calca-protein--human and Burns

Sepsis is one of the main causes of mortality in severe burns. However, it is difficult to diagnose early. Procalcitonin (PCT) has been reported as a biomarker for sepsis with controversial results. The aim of the study is to assess the diagnostic value of serum PCT for sepsis in burn patients through a meta-analysis of published studies.. A comprehensive literature search of PubMed, Embase, Web of Science and the Cochrane Library databases for studies published up to 1st March 2014 that evaluated PCT as a marker for diagnosing sepsis in burn patients was conducted. The summary receiver operating characteristic curves served to evaulate overall test performance. Meta-Disc 1.4 software and Stata 12.1 were used to analyze the data.. A total of 566 patients (samples) from nine trials were identified and analyzed. The pooled sensitivity and specificity were 0.74 and 0.88, respectively. No threshold effect was found among studies. The area under the SROC curve (AUC) was 0.92.. The results suggest that serum PCT is a useful biomarker (AUC=0.92) for early diagnosis of sepsis in burn patients. However, the results should be used with caution, because of obvious heterogeneity among those studies. Further large-scale research should regard more attention to the uniform cut-off value, and laboratories test methods.

Topics: Area Under Curve; Biomarkers; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Humans; Protein Precursors; Sensitivity and Specificity; Sepsis

The purpose of this systematic review was to assess the evidence for use of routine procalcitonin testing to diagnose the presence of sepsis in the burn patient. The electronic databases MEDLINE, Cochrane, CINAHL, ProQuest, and SCOPUS were searched for relevant studies using the MeSH terms burn, infection, procalcitonin, and meta-analysis. The focus of the review was the adult burn population, but other relevant studies of critically ill patients were included as data specific to the patient with burns are limited. Studies were compiled in tabular form and critically appraised for quality and level of evidence. Four meta-analyses, one review of the literature, one randomized controlled trial, nine prospective observational, and three retrospective studies were retrieved. Six of these studies were specific to the burn population, with one specific to burned children. Only one meta-analysis, one adult burn and one pediatric burn study reported no benefit of procalcitonin testing to improve diagnosis of sepsis or differentiate sepsis from non-infectious systemic inflammatory response. The collective findings of the included studies demonstrated benefit of incorporating procalcitonin assay into clinical sepsis determination. Evaluation of the burn specific studies is limited by the use of guidelines to define sepsis and inconsistent results from the burn studies. Utility of the procalcitonin assay is limited due to the lack of availability of rapid, inexpensive tests. However, it appears procalcitonin assay is a safe and beneficial addition to the clinical diagnosis of sepsis in the burn intensive care unit.

Topics: Adult; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Humans; Protein Precursors; Sepsis

To investigate the changes in plasma gelsolin (pGSN) levels in severe burn patients with sepsis, and to evaluate the prognosis of patients when combined with other related clinical indexes.. Sixty-five severe burn patients with sepsis hospitalized from June 2013 to June 2015 conforming to the study criteria were divided into death group (n=24) and survival group (n=41) according to the clinical outcome on post sepsis diagnosis day (PSD) 28. The pGSN levels of patients were determined on PSD 1, 3, 7, and 14 with double antibody sandwich enzyme-linked immunosorbent assay. The serum level of C-reactive protein (CRP), serum level of procalcitonin, lactate level of arterial blood, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sequential Organ Failure Assessment (SOFA) score were determined or recorded on PSD 1. Data were processed with repeated measurement analysis of variance, t test, and chi-square test. On PSD 1, the pGSN level, serum level of CRP, serum level of procalcitonin, lactate level of arterial blood, APACHE II score, and SOFA score of 65 patients were collected to screen the independent risk factors related to death with single factor and multi-factor Logistic regression analysis. Receiver operating characteristic (ROC) curves of the independent risk factors related to death were plotted to evaluate the predictive power for death in 65 patients.. (1) The pGSN levels of patients in death group on PSD 1, 3, 7, and 14 were respectively (146±44), (85±24), (28±7), and (19±4) mg/L, obviously lower than those in survival group [(287±82), (179±51), (196±56), and (249±67) mg/L, with t values from 1.735 to 4.304, P<0.05 or P<0.01]. (2) The serum level of CRP, serum level of procalcitonin, lactate level of arterial blood, APACHE II score, and SOFA score of patients in death group on PSD 1 were respectively (56±7) mg/L, (12.54±0.82) μg/L, (2.74±0.27) mmol/L, (24.3±2.4) points, and (11.43±0.57) points, significantly higher than those in survival group [(35±4) mg/L, (2.38±0.16) μg/L, (1.83±0.12) mmol/L, (15.0±1.5) points, and (7.22±0.23) points, with t values from 1.902 to 3.883, P<0.05 or P<0.01]. (3) Multi-factor Logistic regression analysis showed that the pGSN level (odds ratio: 6.83, 95% confidence interval: 4.33-10.25, P<0.01) and APACHE II score (odds ratio: 5.27, 95% confidence interval: 2.28-9.16, P<0.01) were the independent risk factors related to death in 65 patients on PSD 1. (4) The total areas under the ROC curves of pGSN level and APACHE II score for predicting death of 65 patients on PSD 1 were respectively 0.89 and 0.86, and 142 mg/L and 21 points were respectively chosen as the optimal threshold values, with sensitivity of 87% and 83% and specificity of 86% and 89%.. For severe burn patients with sepsis, lowering of pGSN level and elevation of APACHE II score are obviously correlated with increase in case fatality rates. Monitoring the dynamic changes in pGSN level and APACHE II score during the early stage may be useful to predict the prognosis of severe burn patients with sepsis.

Topics: Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Enzyme-Linked Immunosorbent Assay; Gelsolin; Hospitalization; Humans; Organ Dysfunction Scores; Prognosis; Protein Precursors; Regression Analysis; Risk Factors; ROC Curve; Sepsis; Severity of Illness Index

Infection and septic complications in burn patients can be monitored by procalcitonin (PCT) and neopterin plasma values. The aim of the study was to investigate serum neopterin and PCT levels with WBC (white blood cell) and CRP (C-reactive protein) levels in patient group (PG) and healthy control group (HCG) and to investigate the relationship of these markers with burn wound infections (BWI). As the PG, 23 patients between 0-12 ages and up to 30% Total Body Surface Area (TBSA) burned and 15 HCG were included. PCT, neopterin, WBC, and CRP results on the first, the seventh, the fourteenth and the 21st day have been compared. During the follow-up period, 11 patients with BWI and 12 patients without BWI were classified as infected and non-infected patients, respectively. PCT and neopterin levels were detected higher in patients with BWI but no significant difference were present. Also, PCT and neopterin levels within the first 24 hours following the burn were detected higher in PG than HCG. CRP and WBC levels were detected high due to burn trauma. PCT and neopterin levels were increased in patients with BWI. PCT levels were increased during the pre-infectious period, while neopterin levels increased during the post-infectious period.

Topics: Biomarkers; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Humans; Infant; Male; Neopterin; Protein Precursors; Wound Infection

To analyze the changes in serum procalcitonin (PCT) in patients with extremely severe burn and sepsis, and to evaluate its clinical significance in the prognosis of patients.. Thirteen patients with extremely severe burn and sepsis injured in the aluminum dust explosion accident, which occurred in Kunshan of Jiangsu province, were admitted to our unit on August 2nd, 2014. They were involved in this retrospective study and divided into death group (n=5) and survival group (n=8) according to the outcome. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and Sequential Organ Failure Assessment (SOFA) score at post admission hour (PAH) 24 were compared among the patients between two groups. Serum level of PCT, serum level of C-reactive protein (CRP), white cell count, neutrophils, platelet count, level of aspartate transaminase (AST), level of prealbumin (PA), level of creatinine, level of urea nitrogen, and level of blood sodium were compared among the patients between two groups in post admission week (PAW) 1, 2, 3, and 4. Data were processed with Fisher's exact test, analysis of variance for repeated measurement, t test, and Mann-Whitney test. Receiver operating characteristic (ROC) curves of serum PCT values were plotted to evaluate the predictive value for death of 13 patients in PAW 3 and 4.. The differences in APACHE Ⅱ score and SOFA score at PAH 24 and serum level of CRP, white cell count, level of AST, level of creatinine, level of urea nitrogen, and level of blood sodium from PAW 1 to 4 of the patients between two groups were not statistically significant (with t values from -1.164 to 0.587, Z values from -1.872 to -0.442, P values above 0.05). The serum levels of PCT in patients of death group in PAW 3 and 4 were respectively (15.8±14.9) and (13.6±5.6) ng/mL, which were significantly higher than those of survival group [(2.4±1.8) and (4.9±6.1) ng/mL, with Z values respectively -2.635 and -2.208, P<0.05 or P<0.01]. The serum levels of PCT of patients in death group and survival group in PAW 1 and 2 were close (with Z values respectively -0.732 and -1.025, P values above 0.05). Compared with those of survival group, neutrophils in PAW 4 was significantly increased (t=-3.690, P<0.01), the platelet count in PAW 4 was significantly decreased (t=4.858, P<0.01), and the level of PA in PAW 2 was significantly increased in patients of death group (t=-2.320, P<0.05). There were no statistically significant differences in neutrophils, platelet count, and the level of PA at the other time points of patients between death group and survival group (with t values from -1.562 to 1.904, P values above 0.05). The total areas under ROC curves of serum level of PCT for predicting death of 13 patients with extremely severe burn and sepsis in PAW 3 and 4 were respectively 0.938 and 0.906, and 7.45 ng/mL and 8.77 ng/mL were respectively chosen as the optimal threshold values, with sensitivity of 75.0% and 100.0% and specificity of 100.0% and 87.5%.. Serum level of PCT in PAW 3 and 4 can be used as the vital prognostic indicators for patients with extremely severe burn and sepsis, and it can be considered as a guide for rational treatment in clinic.

Topics: Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Prognosis; Protein Precursors; Retrospective Studies; ROC Curve; Sepsis

To explore the effects of oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury at early stage.. Twenty-four patients with severe burn injury admitted to our burn ward from August 2013 to September 2014, conforming to the study criteria, were divided into conventional therapy group (n = 12) and early enteral feeding group (n = 12) according to the random number table. Patients in conventional therapy group received conventional treatment immediately after admission, while those in early enteral feeding group were orally given 100 mL of a mixture of glutamine, probiotics, and prebiotics once a day besides conventional treatment for 7 days. Serum levels of diamine oxidase (DAO) and procalcitonin (PCT) and plasma level of LPS were determined by ELISA before treatment and on treatment day (TD) 1, 3, 7, 14, and 21. Wound secretion and blood samples were collected for bacterial culture within the 21 TD. The incidence of MODS within the 21 TD was observed. Data were processed with Fisher's exact test, rank sum test, analysis of variance for repeated measurement, and LSD-t test.. (1) Serum levels of DAO in patients of early enteral feeding group on TD 7, 14, and 21 were respectively (14.9 ± 3.7), (12.4 ± 3.1), and (9.5 ± 0.7) ng/mL, which were significantly lower than those of conventional therapy group [(17.5 ± 4.0), (16.3 ± 3.3), and (13.0 ± 1.1) ng/mL, with t values from 2.913 to 15.304, P values below 0.01]. Serum levels of DAO at the other time points were close between the two groups (with t values from -0.598 to 0.139, P values above 0.05). (2) Compared with serum levels of PCT in patients of conventional therapy group [(11.7 ± 20.9) and (12.9 ± 23.9) ng/mL], those of early enteral feeding group were significantly lower on TD 7 and 14 [(2.7 ± 8.1) and (2.0 ± 5.6) ng/mL, with Z values respectively -2.919 and -2.139, P < 0.05 or P < 0.01]. Serum levels of PCT at the other time points were close between the two groups (with Z values from -1.833 to -0.346, P values above 0.05). (3) Plasma level of LPS in patients of early enteral feeding group on TD 7 was (33 ± 56) pg/mL, which was significantly lower than that of conventional therapy group [(102 ± 108) pg/mL, Z = -2.046, P < 0.05]. Plasma levels of LPS at the other time points between the two groups showed no significant difference (with Z values from -2.003~-0.526, P values above 0.05). (4) Positive results in bacterial culture of wound secretion were approximately the same between the two groups (P > 0.05). Bacterial culture of blood was positive in 7 patients of conventional therapy group and 1 patient of early enteral feeding group, showing significantly statistical difference (P < 0.05). MODS was observed in 1 patient of conventional therapy group, showing no significantly statistical difference with that of early enteral feeding group (no patient, P > 0.05).. Early intestinal feeding of mixed enteral nutritional agent in addition to conventional therapy can effectively promote repair of the impairment of intestinal mucosal barrier, protect integrity of intestinal mucosa, reduce damage to intestines, and alleviate inflammatory response in patients suffering from severe burn injury.

Topics: Administration, Oral; Amine Oxidase (Copper-Containing); Burns; Calcitonin; Calcitonin Gene-Related Peptide; Enteral Nutrition; Female; Glutamine; Humans; Intestinal Mucosa; Protein Precursors; Treatment Outcome; Wound Healing

To investigate the effects of application of intermittent hemofiltration combined with hemoperfusion (HP) in the early stage of severe burn in the prevention and treatment of sepsis.. Forty severely burned patients, admitted to our burn ward from June 2011 to March 2013, conforming to the study criteria, were divided into conventional treatment group (CT, n=20) and blood purification group (BP, n=20) according to the random number table. Patients in group CT received CT according to the accepted principles of treatment for a severe burn. Patients in group BP received CT and intermittent hemofiltration combined with HP once respectively on post injury day (PID) 3, 5, and 7, spanning 6 to 8 hours for each treatment. On PID 3, 5, 7, 10, and 14, body temperature, heart rate, and respiratory rate were recorded; white blood cell count (WBC), neutrophil granulocytes, blood urea nitrogen (BUN), and creatinine were determined; levels of IL-1, IL-6, TNF-α, and high-mobility group box 1 (HMGB1) in serum were determined by ELISA; level of LPS in serum was determined with the chromogenic substrate limulus amebocyte lysate method; level of procalcitonin (PCT) in serum was determined by double antibody sandwich immune chemiluminescence method. The symptoms and signs of sepsis were observed during the treatment. Data were processed with Fisher's exact test, chi-square test, analysis of variance for repeated measurement, and LSD-t test.. (1) Except for that on PID 5, the mean body temperature of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.87 to 2.97, P values below 0.05). The heart rate was significantly slower in patients of group BP than in group CT from PID 3 to 14 (with t values from 1.78 to 3.59, P values below 0.05). Except for that on PID 3, the respiratory rate of patients in group BP was significantly slower than that of group CT at each of the rest time points (with t values from 1.93 to 2.85, P values below 0.05). (2) The levels of WBC, neutrophil granulocytes, BUN, and creatinine of patients in group BP were significantly lower than those of group CT (with t values from 1.78 to 4.23, P values below 0.05). (3) Except for that on PID 3, the level of IL-1 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.97 to 4.16, P values below 0.05). Except for that on PID 7, the level of IL-6 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 2.11 to 6.34, P values below 0.05). The levels of TNF-α and HMGB1 of patients in group BP were significantly lower than those of group CT from PID 3 to 14 (with t values from 1.98 to 5.29, P values below 0.05). (4) On PID 3, 5, 7, 10, and 14, the levels of LPS and PCT of patients in group BP were respectively (0.23 ± 0.07), (0.27 ± 0.09), (0.22 ± 0.06), (0.20 ± 0.08), (0.15 ± 0.07) EU/mL, and (0.44 ± 0.12), (0.67 ± 0.13), (0.74 ± 0.13), (0.64 ± 0.12), (0.71 ± 0.10) ng/mL, and they were lower than those of group CT [(0.37 ± 0.08), (0.45 ± 0.09), (0.56 ± 0.09), (0.48 ± 0.08), (0.40 ± 0.08) EU/mL, and (0.74 ± 0.11), (1.16 ± 0.12), (1.40 ± 0.13), (1.55 ± 0.15), (1.49 ± 0.14) ng/mL, with t values from 1.88 to 3.43, P values below 0.05]. (5) The incidence of sepsis of patients in group BP was obviously lower than that of group CT (χ² = 6.94, P<0.01).. Intermittent hemofiltration combined with HP can effectively improve blood biochemical indexes and vital signs and reduce the occurrence of burn sepsis by decreasing the levels of proinflammatory cytokines, LPS, and PCT.

Topics: Biomarkers; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Hemofiltration; Hemoperfusion; HMGB1 Protein; Humans; Interleukin-1; Interleukin-10; Interleukin-6; Protein Precursors; Sepsis; Serum; Severity of Illness Index; Treatment Outcome; Tumor Necrosis Factor-alpha

Neutrophil gelatinase associated lipocalin (NGAL) is a novel predictor of acute kidney injury (AKI), which increases with inflammation. We aimed to assess whether serum NGAL (SNGAL) and urine NGAL (UNGAL) can predict AKI in burned children.. Patients were referred within the 12 h of burn to our center. Serum samples for SNGAL, C-reactive protein (CRP), procalcitonin (PCT) and urine for UNGAL, microalbumine (Umalb), creatinine (Ucr) were obtained at both admission and the 5th day after burn. Blood urea nitrogen (BUN) and serum creatinine (Scr) were examined daily.. Twenty-two subjects were enrolled and six (27.2%) of them developed AKI within the 48 h of injury. Burn size and abbreviated burn severity index (ABSI) were significantly increased in patients with AKI. CRP, PCT, SNGAL and UNGAL levels at admission and day 5 were significantly higher in patients with AKI than in those without AKI and controls. Scr was not significant between AKI and non-AKI groups at hospital days 1 and 5. A SNGAL level of 315 ng/ml and a UNGAL level of 100 ng/ml were determined as predictive cut-off values of AKI at admission (sensitivity and specificity: 71.4%, 83.3% and 93.3%, 93.7%, respectively). SNGAL and UNGAL were positively correlated with CRP, PCT, ABSI and Umalb/Ucr.. SNGAL and UNGAL are good early predictors of AKI in children with severe burn. NGAL might reflect the severity of burn insult and also could be used as an indicator of inflammation in burn children.

Topics: Acute Kidney Injury; Acute-Phase Proteins; Albuminuria; Biomarkers; Blood Urea Nitrogen; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Creatinine; Female; Humans; Infant; Inflammation; Injury Severity Score; Lipocalin-2; Lipocalins; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Proto-Oncogene Proteins

Diagnosing sepsis is difficult in burn patients because of the inflammatory mediators that alter postburn metabolic profile. Here, we compare a new marker presepsin with procalcitonin (PCT), c-reactive protein (CRP) and white blood cell (WBC) in diagnosis and follow up of sepsis in burn patients.. Patients admitted to burn center of our institute were prospectively investigated. Presepsin, PCT, CRP and WBC levels were measured at admission and every 6h for first day and daily thereafter. At all timing samples, patients were classified as sepsis or non-sepsis according to the current American Burn Association Consensus Criteria (ABA) 2007.. 37 adult patients were evaluated. A total data of 611 time points were supplied. Sepsis time points differ significantly from non-sepsis in presepsin (p < 0.0001), PCT (p = 0.0012) and CRP (p < 0.0001) levels. Non-surviving patient results differ significantly from survivors in presepsin (p < 0.0001), PCT (p = 0.0210) and CRP (p = 0.0008). AUC-ROC % values for diagnosing sepsis were 83.4% for presepsin, 84.7% for PCT, 81.9% for CRP and 50.8% for WBC. Sepsis patients had significantly different presepsin, CRP and WBC but not PCT levels on their first day of sepsis compared to previous days.. Plasma presepsin levels have comparable performance in burn sepsis.

Topics: Adult; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Female; Humans; Leukocyte Count; Lipopolysaccharide Receptors; Male; Middle Aged; Peptide Fragments; Prospective Studies; Protein Precursors; ROC Curve; Sepsis; Young Adult

To determine the usefulness of procalcitonin (PCT) in decision-making when faced with suspected infection in patients with extensive burns.. Retrospective, observational follow-up study.. Burn Unit of the Complexo Hospitalario Universitario A Coruña (CHUAC), Spain.. We included all patients admitted to the Unit from June 2011 to March 2012 with ≥20% total body surface area burned or ≥10% full-thickness body surface area burned with suspected infection (17 patients with 34 events of suspected infection).. The infections were confirmed in 16/34 episodes (47.1%), and documented in 44.1% (n=15). There were no statistically significant differences in the PCT figures at the time the infection was suspected between the cases with confirmed and unconfirmed infection (p=0.682). The PCT values showed no discriminative value for differentiating patients with SIRS from those with sepsis, severe sepsis and septic shock (area under ROC curve (AUC)=0.546; 95% CI: 0.326-0.766). No significant correlation was found between SOFA and PCT, although there were differences in the PCT values in the patients who had tissue hypoperfusion.. Results show that PCT is not a precise indicator of sepsis at the time of diagnosis. A correlation between PCT levels and hypoperfusion was observed.

Topics: Adult; Aged; Area Under Curve; Biomarkers; Burn Units; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Protein Precursors; Retrospective Studies; ROC Curve; Sepsis; Shock, Septic; Smoke Inhalation Injury; Systemic Inflammatory Response Syndrome; Young Adult

Accurate diagnosis of sepsis is difficult in patients post burn due to the large inflammatory response produced by the major insult. We aimed to estimate the values of serum N-terminal pro-B-type natriuretic peptide and procalcitonin and the changes in hemodynamic variables as markers of sepsis in critically ill burn patients.. Prospective, observational study.. A quaternary-level university-affiliated ICU.. Fifty-four patients with burns to total body surface area of greater than or equal to 15%, intubated with no previous cardiovascular comorbidities, were enrolled.. At admission, a FloTrac/Vigileo system was attached and daily blood samples taken from the arterial catheter. Infection surveillance was carried out daily with patients classified as septic/nonseptic according to American Burns Consensus criteria.. N-terminal pro-B-type natriuretic peptide, procalcitonin, and waveform analysis of changes in stroke volume index and systemic vascular resistance index were measured within the first 24 hours after burn and daily thereafter for the length of the ICU stay or until their first episode of sepsis. Prevalences of stroke volume variation less than 12% (normovolemia) with hypotension (systolic blood pressure < 90 mm Hg) were recorded. Patients with sepsis differed significantly from "no sepsis" for N-terminal pro-B-type natriuretic peptide, systemic vascular resistance index, and stroke volume index on days 3-7. Procalcitonin did not differ between sepsis and "no sepsis" except for day 3. Area under the receiver operating characteristic curves showed excellent discriminative power for B-type natriuretic peptide (p = 0.001; 95% CI, 0.99-1.00), systemic vascular resistance index (p < 0.001; 95% CI, 0.97-0.99), and stroke volume index (p < 0.01; 95% CI, 0.96-0.99) in predicting sepsis but not for procalcitonin (not significant; 95% CI, 0.29-0.46). A chi-square crosstab found that there was no relationship between hypotension with normovolemia (stroke volume variation < 12%) and sepsis.. Serum N-terminal pro-B-type natriuretic peptide levels and certain hemodynamic changes can be used as an early indicator of sepsis in patients with burn injury. Procalcitonin did not assist in the early diagnosis of sepsis.

Topics: Adolescent; Adult; Biomarkers; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Hemodynamics; Hospital Mortality; Hospitals, University; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Sepsis; Young Adult

To evaluate the clinical implication of serum procalcitonin (PCT) in patients with burn sepsis by analyzing its change.. Twenty-eight extensively burned patients with sepsis hospitalized from January 2012 to December 2013 were recruited in this retrospective study. These patients were divided into death group (n = 12) and survival group (n = 16) according to the outcome. The baseline characteristics of patients in the two groups were similar. Some conventional indexes of sepsis, including white blood cell count, percentage of neutrophils, platelet count, organ function parameters [ALT, AST, total bile acid (TBA), creatinine, blood sodium], and acute physiology and chronic health evaluation (APACHE) II score were compared between the two groups when sepsis was diagnosed. Serum levels of PCT of patients in the two groups were determined immediately after diagnosis of sepsis, from post sepsis day (PSD) 1 to 4, and from PSD 5 to 8. Data were processed with t test, chi-square test, and nonparametric rank sum test (Keuskal-Wallis). Receiver operating characteristic (ROC) curve of serum PCT value was used to predict death for 28 burn patients when sepsis was diagnosed.. There were no statistically significant differences in white blood cell count, percentage of neutrophils, platelet count, APACHE II score, and organ function parameters between death group and survival group when sepsis was diagnosed (with t values from -0.601 to 1.726, P values above 0.05). The serum levels of PCT in death group immediately after diagnosis of sepsis, from PSD 1 to 4, and from PSD 5 to 8 were respectively (38.5 ± 41.3), (26.8 ± 38.5), (19.3 ± 16.3) ng/mL, which were significantly higher than those in survival group [(6.1 ± 2.3), (5.4 ± 2.9), (4.9 ± 3.6) ng/mL, with Z values from -4.364 to -2.955, P values below 0.01]. The total area under ROC curve of serum PCT value for predicting death for 28 patients with burn sepsis was 0.990, and 10.9 ng/mL was chosen as the optimal threshold value, with sensitivity of 91.7% and specificity of 100.0%.. Serum PCT value can be served as a vital prognostic indicator for patients with burn sepsis, which can be considered as a guide for rational use of antibiotics, also provide as a reference for treatment, in order to reduce mortality.

Topics: Aged; Anti-Bacterial Agents; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Prognosis; Protein Precursors; Retrospective Studies; ROC Curve; Sepsis; Serum; Statistics, Nonparametric

To evaluate the diagnostic and prognostic performance of inflammatory markers for septic and non septic (localized) bacterial infections in patients with severe burn.. Data of 145 patients were prospectively included in this study. Serum procalcitonin and other inflammatory markers were measured within 24 h after burn and daily thereafter. Maximum procalcitonin (p=0.004) was independent predictors of outcome in logistic regression analysis. PCT thresholds of 1.5 ng/ml, 0.52 ng/ml and 0.56 ng/ml had adequate sensitivity and specificity to diagnose sepsis, respiratory tract and wound infections respectively. A threshold value of 7.8 ng/ml in PCT concentration on day 3 was associated with the effectiveness of the sepsis treatment with an AUC of 0.86 (95% CI 0.69-1.03, p=0.002). C-reactive protein levels and WBCs showed no significant change over the first 3 days in the patients with successfully treated sepsis (p=0.93).. The maximum procalcitonin level has prognostic value in burn patients. PCT can be used as a diagnostic tool in patients with infectious complications with or without bacteremia during ICU stay. Daily consecutive PCT measurements may be a valuable tool in monitoring the effectiveness of antibiotic therapy in burn ICU patients.

Topics: Adult; Aged; Bacterial Infections; Biomarkers; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Leukocyte Count; Logistic Models; Male; Middle Aged; Protein Precursors; Sensitivity and Specificity; Sepsis; Wound Infection

This study was performed to evaluate the clinical significance of procalcitonin in burn patients and to investigate whether procalcitonin levels at admission can be a prognostic indicator for sepsis and mortality.. Between January 2009 and December 2010, procalcitonin levels in 175 patients were tested within the first 48 hours after burn injury. Serum procalcitonin was measured using an enzyme-linked fluorescence assay. Mortality rates and positive culture rates of blood, wound, and sputum were evaluated among the subgroups divided by burn size, procalcitonin levels, and clinical prognosis.. Positive blood culture and mortality rates correlated significantly with procalcitonin concentrations within the first 48 hours after burn injury. The area under the ROC curve for procalcitonin related to mortality was 0.844. Survival analysis revealed that the mortality rate was significantly higher in patients with procalcitonin concentrations ≥ 2 ng/mL than in patients with procalcitonin concentrations < 2 ng/mL (P < 0.001). Multivariate analysis demonstrated that procalcitonin was an independent prognostic factor for burn patients (Hazard ratio = 3.16, P = 0.001).. Procalcitonin concentrations determined within the first 48 hours after burn injury can be a useful prognostic indicator for sepsis and mortality in burn patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Demography; Disease Progression; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; Protein Precursors; Republic of Korea; ROC Curve; Time Factors; Young Adult

Serum macrophage migration inhibitory factor (MIF) and procalcitonin (PCT) concentrations as well as leucocyte numbers were evaluated in a retrospective study with 23 patients with severe burn injuries. The MIF and PCT concentrations as well as the number of leucocytes (LEU) were monitored over a period of 5 days. The total body surface area (TBSA) and sepsis-related organ failure assessment (SOFA) scores were also evaluated. The MIF, PCT concentrations and leucocyte counts were profoundly increased in all patients with severe burn wounds. At the time of admission into the intensive care unit, no significant differences were observed for the MIF and PCT levels between patients with a TBSA<60% (Group 1) and patients with a TBSA>60% (Group 2). After 48 h, however, the MIF and PCT levels reached very high levels in a subgroup of the patients, whereas these levels became normal again in other subgroups. The group of patients with a TBSA>60% was, therefore, subdivided in three groups (subgroups 2a-c). The MIF and PCT data pairs in these subgroups appeared to correlate in an inhomogeneous manner. These levels in the subgroup 2a (i.e., lethal within 5 days) were strongly elevated over those observed in Group 1 (TBSA<60%) and highly increased concentrations of both MIF and PCT correlated with lethal outcome. The combined determination of MIF and PCT might, therefore, be useful to discriminate between post-burn inflammation and systemic inflammatory response syndrome (SIRS) or sepsis with lethal outcome.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Inflammation; Leukocyte Count; Macrophage Migration-Inhibitory Factors; Male; Middle Aged; Prognosis; Protein Precursors; Retrospective Studies; Sepsis; Systemic Inflammatory Response Syndrome; Trauma Severity Indices

Sepsis and multiple organ failure remain the leading cause of mortality and morbidity in burns. The aim of our study was to analyse the predictive value of extravascular lung water index (EVLWI) in the development of severe septic complications and mortality. The records of 28 patients with total burned surface area >20% were analysed (EVLWI, procalcitonin (PCT), intrathoracic blood volume index (ITBVI), positive end-expiratory pressure (PEEP), Baltimore Sepsis Scale (BaSS)). Diagnosis of infection (day 0) was based on consensus conference of the American Burn Association. EVLWI correlated with PCT (r=0.597), and PEEP (r=0.501) on day 0 and with BaSS (r=0.524) and MODS (r=0.513) from day 1. EVLWI was elevated (p<0.05) from one day before diagnosis of infection, PCT was higher (p<0.05) from day 0 only. ROC analysis for EVLWI on day -1 and for PCT on day 0 showed similar areas under curve (0.760; 0.766). EVLWI >9 ml kg(-1) on day -1 predicted sepsis (89% sensitivity, 72% specificity). After antibiotic treatment EVLWI remained high in non-survivors, decreased in survivors, whereas PCT decreased in both groups. Our data suggest that EVLWI is an early warning sign of developing infection and its continuous elevation can predict poor prognosis in burns.

Topics: Adult; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Extravascular Lung Water; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Protein Precursors; Retrospective Studies; Sensitivity and Specificity; Sepsis

Diagnosis of sepsis is difficult, particularly in cases of burn where signs of sepsis may be present in the absence of a real infection. This study compared serum levels of procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) among 60 burned people with and without infection, in order to assess the value of the information for diagnosis of sepsis. A significantly higher PCT level was observed in the septic group compared to those without sepsis (8.45+/-7.8 vs. 0.5+/-1.0, respectively, p<0.001); no significant differences were found in CRP or WBC levels, neutrophil count or ESR. The area under the receiver operating characteristics curve in the diagnosis of sepsis was 0.97 for PCT (p<0.001) with sensitivity of 100% and specificity of 89.3%. Non-survivors had a mean PCT level significantly higher than that of survivors. Thus the serum PCT level was a highly efficient laboratory parameter for the diagnosis of severe infectious complications after burn, but WBC, neutrophil, ESR and CRP levels were of little value.

Topics: Adult; Biomarkers; Blood Sedimentation; Body Temperature; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Female; Humans; Leukocyte Count; Male; Prognosis; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Systemic Inflammatory Response Syndrome

To estimate the diagnostic value of serum PCT, CRP, leukocyte count and temperature as markers of sepsis in critically ill ICU burn patients.. Prospective, observational study in a four bed Burn Intensive Care Unit.. Forty-three patients admitted in a Burn ICU were included in our study.. Serum PCT, CRP concentrations, WCC (white cell count), neutrophils and temperature were measured within the first 24h after-burn and daily thereafter. Severity of organ failure was estimated by sequential organ failure assessment (SOFA) score. Every day we classified all patients in one of the following three categories: non-systemic inflammatory condition (non-SIRS), SIRS non-infected and SIRS 2 infected or sepsis. Patients with infected SIRS differ significantly from non-infected SIRS in PCT (11.8+/-15.8 versus 0.63+/-0.0.43, respectively, p < 0.001). On the other hand, WCC, temperature and neutrophils did not differ significantly between patients with SIRS non-infected and infected SIRS. CRP was elevated in all three groups but didn't differ significantly between SIRS non-infected and septic patients. Area under receiver operating curves was 0.975 and showed reasonable discriminative power (p = 0.002, 95% CI, 0.91-1.035) in predicting of sepsis only for PCT.. Serum procalcitonin levels can be used as an early indicator of septic complication in patients with severe burn injury.

Topics: Analysis of Variance; Biomarkers; Body Temperature; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Critical Illness; Female; Humans; Leukocyte Count; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

The goal of the study was to analyse plasma procalcitonin (PCT) concentrations during infectious events of burns in ICU. Clinical and laboratory data were collected at admission and twice a week in burned patients admitted with a total body surface area (TBSA) >20%. Procalcitonin was determined using both a semi-quantitative detection (PCT-Q) and a quantitative immunoluminometric method (PCT-Lumi). A total of 359 time points in 25 consecutive patients with 40+/-17% (20-86%) TBSA burned, defined as a procalcitonin concentration associated with an inflammatory status according to society critical care medicine definition, were made. The principal site of infection was the respiratory tract (84% of patients required mechanical ventilation). PCT-Lumi values corresponded to the four semi-quantitative ranges of PCT-Q and statistically reflected the simultaneously observed inflammatory status (Kruskall-Wallis test). The area under the receiver operating characteristic curve for C-reactive protein (CRP) was higher than those for PCT and white blood cell (WBC) count, but this difference was not significant. The optimum PCT cut-off value was 0.534 ng/ml with sensitivity and specificity of 42.4% and 88.8%, respectively. However, PCT does not appear to be superior to C-reactive protein (CRP) and white blood count (WBC) as diagnosis marker of sepsis in burns. PCT is not sufficient to diagnose and to follow infection in burns admitted in ICU.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Cross Infection; Female; Humans; Leukocyte Count; Luminescent Measurements; Male; Middle Aged; Prospective Studies; Protein Precursors; Sepsis

To determine the acute immunologic reaction, mediated by cytokines, interleukines (ILs) and growth factors and the susceptibility to infections and sepsis after severe burn injury a prospective, single unit, longitudinal study of acute phase reactants and mediators who performed. After approval by the ethics committee of our hospital, we investigated the plasma concentrations of IL-2, -6, -8, -10, and -13, the soluble IL-2 receptor (sIL-2R), and the acute phase proteins procalcitonin (PCT) and C-reactive protein (CRP) at admission and every 3 days in 24 patients over a time course of 28 days after thermal injury and categorized by percent burn: < or =30% (group 1; n=12) and >30% (group 2; n=12). Shortly after burn injury we found higher concentrations of IL-2, -6, -10 and PCT in those patients >30% TBSA. During the study period, we found significant higher levels of acute phase proteins, IL-6 and -8 in patients >30% TBSA. The incidence of SIRS and MODS was three times increased in patients >30% TBSA. Our results show different patterns of cytokines and acute phase proteins in patients with different burned surface areas over a long time and continuous monitoring of a more distinct inflammatory response in these patients.

Topics: Acute-Phase Proteins; Acute-Phase Reaction; Adult; Analysis of Variance; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Middle Aged; Prospective Studies; Protein Precursors; Time Factors

Sepsis is one of the most frequent causes of death after major burn injury. Usually, sepsis appears as a consequence of a gram-negative bacteriaemia with release of endotoxins. In this study, the plasma endotoxin levels of seven patients (three female, four male; average age 51.3 +/- 23.8 years) with burns between 43.5 and 78 % Total Body Surface Area (Abbreviated Burn Severity Index 8 - 12) were determined for five days after thermal trauma every three hours by ELISA and compared with the concentration of procalcitonin (PCT) and C-reactive protein (CRP). A calculation of the Horrowitz-Index (PaO(2)/FiO(2)) and the Pressure-Adjusted Heart Rate (HR x CVP/MAP) took place to show a possible correlation between the endotoxin concentration and the cardiopulmonary organ function. Additionally, we analysed whether operative treatment can influence the level of plasma endotoxin in the early phase after burn injury. At any time after burn trauma, endotoxins could be detected in the plasma of all patients. Between the second and third day, there was a considerable increase in the endotoxin concentration with a maximum after 57 hours of 0.48 +/- 0.32 EU/ml. Two patients with sepsis and death in the further course had a rather distinctive increase. From the fourth day on, occasional episodes of increases in endotoxin concentration were noted. Postoperatively, there was a short increase in plasma endotoxin on the second and fourth day. The plasma endotoxin level showed no correlation with the PCT and CRP or with the oxygenation in the patients' blood. However, a positive correlation could be observed with the Pressure-Adjusted Heart Rate (p = 0.0061; r(2) = 0.212). An explanation for the endotoxin increase after 57 hours could be the translocation of intestinal bacteria, the beginning of bacterial colonisation or decomposition products of the burn wound with protein-protein complexes. Later on, infectious diseases such as pneumonia with gram-negative bacteria are of importance, too. According to the Two-Hit Model, the increase of plasma endotoxin can serve as a trigger and cause a recurrence of systemic inflammation with the changes observed in cardiac organ function, multiple organ dysfunction, and multiple organ failure.

Topics: Adult; Aged; Aged, 80 and over; Burns; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Endotoxins; Female; Heart Rate; Humans; Male; Middle Aged; Multiple Organ Failure; Postoperative Complications; Predictive Value of Tests; Prognosis; Protein Precursors; Survival Rate; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT), a precursor of calcitonin, and endotoxin were determined in the burn wound sepsis model in which 21 Sprague-Dawley rats were scalded approximately 30% on their back. On day 2 post burn, the wounds were inoculated 1 x 10(8) colony-forming units of Pseudomonas aeruginosa. On day 5 post burn P. aeruginosa was detected by blood culture in 10 of the 21 rats (47.6%). The mortality rate 7 days after burn was 90.5%. Significant correlations were observed between serum endotoxin levels and serum PCT levels on day 5 post burn (r = 0.860, p<0.001). It was suggested that endotoxin may induce the release of PCT and that measuring the levels of PCT may be useful in diagnosing burn wound sepsis.

Topics: Animals; Biomarkers; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Disease Models, Animal; Humans; Male; Protein Precursors; Pseudomonas aeruginosa; Pseudomonas Infections; Rats; Rats, Sprague-Dawley; Sepsis; Wound Infection

Procalcitonin (PCT) levels increase in patients with systemic infections; the highest levels have been found in sepsis. This study tested whether plasma procalcitonin level was related to sepsis, CRP, burn size, inhalation injury or mortality in severely burned patients over the entire clinical course. In 27 patients with 51 (20-91)% TBSA, PCT was measured three times weekly from admission over the entire course of stay in a single ICU. Daily scoring by the "Baltimore Sepsis Scale" was performed. The patients were assigned to three groups depending on the clinical course and outcome: A = no septic complications, B = septic complications-survivors, C = septic complications non-survivors. PCT levels were elevated slightly at admission (mean 2.1 ng/ml) except in three patients who suffered electrical burns (mean 15.7 ng/ml). PCT peak levels correlated well with the Scoring values (r = 0.84) while CRP did not (r = 0.64). Peak PCT levels were significantly higher (p < 0.005) in septic patients (B and C) who averaged 49.8+/-76.9 ng/ml, than in non-septic patients (A) who averaged peak levels of 2.3+/-3.7 ng/ml. The highest PCT levels were found immediately before death (86.8+/-97 ng/ml). Seven patients had an inhalation injury 3rd degree. In these patients at 24 h postburn, there was no relationship between PCT levels and inhalation injury but during the later days postburn there were significant differences in PCT levels in patients with versus without inhalation injury. All patients with inhalation injury 3rd degree developed septic complications. There was no positive correlation between the PCT-admission-levels and the TBSA, but there was a positive correlation between the TBSA and the mean peak PCT levels during the later days postburn (r = 0.73; p < 0.05). The cut-off value of 3 ng/ ml we found reliable to indicate severe bacterial or fungal infection. PCT values over 10 ng/ml increasing over the following days were found only in life-threatening situations due to systemic infections. The individual course of PCT in one patient is more important than absolute values. PCT presented in this study as a useful diagnostic parameter in severely burned patients.

Topics: Adolescent; Adult; Bacterial Infections; Body Surface Area; Burns; Burns, Electric; Burns, Inhalation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cause of Death; Critical Care; Follow-Up Studies; Glycoproteins; Humans; Length of Stay; Middle Aged; Mycoses; Patient Admission; Protein Precursors; Reproducibility of Results; Sepsis; Survival Rate

High concentrations of calcitonin-like immunoreactivity have been found in the blood of patients with various extrathyroid diseases. By means of a monoclonal immunoradiometric assay for calcitonin precursors, we have measured serum concentrations of procalcitonin in patients with various bacterial and viral infections. 79 children (newborn to age 12 years) in hospital with suspected infections were investigated prospectively. 19 patients with severe bacterial infections had very high serum concentrations of procalcitonin at diagnosis (range 6-53 ng/mL) in comparison with 21 children found to have no signs of infection (baseline concentrations < 0.1 ng/mL). Serum procalcitonin values decreased rapidly during antibiotic therapy. 11 patients with peripheral bacterial colonisation or local infections without invasive sepsis and 18 (86%) of 21 patients with viral infections had concentrations within or slightly above the normal range (0.1-1.5 ng/mL). Among 9 severely burned patients studied in an intensive care unit, the post-traumatic course of procalcitonin concentrations (range 0.1-120 ng/mL) was closely related to infectious complications and acute septic episodes. Concentrations of mature calcitonin were normal in all subjects, whatever procalcitonin concentrations were found. Concentrations of a substance immunologically identical to procalcitonin are raised during septic conditions. Serum concentrations seem to be correlated with the severity of microbial invasion.

Topics: Bacterial Infections; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Chromatography, High Pressure Liquid; Glycoproteins; Humans; Infant; Infant, Newborn; Protein Precursors; Virus Diseases