calca-protein--human and Respiratory-Insufficiency

REsearching severe Sepsis and Organ dysfunction in children: A gLobal perspective (RESOLVE), a phase III trial of drotrecogin alfa (activated) in pediatric severe sepsis, examined biomarker changes in inflammation and coagulation. This report describes biomarker profiles in early severe sepsis and the pharmacodynamic assessment of drotrecogin alfa (activated) in RESOLVE.. Serial measurements of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tissue necrosis factor-α, procalcitonin, D-dimer, and thrombin-antithrombin complex were performed at baseline and daily over the first five study days. Protein C levels were performed at baseline and at the end of the 96-hr study drug infusion. Analysis of variance-based log-transformed data compared the treatment groups for each measured variable.. : One hundred four pediatric intensive care units in 18 countries.. Four hundred seventy-seven children between 38 wks corrected gestational age and 17 yrs with sepsis-induced cardiovascular and respiratory dysfunction.. Drotrecogin alfa (activated).. Pharmacodynamic activity of drotrecogin alfa (activated) compared with placebo was observed with reduction of D-dimer on day 1 (p < .01) and thrombin-antithrombin complex on days 1-4 (p < .05). There were no significant changes by treatment in multiple cytokines or procalcitonin. In the overall population, a median protein C difference was not observed (p > .05) with drotrecogin alfa (activated) administration compared with placebo, although a difference (median percentage change from baseline) in favor of drotrecogin alfa (activated) was observed in patients >1 yr old (p = .0449).. While children in the RESOLVE trial were similar to adults in that they showed a relationship between severity of coagulation and inflammation abnormalities and mortality, their pharmacodynamic response to drotrecogin alfa (activated) differed with respect to changes in protein C activity and systemic inflammation.

Topics: Adolescent; Anti-Infective Agents; Antithrombin III; Biomarkers; Blood Proteins; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Cytokines; Disseminated Intravascular Coagulation; Double-Blind Method; Female; Fibrin Fibrinogen Degradation Products; Humans; Infant; Infant, Newborn; Interleukin-10; Interleukin-1beta; Interleukin-6; Interleukin-8; Male; Peptide Hydrolases; Protein C; Protein Precursors; Recombinant Proteins; Respiratory Insufficiency; Sepsis; Survival Analysis; Time Factors; Tumor Necrosis Factor-alpha

The abnormal conditions to which blood is subjected during cardiopulmonary bypass (CPB) trigger an activation of the inflammatory response and cause pulmonary dysfunction. It has been suggested that high-volume, zero-balanced ultrafiltration (ZBUF) facilitates clearance of inflammatory mediators and improves post-operative pulmonary function. Procalcitonin, a newly discovered inflammatory mediator, has been found to be increased after CPB and has been proven to be an appropriate parameter for predicting pulmonary dysfunction secondary to CPB. The aim of this study was to investigate the effects of zero-balanced ultrafiltration (ZBUF) on procalcitonin (PCT) and respiratory function of infants with Tetralogy of Fallot (TOF) after CPB. Twenty infants with TOF undergoing open-heart total surgical correction were randomly assigned to two groups. The trial group was given ZBUF (50 ml/kg) and conventional ultrafiltration (CUF), while the control group was given CUF only. Plasma PCT and pulmonary function were monitored and compared between the two groups before the operation (T1), before rewarming (T2), at the end of the operation (T3), and at 12 h, 24 h and 48 h after the operation (T4-T6). PCT was decreased in the trial group between 12 h and 48 h post-operatively, but the differences did not reach statistical significance. The trial group's pulmonary compliance was higher at 12 h post-operatively (p < 0.05). Oxygenation index was increased in the trial group at the end of the operation and 12 h post-operatively (p > 0.05). Intubation time was shorter in the trial group (P < 0.01). A positive correlation was found between peak PCT concentration and intubation time. ZBUF appeared to improve ventilation and shorten intubation time. The improved respiratory function may be due to the lower plasma PCT.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Humans; Infant; Postoperative Complications; Predictive Value of Tests; Protein Precursors; Respiratory Function Tests; Respiratory Insufficiency; Tetralogy of Fallot; Treatment Outcome; Ultrafiltration

Patients with hematological neoplasms transferred to an Intensive Care Unit (ICU) for a life-threatening complication have a poor outcome. In these patients, it is crucial to identify clinical and biologic parameters with potential prognostic significance. This study prospectively evaluated the usefulness of serum procalcitonin (PCT) levels as a predictor of complications (infectious or not) and outcome in these patients.. One hundred patients with hematological malignancy were admitted to the ICU from October 2004 until August 2009. In 59 of them serum PCT levels were daily measured from the ICU admission until a maximum period of 10 consecutive days.. Hematological diseases were acute leukemia (n=30), lymphoma and other lymphoproliferative disorders (n=18), multiple myeloma (n=7) and other (n=4). Twenty-five patients (42%) had received hematopoietic stem cell transplantation. Thirty-seven patients (63%) presented neutropenia. Those patients who could not be discharged alive from the ICU presented higher PCT levels on days 1, 2 and 3. PCT levels were significantly higher in those patients with neutropenia or septic shock or other causes of hemodynamic instability. The presence of a microbiologically documented infection, respiratory failure or the need of mechanical ventilation support did not significantly affect PCT levels in this study.. Early serum PCT levels measurement might be useful for predicting mortality in patients with hematological malignancy requiring advanced life support.

Topics: Actuarial Analysis; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Calcitonin; Calcitonin Gene-Related Peptide; Combined Modality Therapy; Female; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Hemodynamics; Humans; Infections; Intensive Care Units; Lymphoproliferative Disorders; Male; Middle Aged; Neutropenia; Protein Precursors; Respiratory Insufficiency; Shock, Septic; Treatment Outcome; Young Adult

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

Postoperative care after oesophageal tumour resection holds a high risk of respiratory complications. We therefore aimed to determine the value of systemic inflammatory markers in predicting arterial hypoxaemia as the earliest sign of developing lung injury after oesophageal tumour resection.. In a prospective observational study, 33 consecutive patients were observed for three days (T1-T3) after admission (T0) to an intensive care unit following oesophageal tumour resection. The daily highest values of the heart rate, axillary temperature, leukocyte count and PaCO2 were recorded. Serum C-reactive protein and procalcitonin concentrations and the leukocyte antisedimentation rate (LAR) were determined at T1 and T2. Respiratory function was monitored 6-hourly measurement of the PaO2/FIO2 ratio, and the lowest value was recorded at T3. Patients were categorised as normoxaemic or hypoxaemic using the cutoff value of 300 mmHg for PaO2/FIO2.. Seventeen out of 33 patients were classified as hypoxaemic and 16 patients as normoxaemic at T3. Increases of temperature at T0 and of the procalcitonin and LAR values at T2 were predictive of hypoxaemia at T3 (P < 0.05, P < 0.01 and P < 0.001, respectively). The area under the receiver-operating characteristic curve was 0.65 for the temperature at T0, which was significantly lower than that for the procalcitonin level at T2 (0.83; 95% confidence interval, 0.69-0.97; P < 0.01) and that for LAR at T2 (0.89; 95% confidence interval, 0.77-1.00; P < 0.001).. These results suggest that an elevated LAR (>15%) and an elevated procalcitonin concentration (>2.5 ng/ml) measured on the second postoperative day can predict next-day arterial hypoxaemia (PaO2/FIO2 < 300 mmHg) after oesophageal tumour resection.

Topics: Aged; Biomarkers, Tumor; Blood Sedimentation; Calcitonin; Calcitonin Gene-Related Peptide; Esophageal Neoplasms; Female; Humans; Leukocyte Count; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Respiratory Insufficiency

We investigated the value of procalcitonin kinetics as a prognostic marker during ventilator-associated pneumonia (VAP). This prospective, observational study was conducted in a medical intensive care unit in a university hospital. All consecutive patients with microbiologically proven VAP who survived 3 days after its diagnosis were included and grouped according to clinical outcome: favorable or unfavorable, defined as death, VAP recurrence, or extrapulmonary infection requiring antibiotics before Day 28. Serum procalcitonin levels were measured on Days 1, 3, and 7 for all patients. Among the 63 patients included, 38 had unfavorable outcomes. On Day 1, they were more critically ill than patients with a favorable outcome. Serum procalcitonin levels decreased during the clinical course of VAP but were significantly higher from Day 1 to Day 7 in patients with unfavorable outcomes. Multivariate analyses retained serum procalcitonin levels on Days 1, 3, and 7 as strong predictors of unfavorable outcome. Based on these data, procalcitonin could be a prognostic marker of outcome during VAP.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glycoproteins; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prognosis; Protein Precursors; Recurrence; Respiration, Artificial; Respiratory Insufficiency; Sensitivity and Specificity

To investigate the correlation between microalbuminuria and extravascular lung water in patients in septic shock who require mechanical ventilation for severe respiratory failure.. Prospective, observational, clinical study in the 20-bed intensive care unit of a university hospital.. 25 consecutive patients in septic shock and also in severe respiratory failure requiring mechanical ventilation.. Hemodynamic parameters and extravascular lung water were determined by single arterial thermodilution. Together with each hemodynamic measurement the PaO(2)/FIO(2) ratio and urinary microalbumin to creatinine ratio (M:Cr) was measured. Serum C-reactive protein (CRP) and procalcitonin (PCT) levels were also determined daily.. The EVLW index was significantly higher than normal throughout the study. Microalbuminuria was in the normal range on entry and remained so for the rest of the study period. Serum PCT and CRP levels were significantly higher than normal at every assessment points. No significant correlation was found between M:Cr and either EVLW or PaO(2)/FIO(2).. In this study patients in septic shock with significantly elevated EVLW had normal urinary M:Cr, and there was no correlation between M:Cr and EWLV, and PaO(2)/FIO(2). Therefore based on the current results routine measurements of microalbuminuria to determine endothelial permeability cannot be recommended in critically ill patients.

Topics: Aged; Albuminuria; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Capillary Permeability; Creatinine; Extravascular Lung Water; Female; Hemodynamics; Humans; Linear Models; Male; Middle Aged; Multiple Organ Failure; Prospective Studies; Protein Precursors; Respiration, Artificial; Respiratory Insufficiency; Shock, Septic; Statistics, Nonparametric; Thermodilution