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1.
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
3.
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
4.
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
5.
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
6.
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
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 938-941, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537215

RESUMO

OBJECTIVE: To investigate the assessment values of procalcitonin (PCT), lactic acid (LAC), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation II (APACHE II) score in patients with sepsis. METHODS: 140 patients with suspicious bacterial infection admitted to emergency department of Beijing Chaoyang Hospital of the Capital Medical University from August 2017 to June 2018 were enrolled. They were divided into three groups according to diagnostic criteria of Sepsis-3: non-sepsis group (n = 58), sepsis group (n = 66) and septic shock group (n = 16). The PCT, LAC, SOFA score, APACHE II score, 28-day prognosis, and positive detection rate of PCT and LAC were compared among three groups. Independent predictors of 28-day mortality were analyzed by Logistic regression; predictive values of PCT, LAC, SOFA score and APACHE II score for 28-day mortality in sepsis patients were analyzed by receiver operating characteristic (ROC) curve. RESULTS: PCT, LAC, SOFA score, APACHE II score at admission, and 28-day mortality in sepsis group and septic shock group were significantly higher than those in non-sepsis group, and PCT, LAC, APACHE II score, and 28-day mortality in sepsis shock group were further higher than those in sepsis group [PCT (µg/L): 38.1±12.6 vs. 4.6±2.3, LAC (mmol/L): 3.3±2.1 vs. 2.4±2.1, APACHE II score: 14.9±2.4 vs. 9.5±4.3, 28-day mortality: 75.0% vs. 24.2%, all P < 0.05]. The positive detection rate of PCT and LAC in sepsis group and septic shock group were higher than those in non-sepsis group (positive detection rate of PCT: 56.1%, 81.3% vs. 32.8%; positive detection rate of LAC: 42.4%, 62.5% vs. 13.7%; all P < 0.01). Logistic regression analysis showed that PCT, LAC, SOFA score and APACHE II score were independent predictors of 28-day mortality [PCT: odds ratio (OR) = 0.933, 95% confidence interval (95%CI) = 0.878-0.991; LAC: OR = 0.539, 95%CI = 0.347-0.838; SOFA score: OR = 0.291, 95%CI = 0.514-0.741; APACHE II score: OR = 0.808, 95%CI = 0.669-0.976; all P < 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) of PCT, LAC, SOFA score and APACHE II score predicting 28-day mortality was 0.76, 0.86, 0.81 and 0.87, respectively. The assessment values of APACHE II score and LAC were higher than PCT in predicting 28-day mortality (Z1 = 2.56, Z2 = 2.45, both P < 0.01), and the performance of SOFA score was similar to PCT. CONCLUSIONS: PCT, LAC, SOFA score and APACHE II score were reliable indexes to evaluate disease severity for patients diagnosed with infection. The assessment values of APACHE II score and LAC in 28-day mortality were superior to SOFA score and PCT.


Assuntos
Ácido Láctico/metabolismo , Pró-Calcitonina/metabolismo , Sepse/metabolismo , APACHE , Humanos , Escores de Disfunção Orgânica , Prognóstico , Curva ROC
8.
J Glob Oncol ; 5: 1-6, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31526283

RESUMO

PURPOSE: The purpose of this study was to evaluate the clinical significance of the biomarkers procalcitonin (PCT) and C-reactive protein (CRP) in patients with febrile neutropenia (FN) undergoing chemotherapy for acute leukemia. METHODS: We conducted a prospective, observational study in patients who developed FN while undergoing chemotherapy for acute leukemia. PCT and CRP were obtained in patients who presented with FN. Blood cultures also were obtained. The primary goals were to evaluate the ability of PCT and CRP to predict bacteremia in patients with FN. The secondary goals were to assess the prognostic role of PCT and CRP and to assess the microbiologic profile and culture sensitivity patterns in the study population. RESULTS: A total of 124 episodes of FN that involved 67 patients with acute leukemia occurred in the study. PCT was superior to CRP in the prediction of bacteremia. The median PCT level in the bacteremia group was 3.25 ng/mL compared with 0.51 ng/mL in the group without bacteremia (P < .01). The median values of CRP in the bacteremia and without-bacteremia groups were 119.3 mg/L and 94.5 mg/L, respectively (P = .07). There were no differences in median PCT and CRP in patients who died and those who improved. Of the 42 positive cultures, Gram-negative bacteremia was common (86%), and Escherichia coli was the most frequent organism isolated. Carbapenem resistance was seen in 39% of positive cultures. CONCLUSION: PCT is an effective biomarker to predict bacteremia in patients with FN undergoing chemotherapy for acute leukemia.


Assuntos
Bacteriemia/diagnóstico por imagem , Proteína C-Reativa/metabolismo , Neutropenia Febril/diagnóstico por imagem , Leucemia/complicações , Pró-Calcitonina/metabolismo , Doença Aguda , Adolescente , Adulto , Humanos , Leucemia/patologia , Pessoa de Meia-Idade , Nepal , Estudos Prospectivos , Adulto Jovem
9.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 680-683, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315722

RESUMO

OBJECTIVE: To explore the correlation between major inflammatory factors and septic shock in intensive care unit (ICU) patients, and to provide a basis for the diagnosis and treatment of septic shock. METHODS: The patients admitted to ICU of the Third People's Hospital of Datong from March 2017 to August 2018 were selected as the research objects. According to the diagnostic criteria of septic shock, the patients were divided into septic shock group and non-septic group. The basic information and inflammatory factors levels of the two groups, including age, gender, body mass index (BMI), course of disease, acute physiology and chronic health evaluation II (APACHE II), infection site and pathogenic; and C-reactive protein (CRP), procalcitonin (PCT), neutrophil lymphocyte ratio (NLR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), interleukins (IL-1ß, IL-2, IL-6, IL-8) at 8 hours after diagnosis, were compared. Logistic regression was used to analyze the influencing factors of septic shock in ICU patients. RESULTS: A total of 154 ICU patients were selected, of whom 74 had septic shock. The APACHE II score of septic shock group was significantly higher than that of non-sepsis group (23.42±3.64 vs. 15.67±2.26, P < 0.05). There was no significant difference in other baseline data between the two groups. The levels of CRP, NT-proBNP, TNF-α, IFN-γ, PCT, IL-6, IL-8 in the septic shock group were significantly higher than those in the non-septic group [CRP (mg/L): 164.3±22.6 vs. 52.3±16.2, NT-proBNP (ng/L): 426.3±288.9 vs. 167.3±80.6, TNF-α (ng/L): 193.4±39.3 vs. 88.1±20.3, IFN-γ (ng/L): 133.3±52.0 vs. 97.0±56.1, PCT (ng/L): 27.6±10.2 vs. 7.3±4.1, IL-6 (ng/L): 83.0±17.6 vs. 20.9±6.4, IL-8 (ng/L): 445.8±34.0 vs. 84.0±25.7, all P < 0.05]. It was shown by Logistic regression analysis that CRP, NT-proBNP, TNF-α, PCT, IL-6 were independent risk factors for septic shock [CRP: odds ratio (OR) = 1.662, 95% confidence interval (95%CI) = 1.132-2.567; NT-proBNP: OR = 14.688, 95%CI = 3.580-20.238; TNF-α: OR = 1.093, 95%CI = 1.043-1.343; PCT: OR = 6.378, 95%CI = 4.556-12.243; IL-6: OR = 9.641, 95%CI = 2.242-13.786; all P < 0.05]. CONCLUSIONS: The levels of inflammatory factors CRP, NT-proBNP, TNF-α, PCT and IL-6 were significantly increased, which were important factors for early diagnosis of septic shock.


Assuntos
Choque Séptico/diagnóstico , Choque Séptico/metabolismo , APACHE , Proteína C-Reativa/metabolismo , Feminino , Humanos , Unidades de Terapia Intensiva , Interleucina-6/metabolismo , Masculino , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Pró-Calcitonina/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
10.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 566-570, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198141

RESUMO

OBJECTIVE: To investigate the changes in serum procalcitonin (PCT) in patients with severe pneumonia, and to analyze its value on evaluating the clinical outcome of patients with severe pneumonia. METHODS: A total of 58 patients with severe pneumonia aged over 18 years, and admitted to intensive care unit (ICU) of Zhuozhou City Hospital of Hebei Province from January 2017 to July 2018 were enrolled. The patients were divided into recovery group (the symptoms and signs of pneumonia disappeared or improved, and the X-ray chest films improved or did not make significant progress) and deterioration group (the symptoms and signs of pneumonia persisted or progressed, while X-ray chest radiography progressed, as well as serious complications such as involvement of other organ functions due to deterioration of pulmonary infection or septic shock) according to the therapeutic outcome. The serum PCT levels at 1, 3, 5, 7, 9 days after severe pneumonia diagnosed were recorded, and procalcitonin clearance rate (PCTc) was calculated. The acute physiology and chronic health evaluation II (APACHE II) score was estimated within 24 hours when severe pneumonia was diagnosed. Receiver operating characteristic (ROC) curve was drawn, and the area under ROC curve (AUC) was calculated to analyze the value of PCTc on evaluating the clinical outcome of patients with severe pneumonia. RESULTS: Among 58 patients, 33 (56.9%) had better outcome after active treatment (recovery group), and 25 (44.1%) had worse condition (deterioration group). There was no significant difference in PCT level at 1 day or 3 days between the recovery group and the deterioration group [µg/L: 5.05 (3.89, 7.61) vs. 5.29 (4.15, 7.46) at 1 day, 4.59 (4.02, 6.90) vs. 5.70 (4.59, 7.28) at 3 days, both P > 0.05]. With the prolongation of treatment time, serum PCT level was gradually decreased in the recovery group, while remained at higher level in the deterioration group, which was significantly lowered at 5, 7, 9 days in the recovery group as compared with that in the deterioration group [µg/L: 2.92 (2.09, 3.42) vs. 6.09 (3.24, 7.96) at 5 days, 1.94 (1.50, 2.07) vs. 7.65 (5.60, 10.52) at 7 days, 1.37 (0.91, 1.74) vs. 8.96 (6.09, 10.87) at 9 days, all P < 0.01]. PCTc at 3, 5, 7, 9 days in the recovery group were significantly higher than those in the deterioration group [15.10 (-17.80, 32.10)% vs. -1.53 (-20.80, 11.48)% at 3 days, 47.50 (30.25, 60.34)% vs. 6.25 (-14.58, 29.05)% at 5 days, 76.44 (53.18, 77.92)% vs. -11.20 (-66.75, -1.38)% at 7 days, 80.01 (59.86, 88.27)% vs. -38.15 (-99.38, -2.81)% at 9 days, all P < 0.05]. ROC curve analysis showed that PCTc at 3, 5, 7 and 9 days were valuable for evaluating the clinical outcome of patients with severe pneumonia, and 9-day PCTc had the greatest value, the AUC was 0.978 [95% confidence interval (95%CI) = 0.945-1.000, P = 0.000], which was higher than APACHE II (AUC = 0.442, 95%CI = 0.280-0.610, P = 0.392); when the best cut-off value of 9-day PCTc was 93.00%, its sensitivity was 99.0%, and specificity was 87.3%. CONCLUSIONS: The PCT level of patients with severe pneumonia remained at a high level, which was related with the deterioration of the disease. PCTc, as an index to evaluate the clinical outcome of patients with severe pneumonia, has good application value.


Assuntos
Pneumonia/terapia , Pró-Calcitonina/metabolismo , Adulto , Humanos , Pneumonia/metabolismo , Índice de Gravidade de Doença , Resultado do Tratamento
11.
Clin Chim Acta ; 496: 7-12, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31194966

RESUMO

Sepsis is a life-threatening organ dysfunction caused by a dysregulated response of the host to infection. It represents one of the major health care problems worldwide. Unfortunately, the diagnosis of sepsis is challenging for many reasons, including a lack of a sufficiently sensitive and specific diagnostic test. When procalcitonin (PCT) was discovered, it was thought that it could become the best test for identifying patients with sepsis. From the evidence sources in the available literature, it is now clear that the power of PCT in differentiating infectious from non-infectious forms of systemic inflammatory response syndrome in adults, and in stratifying morbidity and mortality risk, is limited. Nevertheless, PCT determination can be a useful tool for diagnosing late-onset neonatal sepsis, bacterial meningitis and other forms of organ-related bacterial infections and, above all, it can be used for guiding antibiotic stewardship in critical patients. The real impact of this application of PCT testing, however, still needs to be clearly defined. Laboratories should offer unrestricted PCT testing only to intensive care units (as an aid in decision for continuing or stopping antibiotics) and pediatric wards. For all other clinical wards, the laboratory should guide PCT requests and give them support towards the most appropriate approach to testing.


Assuntos
Medicina Baseada em Evidências , Pró-Calcitonina/metabolismo , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/metabolismo , Custos e Análise de Custo , Humanos , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/metabolismo
13.
Clin Perinatol ; 46(1): 1-17, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30771811

RESUMO

Necrotizing enterocolitis (NEC) is a devastating disease of prematurity, with no current method for early diagnosis. Diagnosis is particularly challenging, frequently occurring after the disease has progressed to the point of significant and often irreversible intestinal damage. Biomarker research has tremendous potential to advance clinical management of NEC and our understanding of its pathogenesis. This review discusses the need for novel biomarkers in NEC management, evaluates studies investigating such biomarkers, and explains the difficulties associated with translating biomarker discovery into clinical use.


Assuntos
Biomarcadores/metabolismo , Enterocolite Necrosante/metabolismo , alfa-Globulinas/metabolismo , Contagem de Células Sanguíneas , Testes Respiratórios , Proteína C-Reativa/metabolismo , Claudinas/metabolismo , Complemento C5a/metabolismo , Citocinas/metabolismo , Diagnóstico Precoce , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/microbiologia , Fator de Crescimento Epidérmico/metabolismo , Proteínas de Ligação a Ácido Graxo/metabolismo , Microbioma Gastrointestinal , Genômica , Humanos , Hidrogênio/metabolismo , Recém-Nascido , Recém-Nascido Prematuro , Complexo Antígeno L1 Leucocitário/metabolismo , Metabolômica , Fator de Ativação de Plaquetas/metabolismo , Pró-Calcitonina/metabolismo , Prognóstico , Proteômica , Medição de Risco , Proteína S100A12/metabolismo , Sensibilidade e Especificidade , Albumina Sérica Humana/metabolismo , Proteína Amiloide A Sérica/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho , Fator Trefoil-3/metabolismo , Ultrassonografia , Compostos Orgânicos Voláteis
14.
Eur Arch Otorhinolaryngol ; 276(5): 1367-1372, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30739179

RESUMO

PURPOSE: The aim of this study is to investigate serum and tissue procalcitonin (PCT) levels in patients with nasal polyps. METHODS: The study was designed to be prospectively controlled and included 26 patients chronic rhinosinusitis with nasal polyp (CRSwNP) endoscopically diagnosed and as a control group 25 chronic rhinosinusitis without nasal polyp (CRSsNP). NP specimens, nasal mucosal tissue and venous blood samples of both groups were collected and PCT levels determined by Elisa method. The results were compared statistically. RESULTS: Serum PCT values were 1319.5 pg/mL in the NP group and 818.8 pg/mL in the control group. The difference between the groups was statistically significant (p = 0.0001). In the NP group, the average PCT value of the polyp tissue was 1521.5 pg/gr, while the mean PCT value of the control group in the nasal mucosa was 414.6 pg/gr. There was a statistically significant difference between the groups (p = 0.0001). The tissue cut-off value of PCT 750 was significant [area under curve 0.940 (0.863-1.00)]. Serum PCT 950 cut-off value was significant [area under curve 0.860 (0.748-0.972)] activity (CI: 95%). CONCLUSIONS: This is the first study of its kind to objectively examine PCT in the polyp and serum of CRSwNP patients. PCT may serve as a diagnostic biomarker in nasal polyps.


Assuntos
Pólipos Nasais , Pró-Calcitonina , Adulto , Área Sob a Curva , Biomarcadores/sangue , Biomarcadores/metabolismo , Biópsia/métodos , Doença Crônica , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/metabolismo , Mucosa Nasal/patologia , Pólipos Nasais/metabolismo , Pólipos Nasais/patologia , Pró-Calcitonina/sangue , Pró-Calcitonina/metabolismo , Reprodutibilidade dos Testes , Rinite/metabolismo , Rinite/patologia , Sinusite/metabolismo , Sinusite/patologia
16.
Surg Laparosc Endosc Percutan Tech ; 29(2): 101-108, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30601429

RESUMO

It is well known that surgery provokes an inflammatory response. However, the induced inflammatory response to laparoscopic compared with open surgery under combined anesthesia has never been compared following colorectal cancer surgery. We hypothesize that laparoscopic technique under general anesthesia results in a decreased proinflammatory state. We compared cytokines plasma secretion after laparoscopic technique under general anesthesia (LG), open surgery under combined anesthesia (thoracic epidural and general anesthesia) (OGE), and open surgery under general anesthesia as the control group (OG). Proinflammatory cytokines measured postoperatively were significantly increased in the OG group (n=19), compared with the LG (n=18) and OGE (n=20) groups. Post hoc analysis showed that CCL2 levels were significantly lower in LG at all times postoperatively (P<0.01), while interleukin-4, an anti-inflammatory cytokine, was increased in the OGE group (P<0.01). Laparoscopic technique blunts the postoperative proinflammatory response from the very early stages of the inflammatory cascade, whereas combined anesthesia is a more anti-inflammatory approach.


Assuntos
Quimiocina CCL2/metabolismo , Neoplasias Colorretais/cirurgia , Laparoscopia , Idoso , Proteína C-Reativa/metabolismo , Feminino , Humanos , Hidrocortisona/metabolismo , Leucócitos/fisiologia , Masculino , Metaloproteinase 3 da Matriz/metabolismo , Pró-Calcitonina/metabolismo , Estudos Prospectivos , Fator A de Crescimento do Endotélio Vascular/metabolismo
17.
J Crit Care ; 49: 149-154, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30439629

RESUMO

PURPOSE: The purpose of this study was to prospectively analyze the predictive role of classic predictors for suspected infection (temperature, WBC and derivatives) with two biomarkers, procalcitonin and lactate, on the incidence of culture-proven infection in the surgical intensive care unit (SICU). MATERIALS AND METHODS: One hundred forty-six consecutive patients admitted for suspected infection had admission and 12-h procalcitonin values, admission and every 6-h lactate values for 24 h, and admission temperature, leukocyte count, lymphocyte count and percentage measured and analyzed in this study. RESULTS: Peak (highest measured value ≤24-h of admission) procalcitonin values were not predictive for culture-proven infection. However, a culture-negative subset was identified when peak procalcitonin values were  < 2.9 ng/mL and when peak lactate values were  < 1.3 mmol/L with a probability of 98.3% (P < .001). No other admission predictor was statistically associated with culture-proven infection. Following boosted-tree partitioning, a C-index of 0.85 was calculated with a misclassification rate of 23.3%. CONCLUSIONS: The ability to utilize procalcitonin values in the diagnosis of culture-proven infection was not realized in this study. However, the association of admission peak procalcitonin values with admission peak lactate values identified a group of patients who were culture-negative for suspected infection. No other admission predictor was associated with culture-proven infection.


Assuntos
Infecções/diagnóstico , Lactatos/metabolismo , Pró-Calcitonina/metabolismo , Idoso , Biomarcadores/metabolismo , Cuidados Críticos , Feminino , Febre/etiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos
18.
Clin Chim Acta ; 490: 200-206, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30201367

RESUMO

BACKGROUND: Levels of the biomarkers presepsin and procalcitonin are affected by renal function. We evaluated the accuracies of presepsin and procalcitonin levels for diagnosing sepsis in patients with and without acute kidney injury (AKI). METHODS: We evaluated patients with presepsin and procalcitonin data, and classified them into AKI and non-AKI groups based on the Kidney Disease Improving Global Outcomes criteria. Each group was then subdivided according to sepsis status for each stage of AKI. Receiver operating characteristic curve analyses were used to investigate the accuracies of biomarker levels for diagnosing sepsis. RESULTS: In the non-AKI group, the area under the curves (AUCs) for procalcitonin and presepsin levels were 0.897 and 0.880, respectively (p = .525) and optimal cut-off values were 0.10 ng/ml (sensitivity: 85.1%, specificity: 79.1%) and 240 pg/ml (sensitivity: 80.9%, specificity: 83.2%), respectively. In the stage 3 subgroup, the AUC for procalcitonin (0.946) was significantly higher than that for presepsin (0.768, p < .001). The optimal cut-off values for diagnosing sepsis were 4.07 ng/ml (sensitivity: 87.2%, specificity: 93.5%) for procalcitonin and 500 pg/ml (sensitivity: 89.7%, specificity: 59.7%) for presepsin. CONCLUSIONS: In patients with severe AKI, the accuracy of the diagnosis of sepsis with procalcitonin was significantly higher than with presepsin.


Assuntos
Lesão Renal Aguda/complicações , Limite de Detecção , Receptores de Lipopolissacarídeos/metabolismo , Fragmentos de Peptídeos/metabolismo , Pró-Calcitonina/metabolismo , Sepse/diagnóstico , Sepse/metabolismo , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/complicações
19.
Expert Rev Anti Infect Ther ; 17(2): 99-105, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30582713

RESUMO

INTRODUCTION: Bloodstream infections (BSI) and their evolution to sepsis or septic shock are one of the most important causes of morbidity and mortality; for this reason, arapid recognition and diagnosis of these infections are crucial to improve patients' outcome. Area covered: Procalcitonin (PCT) is considered an important biomarker for diagnosis of infection, routinely used to identify patients developing severe bacterial infections. In this scenario, management of BSI is complicated by the increasing rate of multidrug-resistantstrains, and an early recognition of severe infections is mandatory. Moreover, an appropriate use and prescription of antibiotics is important to reduce the risk of development of further antibiotic resistances. Expert opinion: we reviewed recent literature about the use of PCT in bacteremic patients to determine its role to predict infections, severity of clinical condition and antibiotic therapy duration; its role was defined in many studies to reduce duration of antibiotic treatment, especially in critically ill patients and for lower respiratory tract infections. Moreover, we reported recent studies in which PCT showed ahigh performance to detect precociously infections due to Gram-negativestrains. Data from the literature confirm that PCT should not be used as astand-alonetest in the absence of clinical judgment.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/diagnóstico , Pró-Calcitonina/metabolismo , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Biomarcadores/metabolismo , Estado Terminal , Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/microbiologia , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia
20.
Pak J Pharm Sci ; 32(5(Special)): 2437-2441, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31894031

RESUMO

This study was aimed to investigate the changes of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase inhibitor-1 (TIMP-1) in cerebrospinal fluid (CSF) of neonates with purulent meningitis. 195 cases (n=195) were divided into PM group (neonatal purulent meningitis), VM group (neonatal virus meningitis) and control group (healthy neonates). The expression levels of MMP-2 and TIMP-1 were detected by ELISA while the level of PCT was determined by chemiluminescence analyzer. The levels of MMP-2 and TIMP-1 in CSF and PCT in serum were compared in three groups and the correlation was discussed. The level of MMP-2 in CSF in 3 groups were statistically significant (F=16.126, P<0.05) similarly the level of TIMP-1 in CSF of 3 groups were statistically significant (F=16.093, P<0.05). The serum level of PCT in PM group was 14.73±2.14ng/l, in VM group was 9.06±1.05ng/l and in control group it was 0.37±0.12ng/l. The levels of MMP-2 and TIMP-1 in CSF were positively correlated with the serum level of PCT in both PM and VM group. The expression of MMP-2, TIMP-1 and serum PCT in CSF of newborns with purulent meningitis was increased. The findings suggest that MMP-2, TIMP-1 and PCT are involved in the occurrence and development of neonatal purulent meningitis.


Assuntos
Metaloproteinase 2 da Matriz/líquido cefalorraquidiano , Meningites Bacterianas/líquido cefalorraquidiano , Pró-Calcitonina/líquido cefalorraquidiano , Inibidor Tecidual de Metaloproteinase-1/líquido cefalorraquidiano , Estudos de Casos e Controles , Feminino , Regulação da Expressão Gênica , Humanos , Recém-Nascido , Masculino , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Meningite Viral/líquido cefalorraquidiano , Pró-Calcitonina/genética , Pró-Calcitonina/metabolismo , Inibidor Tecidual de Metaloproteinase-1/genética , Inibidor Tecidual de Metaloproteinase-1/metabolismo
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