calca-protein--human and Systemic-Inflammatory-Response-Syndrome

The objective of this study is to evaluate the benefits of adjuvant treatment with crude rhubarb in patients with systemic inflammation reaction syndrome/sepsis by conducting a meta-analysis.. We conducted a systematic literature search of medical electronic databases (up to October 2013). Only randomized controlled trials (RCTs) assessing adjuvant treatment with crude rhubarb in septic patients were included.. A total of 15 RCTs with 869 patients were identified. Pooled analysis showed that interleukin 6 (standardized mean differences [SMDs], -1.30; 95% confidence intervals [CIs], -1.94 to -0.66), tumor necrosis factor α (SMD, -0.95; 95% CI, -1.55 to -0.36), procalcitonin (SMD, -1.50; 95% CI, -2.20 to -0.80), von Willebrand factor (mean differences [MDs], -144.11; 95% CI, -253.87 to -34.35), prothrombin time (MD, -2.38; 95% CI, -2.67 to -2.10), acute physiology and chronic health evaluation II scores (MD, -4.51; 95% CI, -5.30 to -3.73), and gastrointestinal dysfunction (risk ratio, 0.28; 95% CI, 0.16-0.49) were significantly reduced after treatment with crude rhubarb. Platelet number (MD, 58.16; 95% CI, 51.16-65.15) was significantly increased. However, crude rhubarb therapy did not significantly reduce 28-day mortality (risk ratio, 0.60; 95% CI, 0.36-1.00) compared with the usual treatment.. Adjuvant treatment with crude rhubarb appears to have additional benefits in septic patients. Antiinflammation and anticoagulant/antiaggregant properties may be its potential mechanism.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Inflammation; Interleukin-6; Male; Middle Aged; Phytotherapy; Protein Precursors; Randomized Controlled Trials as Topic; Rheum; Sepsis; Systemic Inflammatory Response Syndrome; Treatment Outcome; Tumor Necrosis Factor-alpha; Young Adult

Surgery associated with trauma and soft tissue injuries after surgery significantly activates the systemic immune response. If an infection after surgery occurs, the response is even stronger. Due to spontaneous activation of immune response and elevated biomarkers for sepsis and cytokines, posttraumatic complications such as new-coming postoperative infections are difficult to diagnose. Sepsis as systemic inflammatory response syndrome (SIRS) rapidly progresses through severe sepsis to septic shock and organ failure, and with no applied antibiotic treatment, the disease often ends at death of the patients. In the treatment of non-surgery patients, the biomarkers like white cell blood count, C-reactive protein (CRP) or procalcitonin (PCT) proved to be useful in sepsis recognition. However, diagnostics after surgeries are more complicated and these biomarkers are not ideal. The solution is a sepsis biomarker, which would have high sensitivity and specificity, that can improve diagnostic accuracy of sepsis, should also be measured easily by the patients, and should not be too expensive. We think more sensitive and specific biomarkers such as presepsin (sCD14-ST) or CD64 index on neutrophils could be useful. A diagnosis of sepsis should be based on clinical signs, and clinicians should use biomarker that is not only most sensitive and specific but also is cost effective. Furthermore, confirmation of the bacterial or fungal infection with blood cultures or with the use of broad range polymerase chain reaction (PCR), when culturing is impossible, should be performed.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Lipopolysaccharide Receptors; Peptide Fragments; Postoperative Complications; Protein Precursors; Receptors, IgG; Sepsis; Severity of Illness Index; Surgical Procedures, Operative; Systemic Inflammatory Response Syndrome

To assess the clinical value of procalcitonin (PCT ) in the diagnosis of sepsis in adults.. An extensive search for related literature from the Wanfang data, CNKI, VIP, Medline/PubMed, Embase/OvidSP and the Cochrane Library up to December 2014 was performed. The articles, including prospective observational studies or randomized controlled trials, regarding PCT for the diagnosing of sepsis were enrolled. Only patients older than 18 years were included. Patients with sepsis, severe sepsis, or septic shock served as the experimental group, and those with a systemic inflammatory response syndrome (SIRS) of non-infectious origin as control group. The language of literature included was English or Chinese. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC) and subgroup analysis were analyzed with the software of Metadisc 1.4.. A total of 6 385 published reports were collected, and among them 24 met the inclusion criteria, including a total. of 3 107 patients. The studies showed substantial heterogeneity (I2 = 69.4%), and random effect model was used for Meta analysis, showing that the pooled DOR was 10.37 [95% confidence interval (95%CI) = 7.10-15.17]. No evidence of a threshold effect was found (Spearman correlation coefficient = 0.27, calculated by logarithm of sensitivity and logarithm of 1-specificity, P = 0.20). The DOR values of pooled and each study were not distributed along the same line in forest plots, and Cochran-Q = 78.33, P = 0.000 0, showing that there was heterogeneity in result from non threshold effect. Except for partial heterogeneity caused by non threshold effect, the result of Meta regression analysis including PCT detection method, categories of disease, research location and so on showed P values were all higher than 0.05. Thus, the heterogeneity could not be explained by Meta regression analysis. The pooled sensitivity was 74% (95% CI = 72%-76%), the pooled specificity was 70% (95% CI = 67%-72%), the pooled positive likelihood ratio was 2.79 (95% CI = 2.31-3.38), the pooled negative likelihood ratio was 0.34 (95% CI = 0.28-0.41), and the pooled AUC was 0.83 (95% CI = 0.79-0.87). AUC in medical patients was 0.80 (95% CI = 0.75-0.85), which was higher than that in surgical patients [0.71 (95% CI = 0.65-0.81)].. Our results indicate a moderate degree of value of PCT for diagnosis of sepsis in adult patients. The diagnostic accuracy in medical patients is higher than that in surgical patients. PCT is a good auxiliary biomarker for diagnosis of sepsis.

Topics: Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Observational Studies as Topic; Prospective Studies; Protein Precursors; Randomized Controlled Trials as Topic; ROC Curve; Sensitivity and Specificity; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

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

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

Over the past two decades, the body of literature on the clinical usefulness of procalcitonin (PCT) in adults has grown rapidly. Although this approach has led to increased insight, it has also prompted debate regarding its potential use in diagnosis and management of severe infection. Clinicians, however, are less familiar with the use of PCT in pediatric populations. In this review, we examine PCT as a marker of severe clinical pediatric conditions including its role in systemic inflammation, infection, and sepsis.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Infant, Newborn; Infections; Intensive Care Units, Neonatal; Meningitis; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Procalcitonin is a promising marker for identification of bacterial infections. We assessed the accuracy and clinical value of procalcitonin for diagnosis of sepsis in critically ill patients.. We searched Medline, Embase, ISI Web of Knowledge, the Cochrane Library, Scopus, BioMed Central, and Science Direct, from inception to Feb 21, 2012, and reference lists of identified primary studies. We included articles written in English, German, or French that investigated procalcitonin for differentiation of septic patients--those with sepsis, severe sepsis, or septic shock--from those with a systemic inflammatory response syndrome of non-infectious origin. Studies of healthy people, patients without probable infection, and children younger than 28 days were excluded. Two independent investigators extracted patient and study characteristics; discrepancies were resolved by consensus. We calculated individual and pooled sensitivities and specificities. We used I(2) to test heterogeneity and investigated the source of heterogeneity by metaregression.. Our search returned 3487 reports, of which 30 fulfilled the inclusion criteria, accounting for 3244 patients. Bivariate analysis yielded a mean sensitivity of 0 · 77 (95% CI 0 · 72-0 · 81) and specificity of 0 · 79 (95% CI 0 · 74-0 · 84). The area under the receiver operating characteristic curve was 0 · 85 (95% CI 0 · 81-0 · 88). The studies had substantial heterogeneity (I(2)=96%, 95% CI 94-99). None of the subgroups investigated--population, admission category, assay used, severity of disease, and description and masking of the reference standard--could account for the heterogeneity.. Procalcitonin is a helpful biomarker for early diagnosis of sepsis in critically ill patients. Nevertheless, the results of the test must be interpreted carefully in the context of medical history, physical examination, and microbiological assessment.. Ministry of Education and Research, the Deutsche Forschungsgemeinschaft, Thuringian Ministry for Education, Science and Culture, the Thuringian Foundation for Technology, Innovation and Research, and the German Sepsis Society.

Topics: Age Factors; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Databases, Factual; Humans; Prevalence; Protein Precursors; Regression Analysis; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Sepsis is a clinical syndrome defined by physiologic changes indicative of systemic inflammation, which are likely attributable to documented or suspected infection. Septic shock is the progression of those physiologic changes to the extent that delivery of oxygen and metabolic substrate to tissues is compromised. Biomarkers have the potential to diagnose, monitor, stratify and predict outcome in these syndromes. C-reactive protein is elevated in inflammatory and infectious conditions and has long been used as a biomarker indicating infection. Procalcitonin has more recently been shown to better distinguish infection from inflammation. Newer candidate biomarkers for infection include IL-18 and CD64. Lactate facilitates the diagnosis of septic shock and the monitoring of its progression. Multiple stratification biomarkers based on genome-wide expression profiling are under active investigation and present exciting future possibilities.

Topics: Adolescent; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Infections; Inflammation; Interleukin-18; Lactates; Protein Precursors; Receptors, IgG; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

The worldwide yearly mortality from sepsis is substantial, greater than that of cancer of the lung and breast combined. Moreover, its incidence is increasing, and its response to therapy has not appreciably improved. In this condition, the secretion of procalcitonin (ProCT), the prohormone of calcitonin, is augmented greatly, attaining levels up to thousands of fold of normal. This hypersecretion emanates from multiple tissues throughout the body that are not traditionally viewed as being endocrine. The serum values of ProCT correlate with the severity of sepsis; they recede with its improvement and worsen with exacerbation. Accordingly, as highlighted in this review, serum ProCT has become useful as a biomarker to assist in the diagnosis of sepsis, as well as related infectious or inflammatory conditions. It is also a useful monitor of the clinical course and prognosis, and sensitive and specific assays have been developed for its measurement. Moreover, it has been demonstrated that the administration of ProCT to septic animals greatly increases mortality, and several toxic effects of ProCT have been elucidated by in vitro experimental studies. Antibodies have been developed that neutralize the harmful effects of ProCT, and their use markedly decreases the symptomatology and mortality of animals that harbour a highly virulent sepsis analogous to that occurring in humans. This therapy is facilitated by the long duration of serum ProCT elevation, which allows for a broad window of therapeutic opportunity. An experimental groundwork has been established that suggests a potential applicability of such therapy in septic humans.

Topics: Animals; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Inflammation; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The prompt recognition and management of septic patients remains a challenge within the busy Emergency Department (ED). Prognostic screening aids have traditionally required time-delayed laboratory measurements not validated upon the emergency medicine population. Recently, a brief prognostic tool has been derived and subsequently validated in heterogeneous ED populations.. Can a risk-stratification tool predict 1-month mortality in ED patients with suspected infection?. Six studies evaluating the Mortality in the Emergency Department Sepsis (MEDS) score were identified and evaluated.. Higher MEDS scores are associated with increasing mortality. MEDS score's short- and long-term prognostic accuracy is superior to other sepsis scales as well as isolated biomarkers C-reactive protein and procalcitonin. MEDS' prognostic accuracy in severe sepsis is inferior to undifferentiated systemic inflammatory response syndrome (SIRS) patients.. The MEDS score is an accurate and reliable prognostic tool for 28-day mortality in ED SIRS patients, but may not be optimal for those with severe sepsis.

Topics: Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Emergency Service, Hospital; Evidence-Based Emergency Medicine; Female; Hospital Mortality; Humans; Lactic Acid; Predictive Value of Tests; Prognosis; Protein Precursors; Risk Assessment; ROC Curve; Sepsis; Severity of Illness Index; Systemic Inflammatory Response Syndrome

Procalcitonin is widely reported as a useful biochemical marker to differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome. In this systematic review, we estimated the diagnostic accuracy of procalcitonin in sepsis diagnosis in critically ill patients. 18 studies were included in the review. Overall, the diagnostic performance of procalcitonin was low, with mean values of both sensitivity and specificity being 71% (95% CI 67-76) and an area under the summary receiver operator characteristic curve of 0.78 (95% CI 0.73-0.83). Studies were grouped into phase 2 studies (n=14) and phase 3 studies (n=4) by use of Sackett and Haynes' classification. Phase 2 studies had a low pooled diagnostic odds ratio of 7.79 (95% CI 5.86-10.35). Phase 3 studies showed significant heterogeneity because of variability in sample size (meta-regression coefficient -0.592, p=0.017), with diagnostic performance upwardly biased in smaller studies, but moving towards a null effect in larger studies. Procalcitonin cannot reliably differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome in critically ill adult patients. The findings from this study do not lend support to the widespread use of the procalcitonin test in critical care settings.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Diagnosis, Differential; Emergency Medical Services; Humans; Predictive Value of Tests; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Procalcitonin measurement has been claimed as a helpful marker in bacterial infection and sepsis. It has obtained FDA approval and is now widely marketed in the United States and Europe. This review summarises the current assays available, the evidence for its use and possible future applications of the assay.

Topics: Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Sepsis and its complications are the most common cause of the death in the intensive care unit. In spite of the treatment mortality remains up to 28-50%, and 60-90% of the patients are lost because of the complications of sepsis. So it is very important to diagnose this pathology and start the treatment early. The diagnosis of sepsis is complicated for clinical signs and symptoms are not specific and manifest in the patients who have non-infective diseases, when systemic inflammatory response is involved. Parameters of systemic inflammatory response, such as body temperature, heart rate, respiratory rate, leukocyte count, and C-reactive protein concentration, used in clinical practice are neither specific, non sensitive. These parameters often provide information that is inadequate for the discrimination of bacterial and nonbacterial infections and for diagnosis. So it is impossible to differentiate systemic inflammatory response and sepsis. Procalcitonin is a new parameter for diagnosis of bacterial, fungal and parasitical infections. In healthy humans almost all procalcitonin, which is produced in thyroid gland, is resolved and does not reach the blood stream. Its half-life in plasma is only few minutes, so in healthy humans the level of procalcitonin is very low (<0.1 ng/ml) and is not detectable by standard methods. In the case of infection the level of procalcitonin rapidly increases during 2-6 hours and reaches the maximum level after 6-12 hours. The measurement of procalcitonin levels can be used for instant diagnosis as well as for evaluation of the treatment effectiveness. In our article we review the new literature data on the importance of procalcitonin level for sepsis diagnosis in comparison with other parameters of systemic inflammatory reaction, and discuss the indications for procalcitonin analysis.

Topics: Adult; Bacterial Infections; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Diagnosis, Differential; Humans; Infant, Newborn; Intensive Care Units; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome; Time Factors

Systemic inflammatory response syndrome is common after surgery, and it can be difficult to discriminate between infection and inflammation. We performed a review of the literature with the aims of describing the evolution of serum procalcitonin (PCT) levels after uncomplicated cardiac surgery, characterising the role of PCT as a tool in discriminating infection, identifying the relation between PCT, organ failure, and severity of sepsis syndromes, and assessing the possible role of PCT in detection of postoperative complications and mortality.. We performed a search on MEDLINE using the keyword 'procalcitonin' crossed with 'cardiac surgery,' 'heart,' 'postoperative,' and 'transplantation.' Our search was limited to human studies published between January 1990 and June 2006.. Uncomplicated cardiac surgery induces a postoperative increase in serum PCT levels. Peak PCT levels are reached within 24 hours postoperatively and return to normal levels within the first week. This increase seems to be dependent on the surgical procedure and on intraoperative events. Although PCT values reported in infected patients are generally higher than in non-infected patients after cardiac surgery, the cutoff point for discriminating infection ranges from 1 to 5 ng/ml, and the dynamics of PCT levels over time may be more important than absolute values. PCT is superior to C-reactive protein in discriminating infections in this setting. PCT levels are higher with increased severity of sepsis and the presence of organ dysfunction/failure and in patients with a poor outcome or in those who develop postoperative complications. PCT levels typically remain unchanged after acute rejection but increase markedly after bacterial and fungal infections. Systemic infections are associated with greater PCT elevation than is local infection. Viral infections are difficult to identify based on PCT measurements.. The dynamics of PCT levels, rather than absolute values, could be important in identifying patients with infectious complications after cardiac surgery. PCT is useful in differentiating acute graft rejection after heart and/or lung transplantation from bacterial and fungal infections. Further studies are needed to define cutoff points and to incorporate PCT levels in useful prediction models.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiovascular Surgical Procedures; Diagnosis, Differential; Humans; Prognosis; Protein Precursors; Systemic Inflammatory Response Syndrome

To evaluate the accuracy of C-reactive protein (CRP), procalcitonin (PCT), neopterin, and endotoxin in the differential diagnosis of sepsis and non-infectious systemic inflammatory response syndrome (SIRS).. A Medline database and references from identified articles were used to perform a literature search relating to the differential diagnosis of sepsis versus non-infectious SIRS.. CRP, PCT, and neopterin are released both in sepsis and in non-infectious inflammatory disease. CRP and PCT are equally effective, although not perfect, in differentiating between sepsis and non-infectious SIRS. However, CRP and PCT have different kinetics and profiles. The kinetics of CRP is slower than that of PCT, and CRP levels may not further increase during more severe stages of sepsis. On the contrary, PCT rises in proportion to the severity of sepsis and reaches its highest levels in septic shock. PCT tends to be higher in nonsurvivor than in survivor. Therefore, PCT demonstrated a closer correlation with the severity of sepsis and outcome than CRP. Unlike CRP and PCT, neopterin is increased in viral infection as well as bacterial infection, and neopterin is also a useful indicator of sepsis. Endotoxemia was detected in no more than half of patients with Gram-negative bacteremia, and Gram-negative bacteremia was detected in half of patients with endotoxemia.. The diagnostic capacity of PCT is superior to that of CRP due to the close correlation between PCT levels and the severity of sepsis and outcome. Neopterin is very useful in the diagnosis of viral infection. The endotoxin assay in combination with CRP, PCT, or neopterin may help as a diagnostic marker for Gram-negative bacterial infection.

Topics: Animals; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Humans; Infections; Neopterin; Protein Precursors; Systemic Inflammatory Response Syndrome

Despite advances in the diagnosis and treatment of infections diseases, sepsis and ensuing multiorgan failure are the major causes of morbidity and mortality in the intensive care units. Such manifestations of systemic inflammation as fever, leukocytosis, tachycardia, etc. may be noninfectious in origin and are neither specific nor sensitive for sepsis. Procalcitonin is a new potential marker for detection of bacterial, fungal and protozoal infections. Procalcitonin, a propeptide of calcitonin, is normally produced in the C-cells of the thyroid gland. Procalcitonin is a polypeptide consisting of 116 amino acids and with a molecular weight of about 13 kDa. During severe systemic infections it is produced by extrathyroidal tissues. Procalcitonin can be put to immediate use in both diagnostic and therapeutic decision-making. This review article discusses biology of procalcitonin, its laboratory determination, usage as an indicator for severe infection and sepsis, and comparison with circulating cytokines in severe infection. It also reviews value of procalcitonin in differentiation of infectious vs non-infectious inflammatory host response, possible elevation of procalcitonin in the absence of infection, its use for differentiation of viral and non-viral infections and as marker for prognosis and evaluation of therapy. Specific indications for determination of procalcitonin are also discussed.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chromatography; Cytokines; Diagnosis, Differential; Humans; Intensive Care Units; Luminescence; Prognosis; Protein Precursors; Sensitivity and Specificity; Shock, Septic; Systemic Inflammatory Response Syndrome

Elevation in the serum concentration of procalcitonin (PCT) is associated with systemic infection. This association has led to the proposed use of PCT as a novel biomarker of bacterial sepsis. The advantages and limitations of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definitions of sepsis are an important consideration that affects the impact of any diagnostic test for sepsis and these issues are discussed. Our main objective is to perform a systematic health technology assessment of PCT as a diagnostic test for sepsis. In an adult intensive care unit (ICU) population, we identify a specific and important question-can PCT accurately distinguish sepsis in patients with systemic inflammatory response syndrome (SIRS) who have a suspected infection? Likelihood ratios are calculated from published data to attempt to find the best answer. The published evidence does not support a general claim that PCT is a useful decision support tool for diagnosing sepsis in patients who have SIRS. Procalcitonin has a slightly better ability to exclude the diagnosis of sepsis. The role for using PCT testing in the ICU will continue to evolve along with our understanding and definition of sepsis.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Intensive Care Units; Predictive Value of Tests; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome; Technology Assessment, Biomedical

Systemic inflammatory response syndrome and the resulting complications continue to be important causes of morbidity in surgical patients. A favourable prognosis of patients with postoperative inflammatory intraabdominal complications is limited by forwardness if diagnosis of this severe complication. Cytokines play a significant role not only in regulating pathogenic mechanisms, during the rising of SIRS, but can themselves directly lead to tissue damage. Increased concentrations of inflammatory cytokines observed in the initial phase of postoperative complications have great significance in the early diagnosis of systemic complications. Procalcitonin, alongside to cytokines, appears as a significant parameter. Despite lots of its pathophysiological points are unclear it is a highly selective and specific indicator of systemic bacterial inflammation. Leptin is not only a hormone of adipocytes but also a member of inflammatory network of cytokines and acute phase reactants. Leptin is possibly a necessary factor for adequate course of acute phase reaction. Proinflammatory cytokines as interleukin-1 or tumour necrosis factor-alpha are the main regulatory factors of leptin in this period.

Topics: Acute-Phase Proteins; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Humans; Leptin; Postoperative Complications; Protein Precursors; Surgical Procedures, Operative; Systemic Inflammatory Response Syndrome

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

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

Early diagnosis of the different severities of septic inflammation is important for early implementation of specific therapies. Sepsis and severe sepsis are accompanied by clinical and laboratory signs of systemic inflammation. However, patients suffering from non-infectious inflammation may present with similiar signs and symptoms making it difficult to diagnose infection based on clinical findings alone. Bacteriological evidence of sepsis, though definitive and specific, may not be obtainable, is time-consuming and even may not occur concurrently with clinical signs of sepsis. It is therefore important to identify markers, which, by enabling an early diagnosis of sepsis and organ dysfunction, would allow early specific therapeutic interventions. Wheras C-reactive Protein is a more sensitive parameter for the diagnosis of non-systemic infections, Procalcitonin seems to be a useful parameter to improve the diagnosis and monitoring of therapy in patients with severe sepsis and septic shock.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Humans; Prognosis; Protein Precursors; Shock, Septic; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) is a protein consisting of 116 aminoacids with molecular weight 13 kDa. It is encoded by CALC-1 gene. According to the basic and clinical research results PCT appears to be a highly sensitive and specific marker reflecting severity of the systemic inflammatory response to infectious stimuli. Despite the investigation focused on CALC-1 gene, little is known about the biology of PCT and cellular sources of PCT during inflammation. One of the possible sources may be human peripheral blood mononuclear cells. PCT is an indicator of bacterial infections minimally stimulated by viral infections, autoimmune diseases and tumors.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Infections; Multiple Organ Failure; Protein Precursors; Systemic Inflammatory Response Syndrome

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Diagnosis, Differential; Glycoproteins; Humans; Predictive Value of Tests; Protein Precursors; Systemic Inflammatory Response Syndrome

Any delay in the management of infection is deleterious, especially in patients whose illness is severe. It is of paramount importance to shorten this delay. This article emphasizes the different ways to reach this goal, including the use of new biologic markers, such as cytokines or procalcitonin.

Topics: Animals; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Humans; Inflammation; Intensive Care Units; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The empiric antibiotic therapy can result in antibiotic overuse, development of bacterial resistance and increasing costs in critically ill patients. The aim of the present study was to evaluate the effect of procalcitonin (PCT) guide treatment on antibiotic use and clinical outcomes of patients admitted to intensive care unit (ICU) with systemic inflammatory response syndrome (SIRS). A total of 60 patients were enrolled in this study and randomly divided into two groups, cases that underwent antibiotic treatment based on serum level of PCT as PCT group (n=30) and patients who undergoing antibiotic empiric therapy as control group (n=30). Our primary endpoint was the use of antibiotic treatment. Additional endpoints were changed in clinical status and early mortality. Antibiotics use was lower in PCT group compared to control group (P=0.03). Current data showed that difference in SOFA score from the first day to the second day after admitting patients in ICU did not significantly differ (P=0.88). Patients in PCT group had a significantly shorter median ICU stay, four days versus six days (P=0.01). However, hospital stay was not statistically significant different between two groups, 20 days versus 22 days (P=0.23). Early mortality was similar between two groups. PCT guidance administers antibiotics reduce antibiotics exposure and length of ICU stay, and we found no differences in clinical outcomes and early mortality rates between the two studied groups.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Organ Dysfunction Scores; Patient Admission; Prospective Studies; Protein Precursors; Sepsis; Single-Blind Method; Systemic Inflammatory Response Syndrome

The aims of the present study were to evaluate the prognostic value of adrenomedullin (AM) in septic patients in the emergency department (ED) and to compare it with procalcitonin (PCT) and Mortality in Emergency Department Sepsis (MEDS) score.. We enrolled 837 consecutive patients who fulfilled the systemic inflammatory response syndrome criteria and were admitted to the ED of Beijing Chaoyang Hospital and 100 age-matched healthy controls. Serum AM and PCT were determined, and MEDS score was calculated at enrollment. The prognostic value of AM was compared with PCT and MEDS score. Primary outcome was in-hospital mortality.. On admission, mean levels of AM were 28.66 ± 6.05 ng/L in 100 healthy controls, 31.65 ± 6.47 ng/L in 153 systemic inflammatory response syndrome patients, 33.24 ± 8.59 ng/L in 376 sepsis patients, 34.81 ± 8.33 ng/L in 210 severe sepsis patients, and 45.15 ± 9.87 ng/L in 98 septic shock patients. The differences between the 2 groups were significant. Adrenomedullin level was higher in nonsurvivors than in survivors in every group. The area under receiver operating characteristic curve of AM for predicting in-hospital mortality in septic patients was 0.773, which was better than PCT (0.701) and MEDS score (0.721). Combination of AM and MEDS score improved the accuracy of AM and MEDS score in predicting the risk of in-hospital mortality (area under receiver operating characteristic curve, 0.817). In logistic regression analysis, AM and MEDS score were independent predictors of in-hospital mortality.. Adrenomedullin is valuable for prognosis in septic patients in the ED.

Topics: Adrenomedullin; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Emergency Service, Hospital; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Prognosis; Protein Precursors; ROC Curve; Sepsis; Severity of Illness Index; Shock, Septic; Systemic Inflammatory Response Syndrome

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

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

: The lack of specific clinical manifestations for sepsis frequently leads to delayed diagnosis. Identification of sensitive and specific indicators that can be easily assessed, accurately reflect infection severity and prognosis and are clinically important in the differential diagnosis of sepsis, is of great significance. The purpose of this study was to evaluate the diagnostic and prognostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in high selected, mostly postoperative patients with suspicion of sepsis.. : Fifty-two consecutive patients hospitalized in a surgical intensive care unit with suspicion of infection included 14 patients with systemic inflammatory response syndrome (SIRS), 9 patients with sepsis, 14 patients with severe sepsis and 15 patients with septic shock. Within 12 hours after enrollment, plasma levels of sTREM-1, procalcitonin (PCT), tumor necrosis factor (TNF)-α, interleukin-6 and C-reactive protein were measured and compared between subgroups to elucidate their diagnostic and prognostic values.. : Plasma sTREM-1 levels were higher in patients with sepsis than in patients with SIRS (111.7 versus 64.1 pg/mL, P < 0.05), with sensitivity, specificity and a predictive value higher than those of PCT and TNF-α. Plasma sTREM-1 levels were significantly different between the sepsis, severe sepsis and septic shock subgroups (P < 0.001). For the receiver operating characteristic for predicting death, the area under the curve of sTREM-1 was 0.861, similar to that of TNF-α, blood lactate and PCT (0.848, 0.719 and 0.706, respectively).. : In postoperative patients, plasma levels of sTREM-1 and TNF-α could differentiate sepsis from SIRS. sTREM levels also reflected the severity of sepsis and were noninferior for prognosis compared with other biochemical indexes.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Diagnosis, Differential; Female; Humans; Intensive Care Units; Lactic Acid; Male; Membrane Glycoproteins; Middle Aged; Postoperative Complications; Prognosis; Protein Precursors; Receptors, Immunologic; Sensitivity and Specificity; Shock, Septic; Systemic Inflammatory Response Syndrome; Time Factors; Triggering Receptor Expressed on Myeloid Cells-1; Tumor Necrosis Factor-alpha

Glutamine is the most abundant amino-acid in the extra- and intracellular compartments of the human body, which accounts for over 50% of its free amino-acid content. Utilization of glutamine peptides is explicitly useful, resulting in a decrease in the number of postoperative infectious complications, period of hospitalization, and therapeutic costs. This article aims to study the effects of glutamine on systemic inflammatory response, morbidity, and mortality after esophagectomy. A prospective, randomized, double-blind, and controlled trial was used. Following sealed-envelope block randomization, the patients were divided into two groups. Members of the glutamine group (group G) received glutamine (Dipeptiven, Fresenius) as continuous infusion for 6 hours at 0.5 g/kg for 3 days prior to, and 7 days following surgery; while patients of the control group were given placebo. We examined 30 patients in group G, and 25 patients as controls. In both patient groups, the levels of total protein, albumin, pre-albumin, retinol binding protein, transferrin, transferring-saturation, C-reactive protein, procalcitonin, lymphocte, Interleukin-6, Interleukin-8, tumor necrosis factor alpha, and serum lactate were determined prior to surgery (t(0)), directly after surgery (t(u)), following surgery on day 1 (t(1)), day 2 (t(2)), and day 7 (t(7)). For statistical analysis Mann-Whitney U test and chi-square test were used. There was no significant difference between the two groups regarding age, male/female ratio, and SAPS II scores. Intensive care unit morbidity and mortality was similar in both groups (group G: 24 survivors/6 nonsurvivors;. 17 survivors/8 nonsurvivors; P= 0.607). Daily Multiple Organ Dysfunction Score did not differ significantly between the two groups. The observed inflammatory markers followed the pattern we described without significant difference. Based on our study, the glutamine supplementation that we used had no influence on morbidity, mortality, or postoperative inflammatory response after esophagectomy.

Topics: Adult; Aged; Blood Proteins; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Double-Blind Method; Esophagectomy; Female; Follow-Up Studies; Glutamine; Glycoproteins; Humans; Interleukin-6; Interleukin-8; Lactic Acid; Lymphocyte Count; Male; Middle Aged; Placebos; Postoperative Complications; Prealbumin; Premedication; Prospective Studies; Protein Precursors; Retinol-Binding Proteins; Serum Albumin; Survival Rate; Systemic Inflammatory Response Syndrome; Transferrin; Tumor Necrosis Factor-alpha

Diagnosis/grading of infection and the systemic response to infection may be difficult on admission to the intensive care unit, but it is even more complicated for severely ill patients with long intensive care stays. The ACCP-SCCM criteria are difficult to apply for such patients, and objective, validated biomarkers would be of great use in this setting.. Long-term (>6 days) critically ill patients in the general ICU of University Hospital were prospectively enrolled in the study. All patients were assessed daily by the attending physician using the ACCP-SCCM classification. C-reactive protein (CRP, mg/dL), procalcitonin (PCT, ng/mL), and interleukin-6 (IL-6, pg/mL) of daily stored sera were measured after each patient's discharge. After discharge, an independent, overall clinical evaluation and an a posteriori ACCP-SCCM classification were chosen as the reference standard for all comparisons. The assessor was aware of the patient's clinical course but was blinded to levels of biomarkers.. We studied clinical variables and biomarkers of 26 patients over a total of 592 patient days. The day-by-day ACCP-SCCM classification of the attending physician overestimated the severity of the inflammatory response to infection. The diagnostic discriminative ability of severe-sepsis/septic-shock for PCT was high (ROC area 0.952 [0.931-0.973]) and had a best threshold value of 1.58 (83.7% sensitivity, 94.6 % specificity). IL-6 had better discriminative ability than CRP, but both were worse than PCT.. PCT > 0.43 ng/mL could add to the clinical propensity for sepsis vs. SIRS not related to infection. Values higher than 1.58 ng/mL may support the bedside clinical diagnosis of severe-sepsis. PCT between 0.5 and 1.0 suggest tight daily monitoring of clinical conditions and re-evaluation of PCT.

Topics: Aged; Anti-Bacterial Agents; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Critical Illness; Decision Making; Diagnosis, Differential; Female; Hospitals, University; Humans; Intensive Care Units; Interleukin-6; Male; Middle Aged; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Shock, Septic; Single-Blind Method; Systemic Inflammatory Response Syndrome

The development of resistance by bacterial species is a compelling issue to reconsider indications and administration of antibiotic treatment. Adequate indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care setting. Until recently, no laboratory marker has been available to differentiate bacterial infection from viral or non-infectious inflammatory reaction; however, over the past years, procalcitonin (PCT) is the first among a large array of inflammatory variables that offers this possibility. The present study aimed to investigate the clinical usefulness of PCT for guiding antibiotic therapy in surgical intensive care patients.. All patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections and at least two concomitant systemic inflammatory response syndrome criteria were eligible. Patients were randomly assigned to either a PCT-guided (study group) or a standard (control group) antibiotic regimen. Antibiotic therapy in the PCT-guided group was discontinued, if clinical signs and symptoms of infection improved and PCT decreased to <1 ng/ml or the PCT value was >1 ng/ml, but had dropped to 25 to 35% of the initial value over three days. In the control group antibiotic treatment was applied as standard regimen over eight days.. A total of 110 surgical intensive care patients receiving antibiotic therapy after confirmed or high-grade suspected infections were enrolled in this study. In 57 patients antibiotic therapy was guided by daily PCT and clinical assessment and adjusted accordingly. The control group comprised 53 patients with a standardized duration of antibiotic therapy over eight days. Demographic and clinical data were comparable in both groups. However, in the PCT group the duration of antibiotic therapy was significantly shorter than compared to controls (5.9 +/- 1.7 versus 7.9 +/- 0.5 days, P < 0.001) without negative effects on clinical outcome.. Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients. This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistance and costs in intensive care medicine. ANNOTATION: Results were previously published in German in Anaesthesist 2008; 57: 571-577 (PMID: 18463831).. ISRCTN10288268.

Topics: Aged; Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Drug Monitoring; Female; Humans; Male; Postoperative Complications; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The development of resistance by infective bacterial species is an incentive to reconsider the indications and administration of available antibiotics. Correct recognition of the indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care situation. There has as yet been no clinical chemical parameter which is capable of specifically distinguishing a bacterial infection from a viral or non-infectious inflammatory reaction, but it now appears that procalcitonin (PCT) offers this possibility. The present study was intended to clarify whether PCT can be used to guide antibiotic therapy in surgical intensive care patients. A total of 110 patients in a surgical intensive care ward receiving antibiotic therapy after confirmed infection or a high grade suspicion of infection were enrolled in this study. In 57 of these patients a new decision was reached each day as to whether the antibiotic therapy should be continued after daily PCT determination and clinical assessment. The control group consisted of 53 patients with a standardized duration of antibiotic therapy over 8 days. Demographic and clinical data were comparable in both groups. However, in the PCT group the duration of antibiotic therapy was significantly shorter compared to controls (5.9+/-1.7 vs. 7.9+/-0.5 days, p<0.001) without unfavorable effects on clinical outcome.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Drug Resistance, Bacterial; Female; Humans; Interleukin-6; Male; Middle Aged; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome; Treatment Outcome

Evaluation the value of procalcitonin as a diagnostic and prognostic marker in septic patients and patients with systemic inflammatory response syndrome (SIRS).. 126 patients were included into the study. The patients were divided into four groups: 1--septic patients with positive blood cultures, 2--septic patients with negative blood cultures, 3--patients with SIRS, 4--patients without sepsis and SIRS. PCT level was measured by imunoluminometric assay (LUMItest) and immunochromatographic assay (PCT-Q).. PCT level is higher in patients with sepsis than in patients with SIRS. PCT level is only slightly elevated in patients without sepsis and SIRS. The highest PCT level is found in patients with septic shock. In patients with the clinical improvement the frequency of PCT level increase is approximately twice lower than in patients who died.. Measurement of PCT level on the first, second and third day of hospitalization has no prognostic value. There is no significant difference in PCT level in sepsis caused by Gram positive and Gram negative bacteria. PCT is a useful marker in diagnosis of sepsis but its role in monitoring the severity of sepsis requires more clinical studies.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chromatography; Female; Humans; Immunoassay; Male; Middle Aged; Protein Precursors; Sepsis; Severity of Illness Index; Systemic Inflammatory Response Syndrome

To compare intrathoracic blood volume (ITBV) guided fluid management and central venous pressure (CVP) guided therapy in ameliorating the progression of early systemic inflammatory response in patients undergoing major surgery.. Prospective, randomized clinical trial.. Forty patients undergoing major abdominal surgery were randomized into CVP and ITBV groups.. In the CVP group the target CVP was 8-12 mmHg while in the ITBV group the goal was to keep the ITBV between 850 and 950 ml/m2 during the operation.. Hemodynamic parameters were determined by single arterial thermodilution. Measurements were repeated every 30 min intraoperatively. Serum procalcitonin (PCT) and C-reactive protein (CRP) was monitored preoperatively, on ICU admission, and then daily for 3 days. Serum TNF-alpha levels were measured intraoperatively hourly and then daily for 3 days. There was no significant difference between the two groups regarding hemodynamic parameters at any assessment point. In the overall population changes in the stroke volume index showed a significant correlation with changes in CVP and ITBV. TNF-alpha levels remained in the normal range intraoperatively and during the three postoperative days in both groups. Preoperatively normal PCT and CRP levels increased significantly postoperatively, without significant differences between the groups.. ITBV guided fluid therapy did not alter the magnitude of inflammatory response as monitored by serum PCT, CRP, and TNF-alpha in the early postoperative period.

Topics: Blood Volume Determination; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Central Venous Pressure; Female; Fluid Therapy; Hemodynamics; Humans; Male; Middle Aged; Monitoring, Intraoperative; Postoperative Complications; Prospective Studies; Protein Precursors; Systemic Inflammatory Response Syndrome; Thermodilution; Tumor Necrosis Factor-alpha

To determine the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) concentration after pediatric cardiac surgery with cardiopulmonary bypass.. Prospective, clinical cohort study.. A fifteen-bed tertiary-care pediatric intensive care unit.. Fourteen pediatric patients admitted for cardiac surgery.. Serum PCT and CRP were measured before cardiopulmonary bypass (CPB); after CPB; and on the first, second, and third days after surgery by means of immunoluminometry and nephelometry, respectively. Reference values for systemic inflammatory response syndrome are 0.5 to 2.0 ng/mL for PCT and <5 mg/L for CRP. Baseline serum PCT and CRP concentrations were 0.24 +/- 0.13 ng/mL and 4.06 +/- 3.60 mg/L (median 25th percentile-75th percentile), respectively. PCT concentrations increased progressively from the end of CPB (0.62 +/- 0.30 ng/mL), peaked at 24 hours postoperatively (POD1) (0.77 +/- 0.49 ng/mL), and began to decrease at 48 hours or POD2 (0.35 +/- 0.21 ng/mL). CRP increased just after CPB (58.82 +/- 42.23 mg/L) and decreased after 72 hours (7.09 +/- 9.81 mg/L).. An increment of both PCT and CRP was observed just after CPB. However, PCT values remained within reference values, whereas CRP concentrations increased significantly after CPB until the third day. These preliminary results suggest that PCT was more effective than CRP to monitor patients with SIRS and a favorable outcome.

Topics: Analysis of Variance; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Male; Nephelometry and Turbidimetry; Postoperative Period; Prospective Studies; Protein Precursors; Systemic Inflammatory Response Syndrome; Time Factors

The diagnosis of sepsis in critically ill patients is challenging because traditional markers of infection are often misleading. The present study was conducted to determine the procalcitonin level at early diagnosis (and differentiation) in patients with systemic inflammatory response syndrome (SIRS) and sepsis, in comparison with C-reactive protein, IL-2, IL-6, IL-8 and tumour necrosis factor-alpha.. Thirty-three intensive care unit patients were diagnosed with SIRS, sepsis or septic shock, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria. Blood samples were taken at the first and second day of hospitalization, and on the day of discharge or on the day of death. For multiple group comparisons one-way analysis of variance was applied, with post hoc comparison. Sensitivity, specificity and predictive values of PCT and each cytokine studied were calculated.. PCT, IL-2 and IL-8 levels increased in parallel with the severity of the clinical condition of the patient. PCT exhibited a greatest sensitivity (85%) and specificity (91%) in differentiating patients with SIRS from those with sepsis. With respect to positive and negative predictive values, PCT markedly exceeded other variables.. In the present study PCT was found to be a more accurate diagnostic parameter for differentiating SIRS and sepsis, and therefore daily determinations of PCT may be helpful in the follow up of critically ill patients.

Topics: Adult; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Female; Humans; Interleukin-2; Interleukin-6; Interleukin-8; Male; Middle Aged; Predictive Value of Tests; Protein Precursors; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome; Tumor Necrosis Factor-alpha

Procalcitonin (PCT) is currently recommended as a suitable parameter to detect and to evaluate the course of bacterial, fungal or parasitic infections. However, recent studies provide evidence that surgical trauma and humoral mediators of inflammation, respectively,may induce PCT synthesis, thereby reducing the validity and reliability of PCT as an "infection-monitoring" parameter. The aim of the present study was to assess and to compare PCT and CRP (C-reactive protein) plasma concentrations in patients presenting without infection following different types of surgery in the absence or presence of a systemic inflammatory response syndrome (SIRS).. PCT and CRP plasma concentrations were assessed daily on postoperative days 1-5 and maximal values were determined in 94 patients. The patients were allocated to four groups of different types of surgery as follows: A: minor, primarily aseptic surgery, B: major abdominal surgery, C: major vascular surgery and D: thoracic surgery including esophagectomy. All categories were divided into two subgroups representing patients with and without SIRS, respectively. RESULTS. PCT plasma concentrations increased moderately compared to normal values in 21% of patients after minor and aseptic surgery (A), in 27% and 41% after major vascular (C) and thoracic (D) surgery, respectively, and in 65% of patients after major abdominal (B) surgery. The difference between PCT concentrations in patients undergoing major abdominal surgery and the patients after minor, aseptic surgery was significant ( p<0,05: A vs. B). Comparing the patients presenting with or without systemic inflammatory response (SIRS), no significant differences in PCT concentrations between groups could be observed. In the majority of patients PCT values rose to peak levels on the first and second postoperative days, followed by a rapid decline based on the plasma half-life of PCT. In contrast, postoperative CRP plasma concentrations were markedly elevated above normal values in all investigated patients during the whole observation period. Between-categories statistical analysis revealed significant differences comparing patients undergoing minor and aseptic surgery with patients after major vascular, and thoracic surgery, respectively ( p<0,05,A vs.C, D). CRP concentrations were significantly increased in patients with systemic inflammatory response compared to patients with normal postoperative course in surgical categories B, C, and D, respectively ( p<0,05).. Postoperative PCT plasma concentrations in patients presenting without signs of infection are largely influenced by the type of surgical procedure. During the first and second postoperative day PCT concentrations are more frequently elevated in patients after major abdominal, major vascular and thoracic surgery compared to patients undergoing minor, aseptic operations. Thus an "infection monitoring" considering PCT value analysis during the postoperative course may transiently be impeded after major and particularly after intestinal surgery during the first 2 days postoperatively, whereas it appears not to be substantially affected by the presence or absence of systemic inflammatory response.

Topics: Abdomen; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Postoperative Complications; Protein Precursors; Systemic Inflammatory Response Syndrome; Thoracic Surgical Procedures; Vascular Surgical Procedures

Our objective was to investigate whether short-term infusion of the oxygen free radical scavenger N-acetylcysteine (NAC) administered before and during extensive abdominal surgery could ameliorate the progression of early systemic inflammatory response.. Prospective, randomised, double-blinded, placebo-controlled clinical trial.. Twenty-bed intensive care unit in a university hospital.. Following written informed consent, 100 patients were randomised into NAC and placebo groups. Three patients from the NAC group and four from the placebo group withdrew before the final analysis.. The treatment group (n=47) received NAC (150 mg/kg(-1) bolus followed by a continuous infusion of 12 mg/kg(-1)/h(-1)) and the placebo group ( n=46) received the same volume of 5% dextrose during surgery.. Serum procalcitonin (PCT), C-reactive protein (CRP) and microalbuminuria was monitored preoperatively, on admission to ICU, then daily during the first 3 postoperative days. For statistical analysis Mann Whitney and Chi-squared tests were used. Patients' clinical course was similar in each group as monitored by the Multiple Organ Dysfunction Scores. There was no significant difference between the two groups regarding PCT and microalbuminuria at any assessment point. Significantly lower CRP levels were found in the NAC group on days 1 and 2 (t(24): median: 84.5 interquartile range: [62-120] vs. 118 [86-137] mg/l; p=0.020; t(48): 136 [103-232] vs. 195 [154-252] mg/l; p=0.013, NAC vs. placebo respectively).. In this study, short-term NAC treatment decreased CRP levels, but failed to attenuate any other inflammatory response, as monitored by serum PCT and microalbuminuria. Overall, our results do not support the routine prophylactic use of NAC as a free radical scavenger in abdominal surgery.

Topics: Abdomen; Acetylcysteine; Aged; Albuminuria; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Double-Blind Method; Female; Free Radical Scavengers; Humans; Intensive Care Units; Male; Middle Aged; Multiple Organ Failure; Postoperative Period; Protein Precursors; Systemic Inflammatory Response Syndrome

A number of European studies have documented the ability of procalcitonin (PCT), a novel inflammatory marker, to discriminate patients with sepsis from those with other causes of systemic inflammatory response syndrome (SIRS). The aim of this study was to assess procalcitonin's performance in an Australian intensive care unit (ICU) setting to examine whether it could discriminate between these two conditions. One hundred and twenty-three consecutive adult ICU patients fulfilling criteria for SIRS were enlisted in the study. Over a period of five days, daily serum PCT and C-reactive protein (CRP) levels were measured. At least two sets of cultures were taken of blood, sputum/broncho-alveolar lavage (BAL) and urine. Other cultures were taken as clinically indicated. Questionnaires to ascertain clinical suspicion of sepsis were prospectively answered by the ICU senior registrars. PCT values were ten times higher in patients with positive blood cultures; CRP values were also significantly higher in the bacteraemic patients. Both PCT and CRP had a good ability to discriminate bacteraemia from non-infectious SIRS, with the area under receiver operating characteristics (ROC) curves for PCT being 0.8 and for CRP being 0.82. However neither PCT or CRP was able to discriminate patients with localized sepsis from those without. Utilizing both tests resulted in a more sensitive screen than either one alone, while PCT was a more accurate diagnostic test for bacteraemia than CRP. The PCT value also differed between those who died in hospital and those who survived. Measurement of PCT alone or in combination with CRP can aid discrimination of septicaemia/bacteriemia with associated SIRS from non-infectious SIRS in an Australian ICU setting.

Topics: Australia; Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Type and frequency of postoperative abnormalities were registered after cardiovascular surgery to evaluate the aetiology and diagnostic value of increased concentrations of procalcitonin (PCT) and C-reactive protein (CRP) during the early postoperative period.. Prospective, observational study.. Two hundred and eight patients undergoing coronary artery bypass grafting or valve replacement requiring cardiopulmonary bypass were monitored for 7 days postoperatively for various types of infectious or non-infectious complications. Plasma PCT and CRP levels were measured on day 1 and day 2 after surgery and, when increased, until day 7.. More patients with PCT above 2 ng/ml on day 1 or 2 (n=55) had postoperative abnormalities (95%) than patients with lower PCT (59%). Specifically, the incidence of three or more criteria of the "systemic inflammatory response syndrome" was 45% versus 4% (area under the curve of the receiver operating characteristic 0.866); positive inotropic support was needed in 65% versus 9% (0.870); respiratory insufficiency (PaO(2)/FIO(2)<200) 38% versus 12% (0.704); proven and suspected bacterial infection 9% versus 1% (0.900) and 24% versus 1% (0.897), respectively. For CRP, the respective areas under the curve were all below 0.63, while all patients had elevated CRP levels, whether they had a complication or not.. Elevated PCT, but not CRP, correlates with evidence of systemic inflammation and other complications early postoperatively after cardiac surgery. Although the PCT levels do not rise as quickly as the criteria of the systemic inflammatory response syndrome appear, they do reflect systemic inflammation. Early identification and quantification of a systemic inflammatory response may help reduce postoperative complications.

Topics: APACHE; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Cardiovascular Diseases; Female; Heart Valve Prosthesis; Humans; Male; Postoperative Complications; Protein Precursors; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome

To understand the presence or absence of bacterial infection in patients with systemic inflammatory response syndrome (SIRS), the level of procalcitonin (PCT), a precursor of calcitonin, was determined. Subjects consisted of 14 SIRS patients without complication by bacterial infection, 14 SIRS patients complicated by sepsis, and 14 SIRS patients complicated by severe sepsis and septic shock. PCT levels in SIRS patients with sepsis (2.9 +/- 2.3 ng/ml) were significantly higher than those in SIRS patients without complication by infection (0.7 +/- 1.1 ng/ml). However, there were no significant differences in the levels of C-reactive protein (CRP), interleukin 6 (I-6) or tumor necrosis factor-alpha (TNF-alpha) between the two groups. PCT levels in SIRS patients with severe sepsis and septic shock (172.2 +/- 276.3 ng/ml) were significantly higher than those in SIRS patients with sepsis. Levels of CRP, IL-6 and TNF-alpha were also significantly higher in the patients with sepsis compared to those in patients with local infection. Significant correlations were observed between the levels of PCT and those of CRP, IL-6 and TNF-alpha in SIRS patients. It was suggested that to measure the levels of procalcitonin in patients with SIRS is useful to diagnose the infection and severity of illness.

Topics: Adult; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Glycoproteins; Humans; Infections; Middle Aged; Protein Precursors; Sepsis; Severity of Illness Index; Systemic Inflammatory Response Syndrome

The systemic side effects of isolated limb perfusion (ILP) with rhTNF alpha and melphalan are characterised by the induction of a systemic inflammatory response syndrome (SIRS). Procalcitonin (PCT), a serum marker of bacterial sepsis, was investigated with respect to its role in SIRS after TNF-ILP. Serum-PCT was analysed in 24 patients (12 male, 12 female), who treated by ILP for regionally metastasized melanoma (n = 8) or locally advanced soft tissue sarcoma (n = 16). Serum samples were analysed pre- and intraoperatively, and at defined intervals after reperfusion of the limb. In addition to PCT, serum IL-6 and IL-8 were analysed in 11 patients. PCT was significantly elevated over baseline after ILP with a maximum between 8 and 36 hours (p < 0.001). Even 96 hours after reperfusion, PCT was still significantly elevated as compared to baseline levels (p = 0.005). There was no correlation to the systemic leakage rate during the perfusion. IL-6 and IL-8 were also significantly increased after ILP (p = 0.001), but the maximum peaks of both cytokines were reached much earlier than for PCT (IL-8 max. at 1 hour and IL-6 max. at 4 hours after reperfusion). Serum procalcitonin is induced as part of the specific SIRS after ILP with rhTNF alpha and melphalan. It may be induced directly by rhTNF alpha or by different cytokines, as serum peaks of IL-6 and IL-8 are reached well before the peak of PCT. Determination of PCT prior to and after ILP with TNF might be useful to assess patients at risk of developing hyperdynamic shock.

Topics: Antineoplastic Combined Chemotherapy Protocols; Calcitonin; Calcitonin Gene-Related Peptide; Chemotherapy, Cancer, Regional Perfusion; Extremities; Female; Humans; Interleukin-6; Interleukin-8; Male; Melanoma; Melphalan; Predictive Value of Tests; Protein Precursors; Sarcoma; Skin Neoplasms; Soft Tissue Neoplasms; Systemic Inflammatory Response Syndrome; Tumor Necrosis Factor-alpha

Topics: Adult; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Middle Aged; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The reasons for a systemic inflammatory response syndrome (SIRS) following ECC are not yet fully understood. Procalcitonin (PCT) blood levels may distinguish between bacterial infections and a non-bacterial systemic inflammation. We investigated the influence of ECC, ECC modified by application of aprotinin, systemic inflammation, and bacterial infection on the PCT values.. 20 CABG patients were randomized and divided in two groups. Group A served as the control group, while group B perioperatively received a high dose of aprotinin. Blood samples for measurement of PCT were taken 6 times perioperatively. Furthermore, blood samples were taken from 20 preoperatively comparable patients who suffered from bacterial infection (n = 10) (group C) or a SIRS (n = 10) (group D) after ECC; in these groups PCT was determined daily after the onset of inflammation.. There was no significant elevation of PCT in group A or B at any time. In sepsis patients a significant elevation of PCT was seen, with the peak level of 18.6+/-6.3 ng/ml on the second day after diagnosis; the PCT level of SIRS patients remained constantly low (<0.9 ng/ml).. In this study it was demonstrated that ECC and the use of aprotinin did not have any influence on the secretion of PCT. A systemic bacterial infection caused a significant increase of PCT, whereas PCT values remained normal in case of a SIRS. So it seems to be possible to distinguish between a primary SIRS and a bacterial sepsis by means of PCT.

Topics: Aged; Aprotinin; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Coronary Artery Bypass; Glycoproteins; Hemostatics; Humans; Middle Aged; Protein Precursors; Systemic Inflammatory Response Syndrome

This study aims to assess the diagnostic and prognostic value of endocan in patients with severe sepsis or septic shock on a medical intensive care unit (ICU).. 150 patients suspected for at least severe sepsis were enrolled on a medical ICU. On days 1, 3, and 8, plasma levels of endocan, procalcitonin (PCT), and interleukin (IL)-6 were measured. Follow-up on all-cause mortality was performed after 30 days and 6 months.. Endocan correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiology Score II (SAPS II) (P < .006). Endocan was higher in patients with at least severe sepsis compared with systemic inflammatory response syndrome (SIRS) or sepsis patients (P = .0006) on days 1, 3, and 8. With a minimum sensitivity of 70%, uniform cutoff levels were set for ≥ sepsis at 1.8 ng/mL, for ≥ severe sepsis at 2.6 ng/mL, for ≥ septic shock at 2.9 ng/mL. On day 1, endocan levels of the fourth quartile were significantly associated with 30-days and 6-months mortality compared to lower levels. After adjustment in Cox regressions, endocan still revealed prognostic value.. Endocan showed diagnostic capacity to diagnose patients with severe sepsis and septic shock and revealed prognostic information for 30-days and 6-months all-cause mortality.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Interleukin-6; Male; Middle Aged; Neoplasm Proteins; Predictive Value of Tests; Prognosis; Protein Precursors; Proteoglycans; Regression Analysis; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

Cytoreductive-surgery for peritoneal-malignancy (PM) involves extensive intra-abdominal surgery and a massive post-operative systemic-inflammatory-response (SIRS). It is often challenging to differentiate SIRS that are solely surgery-associated from those of post-operative infections. White-Cell-Counts (WCC) and C-Reactive-Protein (CRP) are routinely used as markers for infection, but are non-specific and their elevation is often delayed in PM cases. Other markers need to be evaluated to assist early identification/prediction of post-operative infections.. Prospective evaluation of serum procalcitonin (PCT), CRP and WCC in 50 patients pre-operatively (Day0), and on post-operative days (POD) 1, 3 & 6, following cytoreductive-surgery with or without splenectomy.. Day0 PCT, CRP and WCC values were within normal limits, but increasing physiologically in post-operative period without infection, with noticeable higher PCT in splenectomized patients. In our cohort post-operative infections were diagnosed in 14 patients, often within 48 h. There was a trend for faster rise in serum PCT on POD1 compared to CRP and WCC, and faster PCT decline following appropriate therapy on POD3 and POD6 when infected cases were clinically resolving while WCC and CRP continued to rise, particularly in non-spelenectomised patients. The AUC on POD1 was significantly higher for PCT (0.689) vs. WCC (0.476) and CRP (0.477) (p = 0.04). Sensitivity, specificity, positive-predictive-value and negative-predictive-values for PCT ranged between (57%-100%), (22%-74%), (33%-47%) & (81%-100%), for CRP (28%-78%), (5.5%-86%), (18%-44.4%) & (40%-75.5%) and for WCC (14%-26.5%), (65.5-80.5%), (22%-25%), (67%-70%) respectively.. PCT, like WCC and CRP, needs to be interpreted with extreme cautions in the context of infections post-cytoreductive-surgery and should only be used in association with other clinical and investigational findings.

Topics: Adult; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cytoreduction Surgical Procedures; Diagnosis, Differential; Female; Humans; Infections; Intraabdominal Infections; Leukocyte Count; Male; Middle Aged; Peritoneal Neoplasms; Pneumonia, Bacterial; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sepsis; Splenectomy; Surgical Wound Infection; Systemic Inflammatory Response Syndrome; Time Factors

Cell-free circulating DNA (cf-DNA) can be detected by various of laboratory techniques. We described a branched DNA-based Alu assay for measuring cf-DNA in septic patients. Compared to healthy controls and systemic inflammatory response syndrome (SIRS) patients, serum cf-DNA levels were significantly higher in septic patients (1426.54 ± 863.79 vs 692.02 ± 703.06 and 69.66 ± 24.66 ng/mL). The areas under the receiver operating characteristic curve of cf-DNA for normal vs sepsis and SIRS vs sepsis were 0.955 (0.884-1.025), and 0.856 (0.749-0.929), respectively. There was a positive correlation between cf-DNA and interleukin 6 or procalcitonin or Acute Physiology and Chronic Health Evaluation II. The cf-DNA concentration was higher in intensive care unit nonsurviving patients compared to surviving patients (2183.33 ± 615.26 vs 972.46 ± 648.36 ng/mL; P < .05). Branched DNA-based Alu assays are feasible and useful to quantify serum cf-DNA levels. Increased cf-DNA levels in septic patients might complement C-reactive protein and procalcitonin in a multiple marker format. Cell-free circulating DNA might be a new marker in discrimination of sepsis and SIRS.

Topics: Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Cell-Free System; DNA; Female; Humans; Interleukin-6; Male; Mass Screening; Middle Aged; Predictive Value of Tests; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Differentiation between culture-negative sepsis and noninfectious systemic inflammatory response syndrome (SIRS) remains a diagnostic challenge for clinicians, both conditions having similar clinical presentations. Therefore, a swift accurate diagnostic tool, which helps differentiate these 2 conditions would immensely aid appropriate therapeutic continuum. This prospective study was conducted to evaluate the potential diagnostic role of biomarkers, procalcitonin (PCT) and interleukin 6 (IL-6), in culture-negative sepsis patients.. Enrolled patients (208) included 46 noninfectious SIRS, 90 culture-negative sepsis, and 72 culture-positive sepsis. Culture, PCT, and IL-6 estimations were performed on day 1 of intensive care unit admission.. Procalcitonin and IL-6 levels were significantly higher (P < .001) in both culture-negative and culture-positive groups as compared with SIRS group. Procalcitonin was a better predictor of sepsis in both culture-negative (area under curves 0.892 vs 0.636) and culture-positive (area under curves 0.959 vs 0.784) groups as compared with IL-6. In culture-negative group, the best cutoff point for PCT was at 1.43 ng/mL (92% sensitivity; 83% negative predictive value), best cutoff point for IL-6 was at 219.85 pg/mL (47% sensitivity and 42% negative predictive value).. Procalcitonin can accurately differentiate culture-negative sepsis from noninfectious SIRS and thereby contribute to early diagnosis and effective management of these conditions.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Bacteremia; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Early Diagnosis; Female; Humans; Intensive Care Units; Interleukin-6; Male; Middle Aged; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome; Young Adult

To observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.. A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluation II (APACHE II) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.. Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, both P < 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73), Z = -2.447, P < 0.001]. With exacerbation of illness, APACHE II score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P < 0.05 or P < 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823, P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHE II score (r = 0.351, P = 0.031), PCT (r = 0.412, P = 0.005), IL-6 (r = 0.535, P = 0.030), IL-1β (r = 0.674, P = 0.030), TNF-α (r = 0.250, P = 0.030), sST2 (r = 0.620, P < 0.001), and length of stay in ICU (r = 0.296, P = 0.013), duration of mechanical ventilation (r = 0.385, P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37, F = 7.798, P < 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283, P > 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70 μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.. The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; China; Humans; Intensive Care Units; Interleukin-1beta; Interleukin-33; Interleukin-6; Prognosis; Prospective Studies; Protein Precursors; Respiration, Artificial; ROC Curve; Sensitivity and Specificity; Sepsis; Shock, Septic; Single-Blind Method; Systemic Inflammatory Response Syndrome; Tumor Necrosis Factor-alpha

It is relatively difficult to diagnose bacterial sepsis in nephrolithiasis patients. The aim of the study is to evaluate the diagnostic ability of presepsin in the differential diagnosis including SIRS, infection, or sepsis and to compare its diagnostic value with other markers, mainly as CRP, procalcitonin (PCT), and white blood cell (WBC) in patients of nephrolithiasis presenting with SIRS. 39 patients of nephrolithiasis who were diagnosed as SIRS were prospectively investigated. Plasma presepsin was detected by Pathfast presepsin assay system; CRP and PCT were measured as well. Additionally, 25 nephrolithiasis patients without SIRS were included. At all timing samples, patients were classified as SIRS or non-SIRS group. Median plasma presepsin levels were significantly increased in the SIRS group compared with non-SIRS group (452 pg/mL versus 178 ng/mL, P < 0.001), and presepsin was markedly elevated even in the early stage of SIRS (584 pg/mL 6 h, 660 pg/mL 24 h versus 452 pg/mL, P < 0.001). According to the receiver-operating characteristic (ROC) analysis, presepsin demonstrated a high diagnostic value compared with either PCT or CRP. In the early stage of SIRS, presepsin remained a highly sensitive (74.7%) and specific (88.4%) diagnostic marker compared with either PCT, CRP, or WBC. Moreover, the areas under the curve (AUCs) of presepsin (84.6%) were also superior to those seen in either PCT (79.6%) or CRP (71.8%). Thus plasma presepsin levels have comparable performance in SIRS for patients with nephrolithiasis.

Topics: Adult; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Early Diagnosis; Female; Humans; Leukocytes; Lipopolysaccharide Receptors; Male; Middle Aged; Nephrolithiasis; Peptide Fragments; Protein Precursors; Systemic Inflammatory Response Syndrome

Alcoholic hepatitis (AH) frequently progresses to multiple organ failure (MOF) and death. However, the driving factors are largely unknown. At admission, patients with AH often show criteria of systemic inflammatory response syndrome (SIRS) even in the absence of an infection. We hypothesize that the presence of SIRS may predispose to MOF and death. To test this hypothesis, we studied a cohort including 162 patients with biopsy-proven AH. The presence of SIRS and infections was assessed in all patients, and multivariate analyses identified variables independently associated with MOF and 90-day mortality. At admission, 32 (19.8%) patients were diagnosed with a bacterial infection, while 75 (46.3%) fulfilled SIRS criteria; 58 patients (35.8%) developed MOF during hospitalization. Short-term mortality was significantly higher among patients who developed MOF (62.1% versus 3.8%, P < 0.001). The presence of SIRS was a major predictor of MOF (odds ratio = 2.69, P = 0.025) and strongly correlated with mortality. Importantly, the course of patients with SIRS with and without infection was similar in terms of MOF development and short-term mortality. Finally, we sought to identify serum markers that differentiate SIRS with and without infection. We studied serum levels of high-sensitivity C-reactive protein, procalcitonin, and lipopolysaccharide at admission. All of them predicted mortality. Procalcitonin, but not high-sensitivity C-reactive protein, serum levels identified those patients with SIRS and infection. Lipopolysaccharide serum levels predicted MOF and the response to prednisolone.. In the presence or absence of infections, SIRS is a major determinant of MOF and mortality in AH, and the mechanisms involved in the development of SIRS should be investigated; procalcitonin serum levels can help to identify patients with infection, and lipopolysaccharide levels may help to predict mortality and the response to steroids.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Disease Progression; Female; Hepatitis, Alcoholic; Humans; Lipopolysaccharides; Logistic Models; Male; Middle Aged; Multiple Organ Failure; Multivariate Analysis; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Protein Precursors; Retrospective Studies; Risk Assessment; Severity of Illness Index; Spain; Survival Analysis; Systemic Inflammatory Response Syndrome

Sepsis is a serious problem in intensive care units all over the world. Biomarkers could be useful to identify patients at risk. We focused especially on the performance of presepsin (sCD14-ST), compared to C-reactive protein (CRP), procalcitonin (PCT) and CD64, to determine its diagnostic and prognostic indications.. The study was conducted on 47 hospitalized patients after procedures, who were divided into three groups; systemic inflammatory response (SIRS), sepsis and septic shock. Expression of CD64 on neutrophils presented as CD64 index, sCD14-ST, CRP and PCT were measured in whole blood or plasma samples. All patients had standard samples like urine, respiratory tract samples etc. taken for culturing. Blood cultures were drawn to confirm bloodstream infection.. Forty (85 %) patients had SIRS with bacterial infection and seven (15 %) patients had SIRS with no infection. All infections were confirmed with blood cultures. Biomarkers were evaluated in all patients. In patients with confirmed infection the values were high. The patients with bacterial infection showed statistical significance with CD64 index (p = 0.003), CRP (p = 0.049) and sCD14-ST (p = 0.026), but not with PCT (p = 1.000). The severity of diagnosed SIRS was significant only with PCT (p < 0.001).. CD64 index, CRP and sCD14-ST served as good parameters to determine possible infection in patients that needed intensive care after major procedures. Values of PCT were the only ones to predict SIRS severity and could distinguish between sepsis and severe sepsis or septic shock.

Topics: Austria; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Hospitalization; Humans; Intensive Care Units; Lipopolysaccharide Receptors; Male; Peptide Fragments; Prevalence; Prognosis; Protein Precursors; Receptors, IgG; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

The arsenal of maternal and amniotic fluid (AF) immune response to local or systemic infection includes among others the acute-phase reactants IL-6, C-Reactive Protein (CRP) and Procalcitonin (PCT). If these molecules can be used as non-invasive biomarkers of intra-amniotic infection (IAI) in the subclinical phase of the disease remains incompletely known.. We used time-matched maternal serum, urine and AF from 100 pregnant women who had an amniocentesis to rule out IAI in the setting of preterm labor, PPROM or systemic inflammatory response (SIR: pyelonephritis, appendicitis, pneumonia) to infection. Cord blood was analyzed in a subgroup of cases. We used sensitive immunoassays to quantify the levels of inflammatory markers in the maternal blood, urine and AF compartment. Microbiological testing and placental pathology was used to establish infection and histological chorioamnionitis.. PCT was not a useful biomarker of IAI in any of the studied compartments. Maternal blood IL-6 and CRP levels were elevated in women with subclinical IAI. Compared to clinically manifest chorioamnionitis group, women with SIR have higher maternal blood IL-6 levels rendering some marginal diagnostic benefit for this condition. Urine was not a useful biological sample for assessment of IAI using either of these three inflammatory biomarkers.. In women with subclinical IAI, the large overlapping confidence intervals and different cut-offs for the maternal blood levels of IL-6, CRP and PCT likely make interpretation of their absolute values difficult for clinical decision-making.

Topics: Adult; Amniocentesis; Amniotic Fluid; Asymptomatic Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chorioamnionitis; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Interleukin-6; Obstetric Labor, Premature; Placenta; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Protein Precursors; Systemic Inflammatory Response Syndrome

To explore the value of α-1-acid glycoprotein (AGP) for the early diagnostic and prognostic assessment of patients with sepsis.. Eighty-five patients with systemic inflammatory response syndrome (SIRS) and 192 patients with sepsis were enrolled. White blood cell counts and serum levels of AGP, C-reactive protein, and procalcitonin were tested on the day of admission to intensive care unit (ICU; day 1) and the following days 3, 5, 7, and 10.. The sepsis group exhibited significantly higher levels of AGP than did the SIRS group on day 1 (P < .05); the area under the curve (AUC) of AGP was 0.869 with a specificity of 0.902 on diagnosis of sepsis. The differences were statistically significant among sepsis subgroups. On prognostic assessment, the areas under the curve of AGP, Sequential Organ Failure Assessment (SOFA) scores, and SOFA + AGP on ICU admission were 0.793, 0.813, and 0.878, respectively. The results of logistic regression showed that the odds ratios of AGP, SOFA, Acute Physiology and Chronic Health Evaluation II, and the length of ICU stay were 1.450, 1.212, 1.673, and 1.130.. α-1-Acid glycoprotein could distinguish sepsis from SIRS and also be used to effectively assess the severity of sepsis. In addition, combined AGP and SOFA scores had a great predicting value in prognosis of sepsis.

Topics: Adult; Aged; APACHE; Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; China; Early Diagnosis; Female; Humans; Intensive Care Units; Length of Stay; Leukocyte Count; Logistic Models; Male; Middle Aged; Organ Dysfunction Scores; Orosomucoid; Prognosis; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Neutropaenic patients are at a high risk of contracting severe infections. In particular, in these patients, parameters with a high negative predictive value are desirable for excluding infection or bacteraemia. This study evaluated sepsis biomarkers in neutropaenic patients suffering from systemic inflammatory response syndrome (SIRS). Further, the predictive capacities of evaluated biomarkers in neutropaenic SIRS patients were compared to non-neutropaenic SIRS patients.. In this prospective observational cohort study, patients with clinically suspected sepsis were screened. The predictive capacities of procalcitonin (PCT), C-reactive protein and lipopolysaccharide-binding protein (LBP) in neutropaenic SIRS patients were evaluated in terms of their potential to identify infection or bacteraemia and were compared to results for non-neutropaenic SIRS patients. To select an appropriate control cohort, propensity score matching was applied, balancing confounding factors between neutropaenic and non-neutropaenic SIRS patients.. Of 3370 prospectively screened patients with suspected infection, 51 patients suffered from neutropaenic SIRS. For the identification of infection, none of the assessed biomarkers presented a clinically relevant discriminatory potency. Lipopolysaccharide-binding protein and PCT demonstrated discriminatory capacity to discriminate between nonbacteraemic and bacteraemic SIRS in patients with neutropaenia [receiver-operating characteristics-area under the curves (ROC-AUCs): 0.860, 0.818]. In neutropaenic SIRS patients, LBP had a significantly better ROC-AUC than in a comparable non-neutropaenic patient cohort for identifying bacteraemia (P = 0.01).. In neutropaenic SIRS patients, none of the evaluated biomarkers was able to adequately identify infection. LBP and PCT presented a good performance in identifying bacteraemia. Therefore, these markers could be used for screening purposes to increase the pretest probability of blood culture analysis.

Topics: Acute-Phase Proteins; Adult; Aged; Area Under Curve; Bacteremia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Carrier Proteins; Case-Control Studies; Cohort Studies; Female; Humans; Male; Membrane Glycoproteins; Middle Aged; Neutropenia; Predictive Value of Tests; Propensity Score; Prospective Studies; Protein Precursors; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome

To evaluate interleukin-27 (IL-27) as a sepsis diagnostic biomarker in critically ill adults with sepsis.. A retrospetive study was conducted. A total of 176 systemic inflammatory response syndrome (SIRS) patients in Department of Critical Care Medicine of Xinxiang Medical College First Affiliated Hospital from March to November in 2014 were enrolled. The patients were divided into no sepsis group (n=66), pulmonary originated sepsis group (n=65), and non-pulmonary originated sepsis group (n=45). Plasma IL-27 and procalcitonin (PCT) were determined with enzyme linked immunosorbent assay (ELISA). Receiver operating characteristic curve (ROC) and classification and regression tree methodology was used to evaluate diagnostic biomarker performance.. The proportion of patients in pulmonary original sepsis group whose body temperature in line with SIRS criteria was significantly higher than no sepsis group (66.2% vs. 44.5%, P<0.05), and they were easy to suffer from tumor (44.6% vs. 22.7%, P<0.05). The proportion of patients in non-pulmonary originated sepsis group whose white blood cell count in line with SIRS criteria was significantly higher than no sepsis group (68.9% vs. 42.7%, P<0.05). It indicated that patients in pulmonary originated sepsis group and non-pulmonary originated sepsis group were more in line with SIRS criteria compared with no sepsis group. It was shown by ROC curve that IL-27 and PCT was not effective in discriminating sepsis among unselected patients showing symptoms and signs of SIRS. The area under the curve (AUC) was 0.59 [95% confidence interval (95%CI)=0.49-0.65] and 0.61 (95%CI=0.55-0.71). According to the further analysis from different infection sources, the highest AUC was 0.71 (95%CI=0.59-0.79) for IL-27 in patients with a non-pulmonary originated sepsis. A decision tree incorporating IL-27, PCT, and age had an AUC of 0.78 (95%CI=0.71-0.87) in patients with a non-pulmonary originated sepsis, which was higher than IL-27 [0.71(95%CI=0.59-0.79)] or PCT [0.65 (95%CI=0.57-0.78)]. Compared to that of pediatric cohort with sepsis, lower expression of IL-27 was found in adult patients.. IL-27 performed overall poorly as a sepsis diagnostic biomarker in adults. IL-27 may be a more reliable diagnostic biomarker for sepsis in children than in adults. The combination of IL-27 and PCT can reasonably estimate the risk of sepsis in subjects with a non-pulmonary originated sepsis.

Topics: Adult; Area Under Curve; Biomarkers; Blood Pressure; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Critical Illness; Humans; Interleukins; Leukocyte Count; Protein Precursors; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome

To evaluate the diagnostic and prognostic value of the serum procalcitonin (PCT) level in the non-acquired immune deficiency syndrome (AIDS) immunocompromised critically ill patients suspected to have infection.. A retrospective study was conducted in the non-AIDS immunocompromised patients who were admitted to Department of Critical Care Medicine of Xiangya Hospital, Central South University during January 2011 to December 2014. Demographic characteristics, underlying disease, acute physiology and chronic health evaluation II (APACHEII) score at admission, and clinical records including baseline and peak levels of temperature, white blood count (WBC), PCT, and survival rate within 28 days, infection focus, infectious agents (bacterial, fungi or mixed infection), and the severity of infection (sepsis, severe sepsis, or septic shock) were recorded. Receiver operating characteristic (ROC) curve was plotted, and the diagnostic and protective value of above parameters was evaluated.. A total of 98 patients (43 male and 55 female) were enrolled in the study with a median age of 44 (28, 52) years old and a median APACHEII score of 17 (11, 20); 47 with malignant hematological tumor, 45 with autoimmune diseases, and 6 post solid organ transplantation. Among them 53 patients (54.1%) died within 28 days. Twenty-seven patients were diagnosed as systemic inflammatory response syndrome (SIRS) without infection. Among 71 patients with infection, 45 were diagnosed as bacterial infection, 10 with fungal infection, and 16 with mixed infection. Sepsis was diagnosed in 7 patients, severe sepsis in 32 patients, and septic shock in 32 patients. (1) There was no statistical significance in the baseline and peak levels of PCT and WBC, or baseline level of temperature between the groups of SIRS patients without infection and infected patients. The peak level of temperature was significantly higher in the patients with infection as compared with that of the SIRS without infection patients [centigrade: 39.4 (38.9, 40.0) vs. 38.8 (37.8, 39.2), Z=-3.268, P=0.001]. It was showed by subgroup analysis that in patients with hematological malignant disease or autoimmune diseases, higher level of body temperature was found in infection group compared with non-infection SIRS group [centigrade: 39.5 (39.0, 40.0) vs. 39.0 (38.4, 39.4), Z=-2.349, P=0.019; 39.0 (38.4, 39.5) vs. 38.2 (37.0, 38.9), Z=-2.221, P=0.026]. (2) The baseline level of PCT (μg/L) were 0.54 (0.20, 4.19), 2.78 (0.50, 9.54), 1.00 (0.45, 6.89), and 0.22 (0.07, 1.86) in non-infection SIRS patients or the patients with bacterial, fungal, and mixed infection, respectively. The peak level of PCT (μg/L) were 4.19 (1.95, 13.42), 12.37 (3.82, 45.89), 1.82 (0.49, 17.86), and 5.14 (2.66, 12.62), respectively, in each subgroup. When the comparison was conducted among the patients with different infectious agent, the baseline level of PCT in patients with bacterial infection was significantly higher than that in SIRS patients without infection (P=0.026) and mixed infection patients (P=0.001), and the peak level of PCT was significantly higher than that in the SIRS patients without infection (P=0.009) and the patients with fungal infection (P=0.016). ROC curve showed that the higher value was found in the baseline and peak levels of PCT for diagnosis of septic shock in all patients [ area under ROC curve (AUC) of baseline level=0.681±0.054, P=0.001; AUC of peak level=0.690±0.054, P=0.002], and the same value was. The serum level of PCT is found to be a reliable marker for the diagnosis of bacterial infection in immunocompromised critical patients, especially in those with hematologic malignancy. Additionally, PCT provides a useful tool for evaluating the severity of infection and the prognosis of critically ill patients.

Topics: Adult; APACHE; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Humans; Male; Middle Aged; Prognosis; Protein Precursors; Retrospective Studies; ROC Curve; Sepsis; Survival Rate; Systemic Inflammatory Response Syndrome

Sepsis remains a diagnostic challenge in the intensive care unit (ICU), and the use of biomarkers may help in differentiating bacterial sepsis from other causes of systemic inflammatory syndrome (SIRS). The goal of this study was to assess test characteristics of a number of biomarkers for identifying ICU patients with a very low likelihood of bacterial sepsis. A prospective cohort study was conducted in a medical ICU of a university hospital. Immunocompetent patients with presumed bacterial sepsis were consecutively enrolled from January 2012 to May 2013. Concentrations of nine biomarkers (α-2 macroglobulin, C-reactive protein [CRP], ferritin, fibrinogen, haptoglobin, procalcitonin [PCT], serum amyloid A, serum amyloid P, and tissue plasminogen activator) were determined at baseline and at 24 h, 48 h, and 72 h after enrollment. Performance characteristics were calculated for various combinations of biomarkers for discrimination of bacterial sepsis from other causes of SIRS. Seventy patients were included during the study period; 31 (44%) had bacterial sepsis, and 39 (56%) had other causes of SIRS. PCT and CRP values were significantly higher at all measured time points in patients with bacterial sepsis. A number of combinations of PCT and CRP, using various cutoff values and measurement time points, demonstrated high negative predictive values (81.1% to 85.7%) and specificities (63.2% to 79.5%) for diagnosing bacterial sepsis. Combinations of PCT and CRP demonstrated a high ability to discriminate bacterial sepsis from other causes of SIRS in medical ICU patients. Future studies should focus on the use of these algorithms to improve antibiotic use in the ICU setting.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Immunocompetence; Intensive Care Units; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

This study aimed to evaluate the superiority of procalcitonin (PCT), C-reactive protein (CRP) levels, white blood cell (WBC) counts, and erythrocyte sedimentation rate (ESR) in discriminating among infection, systemic inflammatory response syndrome (SIRS), and sepsis, and their differences according to age groups.. The patients were divided into an adult group and a geriatric group (over 65 years) and classified according to the presence of infection, SIRS, and sepsis. The patients' laboratory values (PCT, CRP, WBC, ESR), demographic characteristics, and vital signs were taken into consideration.. When the laboratory parameters were evaluated, there were no significant differences in the PCT, WBC, and ESR values between the age groups (P > 0.05). CRP was significantly higher in the adult patient group compared to the geriatric group (P < 0.001). When the two groups were compared in terms of infection, there were no significant differences in the PCT levels and the WBC count (P > 0.05) in SIRS and sepsis. In addition, the CRP levels and the ESR were significantly higher in the adult sepsis patients when compared with the geriatric patients (P < 0.001).. PCT levels do not distinguish among infection, SIRS, and sepsis in adult and geriatric age groups.

Topics: Adolescent; Adult; Age Factors; Aged; Bacterial Infections; Biomarkers; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Emergency Service, Hospital; Female; Geriatric Assessment; Hospitalization; Humans; Leukocyte Count; Male; Middle Aged; Protein Precursors; Reproducibility of Results; Retrospective Studies; Sepsis; Systemic Inflammatory Response Syndrome; Young Adult

Sepsis is still a major cause of morbidity and mortality despite the improvements in diagnosis and treatment. The aim of this study was to investigate the values of procalcitonin and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the differential diagnosis of patients with sepsis and noninfectious systemic inflammatory response syndrome (NI-SIRS) and measure their importance in the prognosis of patients with sepsis.. This prospective study included 41 NI-SIRS and 33 sepsis patients hospitalized in Celal Bayar University Hospital, Manisa, Turkey. Blood samples were taken from NI-SIRS patients on days 0 and 3 and from sepsis patients on days 0, 3, 4, 7, and 14. Clinical status of the patients was determined with the SOFA scoring system.. The SOFA scoring system and procalcitonin and sTREM-1 measurements were significant in the differential diagnosis of sepsis and NI-SIRS patients. The SOFA scoring system was considered the most important indicator in determining the prognosis of sepsis patients. Procalcitonin and sTREM-1 levels increased progressively in nonsurvivors and decreased in survivors, but changes were statistically insignificant.. In the differentiation of sepsis and NI-SIRS, and evaluation of the prognosis of sepsis, combined measurements of procalcitonin and sTREM-1 levels are important.

Topics: Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Male; Membrane Glycoproteins; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; Receptors, Immunologic; Sepsis; Systemic Inflammatory Response Syndrome; Triggering Receptor Expressed on Myeloid Cells-1

Because acute liver failure (ALF) patients share many clinical features with severe sepsis and septic shock, identifying bacterial infection clinically in ALF patients is challenging. Procalcitonin (PCT) has proven to be a useful marker in detecting bacterial infection. We sought to determine whether PCT discriminated between presence and absence of infection in patients with ALF.. Retrospective analysis of data and samples of 115 ALF patients from the United States Acute Liver Failure Study Group randomly selected from 1863 patients were classified for disease severity and ALF etiology. Twenty uninfected chronic liver disease (CLD) subjects served as controls.. Procalcitonin concentrations in most samples were elevated, with median values for all ALF groups near or above a 2.0 ng/mL cut-off that generally indicates severe sepsis. While PCT concentrations increased somewhat with apparent liver injury severity, there were no differences in PCT levels between the pre-defined severity groups-non-SIRS and SIRS groups with no documented infections and Severe Sepsis and Septic Shock groups with documented infections, (p = 0.169). PCT values from CLD patients differed from all ALF groups (median CLD PCT value 0.104 ng/mL, (p ≤0.001)). Subjects with acetaminophen (APAP) toxicity, many without evidence of infection, demonstrated median PCT >2.0 ng/mL, regardless of SIRS features, while some culture positive subjects had PCT values <2.0 ng/mL.. While PCT appears to be a robust assay for detecting bacterial infection in the general population, there was poor discrimination between ALF patients with or without bacterial infection presumably because of the massive inflammation observed. Severe hepatocyte necrosis with inflammation results in elevated PCT levels, rendering this biomarker unreliable in the ALF setting.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Inflammation; Liver Failure, Acute; Male; Middle Aged; Prospective Studies; Protein Precursors; Retrospective Studies; Sepsis; Severity of Illness Index; Shock, Septic; Systemic Inflammatory Response Syndrome; Young Adult

Early identification of patients with infection and at risk of developing severe disease with organ dysfunction remains a difficult challenge. We aimed to evaluate and validate the heparin-binding protein, a neutrophil-derived mediator of vascular leakage, as a prognostic biomarker for risk of progression to severe sepsis with circulatory failure in a multicenter setting.. A prospective international multicenter cohort study.. Seven different emergency departments in Sweden, Canada, and the United States.. Adult patients with a suspected infection and at least one of three clinical systemic inflammatory response syndrome criteria (excluding leukocyte count).. None.. Plasma levels of heparin-binding protein, procalcitonin, C-reactive protein, lactate, and leukocyte count were determined at admission and 12-24 hours after admission in 759 emergency department patients with suspected infection. Patients were defined depending on the presence of infection and organ dysfunction. Plasma samples from 104 emergency department patients with suspected sepsis collected at an independent center were used to validate the results. Of the 674 patients diagnosed with an infection, 487 did not have organ dysfunction at enrollment. Of these 487 patients, 141 (29%) developed organ dysfunction within the 72-hour study period; 78.0% of the latter patients had an elevated plasma heparin-binding protein level (>30 ng/mL) prior to development of organ dysfunction (median, 10.5 hr). Compared with other biomarkers, heparin-binding protein was the best predictor of progression to organ dysfunction (area under the receiver operating characteristic curve=0.80). The performance of heparin-binding protein was confirmed in the validation cohort.. In patients presenting at the emergency department, heparin-binding protein is an early indicator of infection-related organ dysfunction and a strong predictor of disease progression to severe sepsis within 72 hours.

Topics: Adult; Aged; Antimicrobial Cationic Peptides; Area Under Curve; Biomarkers; Blood Proteins; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Canada; Carrier Proteins; Cause of Death; Cohort Studies; Critical Illness; Emergency Service, Hospital; Female; Hospital Mortality; Humans; Internationality; Male; Middle Aged; Multiple Organ Failure; Predictive Value of Tests; Prospective Studies; Protein Precursors; Risk Assessment; Sepsis; Survival Analysis; Sweden; Systemic Inflammatory Response Syndrome; Treatment Outcome; United States

To explore the early diagnostic value of pro-adrenomedullin (pro-ADM) in sepsis.. A prospective study was conducted. Eighty-two patients with acute infection admitted to Department of Emergency of Shanxi Medical University Second Hospital from April 2013 to March 2014 were enrolled. According to the diagnostic criteria of sepsis, the patients with acute infection were divided into ordinary infection group [infection without systemic inflammatory response syndrome (SIRS), n = 25] and sepsis group (infection combined with SIRS, n = 57). According to degree of severity of sepsis, the latter group was subdivided into three subgroups: sepsis group (n = 22), severe sepsis group (n = 27) and septic shock group (n = 8). Twenty-four healthy persons were included to serve as healthy control group. The venous blood from all the research objects in hospital was collected within 24 hours. The levels of pro-ADM and procalcitonin ( PCT ) were determined by enzyme linked immunosorbent assay (ELISA), and acute physiology and chronic health evaluation II (APACHE II ) score was recorded. The relationship between pro-ADM and PCT and also APACHE II score was analyzed with Pearson correlation analysis. The receiver-operating characteristic curve (ROC) of pro-ADM and PCT were used to evaluate the diagnostic acuity of sepsis.. The plasma levels of pro-ADM, PCT and APACHE II score in sepsis group were significantly higher than those in ordinary infection group and healthy control group [pro-ADM (ng/L): 66.69 ± 1.73 vs. 53.43 ± 2.70, 45.87 ± 1.43; PCT (ng/L): 1 336.49 ± 40.26 vs. 1 083.09 ± 47.99, 959.04 ± 37.53; APACHE II score: 14.60 ± 0.81 vs. 8.10 ± 1.14, 3.00 ± 1.15, all P < 0.01]. With the aggravation of sepsis, the levels of pro-ADM, PCT and APACHE II score were gradually increased, and there were significant differences among sepsis, severe sepsis, and septic shock groups [pro-ADM (ng/L): 64.91 ± 2.50, 73.56 ± 2.80, 84.67 ± 4.52; PCT (ng/L): 1 152.65 ± 48.62, 1 233.93 ± 63.06, 1 475.71 ± 109.93; APACHE II score: 12.91 ± 1.15, 14.55 ± 1.14, 19.37 ± 2.40, P < 0.05 or P < 0.01]. Pearson correlation analysis results showed that the level of pro-ADM was positively related with PCT (r = 0.473, P = 0.006), and it was also positively correlated with APACHE II score (r = 0.707, P = 0.008). ROC curve analysis showed that area under the ROC curve (AUC) of pro-ADM for diagnosis of sepsis was 0.823 (P = 0.003). When the cutoff value was 59.40 ng/L, the sensitivity was 80.7%, the specificity was 68.0%, the positive predictive value was 85.2%, and the negative predictive value was 60.7%. AUC of the PCT for diagnosis of sepsis was 0.653 (P = 0.043). When the cutoff value was 1 194.67 ng/L, the sensitivity was 68.4%, the specificity was 64.0%, the positive predictive value was 81.8%, and the negative predictive value was 44.7%. It was proved that the pro-ADM had a higher diagnostic value for sepsis than PCT.. The plasma levels of pro-ADM can be used as an early indicator in diagnosis and severity evaluation and prognosis in patients with sepsis.

Topics: Adrenomedullin; APACHE; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Early Diagnosis; Enzyme-Linked Immunosorbent Assay; Humans; Prognosis; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

The objective of this study was to determine the diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL), C-reactive protein (CRP), and procalcitonin (PCT) in the prognosis of patients presenting with the systemic inflammatory response syndrome (SIRS) with nephrolithiasis.. Urine NGAL protein levels were measured by enzyme-linked immunosorbent assay in 87 patients presenting with nephrolithiasis who were diagnosed as SIRS. Additionally, 52 patients presenting with nephrolithiasis but without urinary tract infection and 30 healthy controls were also included in the study. Levels of serum CRP and PCT were also taken into consideration.. Median urinary NGAL levels were significantly increased in the SIRS cohorts compared with nephrolithiasis without urinary tract infection patients (4.28 ng/mL versus 2.69 ng/mL, P < 0.001), and NGAL was markedly elevated even in the early stage of SIRS (3.23 ng/mL versus 2.69 ng/mL, P < 0.001). According to the receiver-operating characteristic analysis, NGAL demonstrated a high diagnostic value compared with either PCT or CRP. In the later stage of SIRS, NGAL remained a highly sensitive (76.8%) and specific (86.5%) diagnostic marker compared with either PCT or CRP. Moreover, the area under the curves of NGAL (0.822) were also superior to those seen in either PCT (0.657) or CRP (0.761).. Urinary NGAL is a highly sensitive and specific predictor of SIRS for patients presenting with nephrolithiasis. Further study of NGAL as a reliable biomarker of SIRS is required.

Topics: Acute-Phase Proteins; Adult; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Lipocalin-2; Lipocalins; Male; Nephrolithiasis; Prognosis; Protein Precursors; Proto-Oncogene Proteins; ROC Curve; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome; Young Adult

The aim of this study was to investigate the prevalence of endotoxemia in critically ill Japanese patients using the endotoxin activity assay, a newly developed rapid assay of endotoxin. The endotoxin levels (EA levels) in the blood of 314 patients admitted to our university hospital's intensive care unit (ICU) were measured within 24 h of admission, and its correlation with disease severity and outcome examined. In addition, the EA levels in 61 samples from healthy volunteers were measured. EA level was 0.39 ± 0.25 (mean ± SD) in patients admitted to the ICU and 0.10 ± 0.09 in healthy controls. There was less overlap of EA level distribution between patients and controls compared with previous reports measuring EA level in mainly Caucasian populations. Our patients' EA levels were significantly correlated with disease severity criteria and 28-d mortality. When EA and procalcitonin levels were used concomitantly, disease severity could be assessed more precisely than when either marker was used alone. These results suggest that EA level is a useful marker for disease severity assessment and outcome prediction in critically ill patients.

Topics: Adult; Aged; APACHE; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Endotoxemia; Endotoxins; Female; Humans; Male; Middle Aged; Mycoses; Protein Precursors; Retrospective Studies; Systemic Inflammatory Response Syndrome

Systemic inflammatory response syndrome and sepsis frequently occur after cardiac surgery with cardiopulmonary bypass. The aim of the present study was to investigate whether preoperative cholesterol levels can predict sepsis onset and postoperative complications in patients undergoing cardiac surgery with cardiopulmonary bypass.. Prospective observational study.. Surgical ICU of a French university hospital.. Two hundred and seventeen consecutive patients older than 18 years admitted for planned cardiac surgery with cardiopulmonary bypass.. Measurements of plasma blood lipids and inflammation markers before anesthesia induction (baseline), at cardiopulmonary bypass start, at cardiopulmonary bypass end, and 3 and 24 hours after cardiac surgery. Outcomes were compared in systemic inflammatory response syndrome patients with sepsis (n = 15), systemic inflammatory response syndrome patients without sepsis (n = 95), and non-systemic inflammatory response syndrome patients (n = 107).. A gradual decrease in plasma cholesterol concentration occurred during surgery with cardiopulmonary bypass but was no longer present after correction for hemodilution. Corrected cholesterol levels were significantly lower at baseline in sepsis patients than in other subgroups, and it remained lower in the sepsis group during and after cardiopulmonary bypass. With regard to sepsis, the discriminatory power of baseline cholesterol was fairly good as indicated by receiver operating characteristic curve analysis (area under the curve, 0.78; 95% CI, 0.72-0.84). The frequency of sepsis progressively decreased with increasing baseline cholesterol level quintiles (18.6% and 0% in the bottom and top quintiles, respectively, p = 0.005). In multivariate analysis, baseline cholesterol levels and cardiopulmonary bypass duration were significant and independent determinants of the 3-hour postcardiopulmonary bypass increase in concentrations of procalcitonin and interleukin-8, but not of interleukin-6.. Low cholesterol levels before elective cardiac surgery with cardiopulmonary bypass may be a simple biomarker for the early identification of patients with a high risk of sepsis.

Topics: Aged; Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cholesterol; Critical Care; Cytokines; Elective Surgical Procedures; Female; Humans; Lipoproteins; Logistic Models; Male; Middle Aged; Postoperative Complications; Prospective Studies; Protein Precursors; Risk Factors; Sepsis; Systemic Inflammatory Response Syndrome; Treatment Outcome

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

Molecular pathogen detection from blood is still expensive and the exact clinical value remains to be determined. The use of biomarkers may assist in preselecting patients for immediate molecular testing besides blood culture. In this study, 140 patients with ≥ 2 SIRS criteria and clinical signs of infection presenting at the emergency department of our hospital were included. C-reactive protein (CRP), neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT) and soluble urokinase plasminogen activator receptor (suPAR) levels were determined. One ml EDTA blood was obtained and selective pathogen DNA isolation was performed with MolYsis (Molzym). DNA samples were analysed for the presence of pathogens, using both the MagicPlex Sepsis Test (Seegene) and SepsiTest (Molzym), and results were compared to blood cultures. Fifteen patients had to be excluded from the study, leaving 125 patients for further analysis. Of the 125 patient samples analysed, 27 presented with positive blood cultures of which 7 were considered to be contaminants. suPAR, PCT, and NLCR values were significantly higher in patients with positive blood cultures compared to patients without (p < 0.001). Receiver operating characteristic curves of the 4 biomarkers for differentiating bacteremia from non-bacteremia showed the highest area under the curve (AUC) for PCT (0.806 (95% confidence interval 0.699-0.913)). NLCR, suPAR and CRP resulted in an AUC of 0.770, 0.793, and 0.485, respectively. When compared to blood cultures, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for SepsiTest and MagicPlex Sepsis Test were 11%, 96%, 43%, 80%, and 37%, 77%, 30%, 82%, respectively. In conclusion, both molecular assays perform poorly when one ml whole blood is used from emergency care unit patients. NLCR is a cheap, fast, easy to determine, and rapidly available biomarker, and therefore seems most promising in differentiating BSI from non-BSI patients for subsequent pathogen identification using molecular diagnostics.

Topics: Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Emergency Medical Services; Humans; Lymphocyte Count; Neutrophils; Protein Precursors; Receptors, Urokinase Plasminogen Activator; ROC Curve; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

We explored the value of procalcitonin (PCT) to differentiate sepsis from systemic inflammatory response syndrome (SIRS), and determine sepsis severity in the neurological intensive care unit (NICU). Blood samples were measured for C-reactive protein (CRP) and PCT levels upon NICU admission, on the day of diagnosis of SIRS or sepsis, and at 3 and 7 days after diagnosis. We found that there were significant differences in serum levels of CRP and PCT as well as Glasgow Coma Scale (GCS) score upon admission between the SIRS and sepsis groups (p<0.05). CRP and white blood cell levels were not significantly different when attempting to differentiate sepsis severity (p>0.05). Multiple comparisons showed that significant differences in serum PCT levels were observed between sepsis and severe sepsis groups, as well as sepsis and septic shock groups (p<0.05). We obtained the highest sensitivity and specificity for SIRS and sepsis with cut-off values of 2 ng/mL for PCT, 44 mg/dL for CRP, and 4 for the GCS. There were no differences in CRP and PCT levels between cerebrovascular disease and non-cerebrovascular disease groups (p>0.05). No differences were found between viral and bacterial meningitis groups (p>0.05). PCT levels are valuable in discriminating sepsis from SIRS and determining sepsis severity in critically ill patients with neurological disease.

Topics: Adult; Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glasgow Coma Scale; Humans; Intensive Care Units; Male; Middle Aged; Protein Precursors; Retrospective Studies; ROC Curve; Sepsis; Statistics, Nonparametric; Systemic Inflammatory Response Syndrome

Systemic inflammatory response syndrome (SIRS) occurs frequently after aneurysmal subarachnoid hemorrhage (aSAH). It is a clinical challenge to distinguish between SIRS and incipient infection. Procalcitonin (PCT) has been studied among general critical care patients as a biomarker for infection. We hypothesized that PCT could be useful to distinguish SIRS from sepsis in aSAH patients.. Prospective, observational study conducted in the multidisciplinary intensive care unit at Mayo Clinic, Jacksonville, FL between August 2009 and September 2010. Main predictor was serum PCT obtained on admission and with subsequent episodes of SIRS. A level of 0.2 ng/mL or higher was considered as elevated PCT. Main outcome was clinical infection, which was subsequently subcategorized into major (systemic) and minor (localized) infections in the sensitivity analysis.. Forty consecutive patients were enrolled. Majority (88 %) developed SIRS during the hospitalization. Infection developed in 16 (40 %) patients, with 6 patients meeting criteria for major infection. Overall, PCT was found to be highly specific for all infections and the subcategory of major infections (97 and 93 %, respectively) with related high negative predictive values. Odds ratio for elevated PCT with clinical infections ranged from 25.2 (95 % CI 2.7-233) to 33.3 (95 % CI 4.3-261) for all and major infections, respectively. Related receiver operating characteristic curves for elevated PCT were 0.74 and 0.96 for all and major infections, respectively.. Procalcitonin of 0.2 ng/mL or greater was demonstrated to be very specific for sepsis among patients with aSAH. Further studies should validate this result and establish its clinical applicability.

Topics: Adult; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Female; Fever; Humans; Infections; Length of Stay; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Subarachnoid Hemorrhage; Systemic Inflammatory Response Syndrome

To determine a combination of biomarkers that assure the diagnosis of sepsis and severe sepsis in patients in emergency department (ED).. A total of 652 patients with systemic inflammatory response syndrome (SIRS) were enrolled for this prospective study in the ED of Beijing Chaoyang Hospital of the Capital Medical University between March 2010 and March 2013. Eight biomarkers were determined, including levels of procalcitonin (PCT), interleukin-6 (IL-6), D-dimer, C-reactive protein (CRP), brain natriuretic peptide (BNP), white blood cell count (WBC), percentage of immature neutrophil, and platelet count (PLT). Patients were divided into the sepsis group (452 cases) and non-sepsis group (200 cases) according to the diagnostic criteria of sepsis. Then all these patients were stratified into severe sepsis group (190 cases, including septic shock) and non-severe sepsis group (462 cases) according to the diagnosis of severe sepsis. Logistic regression was performed to identify the independent factors for the diagnosis of sepsis and severe sepsis, and the optimal combination of biomarkers was established. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic ability of the combination and the biomarkers.A total of 652 patients with systemic inflammatory response syndrome (SIRS) were enrolled for this prospective study in the ED of Beijing Chaoyang Hospital of the Capital Medical University between March 2010 and March 2013. Eight biomarkers were determined, including levels of procalcitonin (PCT), interleukin-6 (IL-6), D-dimer, C-reactive protein (CRP), brain natriuretic peptide (BNP), white blood cell count (WBC), percentage of immature neutrophil, and platelet count (PLT). Patients were divided into the sepsis group (452 cases) and non-sepsis group (200 cases) according to the diagnostic criteria of sepsis. Then all these patients were stratified into severe sepsis group (190 cases, including septic shock) and non-severe sepsis group (462 cases) according to the diagnosis of severe sepsis. Logistic regression was performed to identify the independent factors for the diagnosis of sepsis and severe sepsis, and the optimal combination of biomarkers was established. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic ability of the combination and the biomarkers.. PCT, IL-6 and D-dimer were independent factors for diagnosis of sepsis and severe sepsis. The area under the ROC curve (AUC) of the combination of three biomarkers was 0.866 for diagnosis of sepsis, and it was higher than the AUC of PCT (0.803), IL-6 (0.770) and D-dimer (0.737) alone, and this new combination showed better sensitivity, specificity, positive predictive (PPV), and negative predictive (NPV) values than that when the three biomarkers was used individually (the results of combination were 81.2%, 81.0%, 90.6%, 56.5%; that of PCT were 75.2%, 80.0%, 89.5%, 58.8%; that of IL-6 were 81.0%, 61.0%, 82.4%, 58.7%; and that of D-dimer were 79.9%, 59.0%, 81.5%, 56.5%, respectively). The AUC of the combination was 0.815 for the diagnosis of severe sepsis and was better than the three biomarkers used alone, which was 0.758 for PCT, 0.740 for IL-6, and 0.704 for D-dimer respectively. Moreover, the sensitivity, specificity, PPV and NPV of the combination were higher than that of the three biomarkers used singularly (the results of combination were 81.6%, 73.6%, 56.0%, 90.6%; that of PCT were 79.5%, 65.0%, 48.2%, 88.5%; that of IL-6 were 65.8%, 70.6%, 47.9%, 83.4%; and that of D-dimer were 60.5%, 73.2%, 48.1%, 81.8%, respectively).. The combination of PCT, IL-6 and D-dimer enhances the diagnostic ability for sepsis and severe sepsis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Fibrin Fibrinogen Degradation Products; Humans; Interleukin-6; Male; Middle Aged; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome; Young Adult

The soluble urokinase plasminogen activator receptor (suPAR) reflects inflammation. However, the prognostic value of suPAR measurements, particularly at the very early onset of systemic inflammatory response syndrome (SIRS), is less well defined.. The prognostic potential of suPAR levels in patients with SIRS was evaluated. From November 2010 until April 2013, 902 adult patients presenting with SIRS were investigated. Blood samples for laboratory testing of inflammation markers were collected simultaneously with initial blood cultures. suPAR testing was performed using suPARnostic(©) assay.. Analyses of receiver operating characteristics curves revealed areas under the curve (AUCs) of 0.818 for predicting overall mortality within 48 h (36/902 patients died), 0.739 for 30-day mortality (117/902 died) and 0.706 for predicting 90-day mortality (151/902 died). AUCs for procalcitonin (0.777, 0.671 and 0.638), interleukin-6 (0.709, 0.593 and 0.569) and C-reactive protein (0.66, 0.594 and 0.586) as well as renal function and age were markedly lower. Using multivariable regression analyses, suPAR levels (P < 0.001) remained significant predictors of 48-h mortality, whereas suPAR levels (P < 0.001) and bacteraemia (P = 0.002 and P = 0.001, respectively) remained significant predictors of 30- and 90-day mortality. Using Kaplan-Meier survival plots, patients with suPAR <9.15 ng mL(-1) at SIRS onset had a clear benefit.. suPAR plasma level determined at early SIRS is predictive for mortality.

Topics: Age Factors; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Creatinine; Female; Glycoproteins; Humans; Interleukin-6; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; Receptors, Urokinase Plasminogen Activator; Regression Analysis; ROC Curve; Systemic Inflammatory Response Syndrome

To evaluate the prognostic significance of serum levels of procalcitonin (PCT) and D-dimer in children with systemic inflammatory response syndrome (SIRS).. A prospective case control study was conducted on 67 pediatric patients with SIRS who were treated in the pediatric intensive care unit (PICU). Based on the presence or absence of infectious lesions, patients were categorized as sepsis and non-sepsis. Within 24 hours after admission, white blood cell (WBC) count and serum levels of PCT, C-reactive protein (CRP) and D-dimer were determined, and the pediatric critical illness score (PCIS) was calculated. The correlation of PCIS with each of the other measurements was analyzed. On day 28 of follow-up, receiver operator characteristic (ROC) curve was plotted, and the area under ROC (AUC) was calculated. 28-day survival was estimated. Multivariate logistic regression analysis was performed to identify independent risk factors for in-hospital mortality.. Serum levels of PCT and D-dimer were significantly higher (P<0.05) but PCIS was significantly lower (P<0.05) in patients with sepsis than in those without sepsis. Both PCT and D-dimer were negatively correlated with PCIS (P<0.01). Serum levels of PCT and D-dimer 24 hours after admission were higher (P<0.05) and PCIS was lower (P<0.05) in non-survivors than in survivors on day 28. AUC was 0.875, 0.872 and 0.863 respectively for PCT, D-dimer and PCIS in the prediction of 28-day survival (P<0.01). Logistic regression analysis revealed that PCT and D-dimer were independent prognostic factors (odd ratio: 1.684 and 1.003; P<0.01).. Serum levels of PCT may be helpful in differentiating sepsis and non-sepsis at early stage of SIRS in children. PCT and D-dimer are independent risk factors for in-hospital mortality in children with SIRS, and thus have a prognostic significance in clinical settings.

Topics: Adolescent; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Fibrin Fibrinogen Degradation Products; Humans; Infant; Logistic Models; Male; Prognosis; Protein Precursors; Systemic Inflammatory Response Syndrome

We recently identified interleukin-27 (IL-27) as a sepsis diagnostic biomarker in children. Here we assess IL-27 as a sepsis diagnostic biomarker in critically ill adults with systemic inflammatory response syndrome and sepsis.. IL-27 and procalcitonin (PCT) were measured from plasma samples in three groups: no sepsis (n = 78), pulmonary source of sepsis (n = 66), and non-pulmonary source of sepsis (n = 43). Receiver operating characteristic curves and classification and regression tree methodology were used to evaluate biomarker performance.. IL-27 did not discriminate effectively between sepsis and sterile systemic inflammatory response syndrome in unselected patients. The highest area under the curve (AUC) was 0.70 (95% C.I. 0.60 - 0.80) for IL-27 in subjects with a non-pulmonary source of sepsis. A decision tree incorporating IL-27, PCT, and age had an AUC of 0.79 (0.71-0.87) in subjects with a non-pulmonary source of sepsis. Compared to children with sepsis, adults with sepsis express less IL-27.. IL-27 performed overall poorly in this cohort as a sepsis diagnostic biomarker. Combining IL-27, PCT, and age reasonably estimated the risk of sepsis in subjects with a non-pulmonary source of sepsis. IL-27 may be a more reliable sepsis diagnostic biomarker in children than in adults.

Topics: Age Factors; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Decision Trees; Diagnosis, Differential; Female; Humans; Interleukin-27; Male; Middle Aged; Protein Precursors; Respiratory Tract Infections; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) has previously been proposed as useful marker to rule out bloodstream-infection (BSI). The objective of this study was to evaluate the sensitivity of different PCT cut-offs for prediction of BSI in patients with community (CA)- and hospital-acquired (HA)-BSI.. A total of 898 patients fulfilling systemic-inflammatory-response-syndrome (SIRS) criteria were enrolled in this prospective cohort study at the Medical University of Graz, Austria. Of those 666 patients had positive blood cultures (282 CA-BSI, 384 HA-BSI, enrolled between January 2011 and December 2012) and 232 negative blood cultures (enrolled between January 2011 and July 2011 at the emergency department). Blood samples for determination of laboratory infection markers (e.g. PCT) were collected simultaneously with blood cultures.. Procalcitonin was significantly (p < 0.001) higher in SIRS patients with bacteremia/fungemia than in those without. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value of 0.675 for PCT (95% CI 0.636-0.714) for differentiating patients with BSI from those without. AUC for IL-6 was 0.558 (95% CI 0.515-0.600). However, even at the lowest cut-off evaluated (i.e. 0.1 ng/ml) PCT failed to predict BSI in 7% (n = 46) of patients. In the group of patients with SIRS and negative blood culture 79% (n = 185) had PCT levels > 0.1.. Procalcitonin was significantly higher in patients with BSI than in those without and superior to IL-6 and CRP. The clinical importance of this is questionable, because a suitable PCT threshold for excluding BSI was not established. An approach where blood cultures are guided by PCT only can therefore not be recommended.

Topics: Aged; Area Under Curve; Bacteremia; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Female; Humans; Male; Middle Aged; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

The aims of this study were to assess the reliability of circulating cell-free DNA (cf-DNA) concentrations, compared with C-reactive protein (CRP), procalcitonin (PCT) and eosinophil count, in the diagnosis of infections in patients with systemic inflammatory response syndrome (SIRS) and their prognostic values in a cohort of critically ill patients.. We conducted a prospective cohort study in a medical-surgical intensive care unit of a university hospital. Eosinophil count and concentrations of cf-DNA, CRP, and PCT were measured in patients who fulfilled SIRS criteria at admission to the intensive care unit (ICU) and a second determination 24 hours later. DNA levels were determined by a PCR method using primers for the human beta-haemoglobin gene.. One hundred and sixty consecutive patients were included: 43 SIRS without sepsis and 117 with sepsis. Levels of CRP and PCT, but not cf-DNA or eosinophil count, were significantly higher in patients with sepsis than in SIRS-no sepsis group on days 1 and 2. PCT on day 1 achieves the best area under the curve (AUC) for sepsis diagnosis (0.87; 95% confidence interval = 0.81-0.94). Levels of cf-DNA do not predict outcome and the accuracy of these biomarkers for mortality prediction was lower than that shown by APACHE II score. PCT decreases significantly from day 1 to day 2 in survivors in the entire cohort and in patients with sepsis without significant changes in the other biomarkers.. Our data do not support the clinical utility of cf-DNA measurement in critical care patients with SIRS. PCT is of value especially for infection identification in patients with SIRS at admission to the ICU.

Topics: Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; DNA; Eosinophils; Female; Humans; Leukocyte Count; Male; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; Sepsis; Severity of Illness Index; Systemic Inflammatory Response Syndrome

Differentiating sepsis from other noninfectious causes of systemic inflammation is often difficult in the elderly. The aim of this study was to evaluate the ability of C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), procalcitonin (PCT), and Interleukin-6 (IL-6) to identify elderly patients with sepsis. In this single center prospective observational study, we included all consecutive elderly patients admitted with suspected sepsis and systemic inflammatory response syndrome (SIRS) in an emergency department. Blood samples for measuring CRP, PCT, IL-6, ESR and white blood cells (WBC) count were taken at first day of admission. Sensitivity, specificity, positive and negative predictive values were calculated for each inflammatory markers being studied. A total of 150 elderly patients aged 65 and older, 50 with sepsis and 50 with SIRS, and fifty individuals in a normal health status were included. CRP exhibited the greatest sensitivity (98%) and negative predictive value (98.6%) and performed best in differentiating patients with sepsis from those with SIRS. In a receiver operating characteristic curve analysis, IL-6 performed best in distinguishing between SIRS and the control group (AUC 0.75, 95% CI). On the other hand, both CRP and ESR appeared to be a more accurate diagnostic parameter for differentiating sepsis from SIRS among elderly patients.

Topics: Aged; Biomarkers; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Inflammation; Interleukin-6; Leukocyte Count; Male; Prospective Studies; Protein Precursors; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome

To assess the value of procalcitonin (PCT) for the differential diagnosis between infectious and non-infectious systemic inflammatory response syndrome (SIRS) after cardiac operation.. Patients diagnosed with SIRS after cardiac surgery and admitted to Department of Cardiovascular Surgery of Tokyo Medical and Dental University Graduate School between April 1st, 2011 and March 31st, 2013 were retrospectively studied. A total of 142 patients with SIRS were included, and they were divided into infectious group (n =47) or non-infectious group ( n =95) according to the diagnostic criteria of the Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock: 2012 (SSCG2012). The patients with infectious SIRS were included, and there were 11 with sepsis, 12 with severe sepsis without shock, and 24 with septic shock respectively.The clinical data of patients were compared, and the receiver operating characteristic curve (ROC curve) was plotted to assess the diagnostic value of infection and non-infectious diseases for PCT, C-reactive protein ( CRP) and white blood cell count ( WBC ) , as well as the diagnosis of the severity of sepsis.. PCT, CRP, and WBC were significantly higher in the infectious SIRS group than those in the non-infectious SIRS group [ PCT ( J.Lg/L): 2.80 ( 1.24, 10.20) vs.0.10 (0.06, 0.21), Z=-9.020, P=O.OOl; CRP (mg/L): 158.0 (120.0, 199.0) vs. 58.0 (25.0, 89.0), Z=-7.264,P=O.OOl; WBC ( x 1Q9/L): 15.5 (11.0, 22.6) vs. 9.3 (7.2, 12.6), Z=-5.792, P=O.OOl ]. PCT had the highest sensitivity ( 91.5%) and specificity ( 93.7%) for differential diagnosis, with a cut-off value for infectious SIRS of0.4 7 fLg/L, and the cut-off value of CRP and WBC were 119.5 mg/L and l 0.85 X 1 09/L, respectively. There was no significant difference in WBC among sepsis group, severe sepsis group, and septic shock group (X 109/L: 12.40 (9.10, 24.20),13.30 ( 9.93, 16.93), 20.40 ( 13.45, 28.6), x2=5.638, P=0.060], while PCT, CRP had significant difference (PCT(fLg/L): 1.37 (0.72, 1.85), 3.16 (0.48, 13.24), 3.68 (1.67, 20.96), x2 =7.422, P=0.024; CRP (mg!L): 120.0(74.0, 180.0), 135.7 (81.7, 181.3), 171.1 (151.5, 306.0), x2 =9.524, P=0.009].PCT was more reliable than CRP in diagnosing severe sepsis without shock, but it was ineffective for diagnosing septic shock. The cut-off value of PCT for diagnosing severe sepsis without shock was 2.28 fLg/L, and the sensitivity was 66.7%, specificity was 90.9%.Cut-off value of CRP for the diagnosis of septic shock was 149.5 mg/L, with the sensitivity of 83.3%, and the specificity of 66.7%.. PCT was a useful marker for the diagnosis of infectious SIRS after cardiac operation as compared with WBC and CRP. The optimal PCT cut-off value for diagnosing infectious SIRS was 0.47 fLg/L.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Diagnosis, Differential; Filaggrin Proteins; Humans; Postoperative Complications; Protein Precursors; Retrospective Studies; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

Topics: Algorithms; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Middle Aged; Protein Precursors; Retrospective Studies; Systemic Inflammatory Response Syndrome

Acid sphingomyelinase is involved in lipid signalling pathways and regulation of apoptosis by the generation of ceramide and plays an important role during the host response to infectious stimuli. It thus has the potential to be used as a novel diagnostic marker in the management of critically ill patients. The objective of our study was to evaluate acid sphingomyelinase serum activity (ASM) as a diagnostic and prognostic marker in a mixed intensive care unit population before, during, and after systemic inflammation.. 40 patients admitted to the intensive care unit at risk for developing systemic inflammation (defined as systemic inflammatory response syndrome plus a significant procalcitonin [PCT] increase) were included. ASM was analysed on ICU admission, before (PCT before), during (PCT peak) and after (PCT low) onset of SIRS. Patients undergoing elective surgery served as control (N = 8). Receiver-operating characteristics curves were computed.. ASM significantly increased after surgery in the eight control patients. Patients from the intensive care unit had significantly higher ASM on admission than control patients after surgery. 19 out of 40 patients admitted to the intensive care unit developed systemic inflammation and 21 did not, with no differences in ASM between these two groups on admission. In patients with SIRS and PCT peak, ASM between admission and PCT before was not different, but further increased at PCT peak in non-survivors and was significantly higher at PCT low compared to survivors. Survivors exhibited decreased ASM at PCT peak and PCT low. Receiver operating curve analysis on discrimination of ICU mortality showed an area under the curve of 0.79 for ASM at PCT low.. In summary, ASM was generally higher in patients admitted to the intensive care unit compared to patients undergoing uncomplicated surgery. ASM did not indicate onset of systemic inflammation. In contrast to PCT however, it remained high in non-surviving ICU patients after systemic inflammation.

Topics: Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Female; Humans; Intensive Care Units; Lactates; Male; Pilot Projects; Prognosis; Prospective Studies; Protein Precursors; Risk; ROC Curve; Sphingomyelin Phosphodiesterase; Systemic Inflammatory Response Syndrome

Obesity is a growing problem in industrial nations. Our aim was to examine how overweight patients coped with systemic inflammatory response syndrome (SIRS) after polytrauma.. A total of 651 patients were included in this retrospective study, with an ISS ≥ 16 and age ≥ 16 years. The sample was subdivided into three groups: body mass index (BMI; all in kg/m(2))<25, BMI 25-30 and BMI>30, or low, intermediate and high BMI. The SIRS score was measured over 31 days after admission together with measurements of C-reactive protein (CRP), interleukin-6 (IL-6) and procalcitonin (PCT). Data are given as the mean ± SEM if not otherwise indicated. Kruskal-Wallis and χ(2) tests were used for statistical analysis and the significance level was set at p<.05.. The maximum SIRS score was reached in the low BMI-group at 3.4 ± 0.4, vs. 2.3 ± 0.1 and 2.5 ± 0.2 in the intermediate BMI-group and high BMI-group, respectively (p<.0001). However, the maximum SIRS score was reached earlier in the BMI 25-30 group at 1.8 ± 0.2 days, vs. 3.4 ± 0.4 and 2.5 ± 0.2 days in the BMI<25 and BMI>30 groups, respectively (p<.0001). The incidence of sepsis was significantly higher in the low BMI group at 46.1%, vs. 0.2% and 0% in the BMI 25-30 and BMI>30 groups, respectively (p<.0001). No significant differences in the CRP, IL-6 or PCT levels were found between groups.. A higher BMI seemed to be protective for these patients with polytrauma-associated inflammatory problems.

Topics: Adult; Aged; Body Mass Index; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Interleukin-6; Male; Middle Aged; Multiple Trauma; Obesity; Protein Precursors; Retrospective Studies; Sepsis; Systemic Inflammatory Response Syndrome

Absolute eosinophil count (AEC) and procalcitonin (PCT) level may have a prognostic value in critically ill patients. However, their role in cirrhotic patients has never been studied. We evaluated the role of AEC and PCT, obtained at admission, in predicting in-hospital mortality in cirrhotic patients with systemic inflammatory response syndrome (SIRS).. In consecutive cirrhotic patients with SIRS (with or without sepsis), the levels of AEC and PCT were estimated at admission. Their outcome was correlated with these baseline parameters.. One hundred patients were enrolled [median age 52 (range 17-78) years, 84% men]. The etiology of cirrhosis was alcohol (47%), cryptogenic (35%), viral (13%), and others (5%). Their median model for end-stage liver disease (MELD) and Child-Turcotte-Pugh scores were 24 (range 6-40) and 11 (range 5-15), respectively. Infection was present in 59 patients and the rest of the 41 patients had SIRS without infection. There was a significant difference between the median levels of AEC and PCT between patients who had infection and those who did not have infection (P<0.01). Sixty-three patients recovered from SIRS and were discharged, 33 patients died, and four patients received orthotopic liver transplantation during the same admission. Baseline AEC and PCT levels were significantly different between patients who recovered and died. On multivariate analysis, baseline AEC values could independently predict in-hospital mortality, in addition to MELD and serum sodium. The area under receiver operating characteristic curve of AEC for predicting mortality was 0.785, and the best cutoff of AEC, obtained by Youden's index, was 104 cells/cumm, indicating that patients with baseline AEC values less than 104 cells/cumm had higher in-hospital mortality (sensitivity 78%, specificity 70%, positive predictive value 60%, negative predictive value 85%, and accuracy 73%).. In critically ill cirrhotic patients with SIRS, a baseline AEC value of less than 104 cells/cumm accurately predicts in-hospital mortality. The prediction of mortality by AEC is independent of the MELD score and serum sodium.

Topics: Adolescent; Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Eosinophils; Epidemiologic Methods; Female; Humans; Leukocyte Count; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Prognosis; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome; Young Adult

Postoperative increase in inflammation biologic markers is associated with a nonspecific inflammatory response to a surgical injury. We investigated the kinetics of changes in serum concentrations of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6) after abdominal surgeries and we focused on the behaviour of those markers in the case of development of the systemic inflammatory response syndrome (SIRS). In the single centre we conducted a prospective observational study and we included patients admitted to the ICU after elective abdominal surgery. A total of 41 patients were included and 8 (19.5%) of them had clinical and laboratory signs of SIRS. Sepsis was confirmed in one of the patients, a 72-year old patient operated due to having an abdominal aortic aneurysm. Plasma concentrations of PCT, CRP and IL-6 were measured in all the patients before surgery and at the postoperative day 1 (POD1), postoperative day 2 (POD2) and postoperative day 3 (POD3). Systemic release of PCT, CRP and IL-6 was present in all the measured time points after the abdominal surgery. Median concentrations of IL-6 (100.4 pg/mL) and PCT (1, 17 pg/mL) production were measured highest at POD1 and the median of CRP (147 mg/L) was measured at highest POD2. A larger increase of all three measured markers was found in patients with SIRS compared to those without. IL-6 at POD1 and POD2 was a good predictor of SIRS (areas under curves were 0.71 and 0.765, respectively), showing the highest accuracy among investigated markers at those time points. CRP at POD3 was a good predictor of SIRS (AUC was 0.76). A cut-off of 95 mg/mL in the level of CRP at POD3 yielded a sensitivity of 87.5% and specificity of 66.7% in detecting SIRS. IL-6 and CRP were the best in detecting postoperative SIRS after abdominal surgery with the highest area under ROC curve. This study is showing that PCT is not a good marker of SIRS caused only by surgical injury without sepsis.

Topics: Abdomen; Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Elective Surgical Procedures; Female; Humans; Inflammation; Interleukin-6; Kinetics; Male; Middle Aged; Postoperative Complications; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome; Time Factors

In recent years, procalcitonin has emerged as a promising marker for bacterial infection, with the high sensitivity and specificity.. This report presents a 76-year-old woman with fever, vomiting and diarrhea. The clinical and laboratory examination revealed that the patient had a suspected serious intestinal infection and sepsis. The extremely high level of procalcitonin and positive blood culture result confirmed our diagnosis.. Early identification of severe sepsis sometimes is very difficult. Procalcitonin is a useful tool in the early diagnosis of sepsis, differentiating from other inflammatory syndrome. The high PCT level (10 ng/ml) in this case could suggest serious bacterial infection and sepsis, and also predicts mortality and worse outcome.

Topics: Aged; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intestinal Diseases; Prognosis; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The aim of the study was to identify the diagnostic significance of presepsin in acute abdominal conditions and also to examine the correlation between presepsin, procalcitonin (PCT) and other parameters.. To detect presepsin we used a new rapid method based on a chemiluminescent enzyme immunoassay. The clinical usefulness of presepsin to differentiate bacterial and non-bacterial infection [including systemic inflammation response syndrome (SIRS)] was studied and compared with PCT, C-reactive protein (CRP) and white blood cells (WBC).. The presepsin values in different conditions were (mean±standard deviation): healthy group (n=70) 258.7±92.53 pg/mL; SIRS (n=30) 430.0±141.33 pg/mL; sepsis (n=30) 1508.3±866.6 pg/mL. The presepsin values were significantly higher in patients with sepsis than the SIRS group (p<0.0001, Mann-Whitney U-test). The area under the receiver operating characteristics (ROC) curve (AUC) for discriminating of the SIRS from the sepsis patients was 0.996 for presepsin and it was greater than the AUC of PCT (0.912), CRP (0.857) or WBC (0.777).. The ROC curve of the SIRS patient without infection and the sepsis patient showed that the presepsin concentration was a significantly sensitive indicator of sepsis and useful marker for the rapid diagnosis of sepsis.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Immunoenzyme Techniques; Lipopolysaccharide Receptors; Luminescent Measurements; Male; Middle Aged; Protein Isoforms; Protein Precursors; ROC Curve; Sepsis; Solubility; Systemic Inflammatory Response Syndrome

Topics: Aged; Aged, 80 and over; Autoimmune Diseases; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Humans; Intensive Care Units; Kinetics; Male; Middle Aged; Protein Precursors; ROC Curve; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

Presepsin levels are known to be increased in sepsis. The aim of this study was to evaluate the early diagnostic and prognostic value of Presepsin compared with procalcitonin (PCT), Mortality in Emergency Department Sepsis (MEDS) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score in septic patients in an emergency department (ED) and to investigate Presepsin as a new biomarker of sepsis.. This study enrolled 859 consecutive patients with at least two diagnostic criteria for systemic inflammatory response syndrome (SIRS) who were admitted to Beijing Chao-yang Hospital ED from December 2011 to October 2012, and 100 age-matched healthy controls. Patients were stratified into four groups: SIRS, sepsis, severe sepsis, and septic shock. Plasma Presepsin and serum PCT were measured, and MEDS score and APACHE II score were calculated at enrollment. Comparisons were analyzed using the Kruskal-Wallis and Mann-Whitney U tests.. On admission, the median levels of plasma Presepsin increased with sepsis severity. The areas under the receiver operating characteristic (AUC) curves of Presepsin were greater than those of PCT in diagnosing sepsis, and predicting severe sepsis and septic shock. The AUC of Presepsin for predicting 28-day mortality in septic patients was slightly lower than that of PCT, MEDS score and APACHE II score. The AUC of a combination of Presepsin and MEDS score or APACHE II score was significantly higher than that of MEDS score or APACHE II score alone in predicting severe sepsis, and was markedly higher than that of Presepsin alone in predicting septic shock and 28-day mortality in septic patients, respectively. Plasma Presepsin levels in septic patients were significantly higher in non-survivors than in survivors at 28 days' follow-up. Presepsin, MEDS score and APACHE II score were found to be independent predictors of severe sepsis, septic shock and 28-day mortality in septic patients. The levels of plasma Presepsin were positively correlated with PCT, MEDS score and APACHE II score in every septic group.. Presepsin is a valuable biomarker for early diagnosis of sepsis, risk stratification, and evaluation of prognosis in septic patients in the ED.

Topics: Aged; APACHE; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; China; Female; Humans; Lipopolysaccharide Receptors; Male; Middle Aged; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Shock, Septic; Systemic Inflammatory Response Syndrome

To evaluate the clinical application of measuring procalcitonin (PCT) level for diagnosis of bacterial sepsis in patients with and without systemic inflammatory response syndrome(SIRS), we studied the relationship between blood culture (BC) and serum PCT level in clinical 207 cases. In addition, we evaluated the time courses of PCT and other inflammatory markers: tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), E-selectin, WBC count and C-reactive protein (CRP) in 5 bacterial septic patients with SIRS. Serum PCT showed sensitivity of 41% and specificity of 61%, while BC showed specificity of 88%. In 27 BC-positive cases, serum PCT was significantly elevated in gram-negative bacterial sepsis. We observed 11 cases with BC(+) and serum PCT below 0.5 ng/ml. Major causes of these discrepancies were probably due to gram-positive bacterial infection, local bacterial infection or pretreatment with broad-spectrum antibiotics. In contrast, 10 cases with BC(-) and serum PCT over 10 ng/ml were presumably due to some cytokine elevation caused by virus infection or collagen diseases. In 5 cases studied for inflammatory markers, TNF-alpha level elevated earlier than the others and followed by PCT, IL-6, WBC, CRP, and E-selectin. It was suggested that the measurement of serum procalcitonin in septic patients is clinically useful marker to diagnose gram-negative bacterial septic patients with SIRS.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

To assess the usefulness of procalcitonin (PCT) upon admission to the Intensive Care Unit (ICU) in the diagnosis and prognosis of sepsis. A 12-month prospective observational cohort study was carried out. An 11-bed polyvalent ICU Belonging to a University hospital. Fifty patients with systemic inflammatory response syndrome (SIRS) were included. The mean age of the patients was 51.66 years, and 68% of them were males. Upon admission, the concentration of PCT and C-reactive protein (CRP) was assessed. At discharge, the final diagnosis and outcome were reviewed. Thirty-six patients had sepsis. Mean PCT ± SD was higher in sepsis than in non-infectious SIRS (19.3 ± 4.9 vs. 0.65 ± 0.2) ng/ml) (P=.001). PCT had greater discriminating power than CRP (AUC 0.932 vs. 0.827). The cut-off value of PCT for the diagnosis of sepsis was 0.92 ng/dl, with a sensitivity of 80.56%, specificity 85.71%, positive predictive value 93.55% and negative predictive value 63.16%, LR+ 5.64 and LR- 0.23. Mortality was higher in patients with sepsis (52.78% vs. 21.43%) (P=.039). Mean PCT ± SD upon admission among survivors and deceased patients with sepsis was 18.7 ± 6.7 and 19.5 ± 7.5 ng/ml, respectively (P=.934).. PCT upon admission to the ICU is useful for the diagnosis of sepsis, and is more effective than PCR in this respect. However, it is of no help in estimating the short-term prognosis.

Topics: Adult; Calcitonin; Calcitonin Gene-Related Peptide; Critical Care; Female; Humans; Intensive Care Units; Male; Middle Aged; Patient Admission; Prognosis; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Soluble urokinase plasminogen activator receptor (suPAR) serum concentrations have recently been described to reflect the severity status of systemic inflammation. In this study, the diagnostic accuracy of suPAR, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) to predict bacteremia in patients with systemic inflammatory response syndrome (SIRS) was compared.. A total of 132 patients with SIRS were included. In 55 patients blood cultures had resulted positive (study group 1, Gram positive bacteria: Staphylococcus aureus and Streptococcus spp., n=15; study group 2, Gram-negative bacteria, n=40) and 77 patients had negative blood culture results (control group, n=77). Simultaneously with blood cultures suPAR, CRP, PCT, IL-6 and white blood count (WBC) were determined.. SuPAR values were significantly higher in study group 1 (median 8.11; IQR 5.78-15.53; p=0.006) and study group 2 (median 9.62; IQR 6.52-11.74; p<0.001) when compared with the control group (median 5.65; IQR 4.30-7.83). ROC curve analysis revealed an AUC of 0.726 for suPAR in differentiating SIRS patients with bacteremia from those without. The biomarkers PCT and IL-6 showed comparable results. Regarding combinations of biomarkers multiplying suPAR, PCT and IL-6 was most promising and resulted in an AUC value of 0.804. Initial suPAR serum concentrations were significantly higher (p=0.028) in patients who died within 28 days than in those who survived. No significant difference was seen for PCT, IL-6 and CRP.. In conclusion, suPAR, IL-6 and PCT may contribute to predicting bacteremia in SIRS patients.

Topics: Aged; Aged, 80 and over; Area Under Curve; Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Escherichia coli; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Interleukin-6; Klebsiella; Leukocyte Count; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Receptors, Urokinase Plasminogen Activator; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Staphylococcus aureus; Systemic Inflammatory Response Syndrome

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Humans; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Circulating biomarkers can facilitate sepsis diagnosis, enabling early management and improved outcomes. Procalcitonin (PCT) has been suggested to have superior diagnostic utility compared to other biomarkers.. To define the discriminative value of PCT, interleukin-6 (IL-6), and C-reactive protein (CRP) for suspected sepsis.. PCT, CRP, and IL-6 were correlated with infection likelihood, sepsis severity, and septicemia. Multivariable models were constructed for length-of-stay and discharge to a higher level of care.. Of 336 enrolled subjects, 60% had definite infection, 13% possible infection, and 27% no infection. Of those with infection, 202 presented with sepsis, 28 with severe sepsis, and 17 with septic shock. Overall, 21% of subjects were septicemic. PCT, IL6, and CRP levels were higher in septicemia (median PCT 2.3 vs. 0.2 ng/mL; IL-6 178 vs. 72 pg/mL; CRP 106 vs. 62 mg/dL; p < 0.001). Biomarker concentrations increased with likelihood of infection and sepsis severity. Using receiver operating characteristic analysis, PCT best predicted septicemia (0.78 vs. IL-6 0.70 and CRP 0.67), but CRP better identified clinical infection (0.75 vs. PCT 0.71 and IL-6 0.69). A PCT cutoff of 0.5 ng/mL had 72.6% sensitivity and 69.5% specificity for bacteremia, as well as 40.7% sensitivity and 87.2% specificity for diagnosing infection. A combined clinical-biomarker model revealed that CRP was marginally associated with length of stay (p = 0.015), but no biomarker independently predicted discharge to a higher level of care.. In adult emergency department patients with suspected sepsis, PCT, IL-6, and CRP highly correlate with several infection parameters, but are inadequately discriminating to be used independently as diagnostic tools.

Topics: Adult; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Emergency Service, Hospital; Female; Humans; Infections; Interleukin-6; Length of Stay; Male; Middle Aged; Multivariate Analysis; Patient Discharge; Protein Precursors; ROC Curve; Sepsis; Severity of Illness Index; Statistics, Nonparametric; Systemic Inflammatory Response Syndrome

Fever suggests the presence of microbial infection in critically ill patients. The aim was to compare the role of old and new biomarkers in predicting absence or presence of microbial infection, its invasiveness and severity in critically ill patients with new onset fever.. We prospectively studied 101 patients in the intensive care unit with new onset fever (>38.3 °C). Routine infection parameters, lactate, procalcitonin (PCT), midregional pro-adrenomedullin (MR proADM), midregional pro-atrial natriuretic peptide (MR proANP) and copeptin (COP) were measured daily for three days after inclusion. Likelihood, invasiveness (by bloodstream infection, BSI) and severity of microbial infection were assessed by cultures, imaging techniques and clinical courses.. All patients had systemic inflammatory response syndrome; 45% had a probable or proven local infection and 12% a BSI, with 20 and 33% mortality in the ICU, respectively. Only peak PCT (cutoff 0.65 ng/mL at minimum) was of predictive value for all endpoints studied, i.e. BSI, septic shock and mortality (high risk infection) and infection without BSI, shock and mortality (low risk infection), at areas under the receiver operating characteristic curves varying between 0.67 (P = 0.003) and 0.72 (P < 0.001). In multivariable analysis, the combination of C-reactive protein and lactate best predicted high risk infection, followed by PCT. For low risk infection, PCT was the single best predictor.. In critically ill patients with new onset fever, plasma PCT as a single variable, among old and new biomarkers, best helps, to some extent, to predict ICU-acquired, high risk microbial infection when peaking above 0.65 ng/mL and low risk infection when peaking below 0.65 ng/mL.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Fever of Unknown Origin; Humans; Intensive Care Units; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sepsis; Survival Analysis; Systemic Inflammatory Response Syndrome

The outcome of patients undergoing surgical or interventional therapy is unfavourably influenced by severe systemic inflammation. We assessed the impact of a systemic inflammatory response syndrome (SIRS) on the outcome after transcatheter aortic valve implantation (TAVI).. One hundred and fifty-two high-risk patients (mean age: 80.5 ± 6.5 years, mean logistic EuroSCORE: 30.4 ± 8.1%) with symptomatic severe aortic stenosis underwent TAVI. Proinflammatory cytokines [interleukin-6 (IL-6) and interleukin-8 (IL-8)], and acute phase reactants [C-reactive protein (CRP) and procalcitonin (PCT)] were measured at baseline and 1, 4, 24, 48, 72 h, and 7 days after TAVI. Sixty-one of 152 patients developed SIRS during the first 48 h after TAVI. Systemic inflammatory response syndrome patients were characterized by leucocytosis ≥12 × 10(9)/L (83.6 vs. 12.1%; P < 0.001), hyperventilation (80.3 vs. 35.2%; P < 0.001), tachycardia (37.7 vs. 9.9%; P < 0.001), and fever (31.1 vs. 3.3%; P < 0.001) compared with patients without SIRS. Furthermore, the occurrence of SIRS was characterized by a significantly elevated release of IL-6 and IL-8 with subsequent increase in the leucocyte count, CRP, and PCT. Major vascular complications [odds ratio (OR) 5.1, 95% confidence interval (CI): 1.3-19.6; P = 0.018] and the number of ventricular pacing runs (OR 1.7, 95% CI: 1.1-2.8; P = 0.025) were independent predictors of SIRS. The occurrence of SIRS was related to 30-day and 1-year mortality (18.0 vs. 1.1% and 52.5 vs. 9.9%, respectively; P < 0.001) and independently predicted 1-year mortality risk (hazard ratio: 4.3, 95% CI: 1.9-9.9; P < 0.001).. SIRS may occur after TAVI and is a strong predictor of mortality. The development of SIRS could be easily identified by a significant increase in the leucocyte count shortly after TAVI.

Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Catheterization; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Interleukin-6; Interleukin-8; Kaplan-Meier Estimate; Leukocyte Count; Male; Postoperative Complications; Protein Precursors; Risk Factors; Systemic Inflammatory Response Syndrome

Fetal inflammatory response syndrome is implicated as a cause of fetal or neonatal injury. We analyzed the relationship between the procalcitonin umbilical cord blood level and neonatal outcome. A total of 237 preterms born in a level III perinatal medicine unit of a French university hospital were enrolled in a prospective observational study. Measurement of the procalcitonin umbilical cord blood level was performed at birth. After hospitalization, surviving infants were enrolled in the regional follow-up program. Outcome data were recorded on standardized questionnaires. The main outcome measures were neonatal mortality and impaired functional outcome at 2 years of corrected age. The terciles of procalcitonin levels were calculated. Preterm infants of the third tercile were defined as infants with elevated procalcitonin. Among the 237 infants, 13 (5.5%) died during the neonatal period, 20 (8.4%) were lost to follow-up, and 31 (13.1%) were classified as having an impaired functional outcome. After adjustment, elevated cord blood procalcitonin (>0.33 ng/ml) was significantly associated with an increase in mortality (adjusted odds ratio [aOR] = 8.3 [1.4-48]; p = 0.018), but not with the 2-year impaired functional outcome (aOR = 1.0 [0.4-2.5]; p = 0.93). Elevated umbilical blood cord procalcitonin concentration is an independent risk factor of mortality in preterm infants at less than 33 weeks' gestation.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Female; Fetal Blood; France; Humans; Infant; Infant, Newborn; Infant, Premature; Male; Predictive Value of Tests; Pregnancy; Prospective Studies; Protein Precursors; Risk Factors; Survival Analysis; Systemic Inflammatory Response Syndrome; Tertiary Care Centers; Treatment Outcome

To determine whether procalcitonin discriminates between postcardiopulmonary bypass inflammatory syndrome and infectious complication in children better than does C-reactive protein.. Prospective study of children admitted to the intensive care unit after cardiopulmonary bypass.. Classified according to a diagnosis of systemic inflammatory response syndrome and bacterial infection or systemic inflammatory response syndrome but no bacterial infection. Two hundred thirty-one cases were recruited.. Procalcitonin, C-reactive protein, and leukocyte count were measured daily from surgery until day 3. Twenty-two patients were infected (9.5%). Significant differences were detected in the procalcitonin values of the infected group vs. the noninfected group, especially at day 2 (p = .000). There were no differences in the C-reactive protein values. The optimal cutoff for procalcitonin was >2 ng/mL at day 1 and above 4 ng/mL at the day 2. There was a greater sensitivity and specificity than with C-reactive protein as an infection predictor.. Procalcitonin is useful in the diagnosis of bacterial infection after cardiopulmonary bypass. Because procalcitonin kinetics are different in postcardiopulmonary bypass patients, the cutoff to diagnose infection should be different from the normal cutoff.

Topics: Adolescent; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Coronary Artery Bypass; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Leukocyte Count; Male; Protein Precursors; Systemic Inflammatory Response Syndrome

To observe the dynamic changes in serum procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count in systemic inflammatory response syndrome (SIRS) and their implication in assessment of illness severity and prognosis.. A prospective case control study was conducted. Seventy-two patients with SIRS in Guangdong General Hospital were enrolled in intensive care unit (ICU) from May, 2010 to June, 2011. Parameters including PCT, CRP, and WBC count were determined on the 1st, 3rd, and 5th day after admission. The patients were divided into septic group (n=49) and non-septic group (non-infectious SIRS group, n=23) according to the presence or absence of infectious. Dynamic changes in all parameters were compared between the two groups and correlation analysis was carried out on the basis of differential indexes and sequential organ failure assessment (SOFA). The clinical outcome within 28 days after admission to ICU was observed, and the patients were divided into death group (n=19) and survival group (n=53). Dynamic changes in all parameters between the two groups were compared. Relevant parameters were analyzed with area under receiver operator characteristic curve (ROC curve, AUC) to predict 28-day survival. Logistic regression analysis of the multiple factors was used to screen independent risk factors for predicting death.. PCT level (μg/L) on 1st, 3rd, 5th day after admission were all significantly higher in septic group than those in non-septic group (1st day: 2.5±0.3 vs. 0.9±0.2, 3rd day: 1.9±0.3 vs. 0.6±0.2, 5th day: 0.9±0.1 vs. 0.5±0.1, all P<0.05), while there was no statistically significant difference in CRP and WBC between two groups. PCT level in septic group was gradually decreased with time, there were statistically significant differences between septic group and non-septic group at the different treatment time (all P<0.05), but there was no correlation between PCT and treatment duration in non-septic group. Positive statistical correlation was found between PCT and SOFA score (r=0.979, P<0.05). PCT (μg/L) and CRP levels (mg/L) on 1st, 3rd, 5th day were significantly higher in death group than those of survival group (PCT on 1st day: 2.0±0.8 vs. 0.8±0.3, 3rd day: 2.2±0.7 vs. 0.6±0.3, 5th day: 2.4±1.0 vs. 0.4±0.1; CRP on 1st day: 422±45 vs. 411±44, 3rd day: 418±39 vs. 403±52, 5th day: 392±38 vs. 382±46, all P<0.05), but WBC count showed no statistically significant difference between two groups. PCT level in survival group showed a significant lowering along with treatment duration, and statistical difference was seen by paired comparison between every two time-points (all P<0.05). There was no correlation between PCT level and treatment duration in death group, and it maintained a rather high level. No significant difference was seen in CRP and WBC between two groups with passage of time. AUC was 0.824 and 0.720, respectively, when patient's 28-day survival was predicted by PCT and CRP (both P<0.01). Logistic regression analysis of the multiple factors revealed that PCT>2.23 μg/L was independent risk factor predicting the prognosis [odds ratio (OR) was 1.773, 95% confidence interval (95%CI) 1.033 to 3.214, P=0.015].. Serum PCT evaluation may be helpful in differentiating sepsis and non-sepsis at early stage of disease, and also in predicting the severity of the illness and prognosis of SIRS. PCT may be one of the independent risk factors for 28-day survival.

Topics: Adult; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Female; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) has been proposed as a marker of infection and was studied in neutropenic patients. This study investigated its role in non-neutropenic febrile cancer patients (NNCPs).. Between July 2009 and July 2010, a total of 248 NNCPs with fever were studied. PCT was measured in plasma within 24 hours of fever onset and 4 to 7 days thereafter, using a Kryptor system with a lower limit of quantitation of 0.075 ng/mL. Patients' clinical, microbiological, and radiological data were reviewed to make the diagnosis and were correlated with PCT levels.. This study included 30 patients with bloodstream infection (BSI), 60 with localized bacterial infection, 141 with no documented infection, and 8 with tumor-related fever. Most patients (98%) were inpatients or admitted to the hospital during the study. Patients with BSI had significantly higher PCT levels than did those with documented localized infections (P = .048) and no documented infection (P = .011). PCT levels were significantly higher in septic patients than in those without sepsis (P = .012). Patients with stage IV disease or metastasis had significantly higher baseline PCT levels than did those with early stages of cancer (P < .05). PCT levels dropped significantly in patients with bacterial infections in response to antibiotics (P < .0001).. Baseline PCT levels are predictive of BSI and sepsis in NNCPs. They may be predictors of metastasis and advanced cancer. Subsequent decrease in PCT levels in response to antibiotics is suggestive of bacterial infection. Larger trials are needed to confirm the results of this pilot study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Fever; Humans; Male; Middle Aged; Neoplasms; Neutropenia; Pilot Projects; Protein Precursors; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome

To study the contribution of lactate and procalcitonin (PCT) serum measurements for the diagnosis and the risk-stratification of patients with suspected infection presenting to the ED.. Single-center one year observational study on 462 consecutive patients. Multivariate analysis to assess variables associated with sepsis, severe sepsis, septic shock and severe outcome.. Multivariate analysis (Odds ratio [95% CI]), showed that PCT was the best independent variable to identify sepsis (3.98 [2.60-6.10]), while lactate was the best to diagnose severe sepsis (10.88 [6.51-18.19]). Patients with both lactate above 2 mmol·L(-1) and PCT above 0.8 ng·mL(-1) had an enhanced risk of severe outcome.. the dosages of lactate and PCT are complementary for the diagnosis and risk-stratification of patients evaluated in the ED for suspected infection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Emergency Service, Hospital; Female; Hospitalization; Humans; Intensive Care Units; Lactic Acid; Male; Middle Aged; Multivariate Analysis; Protein Precursors; Risk Assessment; ROC Curve; Systemic Inflammatory Response Syndrome; Young Adult

Procalcitonin (PCT), the prohormone of calcitonin, has an early and highly specific increase in response to systemic bacterial infection. The objectives of this study were to determine the natural history of PCT for patients with critical illness and trauma, the utility of PCT as a marker of sepsis versus systemic inflammatory response syndrome (SIRS), and the association of PCT level with mortality.. PCT assays were done on eligible patients with trauma admitted to the trauma intensive care unit (ICU) of a Level I trauma center from June 2009 to June 2010, at hours 0, 6, 12, 24, and daily until discharge from ICU or death. Patients were retrospectively diagnosed with SIRS or sepsis by researchers blinded to PCT results.. A total of 856 PCT levels from 102 patients were analyzed, with mean age of 49 years, 63% male, 89% blunt trauma, mean Injury Severity Score of 21, and hospital mortality of 13%. PCT concentration for patients with sepsis, SIRS, and neither were evaluated. Mean PCT levels were higher for patients with sepsis versus SIRS (p < 0.0001). Patients with a PCT concentration of 5 ng/mL or higher had an increased mortality when compared with those with a PCT of less than 5 ng/mL in a univariate analysis (odds ratio, 3.65; 95% confidence interval, 1.03-12.9; p = 0.04). In a multivariate logistic analysis, PCT was found to be the only significant predictor for sepsis (odds ratio, 2.37; 95% confidence interval,1.23-4.61, p = 0.01).. PCT levels are significantly higher in ICU patients with trauma and sepsis and may help differentiate sepsis from SIRS in critical illness. An elevated PCT level was associated with increased mortality.

Topics: Adult; Aged; APACHE; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Confidence Intervals; Critical Care; Critical Illness; Diagnosis, Differential; Disease Progression; Female; Hospital Mortality; Humans; Injury Severity Score; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Prognosis; Prospective Studies; Protein Precursors; Risk Assessment; ROC Curve; Sensitivity and Specificity; Sepsis; Survival Rate; Systemic Inflammatory Response Syndrome; Trauma Centers; Wounds, Nonpenetrating

Cardiac surgery with cardiopulmonary bypass (CPB) can cause a systemic inflammatory response (SIRS) making difficult the interpretation of inflammatory markers. Procalcitonin (PCT) is a marker of inflammation that appears to be a good early marker of infection after cardiac surgery. To study the kinetics of PCT after cardiac surgery with CPB and to determine its diagnostic and prognostic value. This is a prospective observational study including 40 adult patients consecutively operated for a coronary or valve surgery with CPB, so programmed or semi-urgent. The anesthetic protocol was standardized for all patients. A determination of PCT and CRP was performed before the CEC, at the decision of the CEC (H0), 4 hours after (H4), then H24, H48, H72 and H96. The rate of PCT and CRP increased significantly from the H4 until 4(th) day compared to baseline. (p<0.05). The concentration of PCT increased at the end of CPB, reaching its peak on 1(st) day (0.96±1.00 ng/mL) and then declined rapidly to J2, J3 and J4. CRP showed a slower kinetics with a peak on day 2 (204±81 mg/L) and decreased more slowly. PCT levels showed no significant variation depending on the type of surgery and they were significantly increased in cases of severe SIRS, late postoperative infection and postoperative renal dysfunction (PORD). However, the rates of CRP were not correlated with these complications. According to ROC curve analysis, a threshold value of 0.958 ng/mL PCT measured on the 1(st) day after surgery had a sensitivity of 85% and a specificity of 95% for the prediction of severe SIRS with organ dysfunction. For a threshold of 1.2 ng/mL measured at day 1 postoperatively, the PCT has a sensitivity of 100% and a specificity of 96% for predicting late infection. For a threshold value of 0.475 ng/mL measured at the decision of the CPB, the PCT has a sensitivity of 80% and a specificity of 69% for predicting PORD. PCT levels were correlated with severity scores. They were also correlated with length of stayin ICU. According to ROC curve analysis, a cutoff of 0.737 ng/mL measured at 1(st )postoperative day, the PCT has a sensitivity of 76% and a specificity of 91% for the prediction of an ICU stay of more 3 days with AUC=0.818. The PCT is a marker that has a fast kinetics and can early predict severe SIRS, and late postoperative infection as well as PORD.

Topics: Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Early Diagnosis; Female; Humans; Kinetics; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Prognosis; Protein Precursors; Systemic Inflammatory Response Syndrome

Differentiating between sterile inflammation and bacterial infection in critically ill patients with fever and other signs of the systemic inflammatory response syndrome (SIRS) remains a clinical challenge. The objective of our study was to mine an existing genome-wide expression database for the discovery of candidate diagnostic biomarkers to predict the presence of bacterial infection in critically ill children.. Genome-wide expression data were compared between patients with SIRS having negative bacterial cultures (n = 21) and patients with sepsis having positive bacterial cultures (n = 60). Differentially expressed genes were subjected to a leave-one-out cross-validation (LOOCV) procedure to predict SIRS or sepsis classes. Serum concentrations of interleukin-27 (IL-27) and procalcitonin (PCT) were compared between 101 patients with SIRS and 130 patients with sepsis. All data represent the first 24 hours of meeting criteria for either SIRS or sepsis.. Two hundred twenty one gene probes were differentially regulated between patients with SIRS and patients with sepsis. The LOOCV procedure correctly predicted 86% of the SIRS and sepsis classes, and Epstein-Barr virus-induced gene 3 (EBI3) had the highest predictive strength. Computer-assisted image analyses of gene-expression mosaics were able to predict infection with a specificity of 90% and a positive predictive value of 94%. Because EBI3 is a subunit of the heterodimeric cytokine, IL-27, we tested the ability of serum IL-27 protein concentrations to predict infection. At a cut-point value of ≥5 ng/ml, serum IL-27 protein concentrations predicted infection with a specificity and a positive predictive value of >90%, and the overall performance of IL-27 was generally better than that of PCT. A decision tree combining IL-27 and PCT improved overall predictive capacity compared with that of either biomarker alone.. Genome-wide expression analysis has provided the foundation for the identification of IL-27 as a novel candidate diagnostic biomarker for predicting bacterial infection in critically ill children. Additional studies will be required to test further the diagnostic performance of IL-27. The microarray data reported in this article have been deposited in the Gene Expression Omnibus under accession number GSE4607.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child, Preschool; Critical Illness; Female; Gene Expression; Humans; Infant; Interleukins; Male; Microarray Analysis; Predictive Value of Tests; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Owing to systemic inflammatory response syndrome, the diagnosis of post-operative infection after cardiopulmonary bypass is difficult to assess in children with the usual clinical and biological tools. Procalcitonin could be informative in this context.. Retrospective study in a paediatric intensive care unit. Blood samples were collected as soon as infection was clinically suspected and a second assay was performed 24 hours later. Using referenced criteria, children were retrospectively classified into two groups: infected and non-infected.. Out of the 95 children included, 14 were infected. Before the third post-operative day, procalcitonin median concentration was significantly higher in the infected group than in the non-infected group - 20.24 nanograms per millilitre with a 25th and 75th interquartile of 15.52-35.71 versus 0.72 nanograms per millilitre with a 25th and 75th interquartile of 0.28 to 5.44 (p = 0.008). The area under the receiver operating characteristic curve was 0.89 with 95% confidence intervals from 0.80 to 0.97. The best cut-off value to differentiate infected children from healthy children was 13 nanograms per millilitre with 100% sensitivity - 95% confidence intervals from 51 to 100 - and 85% specificity - 95% confidence intervals from 72 to 91. After the third post-operative day, procalcitonin was not significantly higher in infected children - 2 nanograms per millilitre with a 25th and 75th interquartile of 0.18 to 12.42 versus 0.37 nanograms per millilitre with a 25th and 75th interquartile of 0.24 to 1.32 (p = 0.26). The area under the receiver operating characteristic curve was 0.62 with 95% confidence intervals from 0.47 to 0.77. A procalcitonin value of 0.38 nanograms per millilitre provided a sensitivity of 70% with 95% confidence intervals from 39 to 89 for a specificity of 52% with 95% confidence intervals from 34 to 68. After the third post-operative day, a second assay at a 24-hour interval can improve the sensitivity of the test.. Procalcitonin seems to be a discriminating marker of bacterial infection during the post-operative days following cardiopulmonary bypass in children.

Topics: Age Distribution; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child, Preschool; Cohort Studies; Cross Infection; Female; Follow-Up Studies; Heart Defects, Congenital; Hospital Mortality; Humans; Incidence; Infant; Intensive Care Units, Pediatric; Male; Postoperative Complications; Predictive Value of Tests; Protein Precursors; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Statistics, Nonparametric; Survival Rate; Systemic Inflammatory Response Syndrome; Treatment Outcome

CD14 is present in macrophage, monocyte, and granulocyte cells and their cell membranes, and it is said to be responsible for intracellular transduction of endotoxin signals. Its soluble fraction is present in blood and is thought to be produced in association with infections. It is called the soluble CD14-subtype (sCD14-ST), and in the following text it is referred to by its generic name, presepsin. We have previously reported that presepsin is produced in association with infection and that it is specifically expressed in sepsis. In the present study we developed a new rapid diagnostic method by using a chemiluminescent enzyme immunoassay that allowed making automated measurements in a shorter time. The results of using this method to measure presepsin values in different pathological conditions were normal, 294.2 ± 121.4 pg/ml; local infection, 721.0 ± 611.3 pg/ml; systemic inflammatory response syndrome, 333.5 ± 130.6 pg/ml; sepsis, 817.9 ± 572.7 pg/ml; and severe sepsis, 1,992.9 ± 1509.2 pg/ml; the presepsin values were significantly higher in patients with local infection, sepsis, and severe sepsis than in patients who did not have infection as a complication. In a comparative study with other diagnostic markers of sepsis based on ROC curves, the area under the curve (AUC) of presepsin was 0.845, and greater than the AUC of procalcitonin (PCT, 0.652), C-reactive protein (CRP, 0.815), or interleukin 6 (IL-6, 0.672). In addition, a significant correlation was found between the APACHE II scores, an index of disease severity, and the presepsin values, suggesting that presepsin values can serve as a parameter that closely reflects the pathology.

Topics: Adult; Aged; Aged, 80 and over; APACHE; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chi-Square Distribution; Female; Humans; Immunoenzyme Techniques; Interleukin-6; Lipopolysaccharide Receptors; Male; Middle Aged; Protein Precursors; ROC Curve; Sepsis; Statistics, Nonparametric; Systemic Inflammatory Response Syndrome

This study was intended to investigate the value of suPAR, C-reactive protein (CRP) and procalcitonin (PCT) in the determination and prognosis of systemic inflammatory response syndrome (SIRS) patients.. The study was performed among patients with at least two SIRS criteria. PCT, CRP and suPAR were analyzed from the blood specimens taken.. Eighty-five patients were enrolled in the SIRS group (44 bacteremia, 20 urinary tract infection, 12 pneumonia and 9 non-infection), and 53 individuals in the control group. A significant correlation was determined between suPAR, PCT and CRP values in both groups (P<0.0001). A suPAR cutoff value of 2.8ng/mL was associated with an NPV of 87% and PPV of 91%, with 92% sensitivity and 85% specificity. A relatively high suPAR level that might predict fatality was also determined in fatal cases (P=0.001).. suPAR possesses high sensitivity and specificity levels in terms of differential diagnosis, and high suPAR levels can predict fatality.

Topics: Adult; Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Pneumonia; Predictive Value of Tests; Prognosis; Protein Precursors; Receptors, Urokinase Plasminogen Activator; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Sepsis is a costly diagnosis in hospitalized patients. Failure to diagnose sepsis in a timely manner creates a potential financial and safety hazard. The use of transthyretin, C-reactive protein and procalcitonin measurement as early markers of systemic inflammatory response syndrome (SIRS) and sepsis in association with admission of emergency department patients to the intensive care unit (ICU) has been studied. In these studies the SIRS criteria as well as the use of an elevated neutrophil count with granulocyte precursors (left shift) have proved to be problematic. Despite the validity of procalcitonin measurement (PCT, Brahms) in the early diagnosis of SIRS the cost and time for testing are limiting considerations. Immature granulocyte (IG) measurement has been proposed as a more readily available indicator of the presence of granulocyte precursors (left shift).. This study calibrates and validates the measurement of granulocyte maturation [Immature granulocytes (IG)] to the identification of sepsis, a study carried out on a Sysmex Analyzer, model XE 2100 (Kobe, Japan). The Sysmex IG parameter is a crucial measure of immature granulocyte counts and includes metamyelocytes and myelocytes, but not band neutrophils.. We found agreement with previous work that designated an IG measurement cut-off of 3.2 as optimal. The analysis was then carried a step further with a multivariable discriminator.

Topics: Area Under Curve; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Emergency Service, Hospital; Female; Flow Cytometry; Granulocytes; Humans; Intensive Care Units; Male; Prealbumin; Protein Precursors; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome

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

To evaluate the diagnostic performance of procalcitonin (PCT) in elderly patients with bacterial infection in the emergency department (ED).. Prospective.. ED of a tertiary care hospital.. Elderly patients with systemic inflammatory response syndrome (SIRS) enrolled from September 2004 through August 2005.. A serum sample for the measurement of PCT, two sets of blood cultures, and other cultures of relevant specimens from infection sites were collected in the ED. Two independent experts blinded to the PCT results classified the patients into bacterial infection and nonbacterial infection groups.. Of the 262 patients with SIRS enrolled, 204 were classified as having bacterial infection and 48 as having bacteremia. PCT levels were significantly higher in patients with bacteremia than in those without. The area under the receiver operating characteristic curve for identification of bacteremia according to PCT was 0.817 for the old-old group (>or=75), significantly higher than 0.639 for the young-old group (65-74); P=.02). The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of PCT for bacteremia in patients aged 75 and older were 96.0%, 68.3%, 33.8%, and 98.8%, respectively, with a PCT cutoff value of 0.38 ng/mL.. PCT is sensitive for diagnosing bacteremia in elderly patients with SIRS at ED admission but is helpful in excluding bacteremia only in those aged 75 and older. PCT is not an independent predictor of local infections in these patients.

Topics: Aged; Bacteremia; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Single-Blind Method; Systemic Inflammatory Response Syndrome

Despite recent advances in treatment of severe injured patients, e.g. due to damage control orthopaedics, multi organ dysfunction syndrome (MODS) and sepsis are major complications in daily practice. During one year 94 patients were prospectively collected.. ISS 16, age 18-60 y, primary admission to our level-1 trauma center, survival > 48 hours after trauma. The development of MODS and sepsis were observed and different groups were formed (+/-). Demographic data revealed no significant differences between the subgroups. Comparing groups +MODS and -MODS significant differences on admission day were observed, when PCT showed first on day 2 after trauma differences. Regarding the development of sepsis PCT was advantageous to IL-6 showing significant higher plasma levels in group +sepsis from the first day after trauma. Serum levels of IL-6 and PCT could be useful in early identification of high risk patients to develop posttraumatic MODS. For sepsis PCT is the better prognostic factor.

Topics: Adolescent; Adult; Calcitonin; Calcitonin Gene-Related Peptide; Enzyme-Linked Immunosorbent Assay; Female; Humans; Injury Severity Score; Interleukin-6; Male; Middle Aged; Multiple Organ Failure; Multiple Trauma; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome; Young Adult

A lot of investigators have reported about the diagnostic and prognostic value of procalcitonin (PCT) for severe bacterial infection. We evaluated the usefulness of semi-quantitative PCT test in respiratory medical practice.. A retrospective study was performed from June to December 2008 at the Chugoku Rosai General Hospital, Hiroshima, Japan. This study analyzed consecutive adult patients, including outpatients and inpatients, who developed systemic inflammatory response syndrome (SIRS) and their PCT were measured semi-quantitatively within the first 24 hours of onset or first visit. We extracted 87 patients with respiratory disease and analyzed their clinical data.. Study patients were divided into two groups: 61 patients with bacterial infection and 26 patients without it. Semi-quantitative PCT test (cut-off value; > or = 0.5 ng/ml) showed sensitivity of 55.7% and specificity of 84.6% for diagnosis of bacterial infection. The diagnostic value of PCT was higher than that of CRP and WBC but it was thought to be not enough to accurate diagnosis. The patients with high PCT value (> or = 2.0 ng/ml) showed higher death rate than the patients without it (36.4% vs 7.7%, P = 0.016).. Semi-quantitative PCT test, which anyone can use quickly and easily, has great prognostic value and limited diagnostic value for respiratory bacterial infection.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chromatography; Humans; Immunoassay; Pneumonia, Bacterial; Protein Precursors; Pulmonary Medicine; Reagent Kits, Diagnostic; Retrospective Studies; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) was initially described as a calcitonin prohormone and later shown to be a useful marker for identifying bacterial infection and sepsis. We evaluated PCT's clinical efficacy in assessing bacterial infection severity, measuring PCT and systemic inflammatory response syndrome (SIRS) markers in 180 subjects with suspected infection. PCT titer was higher with increasing infection severity. PCT was thus useful in identifying those in critical condition.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The efficacy of the rapid semi-quantitative procalcitonin (PCT) test for the diagnosis of bacterial infection was evaluated in patients with systemic inflammatory response syndrome.. A retrospective observational study was performed from June to December 2008 at the Chugoku Rosai General Hospital, Japan. This study analyzed consecutive patients (both outpatients and inpatients) who developed systemic inflammatory response syndrome and whose PCT test was measured semi-quantitatively within 24 hours of onset, or at the first hospital visit. Based on the clinical diagnosis, the patients were divided into two groups. Group I comprised patients with a bacterial infection, and group II comprised patients with a non-bacterial infection, or non-infectious disease. Receiver operating characteristic curves were used to evaluate the diagnostic value of the semi-quantitative PCT test kit, C-reactive protein levels and white blood cells counts for the detection of bacterial infections, and the areas under the resulting curves were compared.. A total of 168 patients were included and divided into groups I (n=112) and II (n=56). Group I showed a significantly higher percentage of positive PCT tests (≥ 0.5 ng/mL) than group II (67.8%vs. 19.6%, p < 0.001). PCT showed a sensitivity of 67.8% [95% confidence interval (CI)=58.4-76.4] and a specificity of 80.4% (95% CI=67.6-89.8). The areas under the resulting curves for PCT (0.764) were significantly larger than those seen for C-reactive protein (0.650, p=0.02) and white blood cells (0.618, p=0.006).. The semi-quantitative PCT test is as useful for distinguishing bacterial infection from other inflammatory diseases in common clinical practice as the quantitative PCT.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Leukocyte Count; Male; Middle Aged; Protein Precursors; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

Chromogranin A (CGA), a stress marker released with catecholamines by the adrenal medulla, has never been associated with acute inflammation in critically ill patients.. To determine evidence for a link between serum concentration of CGA, biomarkers of inflammation, and outcome inpatients admitted with or without the systemic inflammatory response syndrome (SIRS).. At admission, we measured in 53 patients and 14 healthy controls the serum concentrations of CGA,procalcitonin, and C-reactive protein. We also assessed the Simplified Acute Physiological Score (SAPS) in the patients.. Serum CGA concentrations were significantly increased in SIRS patients with a median value of 115 microg/L (68.0-202.8), when compared to healthy controls (PB0.001). In cases where infection was associated with SIRS, patients had the highest increase in CGA with a median value of 138.5 microg/L (65-222.3) (PB0.001). CGA concentrations positively correlated with inflammation markers (procalcitonin, C-reactive protein), but also with SAPS. Receiver operating characteristic (ROC) analysis showed that CGA is equivalent to SAPS as an indicator for 28-day mortality (area under curve (AUC) for both: 0.810).. Patients with CGA concentration superior to 71 microg/L have a significantly shorter survival. A Cox model confirmed that CGA and SAPS were independent predictors of outcome.

Topics: Adult; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chromogranin A; Critical Illness; Female; Humans; Intensive Care Units; Male; Middle Aged; Patient Admission; Prognosis; Prospective Studies; Protein Precursors; ROC Curve; Severity of Illness Index; Survival Rate; Systemic Inflammatory Response Syndrome

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

The aim of this study is evaluation of procalcitonin role in the diagnosis of infectious and non infectious inflammation. This cross-sectional study was conducted in one hundred patients in Baqiyatallah Hospital of Iran in 2008. Patients suspected to infection were recruited to study. They were divided to four groups as: systemic inflammatory response syndrome, sepsis, sepsis syndrome and septic shock. Procalcitonin quantitative was assayed by immunoluminometric kit manufactured in Germany. Procalcitonin level was divided to four groups in < 0.5 ng mL(-1) compatible for SIRS, 0.5-2 ng mL(-1) for sepsis and 2-10 ng mL(-1) for sepsis syndrome and > 10 ng mL(-1) for septic shock. Data was analyzed by SPSS 13 for window software; T student test, ANOVA and Chi-square were used. In this study 53(53%) of subjects were men with mean age of 56.16 +/- 19.5 years old. The diagnosis was SIRS in 36%, sepsis in 38%, sepsis syndrome in 14% and septic shock in 12% of cases. Procalcitonin level was less than 0.5 ng mL(-1) in 61% and more than 10 ng mL(-1) in 10% of patients. Procalcitonin level showed significant association with septic shock, positive blood culture and mental dysfunction. Ultimately this study showed that high level of procalcitonin can differentiate septic shock from SIRS and other stages of infection. Dysfunction of mental status and high level of procalcitonin can determine septic shock.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Child; Cross-Sectional Studies; Diagnosis, Differential; Humans; Male; Middle Aged; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome; Young Adult

The Surviving Sepsis Campaign has recommended that antibiotic therapy should be started within the first hour of recognizing severe sepsis. Procalcitonin has recently been proposed as a biomarker of bacterial infection, although the quantitative procalcitonin assay is often time consuming, and it is not always available in many emergency departments (EDs). Our aim is to evaluate usefulness of the semiquantitative procalcitonin fast kit as a guideline for starting antibiotic administration for patients with severe sepsis or septic shock that requires prompt antibiotic therapy in the ED.. We include those patients who were admitted to the ED and who were suspected of having infection. The procalcitonin concentration was determined by semiquantitative PCT-Q strips, and the points of the severity scoring system were calculated. The receiver operating characteristic curve was used to assess the diagnostic value of the PCT-Q strips to predict severe sepsis or septic shock.. Of the 80 recruited patients, 33 patients were categorized as having severe sepsis or septic shock according to the definition. At a procalcitonin cutoff level of 2 ng/mL or greater, the sensitivity of the PCT-Q for detecting severe sepsis or septic shock was 93.94% and the specificity was 87.23. The receiver operating characteristic curve for PCT-Q to predict severe sepsis or septic shock had an area under the curve of 0.916.. PCT-Q is probably a fast, useful method for detecting severe sepsis in the ED, and it can be used as a guideline for antibiotic treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Emergency Service, Hospital; Female; Glycoproteins; Health Status Indicators; Humans; Immunoassay; Infant; Male; Middle Aged; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome; Young Adult

To compare the diagnostic accuracy of neutrophil and monocyte CD64 indexes (CD64in and CD64im) for sepsis in critically ill neonates and children with that of lipopolysaccharide-binding protein (LBP), procalcitonin (PCT) and C-reactive protein (CRP).. Prospective, observational study in a level III multidisciplinary neonatal and pediatric intensive care unit (ICU).. Forty-six neonates and 36 children with systemic inflammatory response syndrome (SIRS) and suspected infection, classified into two groups: those with bacterial sepsis (microbiologically proven or clinical sepsis) and those without bacterial sepsis (infection not supported by subsequent clinical course, laboratory data and microbiological tests).. Flow cytometric CD64in and CD64im, serum LBP, PCT and CRP measurement on 2 consecutive days from admission to the ICU.. There were 17 cases of bacterial sepsis in neonates and 24 cases of bacterial sepsis in children. All neonates and the majority of children were mechanically ventilated, and more than two-thirds of neonates with sepsis and one-third of children with sepsis needed inotropic/vasopressor drugs. The highest diagnostic accuracy for sepsis on the 1st day of suspected sepsis was achieved by LBP in neonates (0.86) and by CD64in in children (0.88) and 24 h later by CD64in in neonates (0.96) and children (0.98).. Neutrophil CD64 index (CD64in) is the best individual marker for bacterial sepsis in children, while in neonates the highest diagnostic accuracy at the time of suspected sepsis was achieved by LBP and 24 h later by CD64in.

Topics: Acute-Phase Proteins; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Carrier Proteins; Child; Child, Preschool; Critical Illness; Female; Flow Cytometry; Humans; Infant; Infant, Newborn; Male; Membrane Glycoproteins; Monocytes; Neutrophils; Prospective Studies; Protein Precursors; Receptors, IgG; ROC Curve; Severity of Illness Index; Statistics, Nonparametric; Systemic Inflammatory Response Syndrome

Systemic inflammatory response syndrome (SIRS) is a frequent condition after cardiopulmonary bypass (CPB) and makes conventional biological tests fail to detect postoperative sepsis. Biphasic waveform (BPW) analysis is a new biological test derived from activated partial thromboplastin time that has recently been proposed for sepsis diagnosis. The aim of this study was to investigate the accuracy of BPW to detect sepsis after cardiac surgery under CPB.. We conducted a prospective study in American Society of Anesthesiologists' (ASA) physical status III and IV patients referred for cardiac surgery under CPB. Procalcitonin (PCT) and BPW were recorded before surgery and every day during the first week following surgery. Patients were then divided into three groups: patients presenting no SIRS, patients presenting with non-septic SIRS and patients presenting with sepsis.. Thirty two patients were included. SIRS occurred in 16 patients (50%) including 5 sepsis (16%) and 11 (34%) non-septic SIRS. PCT and BPW were significantly increased in SIRS patients compared to no SIRS patients (0.9 [0.5-2.2] vs. 8.1 [2.0-21.3] ng/l for PCT and 0.10 [0.09-0.14] vs. 0.29 [0.16-0.56] %T/s for BPW; P < 0.05 for both). We observed no difference in peak PCT value between the sepsis group and the non-septic SIRS group (8.4 [7.5-32.2] vs. 7.8 [1.9-17.5] ng/l; P = 0.67). On the other hand, we found that BPW was significantly higher in the sepsis group compared to the non-septic SIRS group (0.57 [0.54-0.78] vs. 0.19 [0.14-0.29] %T/s; P < 0.01). We found that a BPW threshold value of 0.465%T/s was able to discriminate between sepsis and non-septic SIRS groups with a sensitivity of 100% and a specificity of 93% (area under the curve: 0.948 +/- 0.039; P < 0.01). Applying the previously published threshold of 0.25%T/s, we found a sensitivity of 100% and a specificity of 72% to discriminate between these two groups. Neither C-reactive protein (CRP) nor PCT had significant predictive value (area under the curve for CRP was 0.659 +/- 0.142; P = 0.26 and area under the curve for PCT was 0.704 +/- 0.133; P = 0.15).. BPW has potential clinical applications for sepsis diagnosis in the postoperative period following cardiac surgery under CPB.

Topics: Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Elective Surgical Procedures; Female; Humans; Leukocyte Count; Male; Middle Aged; Partial Thromboplastin Time; Postoperative Complications; Prospective Studies; Protein Precursors; Sepsis; Stroke Volume; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.. Patients were included in the study provided they were hospitalised in the ICU for > 10 days, were free of infection and presented a new episode of SIRS, with fever >38 degrees C being obligatory. Fifty patients fulfilled the above criteria. PCT was measured daily during the ICU stay. The primary outcome was proven infection.. Twenty-seven out of 50 patients were diagnosed with infection. Median PCT on the day of fever was 1.18 and 0.17 ng/ml for patients with and without proven infections (p < 0.001). The area under the curve for PCT was 0.85 (95% CI; 0.71-0.93), for CRP 0.65 (0.46-0.78) and for WBC 0.68 (0.49-0.81). A PCT level of 1 ng/mL yielded a negative predictive value of 72% for the presence of infection, while a PCT of 1.16 had a specificity of 100%. A two-fold increase of PCT between fever onset and the previous day was associated with proven infection (p 0.001) (OR = 8.55; 2.4-31.1), whereas a four-fold increase of PCT of any of the 6 preceding days was associated with a positive predictive value exceeding 69.65%. A PCT value less than 0.5 ng/ml on the third day after the advent of fever was associated with favorable survival (p 0.01).. The reported data support that serial serum PCT may be a valuable diagnostic and prognostic marker in febrile chronic critically ill patients.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Fever; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

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 assess the clinical value of pro-adrenomedullin (pro-ADM) in the prognosis and risk stratification in sepsis.. Fifty-one critically ill patients admitted to the intensive care unit (ICU) were prospectively stratified into four groups according to internationally recognized criteria: systemic inflammatory response syndrome (SIRS, 25 cases), sepsis (12 cases), severe sepsis (9 cases) and septic shock (5 cases). The levels of plasma pro-ADM was determined in every patient using a new sandwich immunoassay, and compared with procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and the acute physiology and chronic health evaluation II (APACHE II) score.. (1) Median pro-ADM concentration was 0.34 microg/L for SIRS, 2.23 microg/L for sepsis, 4.57 microg/L for severe sepsis and 8.21 microg/L for septic shock. The plasma concentration of pro-ADM exhibited a gradual increase, and the median pro-ADM value was highest in the septic shock group (all P<0.05). (2) Compared with the other biomarkers, in the sepsis, severe sepsis and septic shock groups, the plasma concentration of pro-ADM and APACHE II score in the non-survivors was significantly higher than in the survivors (pro-ADM: 2.01 microg/L vs. 9.75 microg/L, APACHE II score: 23.44 scores vs. 38.21 scores, both P<0.05). (3) By the receiver operating characteristic (ROC) curve plot analysis of pro-ADM in sepsis, the area under the ROC curve for pro-ADM (0.87) in survivors was similar to the area under the ROC curve for PCT (0.81) and APACHE II score (0.81), and was significantly higher than the area under the ROC curve for CRP (0.53) and IL-6 (0.71).. The measurement of pro-ADM is a new and useful marker in sepsis prognosis and risk stratification.

Topics: Adrenomedullin; Adult; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Humans; Intensive Care Units; Interleukin-6; Male; Middle Aged; Peptide Fragments; Postoperative Complications; Protein Precursors; Risk Assessment; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

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

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

Although procalcitonin (PCT) measurement has been performed in patients with infectious diseases, there are few reports on its usefulness in community-acquired pneumonia (CAP) associated with systemic inflammatory response syndrome (SIRS). We investigated 88 patients who visited the internal medicine departments of Nagasaki University Hospital, Nagasaki, Japan, and its 11 affiliated hospitals in Japan because of CAP with or without SIRS. Of the 88 patients, 15 (17.0%), 43 (48.9%), and 30 (34.1%) were judged to have severe, moderate, and mild CAP, respectively. Although 87 patients (98.9%) had C-reactive protein (CRP) levels exceeding 0.3 mg/dL, only 30 patients (34.1%) had PCT levels more than 0.5 ng/mL. In addition, 93.3% (28/30) of patients with mild CAP had negative PCT, and 48.3% (28/58) of patients positive for PCT had moderate or severe CAP. Our findings suggest that PCT level might be more useful for estimating CAP severity than CRP level at the 1st visit.

Topics: Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Female; Humans; Japan; Male; Middle Aged; Plasma; Pneumonia; Protein Precursors; Severity of Illness Index; Systemic Inflammatory Response Syndrome

To evaluate the efficacy of procalcitonin PCT to identify critically ill patients with sepsis in comparison with leukocyte count, body temperature, C-reactive protein CRP, erythrocyte sedimentation rate ESR, and interleukin-6 IL-6.. We performed our prospective observational study in 75 patients admitted with acute systemic inflammatory response and suspected infection. The final diagnosis was systemic inflammatory response syndrome SIRS in 38 patients, sepsis in 22, severe sepsis in 10, and suspected viral sepsis in 5. Blood samples were taken on the first day of hospitalization in Al Mwasaa Hospital, Damascus, Syrian Arab Republic, from July 2006 to January 2007. We estimated the relevance of the different parameters by using the t-test, Pearson's correlation coefficient, and area under the receiver operating characteristic curves.. Mean PCT concentrations on admission were 0.37 ng/ml for SIRS n=38, 3.31 ng/ml for sepsis n=22, 40.2 ng/ml for severe sepsis n=10, and significant differences existed in plasma PCT levels among the 3 groups. The PCT was the only distinguisher between sepsis and non-infectious SIRS, whereas it exhibited the best discriminative power between sepsis and severe sepsis with an area under the curve AUC of 0.966 followed by IL-6 with an AUC of 0.836. The PCT also do not correlate with any of the studied parameters within the SIRS group and the sepsis group.. Assessing PCT levels is a more reliable way to indicate sepsis in newly admitted patients with systemic inflammations compared with conventional inflammatory parameters and IL-6.

Topics: Adult; Blood Sedimentation; Body Temperature; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Interleukin-6; Leukocyte Count; Middle Aged; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Topics: Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Prognosis; Protein Precursors; Randomized Controlled Trials as Topic; Systemic Inflammatory Response Syndrome

To compare the accuracy of procalcitonin and C-reactive protein as diagnostic markers of bacterial infection in critically ill children at the onset of systemic inflammatory response syndrome (SIRS).. Prospective cohort study.. Tertiary care, university-affiliated pediatric intensive care unit (PICU).. Consecutive patients with SIRS.. From June to December 2002, all PICU patients were screened daily to include cases of SIRS. At inclusion (onset of SIRS), procalcitonin and C-reactive protein levels as well as an array of cultures were obtained. Diagnosis of bacterial infection was made a posteriori by an adjudicating process (consensus of experts unaware of the results of procalcitonin and C-reactive protein). Baseline and daily data on severity of illness, organ dysfunction, and outcome were collected.. Sixty-four patients were included in the study and were a posteriori divided into the following groups: bacterial SIRS (n = 25) and nonbacterial SIRS (n = 39). Procalcitonin levels were significantly higher in patients with bacterial infection compared with patients without bacterial infection (p = .01). The area under the receiver operating characteristic curve for procalcitonin was greater than that for C-reactive protein (0.71 vs. 0.65, respectively). A positive procalcitonin level (>or=2.5 ng/mL), when added to bedside clinical judgment, increased the likelihood of bacterial infection from 39% to 92%, while a negative C-reactive protein level (<40 mg/L) decreased the probability of bacterial infection from 39% to 2%.. Procalcitonin is better than C-reactive protein for differentiating bacterial from nonbacterial SIRS in critically ill children, although the accuracy of both tests is moderate. Diagnostic accuracy could be enhanced by combining these tests with bedside clinical judgment.

Topics: Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Critical Illness; Female; Hospitals, University; Humans; Intensive Care Units, Pediatric; Male; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity; 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

To analyse the clinical value of procalcitonin (PCT), C-reactive protein (CRP) and leucocyte count in the diagnosis of paediatric sepsis and in the stratification of patients according to severity.. Prospective, observational study.. Paediatric intensive care unit (PICU).. Ninety-four children.. Leucocyte count, PCT and CRP were measured when considered necessary during the PICU stay. Patients were classified, when PCT and CRP were measured, into one of six categories (negative, SIRS, localized infection, sepsis, severe sepsis, and septic shock) according to the definitions of the American College of Chest Physicians /Society of Critical Care Medicine. A total of 359 patient day episodes were obtained. Leucocyte count did not differ across the six diagnostic classes considered. Median plasma PCT concentrations were 0.17, 0.43, 0.79, 1.80, 15.40 and 19.13 ng/ml in negative, systemic inflammatory response syndrome (SIRS), localized infection, sepsis, severe sepsis, and septic shock groups, respectively, whereas median plasma CRP concentrations were 1.35, 3.80, 6.45, 5.70, 7.60 and 16.2 mg/dl, respectively. The area under the ROC curve for the diagnosis of septic patients was 0.532 for leucocyte count (95% CI, 0.462-0.602), 0.750 for CRP (95% CI, 0.699-0.802) and 0.912 for PCT (95% CI, 0.882-0.943). We obtained four groups using CRP values and five groups using PCT values that classified a significant percentage of patients according to the severity of the different SIRS groups.. PCT is a better diagnostic marker of sepsis in critically ill children than CRP. The CRP, and especially PCT, may become a helpful clinical tool to stratify patients with SIRS according to disease severity.

Topics: Adolescent; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Humans; Infant; Intensive Care Units, Pediatric; Leukocyte Count; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Systemic Inflammatory Response Syndrome

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Humans; Meta-Analysis as Topic; Predictive Value of Tests; Protein Precursors; Selection Bias; Sepsis; Systemic Inflammatory Response Syndrome

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Humans; Meta-Analysis as Topic; Predictive Value of Tests; Protein Precursors; Selection Bias; Sepsis; Systemic Inflammatory Response Syndrome

To study the relationship between the changes of inflammation-associated factors, C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), white blood cell (WBC) and neutrophils, and the severity in children with Mycoplasma pneomoniae pneumonia (MPP).. Ninety-two children with acute MPP consisting of 52 cases with concomitant systemic inflammation response syndrome (SIRS) and 40 cases without SIRS were enrolled in this study. The 52 cases with concomitant SIRS were classified into two groups based on the severity of SIRS: mild SIRS (n=25) and severe SIRS (n=27). CRP, PCT, ESR and WBC count and the percentage of neutrophils (NE%) were detected on admission and one week after anti-inflammation treatment.. All of patients showed increased serum CRP contents at admission. The serum CRP contents were the highest in the severe SIRS group, followed by the mild SIRS and non-SIRS groups on admission (P < 0.05 or 0.01). The serum CRP contents were reduced in all of patients after 1-week treatment. The severe SIRS group still demonstrated higher serum CRP contents than the non-SIRS and the mild SIRS groups (P < 0.01). The severe SIRS group had increased serum PCT contents on admission, which were significantly higher than those of the mild SIRS and non-SIRS groups (P < 0.01). After 1-week treatment, the serum PCT contents were reduced in the severe SIRS group but remained higher than in the mild SIRS and non-SIRS groups (P < 0.01). ESR increased significantly in the severe SIRS group than in the mild SIRS and non-SIRS groups on admission (P < 0.01). One-week treatment did not significantly decrease ESR in all three groups. The WBC count and NE% in the mild and severe SIRS groups were significantly higher than in the non-SIRS group and the severe SIRS group had higher WBC count and NE% than the mild SIRS group on admission (P < 0.05). The WBC count and NE% decreased after 1-week treatment in the mild and severe SIRS groups (P < 0.05). One inflammation-associated factor (only CRP) increase was predominant in the non-SIRS group (65%), 2 factors increase in the mild SIRS group (56%), and three or more factors increase in the severe SIRS group (70.4%).. The detection of inflammation-associated factors, CRP, PCT, ESR, WBC and neutrophils, are valuable to the evaluation of severity in MPP.

Topics: Adolescent; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Humans; Infant; Leukocyte Count; Male; Pneumonia, Mycoplasma; Protein Precursors; Systemic Inflammatory Response Syndrome

To evaluate whether procalcitonin (PCT) and C reactive protein (CRP) are able to discriminate between sepsis and systemic inflammatory response syndrome (SIRS) in critically ill children.. Prospective, observational study in a paediatric intensive care unit. Kinetics of PCT and CRP were studied in patients undergoing open heart surgery with cardiopulmonary bypass (CPB) (SIRS model; group I1) and patients with confirmed bacterial sepsis (group II).. In group I, PCT median concentration was 0.24 ng/ml (reference value <2.0 ng/ml). There was an increment of PCT concentrations which peaked immediately after CPB (median 0.58 ng/ml), then decreased to 0.47 ng/ml at 24 h; 0.33 ng/ml at 48 h, and 0.22 ng/ml at 72 h. CRP median concentrations remained high on POD1 (36.6 mg/l) and POD2 (13.0 mg/l). In group II, PCT concentrations were high at admission (median 9.15 ng/ml) and subsequently decreased in 11/14 patients who progressed favourably (median 0.31 ng/ml). CRP levels were high in only 11/14 patients at admission. CRP remained high in 13/14 patients at 24 h; in 12/14 at 48 h; and in 10/14 patients at 72 h. Median values were 95.0, 50.9, 86.0, and 20.3 mg/l, respectively. The area under the ROC curve was 0.99 for PCT and 0.54 for CRP. Cut off concentrations to differentiate SIRS from sepsis were >2 ng/ml for PCT and >79 mg/l for CRP.. PCT is able to differentiate between SIRS and sepsis while CRP is not. Moreover, unlike CRP, PCT concentrations varied with the evolution of sepsis.

Topics: Adolescent; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Child; Child, Preschool; Diagnosis, Differential; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Postoperative Complications; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

To assess whether different diagnostic and prognostic cutoff values of procalcitonin should be considered in surgical and in medical patients with septic shock.. Prospective observational study.. Intensive care unit of the Avicenne teaching hospital, France.. All patients with septic shock or noninfectious systemic inflammatory response syndrome within 48 hrs after admission.. None.. Patients were allocated to one of the following groups: group 1 (surgical patients with septic shock), group 2 (surgical patients with noninfectious systemic inflammatory response syndrome), group 3 (medical patients with septic shock), and group 4 (medical patients with noninfectious systemic inflammatory response syndrome). Procalcitonin at study entry was compared between group 1 and group 2 and between group 3 and group 4 to determine the diagnostic cutoff value in surgical and in medical patients, respectively. Procalcitonin was compared between survivors and nonsurvivors from group 1 and group 3 to determine its prognostic cutoff value. One hundred forty-three patients were included: 31 in group 1, 36 in group 2, 36 in group 3, and 40 in group 4. Median procalcitonin levels (ng/mL [interquartile range]) were higher in group 1 than in group 3 (34.00 [7.10-76.00] vs. 8.40 [3.63-24.70], p = .01). In surgical patients, the best diagnostic cutoff value was 9.70 ng/mL, with 91.7% sensitivity and 74.2% specificity. In medical patients, the best diagnostic cutoff value was 1.00 ng/mL, with 80% sensitivity and 94% specificity. Procalcitonin was a reliable early prognostic marker in medical but not in surgical patients with septic shock. A cutoff value of 6.00 ng/mL had 76% sensitivity and 72.7% specificity for separating survivors from nonsurvivors.. The diagnostic cutoff value of procalcitonin was higher in surgical than in medical patients. Early procalcitonin was of prognostic interest in medical patients.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Confidence Intervals; Diagnosis, Differential; Disease Progression; Female; Humans; Intensive Care Units; Male; Middle Aged; Predictive Value of Tests; Probability; Prognosis; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Severity of Illness Index; Shock, Septic; Survival Analysis; Systemic Inflammatory Response Syndrome; Treatment Outcome

To evaluate procalcitonin and C-reactive protein as markers of inflammation severity and their value in predicting development of organ failure after pediatric open heart surgery.. Prospective, observational, clinical study.. Single university hospital.. Thirty-three pediatric patients with systemic inflammatory response syndrome (SIRS; n=19) and SIRS+organ failure (SIRS+OF; n=14) following open heart surgery were included.. Plasma procalcitonin and C-reactive protein levels were measured before and after the operation, and 1, 2, 3, and 4 days after surgery. Patients were evaluated daily to assess organ failure. Postoperative procalcitonin levels in the SIRS+OF group were significantly higher than in the SIRS group. C-reactive protein levels were similar between the groups throughout the study period. Peak procalcitonin levels were found to be positively correlated with aortic cross-clamp and cardiopulmonary bypass times, duration of mechanical ventilation, intensive care unit and hospital stay, mortality and organ failure development. Peak procalcitonin was found to be a good predictor of postoperative organ failure development and mortality. However, the predictive value of peak C-reactive protein for organ failure and mortality was found to be weak. Double-peak procalcitonin curves were observed in SIRS+OF patients with infection during the intensive care unit stay.. In the SIRS+OF group peak procalcitonin levels were found to be highly predictive for mortality and organ failure development, whereas C-reactive protein levels were not. Daily procalcitonin measurements in SIRS+OF patients may help identify the postoperative infection during the follow-up period.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Humans; Intensive Care Units; Male; Pediatrics; Postoperative Complications; Protein Precursors; Systemic Inflammatory Response Syndrome; Thoracic Surgery; Turkey

To assess the effectiveness of different procalcitonin cutoff values to distinguish non-infected (negative+SIRS) from infected (sepsis+severe sepsis+septic shock) medical and surgical patients.. PCT plasma concentration was measured using an automated chemiluminescence analyzer in 1013 samples collected in 103 patients within 24 h of admission in ICU and daily during the ICU stay. We compared PCT levels in medical and surgical patients. We also compared PCT plasma levels in non-infected versus infected patients and in SIRS versus infected patients both in medical and in surgical groups.. Median values of PCT plasma concentrations were significantly higher in infected than in non-infected groups, both in medical (3.18 vs. 0.45 microg/L) (p<0.0001) and in surgical (10.45 vs. 3.89 microg/L; p<0.0001) patients. At the cutoff of 1 microg/L, the LR+ was 4.78, at the cutoff of 6 microg/L was 12.53, and at the cutoff of 10 microg/L was 18.4.. This study highlights the need of different PCT cutoff values in medical and surgical critically ill patients, not only at the ICU admission but also in the entire ICU stay.

Topics: Adult; Aged; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intensive Care Units; Male; Middle Aged; Protein Precursors; ROC Curve; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

To study whether plasma concentrations of procalcitonin (PCT), interleukin-6 (IL-6), complement 3a (C3a), C-reactive protein and white blood cell count (WBC) correlate with the presence of systemic inflammatory response syndrome (SIRS) during the early post-operative period after major colorectal surgery.. Prospective, observational study during the first 24 h post-operatively. The setting for the study was the operating theatre and the recovery unit at the university hospital. Fifty consecutive patients, operated on electively with major resection of the large bowel or rectum. PCT levels increased significantly to the maximum level 18 h postoperatively. PCT levels were significantly higher in the SIRS group in comparison to the non-SIRS group of patients 6 and 12 h after surgery (P < 0.05). The IL-6 levels were increased directly after the surgery and then decreased gradually in both study groups. Twenty-four hours after the surgery, C3a levels decreased and then returned to normal levels. Twenty-four hours post-operatively, patients with SIRS had a higher plasma concentration of C3a compared with patients without SIRS (P < 0.05). CRP and WBC increased during the study period in both groups (P < 0.05).. During the early post-operative period after uncomplicated major abdominal surgery, SIRS was reflected by the increase in plasma PCT and C3a concentrations. IL-6, CRP and WBC increased to the same extend in both the SIRS and the non-SIRS group of patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Colon; Complement C3a; Female; Humans; Interleukin-6; Leukocyte Count; Male; Middle Aged; Postoperative Complications; Prospective Studies; Protein Precursors; Rectum; Systemic Inflammatory Response Syndrome; Time Factors

To evaluate the discrimination of serum procalcitonin (PCT) and interleukin-6 (IL-6) between patients with sepsis and non-infectious inflammatory response syndrome (SIRS) and the prediction power of clinical outcome.. A perspective study was performed in 27 patients with sepsis and 30 patients with non-infectious SIRS. The serum concentrations of PCT, IL-6, C-reactive protein (CRP), white blood cell count, percentage of neutrophil, absolute neutrophil count, and maximal body temperature were obtained less than 24 hours after clinical onset of sepsis or SIRS.. The serum levels of PCT and IL-6 and percentage of neutrophil were significantly higher in patients with sepsis than in those with non-infectious SIRS (PCT: 5.54 [1.20, 32.74] microg/L vs 0.77 [0.22, 3.90] microg/L, P=0.001; IL-6: 163.66 [33.60, 505.26] ng/L vs 37.72 [22.52, 110.78] ng/L, P=0.004; CRP [15.28 +/- 8.41] g/L vs [9.51 +/- 7.65] g/L, P=0.010; and percentage of neutrophil: 0.91 +/- 0.04 vs 0.88 +/- 0.04, P=0.010). Receiver operating characteristic curve showed that the power of PCT and IL-6 were the best of all above. There was significant correlation between serum PCT or IL-6 and the acute physiology and chronic health evaluation (APACHE II) or sepsis-related organ failure assessment (SOFA) scores, so was between serum PCT and the intensive care unit (ICU) length of stay.. PCT and IL-6 are more reliable indicators to differentiate sepsis and non-infectious SIRS than the conventional inflammatory markers, and correlate with the disease severity. PCT levels are significantly correlated with ICU length of stay.

Topics: Adult; Aged; APACHE; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Interleukin-6; Length of Stay; Male; Middle Aged; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Patients who undergo major surgery for cancer are at high risk of postoperative sepsis. Early markers of septic complications would be useful for diagnosis and therapeutic management in patients with postoperative sepsis. The aim of this study was to investigate the association between early (first postoperative day) changes in interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) serum concentrations and the occurrence of subsequent septic complications after major surgery.. Serial blood samples were collected from 50 consecutive patients for determination of IL-6, PCT and CRP serum levels. Blood samples were obtained on the morning of surgery and on the morning of the first postoperative day.. Sixteen patients developed septic complications during the first five postoperative days (group 1), and 34 patients developed no septic complications (group 2). On day 1, PCT and IL-6 levels were significantly higher in group 1 (P-values of 0.003 and 0.006, respectively) but CRP levels were similar. An IL-6 cut-off point set at 310 pg ml(-1) yielded a sensitivity of 90% and a specificity of 58% to differentiate group 1 patients from group 2 patients. When associated with the occurrence of SIRS on day 1 these values reached 100% and 79%, respectively. A PCT cut-off point set at 1.1 ng ml(-1) yielded a sensitivity of 81% and a specificity of 72%. When associated with the occurrence of SIRS on day 1, these values reached 100% and 86%, respectively.. PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

Topics: Adult; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Epidemiologic Methods; Female; Gastrointestinal Neoplasms; Genital Neoplasms, Female; Humans; Interleukin-6; Male; Middle Aged; Postoperative Complications; Protein Precursors; Systemic Inflammatory Response Syndrome

The clinical significance of serum procalcitonin (PCT) for discriminating between bacterial infectious disease and nonbacterial infectious disease (such as systemic inflammatory response syndrome (SIRS)), was compared with the significance of endotoxin, beta-D: -glucan, interleukin (IL)-6, and C-reactive protein (CRP) in a multicenter prospective study. The concentrations of PCT in patients with systemic bacterial infection and those with localized bacterial infection were significantly higher than the concentrations in patients with nonbacterial infection or noninfectious diseases. In addition, PCT, endotoxin, IL-6, and CRP concentrations were significantly higher in patients with bacterial infectious disease than in those with nonbacterial infectious disease (P<0.001, P<0.005, P<0.001, and P<0.001, respectively). The cutoff value of PCT for the discrimination of bacterial and nonbacterial infectious diseases was determined to be 0.5 ng/ml, which was associated with a sensitivity of 64.4% and specificity of 86.0%. Areas under the receiver operating characteristic curves (POCs) were 0.84 for PCT, 0.60 for endotoxin, 0.77 for IL-6, and 0.78 for CRP in the combined group of patients with bacterial infectious disease and those with nonbacterial infectious disease, and the area under the ROC for PCT was significantly higher than that for endotoxin (P<0.001). In patients diagnosed with bacteremia based on clinical findings, the positive rate of diagnosis with PCT was 70.2%, while that of blood culture was 42.6%. PCT is thus essential for discriminating bacterial infection from SIRS, and is superior in this respect to conventional serum markers and blood culture.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Humans; Japan; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers.. Prospective observational study to compare PCT levels in infected and uninfected patients.. Geriatric teaching hospital in Switzerland.. Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit.. Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient.. Long-term corticotherapy, chronic immune diseases, fever of 38 degrees C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se.. PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without.

Topics: Aged; Aged, 80 and over; Aging; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Infections; Male; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). The study was performed in 95 patients over 16 years of age who met the criteria of SIRS. PCT and AKBR were assayed in arterial blood samples. The APACHE III score and MODS were recorded after the first 24 hours of surgical ICU (SICU) admission and then daily for two weeks or until either discharge or death. The patients were divided into two groups, survivors (n=71) and nonsurvivors (n=24), in accordance with the ICU outcome. They were also divided into three groups according to the trend of PCT level: declining, increasing or no change. Significant differences between survivors and nonsurvivors were found in APACHE III score and MODS throughout the study period, but in PCT value only up to the 7th day and in AKBR only up to the 3rd day. PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; APACHE; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Ketone Bodies; Male; Middle Aged; Multiple Organ Failure; Predictive Value of Tests; Protein Precursors; Survival Analysis; Systemic Inflammatory Response Syndrome

To evaluate markers of infection in critically ill neonates and children, comparing lipopolysaccharide-binding protein (LBP) with procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP).. Prospective, observational study in the level III multidisciplinary neonatal and pediatric intensive care unit.. Sixty patients with systemic inflammatory response syndrome (SIRS) and suspected infection classified into two groups: SIRS/sepsis ( n=33) and SIRS/no sepsis ( n=27). We included 29 neonates aged less than 48 h (neonates <48 h), 12 neonates older than 48 h (neonates >48 h), and 19 children. Median disease severity was high in neonates aged under 48 h and moderate in neonates aged over 48 h and children.. Serum LBP, PCT, IL-6, and CRP were measured on two consecutive days. Area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and predictive values were evaluated.. Serum LBP was higher in patients with SIRS/sepsis than in patients with SIRS/no sepsis. AUC for LBP on the first day of suspected infection was 0.89 in the younger neonates, 0.93 in the older neonates, and 0.91 in children.. In critically ill neonates aged under 48 h LBP on the first day of suspected infection is a better marker of sepsis than IL-6 and PCT, and is similar to CRP. In critically ill neonates aged over 48 h and children LBP is a better marker than IL-6 and CRP, and is similar to PCT.

Topics: Acute-Phase Proteins; Adolescent; Age Factors; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Carrier Proteins; Child; Child, Preschool; Critical Illness; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Interleukin-6; Membrane Glycoproteins; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Both C-reactive protein (CRP) and procalcitonin (PCT) are accepted sepsis markers. However, there is still some debate concerning the correlation between their serum concentrations and sepsis severity. We hypothesised that PCT and CRP concentrations are different in patients with infection or with no infection at a similar severity of organ dysfunction or of systemic inflammatory response.. One hundred and fifty adult intensive care unit patients were observed consecutively over a period of 10 days. PCT, CRP and infection parameters were compared among the following groups: no systemic inflammatory response syndrome (SIRS) (n = 15), SIRS (n = 15), sepsis/SS (n = 71) (including sepsis, severe sepsis and septic shock [n = 34, n = 22 and n = 15]), and trauma patients (n = 49, no infection).. PCT and CRP concentrations were higher in patients in whom infection was diagnosed at comparable levels of organ dysfunction (infected patients, regression of median [ng/ml] PCT = -0.848 + 1.526 sequential organ failure assessment [SOFA] score, median [mg/l] CRP = 105.58 + 0.72 SOFA score; non-infected patients, PCT = 0.27 + 0.02 SOFA score, P < 0.0001; CRP = 84.53 - 0.19 SOFA score, P < 0.005), although correlation with the SOFA score was weak (R = 0.254, P < 0.001 for PCT, and R = 0.292, P < 0.001 for CRP). CRP levels were near their maximum already during lower SOFA scores, whereas maximum PCT concentrations were found at higher score levels (SOFA score > 12).PCT and CRP concentrations were 1.58 ng/ml and 150 mg/l in patients with sepsis, 0.38 ng/ml and 51 mg/l in the SIRS patients (P < 0.05, Mann-Whitney U-test), and 0.14 ng/ml and 72 mg/l in the patients with no SIRS (P < 0.05). The kinetics of both parameters were also different, and PCT concentrations reacted more quickly than CRP.. PCT and CRP levels are related to the severity of organ dysfunction, but concentrations are still higher during infection. Different sensitivities and kinetics indicate a different clinical use for both parameters.

Topics: Adult; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Intensive Care Units; Middle Aged; Multiple Organ Failure; Prospective Studies; Protein Precursors; ROC Curve; Sepsis; Severity of Illness Index; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) blood concentrations are known to be an appropriate marker of severe systemic inflammatory response syndrome (SIRS) induced by coronary artery surgery with and without cardiopulmonary bypass. Pro-brain natriuretic peptide (N-BNP) is a newly described cardiac hormone considered to be an effective marker of severity and prognosis of acute coronary syndromes and congestive heart failure. We evaluated the perioperative time courses of PCT and N-BNP and investigated their role as early markers of severe SIRS (SIRS with cardiovascular dysfunction) induced by off-pump coronary artery bypass (OPCAB).. Sixty-three patients were prospectively included. The American College of Chest Physicians Classification was used to diagnose SIRS and organ system failure to define severe SIRS. Serum concentrations of PCT and N-BNP were determined before, during and after surgery. Receiver operating characteristic curves and cut-off values were used to assess the ability of these markers to predict postoperative severe SIRS.. SIRS occurred in 25 (39%) patients. Nine of them (14%) showed severe SIRS. Significantly higher serum concentrations of N-BNP and PCT were found in patients with severe SIRS with peak concentrations respectively at 8887 pg ml(-1) (range 2940-29372 pg ml(-1)) for N-BNP and 9.50 ng ml(-1) (range 1-65 ng ml(-1)) for PCT. The area under the curve using N-BNP to detect postoperative severe SIRS was 0.799 before surgery (0.408 for PCT; P<0.01) and 0.824 at the end of surgery (0.762 for PCT; P<0.05).. N-BNP may be an appropriate marker indicating the early development of non-infectious postoperative severe SIRS after OPCAB.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Coronary Artery Bypass; Humans; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Postoperative Complications; Prospective Studies; Protein Precursors; ROC Curve; Systemic Inflammatory Response Syndrome

To define whether procalcitonin should be introduced in the diagnostic criteria of sepsis.. Procalcitonin was estimated in sera of 105 critically ill patients by an immunochemiluminometric assay. Diagnosis was settled by 3 types of criteria: A, the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) 1992 criteria; B, the ACCP/SCCM criteria and concentrations of procalcitonin above 1.0 ng/mL as indicative of SIRS/sepsis; and C, the ACCP/SCCM criteria and concentrations of procalcitonin 0.5 to 1.1 ng/mL for SIRS and above 1.1 ng/mL for sepsis.. Criteria A identified 50.5% of patients with SIRS, 18.1% with sepsis, 0.9% with severe sepsis and 22.9% with septic shock; respective diagnosis by criteria B were 26.7%, 9.5%, 10.5% and 25.7%; and respective diagnosis by criteria C were 19.0%, 25.7%, 9.5%, and 25.7%. Sensitivity of concentrations between 0.5 ng/mL and 1.1 ng/mL was 25.6% for Systemic Inflammatory Response Syndrome (SIRS); and above 1.1 ng/mL 92.8% for sepsis. Sepsis-related death was associated with elevated procalcitonin upon presentation of a clinical syndrome.. Despite the limited diagnostic value of procalcitonin for SIRS, concentrations of procalcitonin above 1.1 ng/mL are highly indicative for sepsis without, however, excluding the presence of SIRS.

Topics: Adult; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Protein Precursors; Sepsis; Severity of Illness Index; Shock, Septic; Systemic Inflammatory Response Syndrome

Sensitive, reliable and early parameters of bacterial infection are extremely valuable in diagnosis of nosocomial infections in neonatal intensive care unit. In this study procalcitonin (PCT) and C-reactive protein (CRP) were evaluated for their diagnostic relevance in neonatal late onset sepsis.. Clinical study. We analysed inflammatory parameters in 48 newborn infants admitted to the Intensive Care Unit of Institute of Paediatrics in Lodz who suffered from nosocomial sepsis. They were sampled for PCT and CRP levels at the time of the onset of signs and 24 hours later. CRP was determined by an nephelometric method and PCT was determined by an immunoluminometric assay.. At the onset of Gram negative sepsis 14 from 17 contaminated newborns had significantly increased CRP levels and 15 of them had increased levels of PCT After 24 hours 100% of them had elevated PCT and CRP levels. At the onset of Gram positive sepsis only 18 from 31 neonates with positive blood culture had increased CRP levels and 28 of them had elevated concentrations of PCT. This difference was statistically significant. After 24 hours 26 of them had elevated CRP and 100% had increased PCT concentrations--this difference was not significant.. Measurement of procalcitonin concentrations may be useful for early diagnosis of late onset sepsis in neonates.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Infant; Infant, Newborn; Protein Precursors; Severity of Illness Index; Systemic Inflammatory Response Syndrome

This prospective study evaluated serum procalcitonin (PCT) and C-reactive protein (CRP) as markers for systemic inflammatory response syndrome (SIRS)/sepsis and mortality in patients with traumatic brain injury and subarachnoid haemorrhage. Sixty-two patients were followed for 7 days. Serum PCT and CRP were measured on days 0, 1, 4, 5, 6 and 7. Seventy-seven per cent of patients with traumatic brain injury and 83% with subarachnoid haemorrhage developed SIRS or sepsis (P=0.75). Baseline PCT and CRP were elevated in 35% and 55% of patients respectively (P=0.03). There was a statistically non-significant step-wise increase in serum PCT levels from no SIRS (0.4+/-0.6 ng/ml) to SIRS (3.05+/-9.3 ng/ml) to sepsis (5.5+/-12.5 ng/ml). A similar trend was noted in baseline PCT in patients with mild (0.06+/-0.9 ng/ml), moderate (0.8+/-0.7 ng/ml) and severe head injury (1.2+/-1.9 ng/ml). Such a gradation was not observed with serum CRP There was a non-significant trend towards baseline PCT being a better marker of hospital mortality compared with baseline CRP (ROC-AUC 0.56 vs 0.31 respectively). This is the first prospective study to document the high incidence of SIRS in neurosurgical patients. In our study, serum PCT appeared to correlate with severity of traumatic brain injury and mortality. However, it could not reliably distinguish between SIRS and sepsis in this cohort. This is in part because baseline PCT elevation seemed to correlate with severity of injury. Only a small proportion of patients developed sepsis, thus necessitating a larger sample size to demonstrate the diagnostic usefulness of serum PCT as a marker of sepsis. Further clinical trials with larger sample sizes are required to confirm any potential role of PCT as a sepsis and outcome indicator in patients with head injuries or subarachnoid haemorrhage.

Topics: Adult; APACHE; Biomarkers; Brain Injuries; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Hospital Mortality; Humans; Male; Middle Aged; Protein Precursors; Sepsis; Subarachnoid Hemorrhage; Survival Rate; Systemic Inflammatory Response Syndrome

Cardiopulmonary bypass is often associated with pathophysiological changes in form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated plasma levels of pro- and anti-inflammatory cytokines in survivors and non-survivors from MODS in the early postoperative course following open heart surgery.. Prospective clinical study.. A University Cardiothoracic Intensive Care Unit.. Levels of cytokines (IL-6, IL-8, IL-10, IL-18, and TGF- ) and procalcitonin (PCT) were measured at the first four postoperative days in 16 adult male patients with an Apache II-score >24 and two or more organ dysfunctions after myocardial revascularization.. All pro-inflammatory cytokines, except for IL-6, were significantly elevated in non-survivors from MODS, with peak values at the first two postoperative days. The plasma levels of immunoinhibitory cytokines showed no differences between the groups.. The results of our study show a different expression of pro-inflammatory cytokines in survivors and non-survivors from MODS following operations with extracorporeal circulation. In addition to Apache-II score, especially IL-8, IL-18, and PCT may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery.

Topics: Aged; APACHE; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Cytokines; Hospitals, University; Humans; Male; Multiple Organ Failure; Myocardial Revascularization; Postoperative Complications; Prospective Studies; Protein Precursors; Survival Rate; Systemic Inflammatory Response Syndrome

To compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations in the detection of infection and sepsis and in the assessment of severity of sepsis.. Prospective study.. Medicosurgical intensive care unit.. Seventy consecutive adult patients who were admitted to the intensive care unit for an expected stay >24 hrs.. None.. PCT and CRP plasma concentrations were measured daily during the intensive care unit stay. Each patient was examined daily for signs and symptoms of infection and was classified daily in one of the following four categories according to the American College of Chest Physicians/Society of Critical Care Medicine criteria: negative, systemic inflammatory response syndrome, localized infection, and sepsis group (sepsis, severe sepsis, or septic shock). The severity of sepsis-related organ failure was assessed by the sepsis-related organ failure assessment score.. A total of 800 patient days were classified into the four categories. The median plasma PCT concentrations in noninfected (systemic inflammatory response syndrome) and localized-infection patient days were 0.4 and 1.4 ng/mL (p <.0001), respectively; the median CRP plasma concentrations were 79.9 and 85.3 mg/L (p =.08), respectively. The area under the receiver operating characteristic curve was 0.756 for PCT (95% confidence interval [CI], 0.675-0.836), compared with 0.580 for CRP (95% CI, 0.488-0.672) (p <.01). The median plasma PCT concentrations in nonseptic (systemic inflammatory response syndrome) and septic (sepsis, severe sepsis, or septic shock) patient days were 0.4 and 3.65 ng/mL (p <.0001), respectively, whereas those for CRP were 79.9 and 115.6 mg/L (p <.0001), respectively. The area under the receiver operating characteristic curve was 0.925 for PCT (95% CI, 0.899-0.952), compared with 0.677 for CRP (95% CI, 0.622-0.733) (p <.0001). The linear correlation between PCT plasma concentrations and the four categories was much stronger than in the case of CRP (Spearman's rho, 0.73 vs. 0.41; p <.05). A rise in sepsis-related organ failure assessment score was related to a higher median value of PCT but not CRP.. PCT is a better marker of sepsis than CRP. The course of PCT shows a closer correlation than that of CRP with the severity of infection and organ dysfunction.

Topics: Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Humans; Multiple Organ Failure; Prospective Studies; Protein Precursors; ROC Curve; Sepsis; Severity of Illness Index; Statistics, Nonparametric; Systemic Inflammatory Response Syndrome

To evaluate the efficacy of using procalcitonin (PCT) and interleukin-6 (IL-6) to differentiate sepsis from non-infectious systemic inflammatory response syndrome (SIRS).. We made a prospective study in a general intensive care unit at Peking Union Medical College Hospital. Twenty patients with sepsis and 31 patients with non-infectious SIRS were enrolled in this study. Serum concentrations of PCT, IL-6 and C-reactive protein (CRP) were determined within 24 h after clinical onset of sepsis or non-infectious SIRS. Leukocyte count, percentage of neutrophils, and absolute neutrophil count, as well as maximal body temperature were also recorded.. Serum concentrations of PCT, IL-6, and CRP, as well as maximal body temperature, were significantly higher in septic patients [3.6 (1.8, 27.5) micro g/L, 810 +/- 516 ng/L, 180 +/- 108 g/L, 38.6 +/- 1.2 degrees C] than non-infectious SIRS patients [0.5 (0.2, 1.8) micro g/L, 235 +/- 177 ng/L, 109 +/- 70 g/L, 37.9 +/- 0.9 degrees C]. IL-6 and PCT exhibited the best discriminative power between sepsis and non-infectious SIRS, with sensitivity above 80% and specificity above 70%. A sepsis score with combination of IL-6 and PCT showed the best discriminative power with the area under the receiver operating characteristic curve of 0.923.. Assessing IL-6 and PCT levels are more reliable ways to differentiate sepsis from non-infectious SIRS, compared with conventional inflammatory parameters.

Topics: Adult; Aged; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Interleukin-6; Male; Middle Aged; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

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

One of the most difficult tasks in differential diagnosis of patients with septic syndrome at the Intensive Care Units is to differentiate between infection and non-infection etiology of this syndrome. In the last years, new parameters have played an important role in this area--C-reactive protein, Interleukin-6 and procalcitonin.. Of the investigation was to compare these three parameters in differential diagnosis of the septic syndrome. THE COHORT AND METHODS: The authors examined 56 patients (17 women and 39 men, mean age being 43 and 51 years, respectively) hospitalized at the Intensive Care Units who corresponded to the criteria of the syndrome of inflammatory response, sepsis or septic shock. A total of 99 examinations were done. The samples were taken up to 24 hours after the beginning of clinical symptomatology and submitted to the laboratory within four hours. Immediately afterwards the determination of concentrations of all three parameters--C-reactive protein, interlaukin-6 and procalcitonin, were done. The results of the examinations were compared to each other as well as to the diagnosis of sepsis--the confirmed infection etiology.. In all the evaluated parameters the authors detected significant differences between the values of entry examination and all measurements between the patients with the syndrome of systemic inflammatory response and septic shock as well as among patients with sepsis and the septic shock. Likewise, the authors confirmed significant differences between concentrations of all three parameters in comparing the patients with sepsis and those with the septic shock. Only in the case of procalcitonin there was a significant difference in concentration between patients with the syndrome of systemic inflammatory response of non-infectious etiology and those with sepsis. The concentration of procalcitonin was the only predictive marker of diagnosis with the correlation coefficient r = 0.7263, r2 = 0.5275, P < 0.00005.. Calcitonin proved to be the most specific parameter in demonstrating infection etiology in patients with the septic syndrome, its predictive value being higher than that of C-reactive protein and Interleukin-6. Monitoring of calcitonin dynamism provides important information on efficiency of the applied antibiotic treatment. In patients with diagnostic uncertainties as far as the etiology of the septic syndrome is concerned; procalcitonin is the parameter of choice, while it may be supplemented with the examination of C-reactive protein.

Topics: Adult; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Intensive Care Units; Interleukin-6; Male; Middle Aged; Protein Precursors; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

Cardiac troponin T (cTnT) >0.1 microg/l and procalcitonin (PCT) >2 microg/l in the serum of heart donors are predictors of early graft failure after heart transplantation (HTx). The current study investigates the relationship between these two markers and their prognostic value when one or both of them are elevated.. Cardiac TnT and PCT were measured in serum from 92 consecutive brain-dead donors accepted for HTx. The donors were retrospectively divided into two groups: group I (n=78) donors of hearts with good function, group II (n=14) donors of hearts with early graft failure after transplantation.. There were no correlations between cTnT and PCT values (r=0.12, P=0.27). In eight donors in group I one or both markers were elevated. In one donor both markers were above the cut-off levels. In 12 donors (86%) in group II one or both markers were elevated. In two donors both markers were above the cut-off levels and in a further two below. There was no significant interaction between the two markers in either group using a logistic regression model (P=0.28).. Elevated cTnT and PCT levels in the serum of heart donors were independent prognostic markers of early graft failure. This fact may suggest two different mechanisms of early graft failure: primary myocardial damage and damage related to systemic inflammatory response. The combination of both markers had a higher sensitivity than each parameter on its own. Their use as additional parameters may improve heart donor selection.

Topics: Adult; Brain Death; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Female; Glycoproteins; Graft Survival; Heart Transplantation; Humans; Logistic Models; Male; Prognosis; Protein Precursors; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome; Time Factors; Tissue Donors; Troponin T

To define the role of procalcitonin in the differential diagnosis, prognosis and follow-up of critically ill patients.. Prospective study during the 2-year period from January 1998-2000.. One hundred nineteen critically ill patients: 29 with systemic inflammatory response syndrome (SIRS) without any signs of infection, 11 with sepsis, 17 with severe sepsis, 10 with septic shock and 52 controls. Daily measurements of procalcitonin were performed by an immunocheminoluminometric assay, and values were correlated to the clinical characteristics of the patients.. Mean concentrations of procalcitonin were 5.45 (95% CI: 2.11, 8.81), 7.29 (95% CI: -1.92,14.59), 6.26 (95% CI: -1.32, 13.85) and 38.76 ng/ml (95% CI: 0.15, 77.38) on the 1st day in patients with SIRS, sepsis, severe sepsis and septic shock, respectively, and were statistically superior to those of control patients. Procalcitonin was gradually diminished over time with the resolution of the syndrome, while it was sustained in the same or more augmented levels upon worsening. Mean concentrations of procalcitonin on the 1st day for patients finally progressing to ARDS, to ARDS and acute renal failure, to ARDS, acute renal failure and DIC and to ARDS, acute renal failure, DIC and hepatic failure were 10.48, 8.08, 32.72 and 43.35 ng/ml, respectively. ROC curves of the sensitivity and specificity of procalcitonin for the evaluation of SIRS and sepsis were similar.. The definite differential diagnosis between SIRS and sepsis may not rely on a single application of procalcitonin but on the complete clinical and laboratory evaluation of the patient with procalcitonin playing a considerable role. Procalcitonin is an early prognostic marker of the advent of MODS; therefore, daily determinations might help in the follow-up of the critically ill patient.

Topics: Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Diagnosis, Differential; Female; Greece; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; ROC Curve; Systemic Inflammatory Response Syndrome

Acute myocardial infarction induces an inflammatory reaction. We related conventional inflammatory parameters including C-reactive protein, erythrocyte sedimentation rate, white blood cell count and axillary temperature to plasma concentrations of procalcitonin in patients with acute myocardial infarction. In a prospective-descriptive study, we evaluated 54 patients with acute myocardial infarction. During a time period of 8 days following myocardial infarction, C-reactive protein, erythrocyte sedimentation rate, white blood cell count and axillary temperature as well as the plasma concentrations of procalcitonin were measured. Maximal procalcitonin remained normal (below 0.5 microgram/L) in patients with uncomplicated acute myocardial infarction. This contrasted with results obtained from patients additionally afflicted by pulmonary edema and cardiogenic shock, in whom maximal procalcitonin increased up to 5.24 micrograms/L. Resuscitation after cardiac arrest and/or concomitant bacterial infection increased procalcitonin to a maximal value of 134 micrograms/L, which was independent of the severity of left heart failure. Conventional inflammatory parameters were all significantly increased even in the absence of cardiac and non-cardiac complications of acute myocardial infarction. In conclusion, procalcitonin increases in patients with acute myocardial infarction only if associated with severe left heart failure, resuscitation after cardiac arrest or in the presence of bacterial infections. Thus, procalcitonin may help to elucidate the etiology of systemic inflammatory response during the early course of acute myocardial infarction.

Topics: Adult; Aged; Aged, 80 and over; Austria; Blood Sedimentation; Body Temperature; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Leukocyte Count; Male; Middle Aged; Myocardial Infarction; Prognosis; Prospective Studies; Protein Precursors; Systemic Inflammatory Response Syndrome

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Prognosis; Protein Precursors; Switzerland; Systemic Inflammatory Response Syndrome

To evaluate the efficacy of serun procalcitonin (PCT) and interleukin (IL)-6 in differentiating between severe sepsis and systemic inflammatory response (SIRS) of non-infectious origin.. The serum PCT, IL-6, C-reactive protein (CRP), white blod cell count, percentage of neutrophils, and absolute neutrophil count were determined, and maximal body temperature was recorded among 21 patients was 3.6 (1.8, 27.5) micro g/L, significantly higher than that in SIRS patients (1.3 micro g/L +/- 1.6 micro g/L, P < 0.05). The IL-6 in sepsis patients was 810 ng/L +/- 516 ng/L, significantly higher than that in SIRS patients (235 ng/L +/- 177 ng/L, P < 0.01). However, the differences of CRP, WBC count, percentage of neutrophil, and absolute neutrophil count between the severe sepsis patients and SIRS patients were not statistically significant. PCT and IL-6 showed sensitivity equal or over 80% and specificity equal to or over 70%. The infection score based on PCT and IL-6 showed the best discriminative power to differentiate between severe sepsis and SIRS with the artea under the receiver operating characteristic curve of 0.923.. In comparison with the conventional inflammatory markers, PCT and IL-6 are more reliable indicators to differentiate between sepsis and SIRS.

Topics: Aged; Aged, 80 and over; Blood Cell Count; Body Temperature; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Humans; Interleukin-6; Male; Middle Aged; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill. This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis. Eighty-five adult ICU patients were studied. Four groups were defined on the basis of clinical, laboratory and bacteriologic findings as systemic inflammatory response syndrome (SIRS) (n = 10), sepsis (n = 16), severe sepsis (n = 18) and septic shock (n = 41). Data were collected including C-reactive protein (CRP), PCT levels and Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores on each ICU day. PCT levels were significantly higher in patients with severe sepsis and septic shock (19.25 +/- 43.08 and 37.15 +/- 61.39 ng/ml) than patients with SIRS (0.73 +/- 1.37 ng/ml) (P < 0.05 for each comparison). As compared with SIRS patients, plasma PCT levels were significantly higher in infected patients (21.9 +/- 47.8 ng/ml), regardless of the degree of sepsis (P < 0.001). PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response. Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP. We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.

Topics: Adult; APACHE; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Humans; Male; Middle Aged; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Shock, Septic; Systemic Inflammatory Response Syndrome

The dynamic changes in levels of procalcitonin (PCT), as well as other cytokines and acute phase proteins (APP) in post-operative stages reflect the systemic immune response, integrating perioperative infectious and non-infectious stimuli. This study evaluates PCT in context of 16 other inflammatory parameters in patients with different types of infectious post-operative complications. It analyses the specificity and sensitivity of PCT, cytokines and APP and their relationships during systemic inflammatory response.. The study involved the following groups of patients: those with confirmed bacterial sepsis, fulfilling the SIRS criteria (N = 28), those with limited infectious site at the wound (N = 16), those with post-operative pneumonia (N = 15) and a control group of N = 25. In 24-hour interval we assessed plasma levels of: PCT, TNF-alpha, IL-1 beta, IL-1ra, IL-6, IL-8, sIL-2R and a spectrum of APP.. PCT in patients with wound infection (1.4 +/- 0.31 ng/ml) and in those with pneumonia (0.7 +/- 0.30 ng/ml) does not rise above levels expected in uncomplicated post-op course (1.7 +/- 0.04 ng/ml), but it differs significantly in comparison to healthy controls (0.2 +/- 0.07 ng/ml). Initial levels of PCT as well as their maximum levels were significantly different in septic patients compared to other groups (p < 0.001). According to specificity and sensitivity tests PCT is the most significant marker for diagnosis of sepsis as opposed to uncomplicated post-operative course (AUC 0.91, CI 0.82-1.0).. Individual inflammatory parameters vary in sensitivity and specificity to causative stimulus. PCT when compared to major cytokines and APP reacts sensitively mainly to systemic stimuli accompanying bacterial infection, notably endotoxin. It is characterized by markedly lower sensitivity to non-bacterial stimuli (trauma of surgery) or localized bacterial inflammations. It is this behaviour that makes it a useful diagnostic tool in post-op courses. Unlike other parameters, PCT allows with sufficient sensitivity and specificity single-test diagnosis of initial sepsis.

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Female; Glycoproteins; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Systemic Inflammatory Response Syndrome

To investigate the role of 3 inflammatory parameters as early markers of severe systemic inflammatory response syndrome (SIRS) induced by coronary artery bypass graft surgery.. Prospective study.. University hospital.. Patients (n = 63) undergoing elective coronary artery bypass graft surgery with cardiopulmonary bypass.. The American College of Chest Physicians/Society of Critical Care Medicine classification was used to diagnose SIRS. Organ system failures were used to define severe SIRS. Serum concentrations of the inflammatory parameters (procalcitonin [PCT], C-reactive protein, leukocyte count) were determined before, during, and after surgery. SIRS occurred in 30 (47%) patients after surgery. Seven patients (11%) showed SIRS with greater-than-or-equal1 organ dysfunction (severe SIRS), whereas patients without SIRS had no organ dysfunction. Significantly higher serum levels of PCT were found in patients with severe SIRS from the 6th postoperative hour until the 3rd postoperative day with a peak level of 10.7 plus minus 13.2 ng/mL. No significant difference was detected between serum PCT of patients with SIRS but without any organ dysfunction and patients without SIRS. PCT levels of these patients remained lower than 1.7 ng/mL. Compared with PCT, plasma concentrations of C-reactive protein peaked later on the 2nd postoperative day and were not able to confirm the severity of SIRS. Leukocyte counts were not significantly modified.. PCT seems to be an appropriate marker to identify the early development of noninfectious postoperative severe SIRS after coronary artery bypass graft surgery with cardiopulmonary bypass.

Topics: Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Cardiovascular System; Coronary Artery Bypass; Female; Hemodynamics; Humans; Leukocyte Count; Male; Prospective Studies; Protein Precursors; Systemic Inflammatory Response Syndrome

Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1beta, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocardial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1beta) and PCT were significantly elevated in MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response.

Topics: Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Cytokines; Humans; Interleukin-18; Male; Middle Aged; Multiple Organ Failure; Myocardial Revascularization; Postoperative Complications; Prognosis; Protein Precursors; Systemic Inflammatory Response Syndrome

Researchers and clinicians have been investigating and implementing various methods of early diagnosis for sepsis before documentation of infection. The aim of this study was to outline the efficiency of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) in determining the early diagnosis of sepsis in the emergency department. Between January 1999 and September 2000, 34 patients with signs of systemic inflammatory response syndrome (SIRS) were enrolled in the study. The patients were divided into 2 groups according to non-suspected sepsis and suspected sepsis clinically. Admission PCT was significantly higher in suspected sepsis group (median 68.7 microg/L; lower [L] = 15.24 microg/L, upper [U] = 120.54 microg/L) compared with the unsuspected sepsis group (.23 microg/L; L =.10 microg/L, U =.44 microg/L). PCT values were compared with WBC and CRP levels. Predictive accuracy for sepsis expressed as area under the receiver operating characteristic (ROC) curve was.88 for PCT,.44 for WBC, and.34 for CRP. PCT can probably be used as a predictive marker in bacterial infections in emergency departments.

Topics: Adult; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Emergencies; Female; Humans; Leukocyte Count; Male; Middle Aged; Prospective Studies; Protein Precursors; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Systemic Inflammatory Response Syndrome; Time Factors; Turkey

Systemic bacterial infections still remain one of the major causes of neonatal morbidity and mortality. Early detection of neonatal sepsis can be difficult, because the first signs of the disease may be unspecific and similar to symptoms of other non-infectious processes. Procalcitonin became a new, sensitive marker of bacterial infections in newborns. The aim of our study was to assess the value of PCT as a diagnostic and prognostic tool of neonatal maternofetal infections. We also tried to estimate normal ranges of PCT in uninfected newborns.. 74 newborns, born in the Department of Obstetrics and Gynaecology, University of Medicine of Wrocław, then hospitalized in the Department of Neonatology entered the study. They were divided into 2 groups: group 1-29 neonates with recognized materno-fetal infection, group 2-45 newborns without infection. In both groups blood samples to measure PCT concentrations were obtained by venipuncture on the 1st, 2nd, 3rd, 5th and between the 10th and 14th day of life (in the group of infected neonates) Sera were stored at -40 degrees C before analysis. PCT was determined using an immunoluminometric assay (BRAHMS Diagnostica).. Serum procalcitonin values were significantly higher in the infected group than in the uninfected neonates (p < 0.001). The most significant differences were noted on the 2nd and 3rd day of life (p < 0.0001). After the treatment had been finished, the PCT levels in both groups were not statistically different.. PCT is a useful tool in early diagnosing and monitoring the course of early-onset infections in neonates, particularly when blood cultures obtained from neonates remain negative. The decreasing concentrations of PCT level in children treated due to infection, indicate successful treatment and may help one to take a decision on termination of antibiotic therapy.

Topics: Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Infant, Newborn; Protein Precursors; Reference Values; Reproducibility of Results; Staphylococcal Infections; Streptococcal Infections; Systemic Inflammatory Response Syndrome

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

Because the use of procalcitonin (PCT) as a marker of bacterial infection has been advocated, this study was carried out to determine the usefulness of plasma PCT in the early diagnosis and differentiation of patients with non-infectious systemic inflammatory response syndrome (SIRS) from those with sepsis, and the relationship between plasma PCT level and severity of organ failure.. Thirty-five patients with non-septic SIRS (n = 16), sepsis (n = 7) or septic shock (n = 12) were included in this study. PCT and C-reactive protein (CRP) levels were measured and sepsis-related organ failure assessment (SOFA) score was calculated for these patients. Plasma PCT was measured by immunoluminometric assay.. The median (minimum, maximum) plasma PCT levels were 0.6 (0.1, 3.4) ng/mL in non-septic SIRS, 5.4 (0.9, 47.7) ng/mL in sepsis and 73.4 (9.6, 824.1) ng/mL in septic shock, and significant differences existed in plasma PCT levels among the three groups. The median (minimum, maximum) CRP levels were 13.8 (0.3, 48.8) mg/dL in non-septic SIRS, 23.3 (1.4, 26.6) mg/dL in sepsis and 17.4 (2.2, 34.1) mg/dL in septic shock, without significant differences among the three groups. A good correlation was found between plasma PCT level and SOFA score (rs = 0.766, P < 0.0001), although no correlation was found between CRP level and SOFA score.. CRP is increased by inflammatory disease as well as infection and is therefore not a good indicator of infection in patients with severe SIRS. On the other hand, PCT is a good indicator of severity of sepsis and organ failure in patients with severe SIRS since PCT levels correlated with sepsis and SOFA scores. PCT level is useful for diagnosis of sepsis and as an indicator of severity of organ failure in patients with SIRS.

Topics: Analysis of Variance; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glycoproteins; Humans; Immunoassay; Male; Middle Aged; Multiple Organ Failure; Protein Precursors; Severity of Illness Index; Systemic Inflammatory Response Syndrome

Cardiopulmonary bypass (CPB) is associated with an immunological injury that may cause pathophysiological alterations in the form of a systemic inflammatory response syndrome (SIRS) or a multiple organ dysfunction syndrome (MODS). Previous studies on this issue have reported different changes of immunological parameters during and after CPB, but there are no reports about the lipopolysaccharide-binding protein (LBP) in relationship to other markers of inflammation in patients with MODS following cardiovascular surgery. In the present study, we investigated the acute-phase response of patients with MODS of infectious and non-infectious origin following open-heart-surgery. Plasma levels of procalcitonin (PCT), c-reactive protein (CRP), interleukin-6 (IL-6), and LBP were measured in the first four postoperative days in 12 adult male patients with the signs of SIRS and two or more organ dysfunctions after myocardial revascularization (MODS-group), and 12 patients without organ insufficiencies (SIRS-group). There were no significant differences regarding age, weight, height, preoperative NYHA-classification, preoperative LVEDP, or the number of anastomosis. Patients with MODS had a significantly longer operation time, duration of ischemia, and duration of extracorporeal circulation. None of the patients in the SIRS group died, whereas in the MODS group, 4 patients died due to septic multiorgan failure. Plasma PCT and IL-6 concentrations were significantly elevated in all MODS patients. CRP and LBP showed no differences between the MODS and the SIRS group. Comparing the MODS patients with and without positive microbial findings, we found significantly elevated levels of PCT and LBP in those patients with documented infections. Our results indicate that LBP may be a new marker for the differentiation between a severe non-infectious SIRS and an ongoing bacterial sepsis in the early postoperative course following CPB, while a microbiological result is still missing.

Topics: Acute-Phase Proteins; Acute-Phase Reaction; Aged; APACHE; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Carrier Proteins; Humans; Interleukin-6; Length of Stay; Male; Membrane Glycoproteins; Middle Aged; Multiple Organ Failure; Myocardial Revascularization; Postoperative Complications; Protein Precursors; Systemic Inflammatory Response Syndrome

To determine the value of procalcitonin (PCT) in the early diagnosis (and differentiation) of patients with SIRS, sepsis, severe sepsis, and septic shock in comparison to C-reactive protein (CRP), white blood cell and thrombocyte count, and APACHE-II score (AP-II).. Prospective cohort study including all consecutive patients admitted to the ICU with the suspected diagnosis of infection over a 7-month period.. A total of 185 patients were included: 17 patients with SIRS, 61 with sepsis, 68 with severe sepsis, and 39 patients with septic shock. CRP, cell counts, AP-II and PCT were evaluated on the first day after onset of inflammatory symptoms.. PCT values were highest in patients with septic shock (12.89+/-4.39 ng/ml;P<0.05 vs patients with severe sepsis). Patients with severe sepsis had significantly higher PCT levels than patients with sepsis or SIRS (6.91+/-3.87 ng/ml vs 0.53+/-2.9 ng/ml;P<0.001, and 0.41+/-3.04 ng/ml;P<0.001, respectively). AP-II scores did not differ significantly between sepsis, severe sepsis and SIRS (19.26+/-1.62, 16.09+/-2.06, and 17.42+/-1.72 points, respectively), but was significantly higher in patients with septic shock (29.27+/-1.35,P<0.001 vs patients with severe sepsis). Neither CRP, cell counts, nor the degree of fever showed significant differences between sepsis and severe sepsis, whereas white blood cell count and platelet count differed significantly between severe sepsis and septic shock.. In contrast to AP-II, PCT appears to be a useful early marker to discriminate between sepsis and severe sepsis.

Topics: Adult; Aged; APACHE; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Diagnosis, Differential; Early Diagnosis; Female; Germany; Humans; Leukocyte Count; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Shock, Septic; Statistics, Nonparametric; Systemic Inflammatory Response Syndrome

To determine the correlations and predictive strength of surrogate markers (body temperature, leukocyte count, C-reactive protein (CRP) and procalcitonin (PCT)) with elevated levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in septic patients on randomly chosen days.. Prospective consecutive case series.. Surgical intensive care unit (ICU) of a university hospital.. Two hundred forty-three patients experiencing ICU stays of longer than 48 h categorized for sepsis according to ACCP/SCCM Consensus Conference criteria.. CRP and PCT were both significantly correlated with TNF-alpha and IL-6. Based on the area under the curve (AUC) of the receiver operating characteristic (ROC) curves, predictive capability was highest for PCT (0.846 for TNF-alpha>40 pg/ml and 0.837 for IL-6>500 pg/ml), moderate with CRP (0.744 and 0.748, respectively), and lowest for leukocyte count (0.562 and 0.534, respectively) and body temperature (0.570 and 0.623, respectively). Sensitivity, specificity, positive and negative predictive values and test effectiveness all followed this same pattern of being highest for PCT followed by CRP, with leukocyte count and body temperature being lowest.. PCT may be an early and better marker of elevated cytokines than the more classic criteria of inflammation.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Body Temperature; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Germany; Humans; Interleukin-6; Male; Middle Aged; Prognosis; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Systemic Inflammatory Response Syndrome; Time Factors; Tumor Necrosis Factor-alpha

Endovascular repair of AAA's using stent grafts is considered to be a minimally invasive procedure. However, in some cases deleterious inflammatory reactions, e.g., flu-like postinterventional symptoms are observed. A few patients even develop a fatal "postimplantation syndrome". It is not clear whether these postoperative complications result from a) the inflammatory and immune response to the inserted graft material, b) alterations of the vascular endothelium during the implantation procedure, c) residual thrombotic material, or d) a combination of all these causes. This clinical trial aimed to prospectively investigate the association between inflammatory mediators like interleukin-1 receptor antagonist (IL-1RA), IL-6, and HLA-DR expression on monocytes and clinical outcome in patients after repair of abdominal aortic aneurysms (AAA). Fifteen patients treated with endovascular stent grafts for abdominal aortic aneurysm (AAA-E) were compared with 15 selected control patients who underwent a conventional surgical procedure (AAA-K) during the same period. Prior to intervention, there were no significant differences in marker levels. One hour postoperatively, IL-6 (421 pg/ml vs. 21 pg/ml) and IL-1RA (10,061 pg/ml versus 407 pg/ml) were significantly increased in the AAA-K-group, whereas in AAA-E patients, these parameters increased more gradually during the first postoperative day and did not reach the same level as in the control group. There was only a slight reduction of HLA-DR expression in both groups compared with baseline and no signs indicating a postimplantation syndrome were found. No excessive inflammatory response or complicated final outcome were observed. It is unclear if this can be explained by the prophylactic use of indometacin.

Topics: Adult; Aged; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Calcitonin; Calcitonin Gene-Related Peptide; Endothelium, Vascular; Female; Foreign-Body Reaction; HLA-DR Antigens; Humans; Immunity, Cellular; Interleukin 1 Receptor Antagonist Protein; Interleukin-6; Male; Middle Aged; Minimally Invasive Surgical Procedures; Monocytes; Postoperative Complications; Prospective Studies; Protein Precursors; Sialoglycoproteins; Stents; Systemic Inflammatory Response Syndrome

One hundred and ten patients were investigated prospectively in a study aimed at creating reference curves for inflammation markers (serum C-reactive protein (CRP), blood leukocyte count, iron, transthyretin and procalcitonin). Blood samples were taken daily and the patients were monitored for signs of infection. Ninety-six patients had no postoperative infections. CRP and leukocyte counts peaked on the third and second postoperative days, respectively. Neither patients operated on off-pump (n = 4) nor patients with minor infections (n = 11) differed from the non-infected group. Two out of three patients with major postoperative infection exhibited a secondary peak in CRP and leukocyte count. Iron and transthyretin decreased initially, followed by a slow increase without any difference between the groups. Procalcitonin was high in some non-infected patients and low in some infected patients. CRP and leukocyte count had a predictable course with a secondary peak in major infections but the other markers did not provide any valuable information.

Topics: Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Heart Diseases; Humans; Inflammation Mediators; Iron; Leukocyte Count; Male; Middle Aged; Postoperative Complications; Prealbumin; Predictive Value of Tests; Prospective Studies; Protein Precursors; Surgical Wound Infection; Systemic Inflammatory Response Syndrome

To evaluate whether plasma concentrations of procalcitonin (PCT), interleukin-6 (IL-6), protein complement 3a (C3a), leukocyte elastase (elastase), and the C-reactive protein (CRP) determined directly after the clinical onset of sepsis or systemic inflammatory response syndrome (SIRS) discriminate between patients suffering from sepsis or SIRS and predict the outcome of these patients.. Prospective study.. Medical intensive care unit at a university hospital.. Twenty-two patients with sepsis and 11 patients with SIRS.. The plasma concentrations of PCT, C3a, and IL-6 obtained < or =8 hrs after clinical onset of sepsis or SIRS but not those of elastase or CRP were significantly higher in septic patients (PCT: median, 16.8 ng/mL, range, 0.9-351.2 ng/mL, p = .003; C3a: median, 807 ng/mL, range, 422-4788 ng/mL, p < .001; IL-6: median, 382 pg/mL, range, 5-1004 pg/mL, p = .009, all Mann-Whitney rank sum test) compared with patients suffering from SIRS (PCT: median, 3.0 ng/mL, range, 0.7-29.5 ng/mL; C3a: median, 409 ng/mL, range, 279566 ng/mL; IL-6: median, 98 pg/mL, range, 23-586 pg/mL). The power of PCT, C3a, and IL-6 to discriminate between septic and SIRS patients was determined in a receiver operating characteristic analysis. C3a was the best variable to differentiate between both populations with a maximal sensitivity of 86% and a specificity of 80%. An even better discrimination (i.e., a maximal sensitivity of 91% and a specificity of 80%) was achieved when PCT and C3a were combined in a "sepsis score." C3a concentrations also helped to predict the outcome of patients. Based on the sepsis score, a logistic regression model was developed that allows a convenient and reliable determination of the probability of an individual patient to suffer from sepsis or SIRS.. Our data show that the determination of PCT, IL-6, and C3a is more reliable to differentiate between septic and SIRS patients than the variables CRP and elastase, routinely used at the intensive care unit. The determination of PCT and C3a plasma concentrations appears to be helpful for an early assessment of septic and SIRS patients in intensive care.

Topics: Adult; Calcitonin; Calcitonin Gene-Related Peptide; Complement C3a; Diagnosis, Differential; Female; Glycoproteins; Humans; Interleukin-6; Male; Middle Aged; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

Since it is of great importance to distinguish between a systemic inflammatory response syndrome (SIRS) and an infection caused by microbes especially after heart transplantation (HTX), we examined patients following heart surgery by determining procalcitonin (PCT), because PCT is said to be secreted only in patients with microbial infections.. Sixty patients undergoing coronary artery bypass grafting (CABG) and 14 patients after heart transplantation were included in this prospective study. In the CABG group we had 30 patients without any postoperative complications (group A). Furthermore we took samples of 30 patients who suffered postoperatively from a sepsis (group B, n=15) or a systemic inflammatory response syndrome (C, n=15). In addition we measured the PCT-levels in 65 blood samples of 14 patients after heart transplantation (Group I: rejection > IIa, II: viral infection (CMV), III: bacterial/fungal infection, IV: controls).. In all patients of group A the pre- and intraoperative PCT-values and the measurement at arrival on intensive care unit (ICU) were less than 0.2 ng/ml. On the second postoperative day the PCT-value was 0.33+/-0.15 ng/ml in the control group. At the same time it was 19.6+/-6.2 ng/ml in sepsis and 0.7+/-0.4 ng/ml in systemic inflammatory response syndrome patients (P<0.05). In transplanted patients we could find the following PCT-values: Gr.I: 0.18+/-0.06 II: 0.30+/-0.09 III: 1.63+/-1.16 IV: 0.21+/-0.09 ng/ml (P<0.05 comparing group III with I, II and IV).. These results show that extracorporeal circulation (ECC) and systemic inflammatory response syndrome do not initiate a PCT-secretion. Septic conditions cause a significant increase of PCT. In addition, PCT is a reliable indicator concerning the essential differentiation of bacterial or fungal--not viral--infection and rejection after heart transplantation.

Topics: Aged; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Extracorporeal Circulation; Female; Glycoproteins; Graft Rejection; Heart Transplantation; Humans; Male; Middle Aged; Mycoses; Prospective Studies; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome; Virus Diseases

Procalcitonin (PCT) has been described as an early, discriminating marker of bacteria-associated sepsis in patients. However, little is known of its source and actions, in part because no appropriate animal models have been available. We tested the hypothesis that plasma PCT increases during various pathophysiological conditions, such as hemorrhagic shock and sepsis, which differ with regard to the degree of associated endotoxemia. We further hypothesized that in sepsis, PCT would be significantly different in survivors vs. nonsurvivors.. Prospective, blinded analysis of previously collected plasma of experimental animals.. Independent nonprofit research laboratory in a trauma hospital and a contract research institute.. A total of 22 male baboons (17.5-31 kg).. Hemorrhagic-traumatic shock was induced by hemorrhage for up to 3 hrs, reperfusion with shed blood and infusion of cobra venom factor (n = 7). By using a similar experimental setup, severe hyperdynamic sepsis was induced (n = 15) by intravenous infusion of live Escherichia coli (2 x 10(9) colony-forming units/kg) over 2 hrs, followed by antibiotic therapy (gentamicin 4 mg/kg twice a day).. Plasma PCT at baseline was barely detectable, but levels increased significantly (p < .05) to 2+/-1.8 pg/mL 2 hrs after the start of reperfusion in the shock group, and to 987+/-230 pg/mL at 4 hrs after E. coli in the sepsis group. Levels were maximal between 6 and 32 hrs and had returned nearly to baseline levels at 72 hrs. Interleukin-6 levels paralleled the course of PCT measurements, whereas a significant increase in neopterin was seen at 24 hrs. PCT levels were approximately three times higher in the sepsis group than in the shock group, corresponding to endotoxin levels (at the end of hemorrhage, 286+/-144 pg/mL vs. 3576+/-979 pg/mL at the end of E. coli infusion; p = .003). PCT levels were significantly different at 24 hrs between survivors (2360+/-620 pg/mL) and nonsurvivors (4776+/-563 pg/mL) in the sepsis group (p = .032), as were interleukin-6 (1562+/-267 vs. 4903+/-608 pg/mL; p = .01) and neopterin/creatinine ratio (0.400+/-0.038 vs. 0.508+/-0.037; p = .032).. PCT is detectable in the baboon as in humans, both in hemorrhagic shock and sepsis. PCT levels are significantly higher in sepsis than in hemorrhage, a finding that is probably related to the differences in endotoxin. The baboon can be used for the study of PCT kinetics in both models; PCT kinetics are clearly different from other markers of sepsis, either IL-6 or neopterin, in both models. There are significant differences between survivors and nonsurvivors in the sepsis model.

Topics: Animals; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Disease Models, Animal; Escherichia coli Infections; Interleukin-6; Male; Neopterin; Papio; Protein Precursors; Shock, Hemorrhagic; Shock, Septic; Survival Rate; Systemic Inflammatory Response Syndrome; Wounds and Injuries

We have measured serum procalcitonin (PCT) concentrations after cardiac surgery in 36 patients allocated to one of three groups: group 1, coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (n = 12); group 2, CABG without CPB (n = 12); and group 3, valvular surgery with CPB (n = 12). Serum PCT and C-reactive protein (CRP) concentrations were measured before operation, at the end of surgery and daily until postoperative day 8. Serum PCT concentrations increased, irrespective of the type of cardiac surgery, with maximum concentrations on day 1: mean 1.3 (SD 1.8), 1.1 (1.2) and 1.4 (1.2) ng ml-1 in groups 1, 2 and 3, respectively (ns). Serum PCT concentrations remained less than 5 ng ml-1 in all patients. Concentrations returned to normal by day 5 in all groups. To determine the effect of the systemic inflammatory response (SIRS) on serum PCT concentrations, patients were divided post hoc, without considering the type of cardiac surgery, into patients with SIRS (n = 19) and those without SIRS (n = 17). The increase in serum PCT was significantly greater in SIRS (peak PCT 1.79 (1.64) ng ml-1 vs 0.34 (0.32) ng ml-1 in patients without SIRS) (P = 0.005). Samples for PCT and CRP measurements were obtained from 10 other patients with postoperative complications (circulatory failure n = 7; active endocarditis n = 2; septic shock n = 1). In these patients, serum PCT concentrations ranged from 6.2 to 230 ng ml-1. Serum CRP concentrations increased in all patients, with no differences between groups. The postoperative increase in CRP lasted longer than that of PCT. We conclude that SIRS induced by cardiac surgery, with and without CPB, influenced serum PCT concentrations with a moderate and transient postoperative peak on the first day after operation. A postoperative serum PCT concentration of more than 5 ng ml-1 is highly suggestive of a postoperative complication.

Topics: Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiopulmonary Bypass; Coronary Artery Bypass; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Protein Precursors; Systemic Inflammatory Response Syndrome

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

High serum levels of the calcitonin (CT) prohormone, procalcitonin (pro-CT), and its component peptides occur in systemic inflammation and sepsis. Using two different assays, we undertook a prospective study to determine the utility of serum precalcitonin peptides (pre-CT) as markers in this condition. Twenty-nine patients meeting criteria for the systemic inflammatory response syndrome were studied daily in two intensive care units. Sera were collected, and APACHE II scores were determined until recovery or death. All patients had markedly elevated serum pre-CT. Prognostically, peak values were the most important. The highest values portended mortality, and a lower level could be ascertained below which all patients survived. Peak pre-CT levels were significantly higher in patients with infection documented by blood cultures than in those patients with no documented infection from any source (P < 0.05). Mature CT remained normal or only moderately elevated. Compared with the serum pre-CT levels, receiver operating characteristic curve analysis revealed that the APACHE II scores, although more cumbersome, were better overall predictors of mortality. Thus, pre-CT is an important serum marker for systemic inflammatory response syndrome and is predictive of outcome. It also provides data concerning the presence of severe infection and may prove to be clinically useful for proactive patient care.

Topics: Adult; Aged; Aged, 80 and over; Bacteremia; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Chromatography, High Pressure Liquid; Critical Care; Fungemia; Humans; Kinetics; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; ROC Curve; Systemic Inflammatory Response Syndrome

Topics: Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Glycoproteins; Humans; Postoperative Complications; Protein Precursors; Sepsis; Systemic Inflammatory Response Syndrome

The systemic inflammatory response syndrome (SIRS) is a marked, generalized response to a variety of injuries, if infection is implicated, the term "sepsis" is used. Systemic inflammatory response syndrome/sepsis, which is initiated by proinflammatory cytokines, has been found to be associated with increased serum levels of the prohormone of calcitonin, procalcitonin (ProCT) and its aminoterminus peptide (nProCT). The serum levels of ProCT and nProCT are very useful markers for SIRS/sepsis, and may be used to follow the course, the response to therapy, and/or the prognosis. We studied the serum levels and distribution of ProCT and its component peptides in normal persons for comparison with similar immunochemical and separatory studies in patients with neuroendocrine cancer and with SIRS/sepsis of various etiologies.. We studied pooled and extracted serum of 13 normal subjects, and sera of patients with neuroendocrine cancer and SIRS/sepsis, using region-specific immunoassays, gel filtration, and high performance liquid chromatography.. Normal sera contained small but measurable levels of the intact ProCT molecule, nProCT, a conjoined calcitonin-calcitonin carboxyterminal peptide (CT:CCP-I), CCP-I, free mature CT, and calcitonin gene-related peptide (CGRP). Sera from neuroendocrine cancer usually contained high levels of these peptides. In such cases, free mature CT was always increased, the mean ratio of the intact ProCT to free CT being 168 +/- 68. Gel filtration and HPLC studies of patients with SIRS/sepsis revealed markedly increased levels of ProCT, nProCT, and CT:CCP-I in varying proportions. Mature CT was normal to minimally elevated. The ratio of ProCT to free CT was 2,900 +/- 800. Although serum CGRP is commonly increased in neuroendocrine cancer, it was very low or undetectable in SIRS/sepsis.. These studies indicate that ProCT and its component peptides circulate in normal persons. The serum of patients with SIRS/sepsis contains greatly increased levels of ProCT, nProCT and often, CT:CCP-I. However, in this condition, post-translational processing is incomplete, resulting in mature CT levels that are normal or minimally elevated. In contrast, patients with neuroendocrine cancer have considerably high mature CT levels. Interestingly, although serum CGRP levels often are high in neuroendocrine cancer, they are low in SIRS/sepsis. The marked hyperprocalcitonemia of SIRS/sepsis is probably a consequence of the pro-inflammatory cytokine cascade, and appears to be secreted in a constitutive fashion; the cell(s) of origin of this remarkable hypersecretion is unknown. There is a very marked positive correlation between serum levels of ProCT and nProCT, and the lower level of sensitivity for nProCT may make its measurement a more useful marker for early or mild SIRS/sepsis.

Topics: Adult; Calcitonin; Calcitonin Gene-Related Peptide; Chromatography, High Pressure Liquid; Glycoproteins; Humans; Male; Middle Aged; Neuroendocrine Tumors; Peptide Fragments; Peptide Mapping; Protein Precursors; Radioimmunoassay; Systemic Inflammatory Response Syndrome