in 76 children with a urinary tract infection (UTI), evaluates the diagnostic value of procalcitonin (PCT) and proinflammatory cytokines (IL-1beta, IL-6 and TNF-alpha) in children with acute pyelonephritis documented by dimercaptosuccinic acid scintigraphy (DMSA). Renal parenchymal involvement was assessed by (99m )Tc-DMSA scintigraphy within 7 days of admission. The diagnosis of acute pyelonephritis was confirmed only in patients with reversible lesions on scintigraphy. According to DMSA scan results, patients were divided into two groups, lower UTI or acute pyelonephritis. In acute pyelonephritis, serum PCT level was found to be significantly higher than it is in the lower UTI (p <0.001). Also, significantly higher serum proinflammatory cytokines (IL-1beta, IL-6 and TNF-alpha) levels were detected in those with acute pyelonephritis than those with lower UTI (p <0.001). We conclude that both serum PCT and proinflammatory cytokine levels may be used as accurate markers for diagnosis of acute pyelonephritis.

Topics: Acute Disease; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Inflammation Mediators; Interleukin-1; Interleukin-6; Kidney; Leukocyte Count; Male; Neutrophils; Protein Precursors; Pyelonephritis; Radionuclide Imaging; Sensitivity and Specificity; Tumor Necrosis Factor-alpha; Ultrasonography; Urinary Tract Infections

A total of 43 patients up to 15 years, who underwent appendectomy with preliminary diagnosis of acute appendicitis have been studied at M. Guramishvili Pediatric Clinic in 2004-2005 years. Procalcitonin concentration has been defined in patients' blood sera using the immunoluminometric method (LUMITest PCT, BRAHMS Diagnostika, Berlin, Germany). Analysis of procalcitonin in different groups of patients has shown that increase in procalcitonin correlates with disease severity, and maximally increases in case of peritonitis due to acute destructive appendicitis. The procalcitonin level can be used to confirm the diagnosis of acute appendicitis. It has been suggested that procalcitonin can be used not only as diagnostic marker for acute appendicitis but also as a prognostic marker of it's complications. Using of procalcitonin in case of acute appendicitis would help to carry out timely surgical interventions and predict disease complications.

Topics: Acute Disease; Adolescent; Appendectomy; Appendicitis; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Humans; Male; Peritonitis; Postoperative Complications; Protein Precursors

There is still no general agreement as to which patients suffering from attacks of acute biliary pancreatitis should undergo emergent endoscopic retrograde cholangiopancreatography (ERCP) with subsequent endoscopic intervention (endoscopic papilotomy, stent placement etc.). Many authors have described large differences in Procalcitonin (PTC) serum levels in patients suffering from biliary pancreatitis as opposed to patients whose acute pancreatitis is based on toxic etiology. Therefore, we have investigated the correlation of Procalcitonin serum levels with the presence of biliary obstruction in patients undergoing ERCP examination.. From 1.8.2004 to 31.3.2005, 97 patients undergoing ERCP were enrolled into the study. Blood samples were taken from each patient just before their ERCP examinations, and PCT serum levels were subsequently correlated to ERCP findings.. ERCP examinations were completed in 90 out of 97 patients. Bile ducts obstructions were confirmed in 61 out of 90 patients and the mean serum level of PTC was 0.078 ng/ml. In the remaining 29 patients ERCP revealed normal findings and the mean PCT value was 0.069 ng/ml. There was no statistical correlation between PCT serum levels and the presence of biliary obstruction on ERCP findings.. The measurement of PCT serum levels is of no help in the identification of patients, who should undergo emergent ERCP due to acute biliary pancreatitis (Tab. 1, Fig. 1, Ref. 6).

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Humans; Pancreatitis; Protein Precursors; Sensitivity and Specificity

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Pancreatitis; Protein Precursors

Procalcitonin (PCT) represents a new marker of systemic inflammatory reactions to bacterial infections. The main aim in this study was to determine the diagnostic value of PCT in predicting the clinical severity of febril neutropenic attacks, compare it with that of C-reactive protein (CRP), and clarify its importance in culture-positive attacks.. Between February 2001 and April 2002, 36 patients who were neutropenic due to various hematologic disorders and febrile were entered into the study. Blood samples were obtained on the first day of fever for the measurement of serum PCT and CRP levels.. In clinically severe neutropenic fever attacks, means of serum PCT and CRP levels were measured as 0.93+/-1.33 ng/mL and 67+/-24 mg/L, while they were 0.37+/-0.23 ng/mL and 32+/-19 mg/L in clinically mild ones (p = 0.033 and p < 0.001). On the other hand, no statistical significance was found between culture-positive and negative attacks when either serum PCT or CRP levels were taken into consideration (p = 0.133 and p = 0.141). The specificity and positive predictive value of the serum PCT test for severe febrile neutropenia was higher than that of the serum CRP test (0.80 vs. 0.57 and 0.50 vs. 0.39). However, sensitivity and negative predictive value for CRP were higher than the values for PCT (1.00 vs. 0.40 and 1.00 vs. 0.73). Diagnostic value and positive likelihood ratio of CRP for severe febrile neutropenia were higher than those of PCT (71 vs. 67 and 2.32 vs. 2.00).. PCT and CRP are comparable with each other in prediction of the clinical severity of febrile neutropenic attacks. Furthermore, serum CRP levels correlate with the duration of fever.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Fever; Humans; Leukemia, Myeloid; Lymphoma, Non-Hodgkin; Male; Middle Aged; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Predictive Value of Tests; Protein Precursors

The aim of our study was to further improve the preoperative diagnosis of acute appendicitis in children and adolescents. All diagnostic parameters from the patients' medical history (duration and quality of abdominal pain, stool behaviour), the laboratory (leukocytes, C-reactive protein), the clinic (defense, tenderness on percussion, nausea, vomiting, dry tongue) and repeated ultrasound investigations (visualisation of the appendix, indirect signs of an inflammatory process in the appendix region) were documented prospectively and were re-assessed with regard to their diagnostic value. As an additional parameter, procalcitonin was determined. 1156 patients (593 male/563 female) with a mean age of 9.51 years (+/- 1.2 yrs) (max. 15 yrs/min. 2.3 yrs), referred to the department with acute abdominal pain, were examined. 233 (141 male/92 female; 20.1 %) of these patients with a mean age of 10.47 years (+/- 1.1 yr) had appendicitis. Based on the patients' medical history, laboratory findings, the initial clinical investigation and the initial ultrasound investigation, 173 patients (74.3 % of the later operated 233 children with appendicitis) were diagnosed with certainty. The diagnosis of 60 patients (25.7 %) of this group remained uncertain. These patients received a saline enema (Clysmol, Pharmacia & Upjohn Company) and were subjected to a second clinical and sonographic investigation after approximately four hours of parenteral fluid substitution (Ringer's lactate, Mayrhofer Pharmazeutika Company, 4 ml/kg/h). The other 923 patients (79.83 %) were discharged and were followed up as outpatients in the following days. Based on this stepwise procedure, the percentage of correctly diagnosed appendicitis could be increased to 97.4 %. The measurement of procalcitonin proved to be of no value in the diagnosis of acute appendicitis. It may be concluded that in children with abdominal pain, high diagnostic accuracy can only be achieved by a carefully combined evaluation of all individual diagnostic parameters and repeated investigations.

Topics: Acute Disease; Adolescent; Algorithms; Appendicitis; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Pain Measurement; Prospective Studies; Protein Precursors

The procalcitonin (PCT) level in the blood was determined in cases of acute pancreatitis. The PCT level was found to show a significant correlation with the severity of acute pancreatitis. Furthermore, the PCT level was significantly higher in the cases which developed MODS than in those which did not. The PCT level was significantly higher in the patients who eventually died than in those who survived. A significant correlation was observed between the serum PCT level and the serum tumor necrosis factor alpha level. Thus, PCT level was found to be a reliable indicator of the severity of acute pancreatitis.

Topics: Acute Disease; Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Multiple Organ Failure; Pancreatitis; Protein Precursors; Severity of Illness Index; Tumor Necrosis Factor-alpha

Topics: Acute Disease; Adult; Bacteremia; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Fever; Humans; Protein Precursors; Sensitivity and Specificity

We analysed the clinical value of the procalcitonin quick test (PCT-Q; BRAHMS Diagnostica, GmbH, Berlin) in infected pancreatic necrosis verified by guided fine-needle aspiration (FNA). In a prospective, controlled study the results of 24 patients were evaluated during 2001. PCT-Q test was performed in patients with necrosis verified on CT scan and/or septic symptoms. If PCT-Q test was positive or septic complication (infected necrosis or abscess) developed CT or US guided fine-needle aspiration was performed with Gram staining and bacterial culture of the sample. Positive FNA result was indication for surgery with repeated staining and bacterial culture of the surgical specimen. Septic complications of pancreatic origin developed in 12 patients. Comparing the results fine-needle aspiration was more authentic with a sensitivity of 92% and a specificity of 100%, while the sensitivity of the PCT-Q test remained 75% and its specificity 83%. Comparing abscess and infected necrosis, significantly higher procalcitonin values were detected in patients with necrosis. These results show that PCT-Q test can be a possible non-invasive method besides fine-needle aspiration. Elevated levels of procalcitonin (higher than 2 ng/ml) clearly suggest infection of the necrosis, while lower values do not exclude the possibility of local septic progression.

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Biomarkers; Biopsy, Needle; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pancreatitis; Pancreatitis, Acute Necrotizing; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Severity of Illness Index; Shock, Septic

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Pancreatitis; Predictive Value of Tests; Protein Precursors

Severe acute pancreatitis is associated with an early increase in intestinal permeability and endotoxemia. Endotoxin is a potent stimulator for the production and release of procalcitonin and its components (calcitonin precursors; [CTpr]). The aim of this study is to evaluate the role of plasma CTpr as an early marker for gut barrier dysfunction in patients with acute pancreatitis.. Intestinal permeability to macromolecules (polyethylene glycol 3350), serum endotoxin and antiendotoxin core antibodies, plasma CTpr, and serum C-reactive protein (CRP) were measured on admission in 60 patients with acute pancreatitis. Attacks were classified as mild (n = 48) or severe (n = 12) according to the Atlanta criteria.. Compared with mild attacks of acute pancreatitis, severe attacks were significantly associated with an increase in intestinal permeability index (median: 0.02 vs. 0.006, P < 0.001), the frequency of endotoxemia (73% vs. 41%, P = 0.04), and the extent of depletion of serum IgM antiendotoxin antibodies (median: 43 MMU vs. 100 MMU, P = 0.004). Plasma CTpr levels were significantly elevated in patients with severe attacks compared with mild attacks on both the day of admission and on day 3 (median: 64 vs. 22 fmol/mL, P = 0.03; and 90 vs. 29 fmol/mL, P = 0.003 respectively). A positive and significant correlation was observed between the admission serum endotoxin and plasma CTpr levels on admission (r = 0.7, P < 0.0001) and on day 3 (r = 0.96, P < 0.0001), and between plasma CTpr on day 7 and the intestinal permeability index (r = 0.85, P = 0.0001). In contrast, only a weak positive correlation was observed between peak serum levels of CRP and plasma CTpr on admission (r = 0.3, P = 0.017) and on day 7 (r = 0.471, P = 0.049), as well as between CRP and each of the admission serum endotoxin (r = 0.3, P = 0.03) and the intestinal permeability index (r = 0.375, P = 0.007).. In patients with acute pancreatitis, plasma concentrations of CTpr appear to reflect more closely the derangement in gut barrier function rather than the extent of systemic inflammation.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Antibodies; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Endotoxemia; Endotoxins; Female; Humans; Inflammation; Intestines; Male; Middle Aged; Pancreatitis; Permeability; Polyethylene Glycols; Prognosis; Protein Precursors

A pilot study was designed to determine if serum procalcitonin levels would assist in the diagnosis of severe bacterial infections in patients presenting to an emergency department (ED) with acute sickle cell pain crisis and evidence of acute inflammatory response.. Prospective single cohort study evaluating measured procalcitonin levels in patients with sickle cell pain crisis and evidence of acute inflammation. Acute inflammation was defined as fever (>38 degrees C) and/or elevation in the white blood cell count (>4000 above baseline) and tachycardia (heart rate >100). Procalcitonin was measured using a semi-quantitative monoclonal antibody test. Patients were followed clinically to determine if procalcitonin has predictive value in excluding severe bacterial infections.. Twenty four subjects were enrolled and completed the study. Sixteen had levels 0.5 ng/ml or less, two had levels 0.5 to 2 ng/ml, one had a level of 2 but less than 10 ng/ml, and four had levels 10 ng/ml or greater. All subjects with documented infections at presentation had procalcitonin levels > or =2.0 ng/ml. The sensitivity of the test in this study sample was 1, and the specificity was 0.95 (95% CI, 0.75-0.99).. A serum procalcitonin less than 2 ng/ml appears to have good negative predictive value in excluding serious bacterial infections in patients that present with acute sickle cell pain crisis and evidence of acute inflammatory response. Further study is needed to investigate if procalcitonin has positive predictive value in identifying patients with serious bacterial infections in this patient population.

Topics: Acute Disease; Anemia, Sickle Cell; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Follow-Up Studies; Heart Rate; Humans; Infections; Inflammation; Leukocytes; Protein Precursors; Temperature

Early identification of patients with severe forms of acute pancreatitis (AP) and subsequent management of these high risk patients are the most important aims in order to decrease mortality from AP. Procalcitonin (PCT) as a marker for systemic inflammation appears to be a useful marker for early identification of severe forms.. 101 patients with confirmed AP have been admitted to department of general surgery. PCT values were measured in each patient on admission and after 12 hours. PCT levels were correlated to the disease's course and prognosis. Results are given through PPV and NPV. Immunoluminometric assay (BRAHMS Diagnostica) was used for measurement.. PPV and NPV for prediction of disease's course were better for PCT than for CRP PPV 64.7% versus 36% and NPV 82,6% versus 79.6% and for prediction of fatal outcome PCT reached 75% and 100% for cut off value 5 ng/ml.. PCT seems to be a useful screening parameter for detecting severe AP and for identifying the patients who need ICU treatment, ATB covering and who can benefit from the novel therapies.

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Glycoproteins; Humans; Outcome Assessment, Health Care; Pancreatitis; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Severity of Illness Index

To determine the relationship between plasma procalcitonin (PCT) levels, C-reactive protein (CRP), white blood cell count (WBC), ionized calcium (Ca2+), and patient outcome; and to compare the diagnostic and prognostic information provided by PCT and by CRP.. Prospective, observational study.. Intensive care unit.. Fifty-three patients with septic shock, consecutively diagnosed according to consensus guidelines.. None.. Blood was sampled at diagnosis and 24 and 48 hrs later and in a subgroup (n = 23) after 120 hrs. PCT was measured with LUMItest and CRP with Vitros slides. Ca2+ was calculated according to McLean-Hastings from calcium and protein levels on Vitros. In all 53 patients, PCT and CRP were elevated (>0.5 ng/mL and >10 mg/L, respectively) within 24 hrs after diagnosis. Nonsurvivors (n = 25) were older (p <.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (p =.02) at diagnosis but did not differ in sepsis etiology, medical history, sex ratio, levels of PCT, CRP, and Ca2+, or WBC count at any time point. Using logistic regression, initial PCT levels were correlated with CRP values (p =.001) and APACHE II score (p <.05), but not with age, gender, Ca2+ levels, survival, or type of pathogen. Within 48 hrs, however, PCT levels decreased more frequently from baseline in survivors than in nonsurvivors (80% vs. 41%, p <.05). Likewise, CRP levels decreased more often in survivors (100% vs. 64%, p <.05) but only at 120 hrs.. PCT levels were correlated with the severity of disease at onset (APACHE II) and inflammation (CRP) but not with Ca2+ levels. Inaugural PCT or CRP levels per se poorly predicted outcome but decreasing levels were associated with a higher probability of survival. In this respect, PCT was found to be an earlier marker than CRP.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Calcium; Female; Humans; Intensive Care Units; Leukocyte Count; Male; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; Shock, Septic

The ability of measurement of serum procalcitonin (PCT) levels to differentiate bacteremic from nonbacteremic infectious episodes in patients hospitalized for community-acquired infections was assessed. Serum samples were obtained from adult inpatients with fever to determine the serum PCT level, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR). Of 165 patients, 22 (13%) had bacteremic episodes and 143 (87%) had nonbacteremic episodes. PCT levels, CRP levels, and ESRs were significantly higher in bacteremic patients than in nonbacteremic patients (P<.001,.007, and.024, respectively). The best cutoff value for PCT was 0.4 ng/mL, which was associated with a negative predictive value of 98.8%. Area under the receiver operating characteristic curve was 0.83 for PCT, which was significantly higher than that for CRP (0.68; P<.0001) and ESR (0.65; P<.05). A serum PCT level of <0.4 ng/mL accurately rules out the diagnosis of bacteremia. The use of PCT assessment could help physicians limit the number of blood cultures to be processed and the number of antibiotic prescriptions.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Diagnosis, Differential; Female; Fever; Fever of Unknown Origin; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Predictive Value of Tests; Protein Precursors; Sensitivity and Specificity

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured serum procalcitonin (PCT) levels and compared these with other commonly used inflammatory markers. We evaluated the ability of serum PCT levels to predict renal involvement, as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. Serum C-reactive protein (CRP), leukocyte counts, and PCT levels were measured in 64 children admitted for suspected UTI. Renal parenchymal involvement was assessed by (99m)Tc-DMSA scintigraphy in the first 7 days after admission. In acute pyelonephritis, the median PCT level was significantly higher than in the lower UTI group (3.41, range 0.36-12.4 microg/l vs. 0.13, range 0.02-2.15 microg/l, P<0.0001). In these two groups, respectively, median CRP levels were 120 (range 62-249 mg/l) and 74.5 (range 14.5-235 mg/l, P=0.012) and leukocyte counts were 15,910/mm(3) (range 10,200-26,900) and 14,600/mm(3) (range 8,190-26,470, P=0.34). For the prediction of acute pyelonephritis, the sensitivity and specificity of PCT were 94.1% and 89.7%, respectively; CRP had a sensitivity of 100%, but a specificity of 18.5%. We conclude that serum PCT may be an accurate marker for early diagnosis of acute pyelonephritis.

Topics: Acute Disease; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Diagnosis, Differential; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Kidney; Leukocyte Count; Male; Prognosis; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Urinary Tract Infections

Early identification of patients who subsequently develop severe acute pancreatitis would enable the selection of patients who may benefit from early intensive management. Because severe acute pancreatitis is characterized by the development of systemic inflammation the authors studied whether procalcitonin, a marker of systemic inflammation, differentiated between patients with mild and severe acute pancreatitis.. On admission and 24 h thereafter, serum procalcitonin level was measured by a rapid, semiquantitative PCT-Q test and serum C-reactive protein (CRP) by an immunoturbidimetric method in a consecutive series of 162 patients with acute pancreatitis. There were 38 severe and 124 mild cases. The accuracy of procalcitonin and CRP in predicting severe acute pancreatitis was compared with that of Ranson and Acute Physiology and Chronic Health Evaluation (APACHE) II scores.. The PCT-Q test was more accurate in predicting severe acute pancreatitis (sensitivity 92 per cent and specificity 84 per cent at 24 h) than CRP, APACHE II score and Ranson score. Its negative predictive value was high (97 per cent at 24 h), and it detected each patient who developed subsequent organ failure (n = 22).. The PCT-Q test was a useful screening method for detecting severe acute pancreatitis. It is simple and quick to perform and, unlike currently available multiple factor scoring systems, can easily be adopted into routine clinical practice.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Analysis of Variance; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Length of Stay; Male; Middle Aged; Pancreatitis; Prospective Studies; Protein Precursors; Reagent Strips; Sensitivity and Specificity

Topics: Acute Disease; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Graft Rejection; Heart Transplantation; Heart-Lung Transplantation; Humans; Immunoassay; Infections; Lung Transplantation; Postoperative Complications; Protein Precursors; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Statistics, Nonparametric

Topics: Acute Disease; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Pancreatitis; Protein Precursors; Reagent Strips; Sensitivity and Specificity

Infection of pancreatic necrosis (IN) has a major impact on management and outcome in acute pancreatitis (AP). Currently, guided fine-needle aspiration (FNA) is the only means for an accurate diagnosis of IN. Procalcitonin (PCT), a 116 amino acid pro-peptide of calcitonin has been found in high concentrations in patients with sepsis. In the present study we analyzed the clinical value of serum PCT for predicting IN in AP and compared the results to guided FNA.. Clinical study.. A collaborative study between the Departments of General Surgery and Clinical Chemistry/ Pathobiochemistry of the University of Ulm, Germany.. 61 patients with AP entered this study and were stratified into three groups according to morphological and bacteriological data: I. 22 patients with edematous pancreatitis (AIP), II. 18 patients with sterile necrosis (SN), III. 21 patients with IN.. During an observation period of 14 days PCT was measured by immunoluminometry, CRP was determined by lasernephelometry on a routine base. In patients with IN overall PCT concentrations were significantly higher than in those with SN, whereas CRP levels did not differ in both groups. In contrast, only low concentrations of both parameters were found in patients with AIP. By ROC analysis the best PCT cut-off level for predicting IN or persisting pancreatic sepsis was obtained at > or =1.8 ng/ml. If this cut-off was reached on at least two consecutive days, IN could be predicted with a sensitivity of 95%, a specificity, of 88%, and an accuracy of 90%. Guided FNA achieved a sensitivity, specificity, and accuracy of 91%. 79%, and 84% in differentiating IN from SN, respectively. After surgical treatment of IN median PCT values continued to be significantly higher in patients with persisting pancreatic sepsis (n=12) compared to those with an uneventful postoperative course (n=7). Our results demonstrate that monitoring of serum PCT could serve as a noninvasive and accurate method to predict IN in AP as well as to select patients with persisting septic complications after surgical debridement.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Germany; Humans; Male; Middle Aged; Necrosis; Pancreas; Pancreatitis, Acute Necrotizing; Prognosis; Protein Precursors; Sensitivity and Specificity; Statistics, Nonparametric

To evaluate the accuracy of procalcitonin (PCT) in predicting bacterial infection in ICU medical and surgical patients.. A 10-bed medical surgical unit.. PCT, C-reactive protein (CRP), interleukin 6 (IL-6) dosages were sampled in four groups of patients: septic shock patients (SS group), shock without infection (NSS group), patients with systemic inflammatory response syndrome related to a proven bacterial infection (infect. group) and ICU patients without shock and without bacterial infection (control group).. Sixty patients were studied (SS group:n=16, NSS group,n=18, infect. group,n=16, control group,n=10). The PCT level was higher in patients with proven bacterial infection (72+/-153 ng/ml vs 2.9+/-10 ng/ml,p=0.0003). In patients with shock, PCT was higher when bacterial infection was diagnosed (89 ng/ml+/-154 vs 4.6 ng/ml+/-12,p=0.0004). Moreover, PCT was correlated with severity (SAPS:p=0.00005, appearance of shock:p=0.0006) and outcome (dead: 71.3 g/ml, alive: 24.0 g/ml,p=0.006). CRP was correlated with bacterial infection (p<10(-5)) but neither with SAPS nor with day 28 mortality. IL-6 was correlated with neither infection nor day 28 mortality but was correlated with SAPS. Temperature and white blood cell count were unable to distinguish shocked patients with or without infection. Finally, when CRP and PCT levels were introduced simultaneously in a stepwise logistic regression model, PCT remained the unique marker of infection in patients with shock (PCT> or =5 ng/ml, OR: 6.2, 95% CI: 1.1-37,p=0.04).. The increase of PCT is related to the appearance and severity of bacterial infection in ICU patients. Thus, PCT might be an interesting parameter for the diagnosis of bacterial infections in ICU patients.

Topics: Acute Disease; Adult; Aged; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Critical Illness; Female; France; Glycoproteins; Humans; Intensive Care Units; Interleukin-6; Male; Middle Aged; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Severity of Illness Index; Shock, Septic

Infected pancreatic necrosis (IPN) is the main cause of death in patients with severe acute pancreatitis. Therefore an early prediction of IPN is of utmost importance.. Analysis of new blood variables as potential early predictors to differentiate between IPN and sterile pancreatic necrosis (SPN).. 64 consecutive patients with acute pancreatitis were enrolled in this prospective study; 29 were suffering from acute oedematous pancreatitis (AIP), and 35 from necrotising disease (NP) as diagnosed by contrast enhanced computed tomography.. Procalcitonin (PCT) and granulocyte colony stimulating factor (G-CSF) in the serum were examined and compared with C reactive protein (CRP). CRP was measured with a turbidimetric immunoassay (Autokit CRP; Wako, Osaka, Japan), and PCT and G-CSF by ELISA (Lumitest PCT; Brahms Diagnostica, Berlin, Germany; G-CSF-Elisa; R&D Systems, Abingdon, Oxon, UK). Monitoring was performed daily and related to the onset of symptoms.. Within the first week, all three variables (CRP, PCT, and G-CSF) were significantly higher in patients with NP than in those with AIP (CRP, p<0.001; G-CSF, p<0. 001; PCT, p<0.001). During the course of the study, 12 of the 35 patients with NP developed late IPN after a median of 20.5 (range 3-49) days. Neither the peak nor the lowest concentrations during the monitoring period were of any value for predicting IPN (median peak values in SPN v IPN: PCT, 0.93 v 1.93 ng/ml; G-CSF, 347 v 421 pg/ml; CRP, 270 v 325 mg/l).. Serum PCT, G-CSF, and CRP concentrations are of similar value for early differentiation between mild and severe acute pancreatitis. However, these variables are not suitable for the early prediction of IPN.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Biomarkers; C-Peptide; Calcitonin; Calcitonin Gene-Related Peptide; Female; Granulocyte Colony-Stimulating Factor; Humans; Male; Middle Aged; Necrosis; Pancreatitis, Acute Necrotizing; Protein Precursors

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Pancreatitis; Protein Precursors; Severity of Illness Index

Leptospirosis is a zoonosis, with clinical manifestations ranging from the imperceptible to severe, potentially fatal renal and liver failure accompanied by haemorrhage and jaundice. In this case report of a patient with severe leptospirosis, serum levels of procalcitonin decreased ahead of any obvious clinical improvement, and thus may be useful as a prognostic marker. Levels of soluble IL-2 receptor were very high and correlated well with the clinical course.

Topics: Acute Disease; Agglutination Tests; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Humans; Immunoassay; Interleukin-6; Leptospira; Leptospirosis; Male; Middle Aged; Prognosis; Protein Precursors; Receptors, Interleukin-2; Treatment Outcome; Tumor Necrosis Factor-alpha

Amyloid A (SAA) and procalcitonin (PCT) have been reported as useful indicators of inflammation. Our aim was to assess the utility of SAA and PCT in establishing the severity of acute pancreatitis in comparison to C-reactive protein (CRP): Thirty-one patients with acute pancreatitis enrolled within 24 hr from the onset of pain and 31 healthy subjects were studied. Nineteen patients had mild acute pancreatitis, and 12 had severe pancreatitis. Serum SAA, PCT, and CRP were measured in all subjects at admission and, in acute pancreatitis patients, during the following five days. Patients with acute pancreatitis had serum concentrations of SAA, PCT, and CRP significantly higher (P < 0.001) than those of healthy subjects during the entire study period. Using cutoff values ranging from 240 to 250 mg/liter for SAA, from 0.252 to 0.255 ng/ml for PCT, and from 12.8 to 12.9 mg/dl for CRP, the sensitivity (calculated on patients with severe pancreatitis), the specificity (calculated on patients with mild pancreatitis), and the efficiency (calculated as the percentage of correct classifications) were 76.8%, 69.3%, and 72.4% for SAA; 21.7%, 83.2%, and 58.2% for PCT; and 60.9%, 89.1%, and 77.6% for CRP. In conclusion, the sensitivity of SAA is significantly higher than that of PCT and CRP in assessing the severity of pancreatitis, whereas PCT and CRP had a specificity significantly higher than SAA. The accuracy and efficiency were similar for SAA and CRP, and both these markers had an accuracy and efficiency significantly higher than those of PCT.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Pancreatitis; Protein Precursors; Reference Values; ROC Curve; Serum Amyloid A Protein; Severity of Illness Index

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been suggested as a model for acute pancreatitis (AP), which allows evaluation of early alterations in the time course of the disease. The influence of the clinical course on procalcitonin (PCT), serum amyloid A (SAA), and several proinflammatory and inhibitory cytokines was evaluated in patients with AP following ERCP. Blood samples were prospectively collected from patients undergoing ERCP. The incidence of ERCP-induced pancreatic damage, defined as abdominal complaints, a threefold increase of serum lipase, and elevation of CRP from <10 to >20 mg/liter was 12.8% (12/94). Only mild clinical courses of acute pancreatitis were observed. PCT significantly increased in subjects with post-ERCP pancreatitis after 24 hr. However, PCT levels did not exceed 0.5 ng/ml in any patient. Interleukin-1 receptor antagonist (IL-1RA) began to differ from baseline 2 hr after ERCP, followed by interleukin-6 (IL-6, 6 hr), solubilized tumor necrosis factor-alpha receptor II (sTNF-alphaRII, 24 hr) and SAA (24 hr). Interleukin 10 (IL-10) showed marked interindividual variations with no obvious peak. Among all parameters evaluated, only peak values of IL-6 and IL-10 showed significant correlations with the reported pain score (r2 = 0.62/0.78), degree of ampullar irritation (r2 = NS/0.87), and the duration of ERCP (r2 = 0.58/0.76). No correlation was found with the volume of the injected contrast agent. We conclude that IL-10 and IL-6 appear to be useful to monitor patients after ERCP. The absence of any PCT elevation in the present study is in accordance with the clinical course of the patients who suffered from mild pancreatic damage without systemic or infectious complications.

Topics: Acute Disease; Acute-Phase Proteins; Adult; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cholangiopancreatography, Endoscopic Retrograde; Female; Humans; Interleukins; Lipase; Male; Middle Aged; Pancreatitis; Prospective Studies; Protein Precursors; Receptors, Tumor Necrosis Factor; Serum Amyloid A Protein; Sphincterotomy, Endoscopic

Elevated serum levels of the prohormone of calcitonin (CT), procalcitonin (ProCT), have been documented in illnesses such as inhalational burn injury, in several sepsis syndromes, and in endotoxemia. In this study, we measured and characterized the circulating precursor forms of CT during the course of infectious pneumonitis. The initial (mean +/- SEM) serum total multiform CT level in 12 patients with acute infectious pneumonia was 1,019 +/- 430 pg/mL. In comparison, the mean level of total CT for 19 age-matched control patients without lung disease was 32 +/- 6 pg/mL (P < 0.001). The mean serum total CT level on initial examination was greater in the 6 patients with bacterial isolates, at 1,793 +/- 752 pg/mL, than in those with nonbacterial infectious pneumonia, at 242 +/- 109 pg/mL (P = 0.018). After admission to the hospital, patients' serum total CT progressively declined concomitantly with the clinical resolution of the pneumonia; at discharge, mean serum level was 121 +/- 34 pg/mL. On discharge, the patients who had persistent radiographic abnormalities had significantly higher levels than did those who had complete resolution. Both the mean serum calcium and phosphate were significantly lower at the initial time of study than at discharge (P < 0.002 and P < 0.0004, respectively). Gel filtration chromatography of sera obtained during the acute pneumonitis phase revealed increased levels of precursor forms of CT, including ProCT; these levels diminished with clinical resolution. In an additional three patients, the serum total CT increased very rapidly after aspiration (within 6 to 12 hours); the peak levels were several times greater than the upper limits of normal. In these patients, the principal serum CT components were ProCT and other precursor forms. These results show that both infectious and aspiration pneumonitis are associated with a rapid increase in circulating ProCT and other precursor forms of CT.

Topics: Acute Disease; Aged; Calcitonin; Calcitonin Gene-Related Peptide; Calcium; Chromatography, Gel; Humans; Longitudinal Studies; Male; Middle Aged; Phosphates; Pneumonia; Pneumonia, Aspiration; Pneumonia, Bacterial; Protein Precursors; Radioimmunoassay

The prognostic value of serum procalcitonin levels in 43 patients with acute melioidosis, an infection with a wide range of clinical manifestations, was assessed. In eight patients with mild localized infections, the median procalcitonin levels were 0.13 ng/mL (range, 0.02-0.46 ng/mL), which were similar to those in 19 healthy controls (median, 0.07 ng/mL; range, 0.03-0.15 ng/mL). In the patients with severe infections, the initial procalcitonin levels were significantly higher in the patients who died (median, 350 ng/mL; range, 63-3,538 ng/mL) than in the survivors (median, 19 ng/mL; range, 0.55-387 ng/mL) (P < .0001); 16 of 19 patients with procalcitonin levels of > 100 ng/mL died, compared with 2 of 16 patients with levels of < 100 ng/mL (relative risk, 6.7; 95% confidence interval, 1.8-25; P = .0001). In those patients who survived, the subsequent procalcitonin levels reflected closely the clinical course of their infection. The serum concentration of procalcitonin correlates well with the severity of Pseudomonas pseudomallei infection and is comparable with other acute-phase markers. However, this prognostic indicator and marker of continuing disease activity is not specific to melioidosis and could be applied to other severe infections.

Topics: Acute Disease; Adolescent; Adult; Aged; Calcitonin; Calcitonin Gene-Related Peptide; Disease Progression; Female; Glycoproteins; Humans; Male; Melioidosis; Middle Aged; Protein Precursors