calca-protein--human and Respiratory-Distress-Syndrome

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Glycoproteins; Humans; Prognosis; Protein Precursors; Respiratory Distress Syndrome; Sepsis

Accurate biomarkers of the acute respiratory distress syndrome (ARDS) may help risk stratification and management. We assessed the relation between several biomarkers and the severity, course and outcome of late onset ARDS in 101 consecutive critically ill patients with new onset fever.. On study days 0, 1, 2 and 7 we measured angiopoietin-2 (ANG2), pentraxin-3 (PTX3), interleukin-6 (IL-6), procalcitonin (PCT) and midregional proadrenomedullin (proADM). ARDS was defined by the Berlin definition and by the lung injury score (LIS).. At baseline, 48% had ARDS according to the Berlin definition and 86% according to the LIS. Baseline markers poorly predicted maximum Berlin categories attained within 7 days, whereas ANG2 best predicted maximum LIS. Depending on the ARDS definition, the day-by-day area under the receiver operating characteristic curves suggested greatest monitoring value for IL-6 and PCT, followed by ANG2. ANG2 and proADM predicted outcome, independently of disease severity.. Whereas IL-6 and PCT had some disease monitoring value, ANG2 was the only biomarker capable of both predicting the severity, monitoring the course and predicting the outcome of late onset ARDS in febrile critically ill patients, irrespective of underlying risk factor, thereby yielding the most specific ARDS biomarker among those studied.

Topics: Adrenomedullin; Adult; Aged; Angiopoietin-2; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Fever; Humans; Interleukin-6; Lung Injury; Male; Middle Aged; Protein Precursors; Respiratory Distress Syndrome; Serum Amyloid P-Component; Severity of Illness Index

Despite recent advances in the prospective identification of the patient with sepsis who may benefit from anti-inflammatory or antithrombotic therapies, successful treatment regimens have been fairly modest. We have explored whether determination of several proinflammatory cytokine or mediator concentrations can complement physiologic scoring systems to identify patients with severe sepsis who will survive or expire within 28 days. The design of the study included an exploratory analysis performed in conjunction with a prospective, randomized, double-blind, placebo-controlled, multicenter, clinical trial and involved 33 academic institutions in the United States. One hundred twenty-four patients with severe sepsis with or without septic shock were included in this analysis. Blood samples were obtained at baseline and on days 1 through 4, and were evaluated for proinflammatory and anti-inflammatory cytokine concentrations, as well as for procalcitonin and total protein C levels. Baseline concentrations and changes in the concentrations of these mediators were evaluated in relationship to the Acute Physiology and Chronic Health Evaluation (APACHE) II and multiple organ dysfunction (MOD) scores, and 28-day all-cause mortality. Using univariate logistic regression analyses, APACHE II and MOD scores, age (but not gender), and baseline plasma interleukin (IL)-6 and soluble tumor necrosis factor receptor (sTNFR) 1 (log transformed) concentrations were all predictive of increased 28-day all-cause mortality (P < 0.01). Baseline total protein C, IL-8, IL-10, TNF-alpha, and procalcitonin concentrations, and the change in plasma cytokine concentrations from baseline over the initial 4 days were not useful in predicting outcome. Selected baseline proinflammatory cytokine concentrations and APACHE II score were correlated (P < 0.01). IL-6 concentration is a strong candidate for predicting clinical outcome in patients with severe sepsis alone, or when combined with the APACHE II or MOD scores. The potential usefulness of the combination of cytokine measurements and prognostic scores to identify patients who may benefit from treatment with anti-inflammatory or antithrombotic therapies should be further evaluated.

Topics: Aged; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Double-Blind Method; Female; Humans; Inflammation; Interleukin-10; Interleukin-6; Interleukin-8; Male; Middle Aged; Placebos; Prognosis; Protein C; Protein Precursors; Receptors, Tumor Necrosis Factor; Regression Analysis; Respiratory Distress Syndrome; Risk; Sepsis; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha

To observe the levels of blood soluble urokinase plasminogen activator receptor (suPAR), receptor of advanced glycation end products (RAGE), procalcitonin (PCT) and C-reactive protein (CRP), and to investigate the effect of ventilator bundle (VB) on prognosis of patients with acute respiratory distress syndrome (ARDS).. A prospective controlled study was conducted. A total of 54 cases of ARDS patients admitted to Department of Critical Care Medicine of the Second Hospital of Lanzhou University who received treatment of invasive mechanical ventilation between January 2013 and December 2013 were enrolled. All of the patients were given VB, and then divided into completely dependent group (VB group, n=29) and non-completely dependent group (NVB group, n=25) according to the dependence. The mechanical ventilation time, intensive care unit (ICU) length of stay, the incidence of ventilator associated pneumonia (VAP), the incidence of complications and 28-day mortality rate were compared between two groups. The blood suPAR, RAGE, PCT and CRP levels before and after treatment were determined. The correlations between oxygenation index (PaO(2)/FiO(2)) and other variables were analyzed by Pearson correlation and linear regression analysis.. (1) There was no significant difference in gender, age, acute physiology and chronic health evaluationII (APACHE II) score and PaO(2)/FiO(2), as well as other basic state between two groups. (2) There was no obvious difference in suPAR, RAGE, PCT and CRP levels before treatment between two groups. The levels of above parameters were significantly decreased after treatment. The blood suPAR and RAGE levels in VB group were significantly decreased compared with those in NVB group [suPAR: 189.87 (135.57) ng/L vs. 309.38 (278.00) ng/L, RAGE: 2.17 (0.75) μg/L vs. 3.17 (2.64) μg/L, both P<0.01]. (3) Compared with NVB group, the mechanical ventilation time, ICU length of stay, and the incidence of VAP in VB group were significantly reduced (mechanical ventilation time: 131.52 ± 44.94 hours vs. 166.28 ± 38.09 hours, t=-3.039, P=0.004; ICU length of hospital stay: 171.14 ± 74.25 hours vs. 210.92 ± 54.89 hours, t=-2.208, P=0.032; incidence of VAP: 17.24% vs. 44.00%, χ² = 4.611, P=0.041), but 28-day mortality rate (27.59% vs. 36.00%, χ² = 0.441, P=0.566) and rates of other related complication showed no significant difference between VB group and NVB group. (4) Correlation analysis showed that PaO(2)/FiO(2) was negatively correlated with age (r=-0.290, P=0.033), suPAR (r=-0.898, P=0.000), RAGE (r=-0.898, P=0.000), PCT (r=-0.486, P=0.000) and CRP (r=-0.280, P=0.040). (5) The linear regression analysis showed PaO(2)/FiO(2) and suPAR (t=2.645, P=0.011), RAGE (t=-2.885, P=0.006), PCT (t=2.649, P=0.011) were significantly negatively co-related.. Blood suPAR, RAGE, PCT and CRP levels were correlated with the severity of ARDS patients. Compliance of VB can affect the prognosis of patients with ARDS. The high compliance of patients can significantly decrease the levels of blood pro-inflammatory markers, shorten the mechanical ventilation time and ICU length of stay, reduce the incidence of VAP, and it showed a positive impact on patients' prognosis.

Topics: Adult; Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Prospective Studies; Protein Precursors; Receptor for Advanced Glycation End Products; Receptors, Immunologic; Receptors, Urokinase Plasminogen Activator; Respiration, Artificial; Respiratory Distress Syndrome

Procalcitonin (PCT) is activated during cardiopulmonary bypass (CPB) and may be a predictor of acute respiratory distress syndrome (ARDS). The objective of this study is to determine whether patients with different serum PCT concentrations exhibit different rates of developing moderate to severe ARDS.. This is a prospective, single centre, observational cohort study. All patients admitted to the cardiosurgery department for cardiac surgery with CPB were screened for study eligibility. All eligible patients received a CPB procedure. Blood samples were obtained to determine white cell counts as well as N-terminal pro-B-type natriuretic peptide, C reactive protein and PCT levels. Patients were assigned to the PCT elevated cohort or the control cohort based on serum PCT concentrations on the first postoperative day with a cut-off value of 7.0 ng/mL. Data, including baseline, perioperative and outcome data, were collected daily for 7 days. The primary end point was the incidence of moderate to severe ARDS, which was diagnosed according to the Berlin definition.. The study was approved by the Institutional Review Board of Fujian Provincial Hospital. Study findings are disseminated through peer-reviewed publications and conference presentations.. Chinese Clinical Trial Registry (ChiCTR-OCH-14005076).

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cohort Studies; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Postoperative Complications; Prospective Studies; Protein Precursors; Respiratory Distress Syndrome; Severity of Illness Index

Topics: Adult; Aged; Biomarkers; Bronchoalveolar Lavage Fluid; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Interleukin-6; Lung Injury; Male; Middle Aged; Neopterin; Prospective Studies; Protein Precursors; Respiratory Distress Syndrome; Sepsis; Young Adult

The aim was to evaluate the clinical usefulness of a single plasma and bronchoalveolar lavage fluid (BALF) PCT and IL-6 measurement in discriminating septic from non-septic causes of acute respiratory distress syndrome (ARDS) and forecasting clinical outcomes.. One hundred patients were enrolled within 48 h of ALI/ARDS recognition. Demographic, clinical data, severity indices were recorded and PCT and IL-6 concentrations were measured in plasma and BALF.. Plasma PCT and IL-6 values were significantly higher in septic compared to non-septic individuals (p=0.001 and 0.0005, respectively), while there were no differences in their respective BALF values. As far as identification of septic vs. non-septic ARDS is concerned, the comparison of the areas under the curves favored PCT vs. IL-6 [0.88, (95% CI 0.81-0.95) vs. 0.71, (95% CI 0.60-0.81); χ(2)=9.04, p=0.003]. A plasma PCT level of 0.815 ng/mL was associated with 74.1% sensitivity and 97.6% specificity in identifying septic ARDS cases; this corresponded to a diagnostic odds ratio value of 116. Linear regression multivariable analysis disclosed a significant relation of plasma PCT with SOFA score in septic ARDS patients (p<0.001), while neither BALF PCT nor IL-6 levels were associated with clinical outcome.. Early plasma - but not BALF - PCT concentrations can discriminate between septic and non-septic ARDS causes and are associated with the severity of multiple organ dysfunction syndrome in septic ARDS patients. However, neither plasma or BALF IL-6 levels nor BALF PCT levels carry any prognostic potential. A single plasma PCT value higher than 0.815 ng/mL makes a non-septic cause of ARDS highly unlikely.

Topics: Adult; Aged; Bronchoalveolar Lavage Fluid; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Humans; Interleukin-6; Male; Middle Aged; Multivariate Analysis; Prognosis; Prospective Studies; Protein Precursors; Respiratory Distress Syndrome; Sensitivity and Specificity; Sepsis

During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection.. The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs.. Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1b were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients.. Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes.

Topics: Adolescent; Adult; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Diagnosis, Differential; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Interleukin-1beta; Male; Prospective Studies; Protein Precursors; Real-Time Polymerase Chain Reaction; Respiratory Distress Syndrome; Virus Diseases; Young Adult

Procalcitonin (PCT) is accepted to be a relevant prognostic marker for the development of clinical complications in multiple trauma patients. Therefore, a prospective cohort study was conducted to investigate whether polymorphisms in the calcitonin (CALCA) gene are associated with PCT levels and posttraumatic complications.. During a 14day observation period, blood samples were drawn once daily for systemic PCT concentrations in multiple trauma patients (Injury Severity Score >16). For analysis of allele frequencies, genotype distribution and PCT concentrations polytraumatized patients were separated, according to the development of SIRS, sepsis, septic shock, ARDS, MODS and mortality. Furthermore, association between CALCA polymorphisms and PCT plasma concentrations was assessed.. One hundred thirty seven patients with a mean ISS of 29.2+/-12.1 were included. When trauma patients were grouped according to different posttraumatic complications no association with CALCA SNPs was observed. Additionally, no association was found between CALCA polymorphisms and systemic PCT levels.. CALCA polymorphisms are unlikely to influence clinical outcome in polytraumatized patients. Effects of microbial and inflammatory mediators, as well as other risk factors (gender, age, etc.) seem to have a more significant influence on the transcriptional regulation of CALCA and on PCT plasma concentrations than CALCA polymorphisms.

Topics: Adult; Calcitonin; Calcitonin Gene-Related Peptide; Female; Gene Frequency; Genotype; Haplotypes; Humans; Male; Middle Aged; Multiple Organ Failure; Multiple Trauma; Polymorphism, Genetic; Polymorphism, Single Nucleotide; Prognosis; Protein Precursors; Respiratory Distress Syndrome; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome; Young Adult

ARDS is life-threatening acute respiratory failure, and pneumonia is one of the most common causes of direct ARDS. Procalcitonin (PCT) has been evaluated for its utility in determining the aetiology of community-acquired pneumonia (CAP), choice of antibiotics and prediction of outcome. This study evaluated the role of PCT in predicting the outcome of patients with ARDS caused by severe CAP.. This was a prospective observational study conducted from September 2002 to December 2003. The plasma PCT was analysed at baseline, 24 and 72 h after enrolment and measured by ELISA.. Of the 22 patients with ARDS caused by CAP and enrolled in the study, 17 (77.3%) were alive 14 days after admission and five (22.7%) had died. The survivors had lower APACHE II scores (22.2 +/- 4.6 vs 30.6 +/- 9.6, P = 0.031), pneumonia severity index (141.9 +/- 2.2 vs 195.6 +/- 23.8, P = 0.005) and lower plasma PCT at baseline (9.83 +/- 3.54 vs 106.70 +/- 67.86, P = 0.004), at 24 h (10.51 +/- 5.39 vs 81.32 +/- 57.68, P = 0.014) and at 72 h (2.03 +/- 0.76 vs 19.57 +/- 6.67, P = 0.005).. PCT analysed within 72 h of the onset of ARDS predicted mortality of patients with ARDS caused by severe CAP.

Topics: Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Female; Humans; Male; Middle Aged; Pneumonia; Prognosis; Protein Precursors; Respiratory Distress Syndrome; ROC Curve

We evaluated a new fully automated microparticle immunoassay for procalcitonin (LIAISON BRAHMS PCT) in comparison with a previously established manual chemiluminescence assay from the same manufacturer (LUMItest PCT, BRAHMS AG). Procalcitonin (PCT) is an early and rather specific marker of systemic bacterial infection. In addition, the efficacy of antibiotic therapy can be monitored by sequential analysis of PCT values. This is why rapid and accurate determinations of PCT are urgently required by intensive care units. The aim of this study was to evaluate in a clinical set-up a new fully automated rapid PCT test. Analytical results are compared with results obtained by a previously introduced quantitative manual test. Intra-assay coefficients of variation (CV) were found in the range of 0.94 to 7.1% at concentrations between 0.46 and 97.2 microg/l. Over a time period of 27 days the inter-assay CV was found below 4.0% at concentrations of 1.93 and 14.29 microg/l and 9.9% at 0.40 microg/l. The functional sensitivity at a CV level of 20% was determined as 0.2 microg/l. Linearity could be demonstrated in a concentration range from 0 to 445 microg/l. When serum and plasma with EDTA, citrate or heparin anti-coagulation were analyzed in parallel, no systematic bias was found. A method comparison by regression analysis showed PCT values determined by both tests in very good agreement (r = 0.99). PCT concentrations in apparently healthy subjects (n =101) were below 0.58 microg/l in line with previously published results. Patients with sepsis (n = 43) or with infectious adult respiratory distress syndrome (ARDS) (n = 28) showed median values of 22.2 and 18.9 microg/l, respectively. In a clinical set-up the LIAISON Brahms PCT assay provided rapid and accurate PCT results supporting the early detection of severe sepsis, the differentiation between systemic bacterial infection and other inflammatory diseases, and the monitoring of antibiotic therapy in septic patients. The results of the new LIAISON BRAHMS PCT assay show an excellent concordance with the LUMItest PCT. The clinical information derived from the measurements is well comparable to the results obtained with the LUMItest PCT, too.

Topics: Adult; Automation; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Immunoassay; Luminescent Measurements; Protein Precursors; Reproducibility of Results; Respiratory Distress Syndrome; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) is an established marker for severe systemic bacterial infection and sepsis. So far the relevance of PCT in healthy individuals or patients with local infections is unclear due to the lack of highly sensitive assays. The aim of our study was the characterization of a new sensitive PCT assay, the establishment of reference values and the assessment of diagnostic accuracy.. We assessed PCT values in 522 patients with different infectious and non infectious conditions and 410 healthy controls by a new coated tube sandwich chemiluminescence assay B.R.A.H.M.S ProCa-S (2 step assay, time to result 2.5 hours).. The lower detection limit was 6.0 ng/L, with a functional assay sensitivity below 7 ng/L. Samples above 250 ng/L gave excellent correlation to the LUMItest PCT (r = 0.98, p < 0.0001). There was no high dose hook effect up to a concentration of 21,300 ng/L. The 410 healthy controls had a median concentration of 12.7 ng/L (95% CI: 12.6-14.7 ng/L). 65 controls had non-detectable PCT values (defined as 5 ng/L). The 2.5th percentile of the normal population was 5 ng/L and the 97.5th percentile was 46.7 ng/L. ROC plot analysis resulted in an area under the curve (AUC) of 0.90. The optimal decision threshold was at 50 ng/L, with a sensitivity for infection of 77.8% and a specificity of 98.5% (positive predictive value 97.7%, negative predictive value 84.9%). There was a highly significant (p < 0.0001) difference in the PCT median between healthy individuals and patients with infections (e.g. pneumonia, peritonitis) but not non-infectious controls (e.g. pregnancy, autoimmune disease).. The new PCT assay is 30 times more sensitive than the established routine assay LUMItest PCT, thus allowing for the first time PCT detection in healthy individuals. First results indicate that the assay is suitable to differentiate local bacterial infections from other non-infectious diseases.

Topics: Adult; Appendicitis; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Fever of Unknown Origin; Humans; Infections; Luminescent Measurements; Lung Diseases; Male; Middle Aged; Pregnancy; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Reference Values; Reproducibility of Results; Respiratory Distress Syndrome; Sensitivity and Specificity

To examine whether measurement of procalcitonin (PCT) in comparison with interleukin-6 is a reliable marker to score the extent of lung contusion in bronchoalveolar lavage (BAL) fluids in polytrauma patients.. Prospective, nonrandomized, observational study.. Twelve-bed intensive care unit in a 1,100-bed primary care university hospital.. Fourteen trauma victims presenting with severe lung contusion and acute lung injury or acute respiratory distress syndrome were enrolled in the study.. Bronchoscopy with collection of lavage fluid and serum blood samples. Samples were obtained on days 1 and 2 after severe chest trauma, and lung contusion was assessed by computed tomography scan.. PCT was detectable in BAL fluids of all 14 patients. A significant correlation for PCT serum and BAL levels was found on day 2 (p =.0063). For PCT, no significant correlations (Spearman rank) were found to the lung injury score (p =.93), the abbreviated injury scale-lung (p =.33), or the sepsis-related organ failure assessment score-lung (p =.38). Also, for interleukin-6 there was no significant correlation to the lung injury score (p =.62), abbreviated injury scale-lung (p =.45), or the sepsis-related organ failure assessment score-lung (p =.54).. PCT and interleukin-6 BAL levels cannot be considered as reliable parameters to assess the extent of lung contusion.

Topics: Adult; Bronchoalveolar Lavage Fluid; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Injury Severity Score; Interleukin-6; Lung Injury; Male; Multicenter Studies as Topic; Prospective Studies; Protein Precursors; Respiratory Distress Syndrome; Wounds and Injuries

We report a 47-year-old male patient with fulminant ornithosis who developed severe respiratory failure leading to acute respiratory distress syndrome (ARDS) complicated by gastrointestinal, neurological and renal symptoms. ARDS was successfully treated by extracorporeal lung assist. As leukocytosis is typically absent in ornithosis, C-reactive protein, interleukin 6 and procalcitonin were used as infection parameters in order to monitor clinical development. The English-language literature on severe cases of ornithosis requiring respiratory support over the past 30 years is reviewed.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Extracorporeal Membrane Oxygenation; Humans; Interleukin-6; Male; Middle Aged; Protein Precursors; Psittacosis; Respiratory Distress Syndrome

To test the sepsis marker procalcitonin (PCT) for its applicability to discriminate between septic and nonseptic causes of acute respiratory distress syndrome (ARDS).. Prospective study, assessing the course of PCT serum levels in early (within 72 hrs after onset) ARDS. The three other inflammation markers neopterin, interleukin-6 (IL-6), and C-reactive protein (CRP) were tested in parallel.. Twenty-four-bed medical intensive care unit of a 1,990-bed primary hospital, providing health care for an estimated 39,000 patients.. Twenty-seven patients, 18 male and nine female, aged 16-85 yrs, with early ARDS of known cause (17 with septic and ten with nonseptic ARDS) were enrolled in a prospective study between May 1994 and May 1995.. Serum samples were drawn every 4-6 hrs for measurement of PCT, neopterin, IL-6, and CRP concentrations. Blood cultures, tracheal aspirates, and urine samples were obtained every 12-24 hrs. In 24 of 27 patients, bronchoscopic cultures were also obtained. Clinical sepsis criteria as defined by the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference were checked daily.. Assessment of inflammation marker serum levels in septic vs. nonseptic ARDS. PCT serum levels were significantly higher (p < .0005) in the patients with septic ARDS than in patients with nonseptic ARDS within 72 hrs after onset of ARDS. There was no overlap between the two groups. Also, neopterin allowed a differentiation (p < .005), although a substantial overlap between serum levels of septic and nonseptic patients was observed. No discrimination could be achieved by determination of CRP and IL-6 levels.. PCT determination in early ARDS could help to discriminate between septic and nonseptic underlying disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; APACHE; Bacteria; Bacterial Infections; Biomarkers; Biopsy; Bronchoscopy; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glycoproteins; Humans; Intensive Care Units; Interleukin-6; Male; Middle Aged; Neopterin; Prospective Studies; Protein Precursors; Respiratory Distress Syndrome; Sepsis