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1.
Medicine (Baltimore) ; 100(6): e24671, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578598

RESUMO

ABSTRACT: The mortality rate of patients diagnosed with sepsis is high. To date, many markers in sepsis patients have been studied to diagnose, determine their prognosis, and contribute to treatment. These studies were conducted in both experimental and clinical settings, but clinical trials remain limited. Therefore, more well-planned clinical studies are needed in patients with sepsis.The current study aimed to examine the prognostic role of signal peptide-CUB-epidermal growth factor-like domain-containing protein 1 (SCUBE-1) in sepsis and sepsis-related mortality. We also wanted to study its relationship with inflammatory markers and scoring systems.This prospective, cross-sectional, observational study included a total of 187 sepsis cases treated in the intensive care unit. Venous samples were obtained after diagnosis. The patients were separated into 2 groups: (1) the survivor group who were discharged or transferred within 28 days of the first diagnosis and (2) the nonsurvivor group who died within 28 days of the first diagnosis.The SCUBE-1, C-reactive protein, procalcitonin, creatinine, lactate values, acute physiology and chronic health evaluation 2, sequential organ failure assessment scores were significantly higher in the survivor group, and platelets were higher in the survivor group. In addition, SCUBE-1 positively correlated with the inflammatory markers C-reactive protein, lactate, sequential organ failure assessment, and acute physiology and chronic health evaluation 2. Additionally, the SCUBE-1 value predicts 28-day mortality, and the optimal cutoff value for predicting mortality is 4,73 pg/mL.Sepsis is a disease with high mortality. SCUBE-1 can be used as a new prognostic factor for sepsis patients.


Assuntos
Biomarcadores/metabolismo , Proteínas de Ligação ao Cálcio/metabolismo , Unidades de Terapia Intensiva/estatística & dados numéricos , Sepse/metabolismo , Sobreviventes/estatística & dados numéricos , APACHE , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Regras de Decisão Clínica , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Ácido Láctico/análise , Masculino , Mortalidade/tendências , Escores de Disfunção Orgânica , Pró-Calcitonina/metabolismo , Prognóstico , Estudos Prospectivos , Sepse/diagnóstico , Sepse/mortalidade , Turquia/epidemiologia
2.
Cardiol Rev ; 29(1): 39-42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33136582

RESUMO

Patients older than 65 years hospitalized with COVID-19 have higher rates of intensive care unit admission and death when compared with younger patients. Cardiovascular conditions associated with COVID-19 include myocardial injury, acute myocarditis, cardiac arrhythmias, cardiomyopathies, cardiogenic shock, thromboembolic disease, and cardiac arrest. Few studies have described the clinical course of those at the upper extreme of age. We characterize the clinical course and outcomes of 73 patients with 80 years of age or older hospitalized at an academic center between March 15 and May 13, 2020. These patients had multiple comorbidities and often presented with atypical clinical findings such as altered sensorium, generalized weakness and falls. Cardiovascular manifestations observed at the time of presentation included new arrhythmia in 7/73 (10%), stroke/intracranial hemorrhage in 5/73 (7%), and elevated troponin in 27/58 (47%). During hospitalization, 38% of all patients required intensive care, 13% developed a need for renal replacement therapy, and 32% required vasopressor support. All-cause mortality was 47% and was highest in patients who were ever in intensive care (71%), required mechanical ventilation (83%), or vasopressors (91%), or developed a need for renal replacement therapy (100%). Patients older than 80 years old with COVID-19 have multiple unique risk factors which can be associated with increased cardiovascular involvement and death.


Assuntos
Injúria Renal Aguda/terapia , Mortalidade Hospitalar , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Vasoconstritores/uso terapêutico , Centros Médicos Acadêmicos , Acidentes por Quedas , Injúria Renal Aguda/etiologia , Idoso de 80 Anos ou mais , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Aspartato Aminotransferases/metabolismo , Proteína C-Reativa/metabolismo , /metabolismo , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Causas de Morte , Transtornos da Consciência/fisiopatologia , Dispneia/fisiopatologia , Feminino , Ferritinas/metabolismo , Febre/fisiopatologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hospitalização , Humanos , Hipóxia/fisiopatologia , Hipóxia/terapia , Vida Independente , Unidades de Terapia Intensiva/estatística & dados numéricos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Contagem de Leucócitos , Hepatopatias/etiologia , Hepatopatias/metabolismo , Contagem de Linfócitos , Masculino , Debilidade Muscular/fisiopatologia , Peptídeo Natriurético Encefálico/metabolismo , Casas de Saúde , Oxigenoterapia , Pró-Calcitonina/metabolismo , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Troponina I/metabolismo
3.
Turk J Med Sci ; 51(2): 448-453, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33315349

RESUMO

Background/aim: The purpose of this study is to evaluate serum pentraxin-3 (PTX-3) levels in Sars-CoV-2 virus infection (COVID-19) patients and to investigate whether PTX-3 predicts the disease prognosis. Materials and methods: This study was conducted on 88 confirmed COVID-19 patients who were hospitalized due to symptomatic pneumonia between April 15 and August 15, 2020. The patients were divided into two groups as survived patients and non-survived patients. Both groups were compared according to demographic features, comorbid conditions and measurement of the PTX-3 and other laboratory parameters of the patients. Results: Of 88 patients with COVID-19, 59 (67%) were discharged with complete cure and 29 (33%) resulted in death. 46 (52.3%) of the patients were men. PTX-3 median value (IQR) was 3.66 ng/mL (0.9­27.9) in all patients, 3.3 ng/mL (0.9­27.9) in survivors and 3.91 ng/mL (1.9­23.2) in nonsurvivors which was significantly higher (P = 0.045). As a receiver operating characteristic curve analysis the cut-off value of PTX-3 for predicting mortality in patients was 3.73 with 65% sensitivity and 65% specificity (AUC: 0.646, 95% CI: 0.525­ 0.767, P = 0.045). Also, we found significant cut-off values with respect to D-dimer, D-dimer/PTX-3, high-sensitivity troponin, high- sensitivity troponin/PTX-3, lymphocyte, PTX-3/lymphocyte, procalcitonin, procalcitonin/PTX-3, CRP, and CRP/PTX-3 (P < 0.05). Conclusion: In this study, as far as we know, for the first time, we have shown PTX-3 as the new mortality biomarker for COVID-19 disease.


Assuntos
Proteína C-Reativa/metabolismo , Componente Amiloide P Sérico/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/metabolismo , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pró-Calcitonina/metabolismo , Prognóstico , Curva ROC , Troponina/metabolismo , Adulto Jovem
4.
Eur J Clin Invest ; 50(10): e13378, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32860457

RESUMO

BACKGROUND: To systematically review clinical and biochemical characteristics associated with the severity of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (COVID-19). MATERIALS AND METHODS: Systematic review of observational studies from PubMed, ISI Web of Science, SCOPUS and Cochrane databases including people affected by COVID-19 and reporting data according to the severity of the disease. Data were combined with odds ratio (OR) and metanalysed. Severe COVID-19 was defined by acute respiratory distress syndrome, intensive care unit admission and death. RESULTS: We included 12 studies with 2794 patients, of whom 596 (21.33%) had severe disease. A slightly higher age was found in severe vs non-severe disease. We found that prevalent cerebrovascular disease (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.73-7.72), chronic obstructive pulmonary disease (OR: 2.39, 95% CI 1.10-5.19), prevalent cardiovascular disease (OR: 2.84, 95% CI 1.59-5.10), diabetes (OR: 2.78, 95% CI 2.09-3.72), hypertension (OR: 2.24, 95% CI 1.63-3.08), smoking (OR: 1.54, 95% CI 1.07-2.22) and male sex (OR: 1.22, 95% CI 1.01-1.49) were associated with severe disease. Furthermore, increased procalcitonin (OR: 8.21, 95% CI 4.48-15.07), increased D-Dimer (OR: 5.67, 95% CI 1.45-22.16) and thrombocytopenia (OR: 3.61, 95% CI 2.62-4.97) predicted severe infection. CONCLUSION: Characteristics associated with the severity of SARS-CoV-2 infection may allow an early identification and management of patients with poor outcomes.


Assuntos
Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/metabolismo , Diabetes Mellitus/epidemiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pneumonia Viral/metabolismo , Pró-Calcitonina/metabolismo , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Trombocitopenia/epidemiologia , Betacoronavirus , Transtornos Cerebrovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Humanos , Hipertensão/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
5.
Eur J Clin Invest ; 50(10): e13362, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32726868

RESUMO

BACKGROUND: Identification of reliable outcome predictors in coronavirus disease 2019 (COVID-19) is of paramount importance for improving patient's management. METHODS: A systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled assessment; cumulative statistics for age and sex were retrieved in 587 790 and 602 234 cases. Two endpoints were defined: (a) a composite outcome including death, severe presentation, hospitalization in the intensive care unit (ICU) and/or mechanical ventilation; and (b) in-hospital mortality. We extracted numeric data on patients' characteristics and cases with adverse outcomes and employed inverse variance random-effects models to derive pooled estimates. RESULTS: We identified 18 and 12 factors associated with the composite endpoint and death, respectively. Among those, a history of CVD (odds ratio (OR) = 3.15, 95% confidence intervals (CIs) 2.26-4.41), acute cardiac (OR = 10.58, 5.00-22.40) or kidney (OR = 5.13, 1.78-14.83) injury, increased procalcitonin (OR = 4.8, 2.034-11.31) or D-dimer (OR = 3.7, 1.74-7.89), and thrombocytopenia (OR = 6.23, 1.031-37.67) conveyed the highest odds for the adverse composite endpoint. Advanced age, male sex, cardiovascular comorbidities, acute cardiac or kidney injury, lymphocytopenia and D-dimer conferred an increased risk of in-hospital death. With respect to the treatment of the acute phase, therapy with steroids was associated with the adverse composite endpoint (OR = 3.61, 95% CI 1.934-6.73), but not with mortality. CONCLUSIONS: Advanced age, comorbidities, abnormal inflammatory and organ injury circulating biomarkers captured patients with an adverse clinical outcome. Clinical history and laboratory profile may then help identify patients with a higher risk of in-hospital mortality.


Assuntos
Injúria Renal Aguda/epidemiologia , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/terapia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pneumonia Viral/terapia , Pró-Calcitonina/metabolismo , Fumar/epidemiologia , Trombocitopenia/epidemiologia , Doença Aguda , Corticosteroides/uso terapêutico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Proteína C-Reativa/metabolismo , Transtornos Cerebrovasculares/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/epidemiologia , Feminino , Ferritinas/metabolismo , Cardiopatias , Mortalidade Hospitalar , Hospitalização , Humanos , Hipertensão/epidemiologia , Unidades de Terapia Intensiva , Interleucina-6/metabolismo , Hepatopatias/epidemiologia , Linfopenia/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/metabolismo , Pneumonia Viral/mortalidade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Respiração Artificial , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
6.
Hosp Pediatr ; 10(10): 902-905, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32636210

RESUMO

Coronavirus disease (COVID-19) has affected children differently from adults worldwide. Data on the clinical presentation of the infection in children are limited. We present a detailed account of pediatric inpatients infected with severe acute respiratory syndrome coronavirus 2 virus at our institution during widespread local transmission, aiming to understand disease presentation and outcomes. A retrospective chart review was performed of children, ages 0 to 18 years, with a positive polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 on nasopharyngeal specimens admitted to our hospital over a 4-week period. We present clinical data from 22 patients and highlight the variability of the presentation. In our study, most children presented without respiratory illness or symptoms suggestive of COVID-19; many were identified only because of universal testing. Because children may have variable signs and symptoms of COVID-19 infection, targeted testing may miss some cases.


Assuntos
Infecções por Coronavirus/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Pneumonia Viral/fisiopatologia , Convulsões/fisiopatologia , Adolescente , Distribuição por Idade , Alanina Transaminase/metabolismo , Aspartato Aminotransferases/metabolismo , Betacoronavirus , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Doença Crônica , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/terapia , Feminino , Cardiopatias/epidemiologia , Hospitalização , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Pneumopatias/epidemiologia , Linfopenia/epidemiologia , Masculino , Programas de Rastreamento , Neoplasias/epidemiologia , Cidade de Nova Iorque/epidemiologia , Ventilação não Invasiva , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/metabolismo , Pneumonia Viral/terapia , Pró-Calcitonina/metabolismo , Respiração Artificial , Estudos Retrospectivos , Distribuição por Sexo , Estados Unidos
7.
Respir Res ; 21(1): 180, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664991

RESUMO

BACKGROUND: In December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy. OBJECTIVE: Analyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators. METHODS: This retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined. RESULTS: All patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function. CONCLUSIONS: COVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pneumonia Viral/epidemiologia , /epidemiologia , Tomografia Computadorizada por Raios X/métodos , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Análise Química do Sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , China/epidemiologia , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pró-Calcitonina/metabolismo , Radiografia Torácica/métodos , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
8.
Am Fam Physician ; 101(12): 721-729, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32538597

RESUMO

Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.


Assuntos
Tomada de Decisão Clínica , Febre/etiologia , Influenza Humana/diagnóstico , Pneumonia Bacteriana/diagnóstico , Infecções Urinárias/diagnóstico , Algoritmos , Combinação Amoxicilina e Clavulanato de Potássio , Antibacterianos/uso terapêutico , Betacoronavirus , Hemocultura , Proteína C-Reativa/metabolismo , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Técnicas de Cultura , Humanos , Lactente , Recém-Nascido , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Contagem de Leucócitos , Pandemias , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/epidemiologia , Pneumonia Viral , Pró-Calcitonina/metabolismo , Radiografia Torácica , Punção Espinal , Combinação Trimetoprima e Sulfametoxazol , Urinálise , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
9.
Travel Med Infect Dis ; 36: 101782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32526372

RESUMO

INTRODUCTION: There are currently no satisfactory methods for predicting the outcome of Coronavirus Disease-2019 (COVID-19). The aim of this study is to establish a model for predicting the prognosis of the disease. METHODS: The laboratory results were collected from 54 deceased COVID-19 patients on admission and before death. Another 54 recovered COVID-19 patients were enrolled as control cases. RESULTS: Many laboratory indicators, such as neutrophils, AST, γ-GT, ALP, LDH, NT-proBNP, Hs-cTnT, PT, APTT, D-dimer, IL-2R, IL-6, IL-8, IL-10, TNF-α, CRP, ferritin and procalcitonin, were all significantly increased in deceased patients compared with recovered patients on admission. In contrast, other indicators such as lymphocytes, platelets, total protein and albumin were significantly decreased in deceased patients on admission. Some indicators such as neutrophils and procalcitonin, others such as lymphocytes and platelets, continuously increased or decreased from admission to death in deceased patients respectively. Using these indicators alone had moderate performance in differentiating between recovered and deceased COVID-19 patients. A model based on combination of four indicators (P = 1/[1 + e-(-2.658+0.587×neutrophils - 2.087×lymphocytes - 0.01×platelets+0.004×IL-2R)]) showed good performance in predicting the death of COVID-19 patients. When cutoff value of 0.572 was used, the sensitivity and specificity of the prediction model were 90.74% and 94.44%, respectively. CONCLUSIONS: Using the current indicators alone is of modest value in differentiating between recovered and deceased COVID-19 patients. A prediction model based on combination of neutrophils, lymphocytes, platelets and IL-2R shows good performance in predicting the outcome of COVID-19.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Fosfatase Alcalina/metabolismo , Aspartato Aminotransferases/metabolismo , Betacoronavirus , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Infecções por Coronavirus/sangue , Infecções por Coronavirus/metabolismo , Feminino , Ferritinas/metabolismo , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , L-Lactato Desidrogenase/metabolismo , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Peptídeo Natriurético Encefálico/metabolismo , Neutrófilos , Pandemias , Tempo de Tromboplastina Parcial , Fragmentos de Peptídeos/metabolismo , Pneumonia Viral/sangue , Pneumonia Viral/metabolismo , Pró-Calcitonina/metabolismo , Prognóstico , Tempo de Protrombina , Curva ROC , Receptores de Interleucina-2/metabolismo , Troponina T/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , gama-Glutamiltransferase/metabolismo
10.
Int J Antimicrob Agents ; 56(2): 106051, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32534186

RESUMO

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared a pandemic. This study analysed 95 SARS-CoV-2-infected patients, including 62 moderate COVID-19 patients, 21 severe COVID-19 patients and 12 critical COVID-19 patients (6 patients died, all critical). The results showed that the mean serum procalcitonin (PCT) levels were over four times higher in severe patients than in moderate patients and were over eight times higher in critical patients than in moderate patients. For discharged patients, both high-normal PCT levels and abnormal PCT levels decreased during recovery. However, in death cases, serum levels of PCT increased as the disease worsened. We demonstrate that PCT may be an indicator of disease severity in COVID-19 and may contribute to determining the severity of patients infected with SARS-CoV-2. Moreover, serial PCT measurements may be useful in predicting the prognosis.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/metabolismo , Pneumonia Viral/metabolismo , Pró-Calcitonina/metabolismo , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
Eur Respir J ; 55(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32341111

RESUMO

Patients with COVID-19 present a broad spectrum of clinical presentation. Whereas hypoxaemia is the marker of severity, different strategies of management should be customised to five specific individual phenotypes. Many intubated patients present with phenotype 4, characterised by pulmonary hypoxic vasoconstriction, being associated with severe hypoxaemia with "normal" (>40 mL·cmH2O-1) lung compliance and likely representing pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin and has low pulmonary compliance, Which is a result of co-infection or acute lung injury after noninvasive ventilation. Identifying these clinical phenotypes and applying a personalised approach would benefit the optimisation of therapies and improve outcomes.


Assuntos
Lesão Pulmonar Aguda/fisiopatologia , Betacoronavirus/genética , Infecções por Coronavirus/genética , Fenótipo , Pneumonia Viral/genética , Vírus da SARS/genética , Lesão Pulmonar Aguda/terapia , Lesão Pulmonar Aguda/virologia , Biomarcadores/sangue , Pesquisa Biomédica , Infecções por Coronavirus/terapia , Gerenciamento Clínico , Feminino , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Complacência Pulmonar/genética , Masculino , Pandemias , Pneumonia Viral/terapia , Pró-Calcitonina/metabolismo , Vírus da SARS/patogenicidade
13.
Sci Rep ; 10(1): 4531, 2020 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-32161314

RESUMO

Procalcitonin (PCT) is a a marker of bacterial infection. Its prognostic role in the critically-ill patient, however, is still object of debate. Aim of this study was to evaluate the capacity of admission PCT (aPCT) in assessing the prognosis of the critically-ill patient regardless the presence of bacterial infection. A single-cohort, single-center retrospective study was performed evaluating critically-ill patients admitted to a stepdown care unit. Age, sex, Simplified Acute Physiology Score II (SAPS-II), shock, troponin-I, aPCT, serum creatinine, cultures and clinical endpoints (in-hospital mortality or Intensive Care Unit (ICU) transfer) were collected. Time free from adverse event (TF-AE) was defined as the time between hospitalization and occurrence of one of the clinical endpoints, and calculated with Kaplan-Meier curves. We engineered a new predictive model (POCS) adopting aPCT, age and shock.We enrolled 1063 subjects: 450 reached the composite outcome of death or ICU transfer. aPCT was significantly higher in this group, where it predicted TF-AE both in septic and non-septic patients. aPCT and POCS showed a good prognostic performance in the whole sample, both in septic and non-septic patients. aPCT showed a good prognostic accuracy, adding informations on the rapidity of clinical deterioration. POCS model reached a performance similar to SAPS-II.


Assuntos
Biomarcadores/metabolismo , Estado Terminal/mortalidade , Mortalidade Hospitalar/tendências , Inflamação/diagnóstico , Unidades de Terapia Intensiva/tendências , Escores de Disfunção Orgânica , Pró-Calcitonina/análise , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Inflamação/metabolismo , Masculino , Pró-Calcitonina/metabolismo , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
14.
Sci Rep ; 10(1): 3918, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32127631

RESUMO

Infections remain an important cause of morbidity and mortality early after liver transplantation. The aim of this prospective longitudinal study was to evaluate clinical utility of c-reactive protein (CRP), procalcitonin, and neutrophil-to-lymphocyte ratio (NLR) in surveillance of infections early after liver transplantation in intensive care setting. A total of 60 liver transplant recipients were included. CRP, procalcitonin, and NLR assessed at 12-hour intervals were primary variables of interest. Infections and severe complications during postoperative intensive care unit stay were the primary and secondary end-points, respectively. Infections and severe complications were diagnosed in 9 and 17 patients, respectively. Only peak CRP beyond first 48 hours was associated with infections (p = 0.038) with AUC, positive and negative predictive value of 0.728, 42.9% and 92.2%, respectively (cut-off: 142.7 mg/L). Peak procalcitonin over first 60 hours was the earliest predictor (p = 0.050) of severe complications with AUC, positive and negative predictive value of 0.640, 53.3% and 80.0%, respectively (cut-off: 42.8 ng/mL). In conclusion, while CRP, procalcitonin, and NLR cannot be used for accurate diagnosis of infections immediately after liver transplantation, peak CRP beyond 48 hours and peak procalcitonin over first 60 hours may be used for initial exclusion of infections and prediction of severe complications, respectively.


Assuntos
Cuidados Críticos , Infecções/diagnóstico , Infecções/metabolismo , Transplante de Fígado/efeitos adversos , Adulto , Biomarcadores/metabolismo , Proteína C-Reativa/metabolismo , Contagem de Células , Feminino , Humanos , Infecções/etiologia , Infecções/imunologia , Inflamação/metabolismo , Linfócitos/citologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Pró-Calcitonina/metabolismo , Estudos Prospectivos , Curva ROC
15.
Medicine (Baltimore) ; 99(7): e18882, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049787

RESUMO

RATIONALE: Procalcitonin (PCT) is used as a biomarker for identifying the occurrence of sepsis. Previous studies have reported high levels of PCT with acetaminophen intoxication without evidence of infection. Here, we report two patients with acetaminophen intoxication with high levels of PCT without showing any symptoms of bacterial infection. PATIENT CONCERNS: This case study examined two unrelated patients with acetaminophen intoxication admitted to emergency at different times. The first patient was admitted to the emergency department after ingesting approximately 8000 mg (153.8 mg/kg) of acetaminophen. On admission, C-reactive protein (CRP), glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) were normal. PCT and acetaminophen levels were 31.89 ng/mL and below 0.5 µg/mL, respectively. The second patient was admitted to the emergency department 8 h after ingesting ∼23,600 mg (280.6 mg/kg) of acetaminophen. By the second day of admission, GOT and GPT increased to 2508 and 1473 IU/L, respectively. PCT was 45.66 ng/mL with acetaminophen level at 116.9 µg/mL. Both patients were clear of symptoms associated with bacterial infection. DIAGNOSIS: Acetaminophen intoxication. INTERVENTIONS: N-acetylcysteine was given intravenously to both patients for 20 h per protocol. OUTCOMES: Both patients were discharged without complications. LESSONS: Observations suggests that elevated levels of PCT in patients intoxicated with acetaminophen may be associated with involvement of other organs impacted by cytokine stimuli from sterile inflammation resulting from hepatic damage rather than PCT secretion directly caused by hepatic cell damage.


Assuntos
Acetaminofen/toxicidade , Acetilcisteína/administração & dosagem , Overdose de Drogas/tratamento farmacológico , Pró-Calcitonina/metabolismo , Acetilcisteína/uso terapêutico , Alanina Transaminase/análise , Aspartato Aminotransferases/análise , Proteína C-Reativa/análise , Overdose de Drogas/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
16.
J Surg Res ; 247: 108-114, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31806239

RESUMO

BACKGROUND: The aim of the present study is to determine the association of melatonin hormone level on CRP, Total Antioxidant Status, Leukocyte, Procalcitonin, and Malondialdehyde, all acute phase reactants in the dark and light cycle of rats with sepsis model. MATERIALS AND METHODS: In this study, 54 rats were divided into three groups. Whereas the first and third groups had a 12 h dark-light cycle, the second group was exposed to light for 24 h at 21°C-22°C for 10 d without any water and food restrictions. In the second and third groups, sepsis model was formed by cecal ligation and puncture (CLP) method at the end of 10th day, and blood samples were taken at the end of the 10th day. C-reactive protein, Malondialdehyde, Procalcitonin in the blood samples were analyzed by ELISA, and the levels of Total Antioxidant Status and leukocyte were determined by colorimetric method in the subsequent 12 and 24 h. RESULTS: CRP values increased in the second group rats, which were kept continuously under light and had undergone CLP, from 288.8 mg/L to 584.0 mg/L at the end of the 12 h and the end of the 24 h, approximately, two times. In rats, which were kept under 12 h of light, 12 h of darkness, and applied CLP (group 3), these values increased from 416.9 to 619.1; an increase of 1.5 times. When assessed for MDA, it was determined that the differences between Group 2 and Group 3 were more prominent between 0 h and 12 h. While the MDA values in group 2 increased from 16.53 nmol/mL at the 12 h to 17.66 nmol/mL at the 24 h. However, MDA values did not yield statistically significant changes in the third group. Changes in the in PCT values were similar to the MDA values obtained. Increase coefficient of the PCT values between 0 h and 12 h in the second group 2 was 1.26; however, in the third group, it was negligible. CONCLUSIONS: An increase in the oxidative stress was observed in the rats that underwent CLP and melatonin deprivation via continuous 24 h light exposure for 10 d. Accordingly, deprivation of light is considered to be effective in sepsis treatment due to the increase in melatonin levels in intensive care unit patients.


Assuntos
Proteína C-Reativa/análise , Melatonina/sangue , Pró-Calcitonina/sangue , Sepse/imunologia , Animais , Proteína C-Reativa/metabolismo , Modelos Animais de Doenças , Humanos , Unidades de Terapia Intensiva , Luz/efeitos adversos , Masculino , Malondialdeído/imunologia , Malondialdeído/metabolismo , Melatonina/imunologia , Melatonina/metabolismo , Estresse Oxidativo/imunologia , Estresse Oxidativo/efeitos da radiação , Pró-Calcitonina/imunologia , Pró-Calcitonina/metabolismo , Ratos , Sepse/sangue , Sepse/terapia , Transdução de Sinais/imunologia , Transdução de Sinais/efeitos da radiação
17.
Sci Rep ; 9(1): 19911, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882648

RESUMO

Patients undergoing allogeneic hematopoietic stem cell transplantation have a high morbidity and mortality, especially after admission to intensive care unit (ICU) during peri-transplant period. The objective of this study was to identify new clinical and biological parameters and validate prognostic scores associated with ICU, short-and long-term survival. Significant differences between ICU survivors and ICU non-survivors for the clinical parameters invasive mechanical ventilation, urine output, heart rate, mean arterial pressure, and amount of vasopressors have been measured. Among prognostic scores (SOFA, SAPSII, PICAT, APACHE II, APACHE IV) assessing severity of disease and predicting outcome of critically ill patients on ICU, the APACHE II score has shown most significant difference (p = 0.002) and the highest discriminative power (area under the ROC curve (AUC) 0.74). An elevated level of lactate at day of admission was associated with poor survival on ICU and the most significant independent parameter (p < 0.001). In our cohort kidney damage with low urine output has a highly relevant impact on ICU, short- and long-term overall survival. The APACHE II score was superior predicting ICU mortality compared to all other tested prognostic scores for patients on ICU during peri-transplant period.


Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , APACHE , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/metabolismo , Prognóstico , Curva ROC , Estudos Retrospectivos
18.
Hosp Pract (1995) ; 47(4): 171-176, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31585520

RESUMO

A high prevalence of invasive candidiasis has been reported in recent years. Patients admitted to an intensive care unit are at the highest risk for invasive candidiasis, mostly due to the severity of their disease, immune-suppressive states, prolonged length of stay, broad-spectrum antibiotics, septic shock, and Candida colonization. Intraabdominal candidiasis comprises a range of clinical manifestations, from just the suspicion based on clinical scenario to fever, leukocytosis, increase in biomarkers to the isolation of the responsible microorganism. In critically ill patients with IAC prompt treatment and adequate source control remains the ultimate goal.


Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/fisiopatologia , Unidades de Terapia Intensiva , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/fisiopatologia , Antifúngicos/administração & dosagem , Biomarcadores , Candidíase Invasiva/mortalidade , Candidíase Invasiva/prevenção & controle , Estado Terminal , Humanos , Infecções Intra-Abdominais/mortalidade , Infecções Intra-Abdominais/prevenção & controle , Mananas/imunologia , Pró-Calcitonina/metabolismo , Fatores de Risco , Índice de Gravidade de Doença , beta-Glucanas/metabolismo
19.
Clin Chem ; 65(12): 1532-1542, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31615771

RESUMO

BACKGROUND: The clinical utility of procalcitonin in the diagnosis and management of pneumonia remains controversial. METHODS: We assessed the clinical utility of procalcitonin in 2 prospective studies: first, a multicenter diagnostic study in patients presenting to the emergency department with acute dyspnea to directly compare the diagnostic accuracy of procalcitonin with that of interleukin 6 and C-reactive protein (CRP) in the diagnosis of pneumonia; second, a randomized management study of procalcitonin guidance in patients with acute heart failure and suspected pneumonia. Diagnostic accuracy for pneumonia as centrally adjudicated by 2 independent experts was quantified with the area under the ROC curve (AUC). RESULTS: Among 690 patients in the diagnostic study, 178 (25.8%) had an adjudicated final diagnosis of pneumonia. Procalcitonin, interleukin 6, and CRP were significantly higher in patients with pneumonia than in those without. When compared to procalcitonin (AUC = 0.75; 95% CI, 0.71-0.78), interleukin 6 (AUC = 0.80; 95% CI, 0.77-0.83) and CRP (AUC = 0.82; 95% CI, 0.79-0.85) had significantly higher diagnostic accuracy (P = 0.010 and P < 0.001, respectively). The management study was stopped early owing to the unexpectedly low AUC of procalcitonin in the diagnostic study. Among 45 randomized patients, the number of days on antibiotic therapy and the length of hospital stay were similar (both P = 0.39) in patients randomized to the procalcitonin-guided group (n = 25) and usual-care group (n = 20). CONCLUSIONS: In patients presenting with dyspnea, diagnostic accuracy of procalcitonin for pneumonia is only moderate and lower than that of interleukin 6 and CRP. The clinical utility of procalcitonin was lower than expected. SUMMARY: Pneumonia has diverse and often unspecific symptoms. As the role of biomarkers in the diagnosis of pneumonia remains controversial, it is often difficult to distinguish pneumonia from other illnesses causing shortness of breath. The current study prospectively enrolled unselected patients presenting with acute dyspnea and directly compared the diagnostic accuracy of procalcitonin, interleukin 6, and CRP for the diagnosis of pneumonia. In this setting, diagnostic accuracy of procalcitonin for pneumonia was lower as compared to interleukin 6 and CRP. The clinical utility of procalcitonin was lower than expected. CLINICALTRIALSGOV IDENTIFIER: NCT01831115.


Assuntos
Pneumonia/diagnóstico , Pró-Calcitonina/análise , Idoso , Área Sob a Curva , Biomarcadores/sangue , Biomarcadores/metabolismo , Proteína C-Reativa/análise , Calcitonina , Testes Diagnósticos de Rotina , Dispneia/diagnóstico , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Interleucina-6/análise , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/metabolismo , Estudos Prospectivos , Precursores de Proteínas/metabolismo , Curva ROC
20.
J Appl Lab Med ; 4(1): 69-77, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31639709

RESUMO

BACKGROUND: Procalcitonin (PCT) concentration increases as a result of systemic inflammation owing to bacterial infection. Many PCT algorithms and medical decision concentrations (MDCs) have been clinically validated using the B·R·A·H·M·S PCT™ sensitive Kryptor™ assay. Alternative PCT assays have recently been approved by the Food and Drug Administration for clinical use in the US and require method verification before clinical implementation. METHODS: Precision, sensitivity, linearity, reportable range, and reference intervals were verified for the Architect B·R·A·H·M·S PCT assay. Accuracy of the Architect B·R·A·H·M·S PCT assay was evaluated by comparison with the B·R·A·H·M·S PCT sensitive Kryptor assay. RESULTS: The Architect B·R·A·H·M·S PCT assay was found to be precise (CV, ≤4.6%), sensitive (limit of blank, 0.001 ng/mL; limit of quantitation, ≤0.01 ng/mL), and linear according to the manufacturer's claims. The analytical measurement range (0.20-100.00 ng/mL) and the reference interval (≤0.07 ng/mL) were also verified. Patient result comparisons indicated high agreement at 0.10 ng/mL and 0.25 ng/mL and reduced positive agreement at 0.50 ng/mL and 2.00 ng/mL MDCs owing to negative bias compared with the B·R·A·H·M·S PCT sensitive Kryptor assay. CONCLUSIONS: The Architect B·R·A·H·M·S PCT assay meets most performance specifications claimed by the manufacturer; however, negative bias at 0.50 ng/mL and 2.00 ng/mL PCT concentrations is evident.


Assuntos
Bioensaio/métodos , Tomada de Decisões , Inflamação/sangue , Pró-Calcitonina/metabolismo , Humanos , Precursores de Proteínas/sangue , Valores de Referência , Reprodutibilidade dos Testes
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