ABSTRACT
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Subject(s)
C-Reactive Protein/metabolism , Calcitonin/blood , Eosinophils , Leukocyte Count , Protein Precursors/blood , Sepsis/diagnosis , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosis , Aged , Biomarkers/blood , Calcitonin Gene-Related Peptide , DNA/blood , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Sepsis/blood , Sepsis/complications , Severity of Illness IndexABSTRACT
Cytomegalovirus (CMV) infection is a frequent disease in immunocompromised patients and can affect the gastrointestinal tract in 50% of patients, giving rise to colitis due to CMV. However, a perforated jejunum is not frequent. We present the case of an immunocompromised patient who was diagnosed with colitis due to CMV infection after bowel perforation. Outcome was favorable after surgery and antiviral treatment.
Subject(s)
Cytomegalovirus Infections/complications , Intestinal Perforation/virology , Jejunal Diseases/virology , Megacolon, Toxic/virology , Humans , Immunocompromised Host , Male , Megacolon, Toxic/pathology , Megacolon, Toxic/surgery , Middle AgedABSTRACT
La infección por citomegalovirus (CMV) es una entidad de relativa frecuencia en los pacientes inmunodeficientes y en la mitad de los casos puede afectar al tracto gastrointestinal y dar lugar a una colitis por CMV; sin embargo, no es frecuente que el proceso se complique con una perforación yeyunal. Presentamos el caso de un paciente inmunodeficiente afectado de colitis por CMV y diagnosticado tras perforación intestinal. Tras cirugía y tratamiento con antivirales, el paciente evolucionó satisfactoriamente (AU)
Cytomegalovirus (CMV) infection is a frequent disease in immunocompromised patients and can affect the gastrointestinal tract in 50% of patients, giving rise to colitis due to CMV. However, a perforated jejunum is not frequent. We present the case of an immunocompromised patient who was diagnosed with colitis due to CMV infection after bowel perforation. Outcome was favorable after surgery and antiviral treatment (AU)