Could presepsin be an alternative marker in the early diagnosis of sepsis in COVID-19?

In critical patients with Coronavirus Disease (COVID-19), we investigated the diagnostic value of presepsin in the early diagnosis of superinfection with sepsis, and the effect of antibiotic treatment (AT) in the levels of presepsin and procalcitonin and C-reactive protein. A total of 68 critical patients with sepsis and septic shock in the intensive care unit and 20 outpatients (control group) with COVID-19 were taken. ICU patients (n = 68) were further divided into three groups. C(-)AT(-) had negative blood or tracheal aspirate cultures (C) and not AT on admission to ICU (n = 18), C(-)AT(+) had negative C and AT on admission to intensive care unit (n = 31) and C(+) had positive C (n = 19). Presepsin, procalcitonin, C-reactive protein results were compared between the groups. There were no significant relationships between presepsin levels with sepsis, septic shock, mortality, or length of stay in ICU in patients with COVID-19. For procalcitonin and C-reactive protein levels in C(-)AT(+) and C(+) groups were significantly higher than in control and C(-)AT(-) groups (p < .001). C-reactive protein levels in C(-)AT(-) group were significantly higher than in the control group (p < .001). PCT and CRP, there was no difference between C(-)AT(+) and C(+) groups, and procalcitonin there was no difference between control and C(-)AT(-) groups. Presepsin was not found as a useful biomarker for the prediction of sepsis in COVID-19 patients. These study findings indicate that procalcitonin and C-reactive protein may be an indicator of an early diagnostic marker for superinfection in critical COVID-19 patients.

Convalescent plasma for COVID-19 in the intensive care unit.

INTRODUCTION: We aimed to investigate the clinical features and mortality of critically ill patients treated with convalescent plasma for COVID-19 in the intensive care unit (ICU). MATERIAL AND METHODS: We retrospectively collected clinical and laboratory data of COVID-19 patients treated in the ICU. The patients were divided into two groups: those who received convalescent plasma and those who did not. We evaluated changes in the laboratory parameters and PaO2/FiO2 of the patients in the convalescent plasma group on days 0, 7, and 14. RESULTS: A total of 188 patients were included, 89 of whom received convalescent plasma. There were no significant differences in length of hospitalization [median: 17 vs. 16 days, P = 0.13] or 28-day mortality between the two groups (59% vs. 65%, P = 0.38). The ICU stay of patients who received convalescent plasma was longer (P = 0.001). The dynamics of the laboratory parameters of 44 patients in the convalescent plasma group, who were still in intensive care on the 14th day, were analysed. There was no differences in CRP or PaO2/FiO2 on day 0, 7 or 14 (P = 0.12; P = 0.10, respectively). CONCLUSIONS: Convalescent plasma treatment was not associated with shorter hospitalisation or lower mortality in patients diagnosed with COVID-19. However, the ICU stay was longer in patients who received convalescent plasma.

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU.

Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; p < 0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; p = 0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n = 13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50-1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96-463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01-0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.