calca-protein--human and Mediastinitis

Poststernotomy mediastinitis (PSM), the severe chest wall and mediastinal infection that may arise at any time after a sternotomy, causes significant morbidity and mortality globally. Late recognition and diagnosis are the major contributors to a poor outcome. This review focuses on recent advances in diagnosing PSM (particularly after cardiovascular surgery) at the earliest opportunity--in the emergency department.. Morbidity and mortality of PSM, especially when associated with numerous other complications, remain unaltered high. Careful history taking and clinical examination remain the mainstays of a preliminary diagnosis. No specific signs are indicative of PSM alone. Procalcitonin as a biomarker and neutrophil volume distribution width obtained during a complete blood count with differential, assessed in the clinical context, offer interesting prospects of obtaining a speedy and accurate diagnosis. Adjunctive diagnostic imaging modalities such as contrast-enhanced computed tomography can differentiate PSM from postcardiac injury syndrome and other causes of vague chest pain some time after sternotomy with increasing accuracy.. The speed and accuracy of diagnosing PSM have improved with recent advances in imaging and laboratory methodologies. In the symptomatic patient with a closed sternotomy wound or scar, with either fever (>38°C) or sternal instability, together with well-described signs on contrast-enhanced computed tomography, in whom other life-threatening causes of chest pain have been excluded, the diagnosis of PSM can be made without awaiting the outcome of microbiological confirmation. Nevertheless, there still remain significant research opportunities for clinicians and scientists to improve the early diagnostic accuracy of PSM.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Electrocardiography; Emergency Service, Hospital; Humans; Leukocyte Count; Mediastinitis; Neutrophils; Platelet Count; Postoperative Complications; Protein Precursors; Radiography, Thoracic; Radionuclide Imaging; Sternotomy; Surgical Wound Infection; Tomography, X-Ray Computed

This study attempts to find a prediction method of death risk in patients with acute mediastinitis (AM). There is no such tool described in available literature for this serious disease. The study comprised 37 consecutive cases of iatrogenic AM. General anamnesis and biochemical data were included. Factor analysis was used to extract the risk characteristic for the patients. The most valuable results were obtained for eight parameters, which were selected for further statistical analysis (all collected during a few hours after admission). Three factors reached eigenvalue > 1. Clinical explanations for these combined statistical factors are as follows: Factor 1--proteinic status (serum total protein, albumin, and hemoglobin level), Factor 2--inflammatory status (white blood cells, C-reactive protein, and procalcitonin), and Factor 3--general risk (age and number of coexisting diseases). Threshold values of prediction factors were estimated using statistical analysis (factor analysis, Statgraphics Centurion XVI). The final prediction result for the patients is constructed as simultaneous evaluation of all factor scores. High probability of death should be predicted if factor 1 value decreases with simultaneous increase of factors 2 and 3. The diagnostic power of the proposed method was revealed to be high [sensitivity = 100 %, specificity = 69.2 %]: Factor 1 [SNC = 95.8 %, SPC = 76.9 %]; Factor 2 [SNC = 100 %, SPC = 53.8 %]; and Factor 3 [SNC = 75 %, SPC = 76.9 %]. The described method may turn out to be a valuable prognostic tool for patients with AM.

Topics: Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Hemoglobins; Humans; Iatrogenic Disease; Inflammation; Leukocyte Count; Male; Mediastinitis; Mediastinum; Middle Aged; Prognosis; Protein Precursors; Risk; Risk Factors; Serum Albumin; Young Adult

We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period June 2004-October 2005 at Henry Dunant Hospital, Athens, Greece. C-reactive protein (CRP) and procalcitonin were assayed from 222 patients preoperatively, and 1-3 days following OPCABG. Variables independently associated with infection were identified by a multivariable logistic regression model. Eighteen of 360 (5%) patients developed postoperative infections; 1.7% developed superficial wound infection, 1.4% pneumonia, 1.1% bacteremia, 0.3% mediastinitis, and 0.3% intra-aortic balloon pump related infection. The mean increase of CRP and procalcitonin levels in the first two or three days, respectively, after surgery was significantly higher (P<0.05) in patients with infection. Independent risk factors of infection (P<0.05) were history of major nervous system disorder, left ventricular heart failure preoperatively, emergent operation, transfusions of red blood cells during ICU stay, and duration of central venous catheter placement. The identification of risk factors for infection in combination with the appropriate evaluation of the increased CRP and procalcitonin values may help clinicians for the early diagnosis of infection after OPCABG.

Topics: Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Catheterization, Central Venous; Coronary Artery Bypass, Off-Pump; Cross Infection; Emergency Medical Services; Erythrocyte Transfusion; Humans; Intra-Aortic Balloon Pumping; Logistic Models; Mediastinitis; Movement Disorders; Odds Ratio; Pneumonia; Prospective Studies; Protein Precursors; Risk Assessment; Risk Factors; Surgical Wound Infection; Time Factors; Treatment Outcome; Up-Regulation; Ventricular Dysfunction, Left

The prognostic value of elevated serum levels of procalcitonin (PCT) in patients early after cardiac surgery on cardiopulmonary bypass (CPB) remains unclear. In a prospective study, we investigated whether PCT is useful as a prognostic marker in cardiac surgery with respect to mortality, complications and infections, and whether PCT is a specific marker for occurrence of infections.. Within 8 months, a subset of 80 high-risk patients (APACHE II-score: 25.1 +/- 4.7 (mean +/- SD)) out of a consecutive cohort of 776 patients was investigated. Demographic data, operative data and clinical endpoints (mortality, infection, severe complication) were documented. Serum levels of PCT were analyzed preoperatively and at postoperative day 1.. Hospital mortality in this high-risk group was 21.3 %, infections occurred in 33.8 % and complications in 58.8 % of the patients. Preoperative PCT was normal in all patients. Postoperative PCT was increased in non-survivors compared to survivors (34.3 +/- 7.0 ng/ml vs. 15.9 +/- 4.9 ng/ml; p < 0.05), in patients with severe complications (30.3 +/- 6.7 ng/ml vs. 5.5 +/- 1.4 ng/ml; p < 0.05) and in patients with infections (38.4 +/- 11.3 ng/ml vs. 10.8 +/- 1.6 ng/ml; p < 0.05). Area under receiver operating characteristic curve for PCT as predictor of mortality, infections and complications was 0.772 (95 %-confidence-interval (CI): 0.651 - 0.894), 0.720 (95 %-CI: 0.603 - 0.837) and 0.861 (95 %-CI: 0.779 - 0.943), respectively. PCT was not different with infectious compared to non-infectious complications.. High levels of PCT are associated with mortality, infections, and severe complications early after cardiac surgery using cardiopulmonary bypass and therefore provide a valuable prognostic marker. However, PCT does not discriminate between infectious and non-infectious complications.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Female; Glycoproteins; Humans; Male; Mediastinitis; Multiple Organ Failure; Pneumonia; Prognosis; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis

Monitoring the immune responses in critically ill patients helps us to understand pathophysiological aspects of inflammation, immune deficiency, and infection, and to assess objective measures of therapeutic success. Monitoring should be adapted to the individual therapeutic approach. We recommend the measurement of substances in plasma that indicate systemic inflammatory processes, such as tumour necrosis factor (TNF), interleukin (IL)-6, and C-reactive protein (CRP), and invasive infection or endotoxaemia, such as procalcitonin (PCT). Moreover, it is important to evaluate the functional activity of the immune system, which can fail like other organs in the process of multiple organ failure. The resulting immunodeficiency results in failure to eliminate invading pathogens. Plasma concentration of IL-10 and of monocytic function and phenotype (HLA-DR+, CD14+ monocytes, ex vivo TNF secretion capacity) are the most valuable measurements for this purpose.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Critical Illness; Endotoxemia; Glycoproteins; HLA-DR Antigens; Humans; Immunoglobulin A; Immunoglobulin M; Immunoglobulins, Intravenous; Immunologic Deficiency Syndromes; Interleukin-10; Interleukin-6; Lipopolysaccharide Receptors; Mediastinitis; Monitoring, Immunologic; Monocytes; Multiple Organ Failure; Protein Precursors; Surgical Wound Infection; Systemic Inflammatory Response Syndrome; Tumor Necrosis Factor-alpha