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INTRODUCTION: Procalcitonin (PCT) is a useful biomarker in the initial evaluation of febrile infants for serious bacterial infections (SBIs). However, PCT is not always available locally and must at times be frozen and shipped to a reference laboratory for research studies. We sought to compare PCT measured locally versus centrally at a reference laboratory during a research study. MATERIALS AND METHODS: This was a secondary analysis of a multicenter study of febrile infants ≤60 days evaluated for SBIs from June 2016 to April 2019. A PCT cutoff value of 0.5 ng/mL was used to stratify infants at low-versus high-risk of SBIs. Statistical analyses consisted of Spearmans correlation, Bland-Altman difference plotting, Passing-Bablok regression, Deming regression, and Fishers exact testing at the 0.5 ng/mL threshold. RESULTS: 241 febrile infants had PCT levels measured both locally and at the reference laboratory. PCT levels measured locally on 5 different platforms and from the frozen research samples demonstrated strong Spearmans correlation (ρ = 0.83) and had similar mean PCT values with an average relative difference of 0.02%. Eleven infants with SBIs had PCT values

Infection is one of the leading causes of death in patients with hematologic cancers. Hematologic cancer patients with compromised immune systems are already susceptible to infections, which come on even more rapidly and are difficult to control after they develop neutrophil deficiencies from high-dose chemotherapy. After patients have developed an infection, the determination of the type of infection becomes a priority for clinicians. In this review, we summarize the biomarkers currently used for the prediction of infections in patients with hematologic cancers; procalcitonin, CD64, cytokines, and CD14 et al. can be used to determine bacterial infections, and (1-3)-β-D-glucan and galactomannan et al. can be used as a determination of fungal infections. We have also focused on the use of metagenomic next-generation sequencing in infections in patients with hematologic cancers, which has excellent clinical value in infection prediction and can detect microorganisms that cannot be detected by conventional testing methods such as blood cultures. Of course, we also focused on infection biomarkers that are not yet used in blood cancer patients but could be used as a future research direction, e.g., human neutrophil lipocalin, serum amyloid A, and heparin-binding protein et al. Finally, clinicians need to combine multiple infection biomarkers, the patient's clinical condition, local susceptibility to the type of infection, and many other factors to make a determination of the type of infection. [ABSTRACT FROM AUTHOR]

Despite infection and sepsis being a major public health challenge, early detection and timely management are often hindered by several factors. These includes the similarity of clinical presentations between infectious and non-infectious conditisons, as well as limitations of current diagnostic methods such as lengthy turnaround times and low sensitivity. Consequently, there is increasing interest in identifying biomarkers that can quickly and accurately differentiate bacterial sepsis from other inflammatory processes, whether infectious or non-infectious. Procalcitonin has emerged as one of the most extensively studied and utilized biomarkers in managing infection and sepsis, especially within the framework of antibiotic stewardship. This review aims to examine the role of Procalcitonin in guiding antibiotic stewardship. It explores the production and release of procalcitonin and its relevance in the context of infection and sepsis. The discussion focus on the clinical and economic impacts of using procalcitonin to guide the initiation and discontinuation of antibiotics in managing these conditions. [ABSTRACT FROM AUTHOR]

AbstractThe purpose of this narrative review is to analyze the most recent studies about the role of C-reactive protein (CRP) and procalcitonin (PCT), two of the main biomarkers of infection, in distinguishing viral from bacterial etiology, in predicting the severity of infection and in guiding antibiotic stewardship in children with community-acquired pneumonia (CAP). The studies examined reveal that both CRP and PCT play a valuable role in diagnosing pediatric CAP, though each has limitations. CRP has moderate accuracy in distinguishing bacterial from viral infections, but its elevated levels are not exclusive to bacterial infections; PCT, however, shows higher specificity for bacterial CAP, with studies confirming its ability to differentiate bacterial causes, especially in severe cases. When integrated with clinical findings, CRP and PCT improve the sensitivity of pneumonia diagnoses and help in predicting severe outcomes such as sepsis and empyema; furthermore, both biomarkers prove useful in guiding antibiotic therapy, with PCT showing a more dynamic response to treatment. However, even though CRP and PCT offer valuable insights into the diagnosis and management of pediatric CAP, their application should be always integrated with clinical assessment rather than used in isolation. More studies are needed to define standardized thresholds and decision algorithms that incorporate these biomarkers. [ABSTRACT FROM AUTHOR]

Background: Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis. Methods: A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C‐reactive protein to albumin ratio, procalcitonin, and lactate. Results: A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP‐to‐albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively. Conclusions: Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED. Clinical Relevance: Early identification of sepsis since the emergency department (ED) triage is challengingImplementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88) [ABSTRACT FROM AUTHOR]

Objective: To analyze the prognostic role of serum procalcitonin in neonatal sepsis at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: Neonates of both genders aged between 1 to 28 days having confirmed neonatal sepsis were included. At baseline, demographic characteristics were noted and necessary laboratory investigations were performed. At baseline, serum procalcitonin levels were evaluated in all neonates. The prognostic value of baseline PCT was assessed by comparing its association with the mortality. Other outcome variables like need for noninvasive ventilation, mechanical ventilation, need for inotropics, and acute kidney injury were also documented. Results: In a total of 131 neonates, 76 (58.0%) were male. The median age was 2.00 days (IQR=1-7 days). The median baseline procalcitonin level was 3.17 ng/ml (IQR=0.55 to 10.34 ng/ml). Need for non-invasive ventilation, and mechanical ventilation was noted in 93 (71.0%), and 19 (14.5%) neonates, respectively. Need for inotropics was documented in 23 (17.6%) neonates. The median duration of NICU stay was 3.00 (2.00-5.00 days). Among neonates who died, procalcitonin levels were significantly higher than those who survived (p=0.015). Mortality was found to have significant association with need for mechanical ventilation (p<0.001), and need for inotropics (p<0.001). Conclusion: High serum procalcitonin was found to be a significant predictor of mortality in neonatal sepsis. Mortality was significantly associated with need for mechanical ventilation, and need for inotropics. [ABSTRACT FROM AUTHOR]

Background/Objectives: This retrospective study analyzed soluble urokinase plasminogen activator receptor (suPAR) plasma levels alongside routine inflammatory markers, including the neutrophil-to-lymphocyte count ratio, C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and D-dimers in COVID-19 patients hospitalized during the Omicron wave of the pandemic. Methods: We measured plasma suPAR levels using a suPARnostic® Quick Triage kit. We divided COVID-19 patients into two groups based on the severity of SARS-CoV-2 infection according to the National Institutes of Health (NIH) criteria. The logistic regression analysis tested the predictive value of the biomarkers. Results: We evaluated 160 consecutive COVID-19 patients hospitalized between January and August 2022. The cohort exhibited a high incidence of comorbidities, with an in-hospital mortality rate of 5.6%. Upon admission, the median suPAR plasma levels were not significantly different between patients with mild COVID-19 (n = 110) and those with moderate/severe disease (n = 50), with 7.25 ng/mL and 7.55 ng/mL, respectively. We observed significant differences (p < 0.01) between the groups for CRP and IL-6 levels that were higher in moderate/severe disease than in mild infection. Additionally, suPAR plasma levels were above the normal range (0–2.00 ng/mL) in all patients, with a significant positive correlation identified between suPAR levels and serum IL-6, PCT, and creatinine levels. Conclusions: These findings indicate that COVID-19 during the Omicron wave is strongly associated with elevated suPAR levels; however, these levels do not directly correlate with the severity of SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Background Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK. Objectives Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups. Methods Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020. Results Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22–0.64 days, P  < 0.001) and of 0.72 days (95% CI: 0.06–1.38 days, P  = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections. Conclusions Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility. Study registration number ISRCTN66682918. [ABSTRACT FROM AUTHOR]

Neutropenic sepsis (NS) is one of the leading causes of death among patients with hematologic malignancies. Identifying its predictive factors is fundamental for early detection. Few studies have evaluated the predictive factors in relation to microbial infection confirmation, which is clinically important for initiating sepsis treatment. This study aimed to determine whether selected biomarkers (i.e., body temperature, C-reactive protein, albumin, procalcitonin), treatment-related characteristics (i.e., diagnosis, duration of neutropenia, treatment modality), and infection-related characteristics (i.e., infection source, causative organisms) can predict NS in patients with hematologic malignancies. We also aimed to identify the optimal predictive cutoff points for these parameters. This retrospective case–control study used the data from a total of 163 patients (58 in the sepsis group and 105 in the non-sepsis group). We collected data with reference to the day of specimen collection, with which microbial infection was confirmed. Multiple logistic regression was used to determine predictive risk factors and the area under the curve (AUC) of the receiver operating characteristic for the optimal predictive cutoff points. The independent predictors of NS were average body temperature during a fever episode and procalcitonin level. The odds for NS rose by 9.97 times with every 1°C rise in average body temperature (95% confidence interval, CI [1.33, 75.05]) and by 2.09 times with every 1 ng/mL rise in the procalcitonin level (95% CI [1.08, 4.04]). Average body temperature (AUC = 0.77, 95% CI [0.68, 0.87]) and procalcitonin levels (AUC = 0.71, 95% CI [0.59, 0.84]) have fair accuracy for predicting NS, with the optimal cutoff points of 37.9°C and 0.55 ng/mL, respectively. This study found that average body temperature during a fever episode and procalcitonin are useful in predicting NS. Thus, nurses should carefully monitor body temperature and procalcitonin levels in patients with hematologic malignancies to detect the onset of NS. [ABSTRACT FROM AUTHOR]

Objective: Despite being a less-invasive procedure, esophagectomy can cause severe infectious complications, such as pneumonia and anastomotic leakage. Herein, we aimed to clarify the inflammatory characteristics of pneumonia/anastomotic leakage after esophagectomy by assessing the difference between the postoperative trends of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in patients with pneumonia/anastomotic leakage using the values on the consecutive postoperative day (POD). Methods: This study included 439 patients who underwent minimally invasive esophagectomy. Serum CRP and PCT levels were measured on PODs 1–7, 10, and 14. Pneumonia and anastomotic leakage were defined as Clavien–Dindo grades ≥ 2. Results: Pneumonia and anastomotic leakage occurred in 96 and 51 patients, respectively. The CRP and PCT levels peaked on POD 3 (11.6 ± 6.8 mg/dL) and POD 2 (0.69 ± 2.9 ng/mL), respectively. Between PODs 3 and 14, CRP levels were significantly higher in patients with pneumonia and anastomotic leakage than in those without complications (P < 0.001). Between PODs 3 and 14, PCT levels were significantly higher in patients with pneumonia; however, on most PODs, there were no significant differences in PCT levels between patients with and without anastomotic leakage. Conclusion: Inflammatory reactions caused by pneumonia may be more intense than those caused by anastomotic leakage after esophagectomy. Postoperative trends in serum CRP and PCT levels may vary depending on the complication type. Pneumonia and anastomotic leakage after esophagectomy can be potentially distinguished by the postoperative trend of PCT values before detailed examinations, such as computed tomography and endoscopy. [ABSTRACT FROM AUTHOR]

Objective To study the diagnosis value of blood culture positive alarm time (TTP) combined with procalcitonin (PCT) and C-reactive protein (CRP) in bacterial bloodstream infection (BSI). Methods A total of 700 patients with bacterial BSI admitted to the hospital from January 2022 to June 2023 were selected for the experiment and as the infection group. Another 100 cases identified as blood culture contamination during the same period were selected as the control group. Detecting and comparing the levels of TTP.PCT.and CRP in two groups, and comparing the efficacy of different detection methods in diagnosing bacterial BSI. In addition, comparing the levels of TTP, PCT, and CRP in patients with different types of pathogen infections and varying degrees of infection. Results The TTP of the infected group was (12.66± 3.43) h,which was shorter than that of the control group [(20.11±5.19) h], while the serum PCT and CRP levels were (1.79±0.42) ng/mL and (41.73±7.55) mg/L.respectvely, both higher than those of the control group [(0.03±0.01) ng/mL and (3.55±1.01) mg/L], with statistically significant differences (P<0.05). Using blood culture results as the "gold standard", the sensitivity, specificity, and accuracy of TTP combined with PCT and CRP in diagnosing bacterial BSI were 91.00%,97.00% and 91.75%, respectively, which were higher than those of the above three indicators separately, and the differences were statistically significant (P <0.05). The PCT level of Gram-positive bacteria infected patients was lower than that of Gram-negative bacteria infected patients(P<0.05), and the differences were statistically significant (P<0.05). There was no statistically significant difference in TTP and CRP levels among patients infected with different types of pathogens(P>0.05). The levels of PCT and CRP in patients with severe infection were higher than those in patients with mild to moderate infection, the differences were statistically significant (P<0.05). Conclusion TTP combined with PCT and CRP has better efficacy in the diagnosis of bacterial BSI, and can effectively identify the types of pathogens, and provide a reliable basis for evaluating the severity of infection in patients. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a complex clinical syndrome characterized by a heterogenous host immune response. Historically, static protein and transcriptomic metrics have been employed to describe the underlying biology. Here, we tested the hypothesis that ex vivo functional TNF expression as well as an immunologic endotype based on both IFNg and TNF expression could be used to model clinical outcomes in sepsis patients. Methods: This prospective, observational study of patient samples collected from the SPIES consortium included patients at five health systems enrolled over 17 months, with 46 healthy control patients, 68 ICU patients without sepsis, and 107 ICU patients with sepsis. Whole blood was collected on day 1, 4, and 7 of ICU admission. Outcomes included in-hospital and 180-day mortality and nonfavorable discharge disposition defined by skilled nursing facility, long-term acute care facility, or hospice. Whole blood ELISpot assays were conducted to quantify TNF expression [stimulated by lipopolysaccharide (LPS)] and IFNg expression (stimulated by anti-CD3/CD28 mAb), which were then used for assignment to one of four subgroups including an 'immunocompetent', 'immunosuppressed endotype', and two 'mixed' endotypes. Results: Whole blood TNF spot-forming units were significantly increased in septic and CINS patients on days 4 and 7 compared to healthy subjects. In contrast, TNF expression per cell on days 1, 4, and 7 was significantly lower in both septic and critically ill non-septic (CINS) patients compared to healthy subjects. Early increases in total TNF expression were associated with favorable discharge disposition and lower in-hospital mortality. 'Immunocompetent' endotype patients on day 1 had a higher proportion of favorable to nonfavorable discharges compared to the 'immunosuppressed' endotype. Similarly, 'immunocompetent' endotype patients on day 4 had a higher in-hospital survival compared to the 'immunosuppressed' endotype patients. Finally, among septic patients, decreased total TNF and IFNg expression were associated with 180- day mortality. Conclusions: Increased ex vivo whole blood TNF expression is associated with improved clinical outcomes. Further, the early 'immunocompetent' endotype is associated with favorable discharge and improved in-hospital and 180-day survival. The ability to functionally stratify septic patients based on blood cell function ex vivo may allow for identification of future immune modulating therapies. [ABSTRACT FROM AUTHOR]

Background: A severe infection of the skin and soft tissues, Necrotizing Fasciitis (NF), spreads quickly along the deep fascia. This study aimed to characterize the clinicopathological features, analyze the implicated bacteria's antibiotic sensitivity, evaluate surgical management, and assess the diagnostic accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in Necrotizing Soft Tissue Infection (NST). Methods: This single-center prospective observational study was conducted in the Department of General Surgery, Kasturba Medical College, Manipal, with 171 proven cases of NSTI between 2019 and 2021. Clinico-demographic data and laboratory investigation values were collected at two-time points (at admission and 72 h after admission). Imaging data, LRINEC score, culture results, and antibiotic sensitivity were recorded. Appropriate descriptive and analytical statistics were used for the statistical analysis. Results: Of the 171 patients, 150 were male (87.7%). The mean age was 57.6 ± 13.1 years. The presenting features in all the cases were pain, swelling, and fever. Diabetes mellitus (DM) is the most common comorbidity. The lower extremities were the most commonly affected sites. Streptococcus pyogenes showed significant growth in 25.41% of the samples. Ceftriaxone sensitivity was seen in 41/141. A score of ≥ 8 was obtained in 118/171 (69%) patients, suggesting a higher severity and significant risk for NSTI. The Area Under the Curve of Receiver Operating characteristic Curve (ROC) for establishing diagnostic accuracy for LRINEC was 0.694. Mortality was significantly higher in the patients with higher LRINEC scores and elevated procalcitonin. The mortality rate was higher in patients who underwent surgery within 12 h. Conclusion: Necrotizing fasciitis is a soft tissue infection with a high mortality rate. The clinical features and determinants of mortality in patients with NF are highlighted in this study. At the outset, a high index of suspicion was critical. Using prognostic evaluation techniques in daily clinical practice will assist medical professionals in providing adequate on-time care and significantly lowering mortality. The AUC for LRINEC score, although significant, is low. LRINEC score is not to be used to determine whether surgical intervention should be expedited or anticipated. Its role is to aid in prognosticating the outcome of the individual patient. Our study concludes that early extensive surgical debridement remains the single most crucial intervention in patients diagnosed with necrotizing fasciitis (NF), regardless of disease severity and the LRINEC score. [ABSTRACT FROM AUTHOR]

Simple Summary: Procalcitonin (PCT) is a blood biomarker that can be used to detect infections and is often combined with clinical judgment to guide antibiotic use, particularly in critically ill patients and those with respiratory infections. In this study, we aimed to evaluate how PCT levels can help guide antibiotic treatment in cancer patients with febrile neutropenia. We found that a 30% decrease in PCT levels or a repeated PCT level of ≤ 0.25 ng/mL was associated with earlier reduction of antibiotics and shorter treatment duration, without affecting patient outcomes. This suggests that monitoring PCT could safely and effectively optimize antibiotic use in these patients, reducing the risk of antibiotic resistance. Objective: Serial procalcitonin (PCT) monitoring has been adopted to supplement clinical judgement and help guide antibiotic therapy as part of antimicrobial stewardship programs. PCT levels peak 24 to 48 h after infection onset and decline with infection resolution. We explored the role of PCT as an infection biomarker for guiding antibiotic therapy in cancer patients hospitalized for febrile neutropenia. Design: Prospective randomized study. Methods: Patients were enrolled between October 2021 and August 2023 and received empiric intravenous broad-spectrum antibiotics (IVBSA) for at least 48 h. PCT was measured at baseline and 48–72 h after IVBSA initiation. PCT drop 48–72 h after IVBSA initiation was defined as a reduction of 30% from baseline or a PCT level < 0.25 ng/mL. De-escalation was defined as a switch from IVBSA to oral or simplified once-daily IV therapy. Results: Of the 89 patients with available PCT levels, 53 (60%) had a PCT drop, most of whom (79%) underwent IVBSA de-escalation. Compared with patients without a PCT drop, patients with a PCT drop had a higher de-escalation rate at 72 h (71% vs. 45%; p = 0.003) and a shorter median antibiotic duration (55 h vs. 98 h; p = 0.004). Patients with bacteremia had a significantly higher median PCT level than those without bacteremia (2.35 ng/mL vs. 0.370 ng/mL, p = 0.013). Conclusions: In patients with cancer and febrile neutropenia, a PCT drop was associated with earlier therapy de-escalation and shorter antibiotic duration. PCT monitoring may be useful in antimicrobial stewardship initiatives in this patient population. Clinical trials identifier: NCT04983901. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of chronic periprosthetic joint infection (CPJI) is crucial for ensuring effective treatment and improving patient outcomes. However, many auxiliary diagnostic tests are challenging to implement on a large scale due to economic and technical constraints, making CPJI diagnosis difficult. This study aims to design and validate a combined diagnostic model based on commonly used serological tests to evaluate its diagnostic value for CPJI and develop a diagnostic nomogram. Methods: A retrospective study from January 2019 to February 2024 involving 170 patients undergoing knee and hip arthroplasty revision for CPJI and aseptic loosening (AL) was conducted across two medical centers. These patients were divided into the training set and validation set. Patients were categorized into CPJI and AL groups based on infection status. Serological tests conducted upon admission were collected, and single-factor and multi-factor logistic regression analyses were used to identify independent diagnostic factors for early infection. These factors were integrated to construct a nomogram model. The model's performance was evaluated using the receiver operating characteristic area under the curve (AUC), Hosmer–Lemeshow test, decision curve analysis (DCA), and calibration curve, with external validation conducted on the validation set. Results: Multivariate logistic regression analysis showed that C-reactive protein (CRP), procalcitonin (PCT), and Platelet count/mean platelet volume ratio (PVR) were independent diagnostic factors for CPJI (p < 0.05). The AUCs for diagnosing CPJI using these individual factors were 0.806, 0.616, and 0.700 (p < 0.05), respectively, while their combined detection achieved an AUC of 0.861 (p < 0.05). The DCA clinical impact curve shows the combined model has good clinical utility when the threshold probability of infection presence is between 0.16 and 0.95. Similar results were obtained in the external validation cohort, with the combined detection having an AUC of 0.893. Conclusion: The combined diagnostic model of CRP, PCT, and PVR significantly improves the The combined diagnostic model of CRP, PCT, and PVR significantly improves the diagnostic performance for CPJI compared to individual serum biomarkers. It exhibits good sensitivity, specificity, and clinical applicability, providing valuable references for CPJI diagnosis. [ABSTRACT FROM AUTHOR]

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a lifesaving treatment but carries a high infection risk. Diagnosing infections remains challenging due to the limited accuracy of standard biomarkers. Methods: This single-center study aimed to evaluate presepsin (PSP) and YKL-40 as infection biomarkers in febrile patients during the allo-HSCT pre-engraftment phase. Biomarker levels were prospectively measured in 61 febrile episodes from 54 allo-HSCT patients at admission, representing baseline levels, and then at Day 1, 3, 5, and 7 following fever onset. The diagnostic value was compared to that of procalcitonin (PCT). Results: PSP showed fair diagnostic value on Day 1 (AUC 0.656; 95% CI: 0.510–0.802) and Day 3 (AUC 0.698; 95% CI: 0.559–0.837). YKL-40 did not provide any significant diagnostic value across measured time points. PCT outperformed PSP and YKL-40, particularly on Day 3 (AUC 0.712; 95% CI: 0.572–0.852). When combining biomarkers, the best model for predicting infection used PSP > 3.144 ng/mL and PCT > 0.28 μg/L on Day 3, resulting in R2 of about 31% (p < 0.001). Conclusions: Neither test showed sufficient discriminative power for early infection to recommend their use as individual diagnostic tools in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of high sensitive CRP and Procalcitonin in admitted patients of Farooq Hospital Lahore, Pakistan. Study Design: Prospective study. Setting: Farooq Hospital Westwood, Lahore. Period: November 2023 to January 2024. Methods: The admitted patients of intensive care units, medical and cardiac care units, with acute kidney infection, chronic kidney disease, diabetes mellitus, hypertension, coronary artery bypass grafting, gastroenteritis, chronic obstructive pulmonary disease, liver disease, hepatitis, and bacterial infections were included. Serum albumin, highsensitive C-reactive protein (hs-CRP), and procalcitonin were analyzed by automated analyzers. Data was analyzed by using SPSS (v.25.0). Results: Among 73 patients, 83.56% were critical and 16.44% stable. It was found that the critical patients were in the range of 61 to 90 years of age. The hs-CRP and procalcitonin levels were non-significantly correlated with age group. The hs-CRP exhibited higher sensitivity than procalcitonin in critical patients (AUC: 0.872 vs. 0.725). Likewise, serum albumin had a significant association with patients having critical conditions (AUC: 0.685). Moreover, it was found that hs-CRP and procalcitonin have a significant association with the period of patient stay in the hospital. Conclusion: The present study concluded that in critically ill patients having high levels of procalcitonin and hs-CRP had longer hospital stay and both biomarkers are equally important in the treatment of critically ill admitted patients. [ABSTRACT FROM AUTHOR]

Background: Critically ill patients with sepsis have a high incidence of vitamin D deficiency. Vitamin D promotes the synthesis of human cathelicidin antimicrobial peptide, a precursor of LL-37, which is a part of the innate immune system. This study investigated the effectiveness and safety of the early administration of high-dose enteral vitamin D3 in comparison with low-dose vitamin D3 in patients with sepsis requiring mechanical ventilation (MV). Methods: Eighty adult patients with sepsis requiring MV with known vitamin D deficiency were randomly assigned to receive either an enteral 50 000 IU (Group I) or 5000 IU (Group II) vitamin D supplementation. Clinical and laboratory parameters were evaluated at baseline and on days 4 and 7 between the study groups. The change in serum procalcitonin (PCT) levels on day 7 was the primary outcome, while the change in serum LL-37 levels on day 7, changes in sequential organ failure assessment (SOFA) score, and clinical pulmonary infection score on day 7, MV duration, and hospital length of stay (LOS) were the secondary outcomes. Results: The (day 7-day 0) change in serum PCT and LL-37 levels and SOFA score were significantly different in Group I (P =.010, P <.001, and P <.001, respectively). The SOFA score was significantly different on days 4 and 7 in Group I (P <.001 and P <.001, respectively). The incidence of early ventilator-associated pneumonia was significantly different between both treatment groups (P =.025). The hospital LOS was shorter in Group I (P <.001). No 25-hydroxyvitamin-D toxicity was observed in either group. Conclusions: Early enteral administration of high-dose vitamin D3 in critically ill patients with sepsis requiring MV along with standard treatment for sepsis decreased serum procalcitonin levels, increased serum LL-37 levels, and ameliorated illness severity scores. [ABSTRACT FROM AUTHOR]

Febrile neutropenia (FN) is a common consequence of intensive chemotherapy in hematological patients. More than 90% of the patients with acute myeloid leukemia (AML) develop FN, and 5%–10% of them die from subsequent sepsis. FN is very common also in autologous stem cell transplant recipients, but the risk of death is lower than in AML patients. In this review, we discuss biomarkers that have been evaluated for diagnostic and prognostic purposes in hematological patients with FN. In general, novel biomarkers have provided little benefit over traditional inflammatory biomarkers, such as C‐reactive protein and procalcitonin. The utility of most biomarkers in hematological patients with FN has been evaluated in only a few small studies. Although some of them appear promising, much more data is needed before they can be implemented in the clinical evaluation of FN patients. Currently, close patient follow‐up is key to detect complicated course of FN and the need for further interventions such as intensive care unit admission. Scoring systems such as q‐SOFA (Quick Sequential Organ Failure Assessment) or NEWS (National Early Warning Sign) combined with traditional and/or novel biomarkers may provide added value in the clinical evaluation of FN patients. [ABSTRACT FROM AUTHOR]

Fetal inflammatory response syndrome or infection after preterm premature rupture of membranes (PPROM) increases neonatal morbidity in preterm deliveries. Biochemical markers from the amniotic fluid (AF) have been used to evaluate possible intra-amniotic infection during the asymptomatic phase after PPROM. This study aimed to describe whether soluble urokinase-type plasminogen activator receptor (suPAR) or procalcitonin (PCT) from AF or maternal sera could reveal fetal inflammatory response or infection after PPROM. AF and maternal serum samples were collected weekly after PPROM (23+ 0 − 34+ 6 gestational weeks) until delivery from twenty women and two women with possible chorioamnionitis with intact membranes. Levels of suPAR, PCT, interleukin-6 (IL-6), glucose, lactate dehydrogenase (LDH), and bacterial PCR were determined from AF and suPAR and PCT and IL-6 from maternal sera. Fetal infection or inflammation response were determined by the histology of the placenta after delivery. AF glucose was significantly lower and AF LDH higher in the fetal site histologic chorioamnionitis (HCA) group, while AF suPAR concentrations tended to be higher in this group. AF suPAR correlated significantly with AF glucose and LDH. Based on receiver operating characteristic (ROC) analysis, AF glucose had the best predictability for fetal site histological chorioamnionitis. The findings of AF PCT were insignificant considering HCA. AF glucose had the highest accuracy in predicting fetal site histologic chorioamnionitis. AF suPAR may be a promising marker; however, our findings were limited by a small study population. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In sepsis treatment, antibiotics are crucial, but overuse risks development of antibiotic resistance. Recent guidelines recommended the use of procalcitonin to guide antibiotic cessation, but solid evidence is insufficient. Recently, concerns were raised that this strategy would increase recurrence. Additionally, optimal protocol or difference from the commonly used C-reactive protein (CRP) are uncertain. We aimed to compare the effectiveness and safety of procalcitonin- or CRP-guided antibiotic cessation strategies with standard of care in sepsis. DATA SOURCES: A systematic search of PubMed, Embase, CENTRAL, Igaku Chuo Zasshi, ClinicalTrials.gov , and World Health Organization International Clinical Trials Platform. STUDY SELECTION: Randomized controlled trials involving adults with sepsis in intensive care. DATA EXTRACTION: A systematic review with network meta-analyses was performed. The Grading of Recommendations, Assessments, Developments, and Evaluation method was used to assess certainty. DATA SYNTHESIS: Eighteen studies involving 5023 participants were included. Procalcitonin-guided and CRP-guided strategies shortened antibiotic treatment (-1.89 days [95% CI, -2.30 to -1.47], -2.56 days [95% CI, -4.21 to -0.91]) with low- to moderate-certainty evidence. In procalcitonin-guided strategies, this benefit was consistent even in subsets with shorter baseline antimicrobial duration (7-10 d) or in Sepsis-3, and more pronounced in procalcitonin cutoff of "0.5 [mu]g/L and 80% reduction." No benefit was observed when monitoring frequency was less than half of the initial 10 days. Procalcitonin-guided strategies lowered mortality (-27 per 1000 participants [95% CI, -45 to -7]) and this was pronounced in Sepsis-3, but CRP-guided strategies led to no difference in mortality. Recurrence did not increase significantly with either strategy (very low to low certainty). CONCLUSIONS: In sepsis, procalcitonin- or CRP-guided antibiotic discontinuation strategies may be beneficial and safe. In particular, the usefulness of procalcitonin guidance for current Sepsis-3, where antimicrobials are used for more than 7 days, was supported. Well-designed studies are needed focusing on monitoring protocol and recurrence. [ABSTRACT FROM AUTHOR]

• The death group exhibits higher APACHE II/SOFA scores and LYM/CRP/Scr levels. • The death group shows higher SII/PCT levels than the survival group. • SII/PCT positively correlate with APACHE II/SOFA scores and LYM/CRP/Scr levels. • SII/PCT are independent risk factors for poor prognosis in septic shock patients. • The SII-PCT combination helps predict the poor prognosis of septic shock patients. Septic shock is the most serious complication of sepsis, with more secure and efficient biomarkers urgently needed. Systemic immune-inflammation index (SII) and serum procalcitonin (PCT) show involvement in predicting septic shock prognosis. Herein, we explored the clinical value of the SII-PCT combination in the short-term prognosis of septic shock patients. Totally 200 septic shock patients were analyzed retrospectively and allocated into the survival and death groups upon 28-day in-hospital outcomes. Correlations of SII, PCT, acute physiology and chronic health evaluation II (APACHE II)/sepsis-related organ failure assessment (SOFA) scores, C-reactive protein (CRP), and serum creatinine (Scr) were analyzed using Spearman. The influencing factors of SII and serum PCT for short-term poor prognosis were analyzed using logistic multivariate regression model. The auxiliary predictive value of SII, PCT, and their combination for short-term adverse septic shock prognosis was evaluated by the receiver operating characteristic curve. Differences in the area under the curve (AUC) were compared using MedCalc. The death group had higher APACHE II/SOFA scores, LYM, CRP, Scr, SII, and PCT levels than the survival group. SII and PCT were positively correlated with APACHE II and SOFA scores, LYM, CRP, and Scr, and were independent risk factors influencing the adverse septic shock prognosis. The AUC of the SII-PCT combination in predicting short-term adverse septic shock prognosis was 0.893 (0.841-0.932), with 76.12% sensitivity and 87.97% specificity, with the combination showing a higher AUC than SII/PCT alone. The SII-PCT combination helps predict the adverse prognosis of septic shock patients. [ABSTRACT FROM AUTHOR]

A prompt diagnosis of urinary tract infection (UTI) is necessary to minimize its symptoms and limit sequelae. The current UTI screening by urine test strip analysis and microscopic examination has suboptimal diagnostic accuracy. A definitive diagnosis of UTI by urine culture takes two to three days for the results. These limitations necessitate a need for better biomarkers for the diagnosis and subsequent management of UTI in children. Here, we review the value of currently available UTI biomarkers and highlight the potential of emerging biomarkers that can facilitate a more rapid and accurate UTI diagnosis. Of the newer UTI biomarkers, the most promising are blood procalcitonin (PCT) and urinary neutrophil gelatinase-associated lipocalin (NGAL). PCT can provide diagnostic benefits and should be considered in patients who have a blood test for other reasons. NGAL, which is on the threshold of clinical care, needs more research to address its scope and utilization, including point-of-care application. Employment of these and other biomarkers may ultimately improve UTI diagnosis, guide UTI therapy, reduce antibiotic use, and mitigate UTI complications. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the correlation between pentraxin-3 and procalcitonin levels with Sequential Organ Failure Assessment (SOFA) scores in septic patients. Design: This observational analysis with a cross-sectional method assessed the correlation between pentraxin-3 (PTX-3) and procalcitonin (PCT) levels and the SOFA scores of septic patients. Setting: We conducted this study in the Intensive Care Unit (ICU) of Dr. Wahidin Sudirohusodo Hospital and Medical Laboratory Center of Hasanuddin University from December 2023 to April 2024. Patients and participants: Thirty-two patients with clinical sepsis were admitted to the ICU of Dr. Wahidin Sudirohusodo Hospital. Intervention: Blood samples were collected on day 1 and day 2 of ICU care in septic patients to measure pentraxin-3 and procalcitonin levels. Measurements and results: The Wilcoxon test showed a significant difference in pentraxin-3 levels on ICU care's first and second days (p=0.036). Similarly, there was a significant difference in procalcitonin levels on the first and second days of ICU care. The Spearman correlation test found a significant correlation between procalcitonin and SOFA scores (p=0.008) with a correlation value r=0.462 on the first and second days. The resulting correlation value showed a positive correlation, which meant that the higher the procalcitonin level in septic patients, the higher the SOFA scores with moderate strength (correlation value 0.4-<0.6). The correlation of pentraxin- 3 with the Spearman test showed a positive correlation on the first day. In contrast, on the second day, there was no significant statistical value with the SOFA scores with a correlation value p=0.093 (p>0.05). Conclusion: Pentraxin-3 and procalcitonin levels correlate with SOFA scores in septic patients admitted to the ICU. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) remains one of the leading causes of mortality and morbidity in children under 5 years of age. Early diagnosis and effective management remain the cornerstone to reduce complications and fatalities associated with CAP. Lately, C-reactive protein (CRP) and procalcitonin (PCT) have gained much attention as useful biomarkers in CAP. Recent data suggest that a very low PCT value has a high negative predictive value while identifying a population of children at low risk of typical bacterial infections. Hence, we propose to take up this study to assess the clinical utility of PCT in pediatric CAP. Aims and Objectives: The aim of this study was to study serum PCT level in children with the clinical diagnosis of CAP admitted at R.G Kar Medical College and Hospital, Kolkata, and its role in severity identification and contribution in the treatment of CAP. Materials and Methods: This cross-sectional hospital-based observational study was performed from January 2020 to June 2021 in the R.G Kar Medical College and Hospital, Kolkata, West Bengal, India. A total of 50 children were included within the age group of 2 months--5 years with CAP admitted in the Children's ward and intensive care unit at our hospital. Clinical characteristics such as age, sex, symptoms such as history of fever, difficulty feeding or drinking, convulsion, lethargy, cyanosis, chest in-drawing, respiratory rates, auscultatory findings such as air entry of bilateral lungs, added sounds like-(inspiratory crept, bronchial breathing), and oxygen saturation were studied. Routine investigations such as complete blood count, serum CRP, blood culture, and chest radiograph sent along with serum PCT. Results: Out of 50 children diagnosed with CAP, 30 (60%) fell within the age range of 2-5 months of age. Among the study population, 70% of children displayed weakly positive and 20% strongly positive serum PCT values. A strong correlation (P < 0.001) was revealed between the severity of pneumonia and PCT, and also a positive correlation (P < 0.001) between clinical outcome and PCT. However, the role in contribution in early diagnosis could not be concluded. Conclusion: This study concluded that serum PCT may be used as a valuable indicator for assessing the severity and prognosis of CAP. All children with elevated PCT who were prescribed antibiotics did not experience further complications of CAP. [ABSTRACT FROM AUTHOR]

Due to the complexity and diversity of infectious diseases, diagnosis based solely on symptoms and imaging manifestations is associated with a high rate of misdiagnosis, so it is particularly important to find reliable and accurate biomarkers. Four inflammatory biomarkers (CRP, IL‐6, PCT and SAA) have different manifestations and roles in different infectious diseases and stages of infection, and the diagnosis and identification of infectious diseases can be realized through quantitative analysis of these four biomarkers simultaneously. In this study, we developed a colloidal gold nanoparticle (AuNP)‐based multiplex LFA strip using eight highly‐sensitive monoclonal antibodies that simultaneously detected CRP, IL‐6, PCT and SAA in serum within 15 min. And quantitative analysis was achieved with a portable strip reader, the LODs were 2.5 μg/mL, 25.3 pg/mL 0.87 ng/mL and 8.8 μg/mL for CRP, IL‐6, PCT and SAA, while detection ranges were 2.5–200 μg/mL, 25.3–8000 pg/mL 0.87–100 ng/mL and 8.8–200 μg/mL. Moreover, the quantitative colloidal gold assay correlated well with the results of a chemiluminescence immunoassay when testing clinical serum samples. Our developed method was reliable and accurate according to the recovery test results. Therefore, the strip can be used as an alternative method for the simultaneous monitoring of CRP, IL‐6, PCT and SAA in serum samples. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether changes in presepsin, procalcitonin, high-sensitivity C-reactive protein, and interleukin 6 levels predict mortality in septic patients in the intensive care unit. This study enrolled septic patients between November 2020 and December 2021. Levels of presepsin, procalcitonin, high-sensitivity C-reactive protein, and interleukin 6 were measured on the first (PSEP_0, PCT_0, hsCRP_0, IL-6_0) and third days (PSEP_3, PCT_3, hsCRP_3, IL-6_3). Follow-up was performed on days 3, 7, 14, 21, and 28 after enrollment. The outcome was all-cause death. The study included 119 participants, and the mortality was 18.5%. In univariable Cox proportional hazards regression analysis, ΔPSEP (= PSEP_3 – PSEP_0) > 211.49 pg/mL (hazard ratio, 2.70; 95% confidence interval, 1.17–6.22), ΔPCT (= PCT_3 – PCT_0) > –0.13 ng/mL (hazard ratio, 7.31; 95% confidence interval, 2.68–19.80), ΔhsCRP (= hsCRP_3 – hsCRP_0) > −19.29 mg/L (hazard ratio, 6.89; 95% confidence interval, 1.61–29.40), and ΔIL-6 (= IL-6_3 – IL-6_0) > 1.00 pg/mL (hazard ratio, 3.13; 95% confidence interval, 1.35–7.24) indicated an increased risk of mortality. The composite concordance index for alterations in all 4 distinct biomarkers was highest (concordance index, 0.83; 95% confidence interval, 0.76–0.91), suggesting the optimal performance of this panel in mortality prediction. In decision curve analysis, compared with the Acute Physiology and Chronic Health Evaluation II and Sequential (sepsis-related) Organ Failure Assessment scores, the combination of the 4 biomarkers had a larger net benefit. Interestingly, interleukin 6 was predominantly produced by monocytes upon lipopolysaccharide stimulation in peripheral blood mononuclear cells. ΔPSEP, ΔPCT, ΔhsCRP, and ΔIL-6 are reliable biomarkers for predicting mortality in septic patients in the intensive care unit, and their combination has the best performance. [ABSTRACT FROM AUTHOR]

Background and Objectives: The predictive value of changes in C-reactive protein (CRP), procalcitonin, and leukocyte levels, which are commonly used in the diagnosis of infection in sepsis and septic shock, remains a topic of debate. The aim of this study was to evaluate the effectiveness of changes in CRP, procalcitonin, and leukocyte counts on the prognosis of 230 patients admitted to the intensive care unit (ICU) with the diagnosis of sepsis and pneumonia-related septic shock between 1 April 2022 and 31 December 2023, and to investigate whether any of these markers have a superior predictive value over the others in forecasting prognosis. Materials and Methods: This single-center, retrospective, cross-sectional observational study included patients who developed sepsis and septic shock due to community-acquired pneumonia and were admitted to the ICU. Demographic data, 1-month and 90-day mortality rates, length of stay in the ICU, discharge to the ward or an outside facility, need for dialysis after sepsis, need for invasive or noninvasive mechanical ventilation during the ICU stay and the duration of this support, whether patients admitted with sepsis or septic shock required inotropic agent support during their stay in the ICU and whether they received monotherapy or combination therapy with antibiotics during their admission to the ICU, the Comorbidity Index score (CCIS), CURB-65 score (confusion, uremia, respiratory rate, BP, age ≥ 65), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) score were analyzed. Additionally, CRP, procalcitonin, and leukocyte levels were recorded, and univariate and multivariate logistic regression analyses were performed to evaluate their effects on 1- and 3-month mortality outcomes. In all statistical analyses, a p-value of <0.05 was accepted as a significant level. Results: According to multivariate logistic regression analysis, low BMI, male gender, and high CCIS, CURB-65, and APACHE-II scores were found to be significantly associated with both 1-month and 3-month mortality (p < 0.05). Although there was no significant relationship between the first-day levels of leukocytes, CRP, and PCT and mortality, their levels on the third day were observed to be at their highest in both the 1-month and 3-month mortality cases (p < 0.05). Additionally, a concurrent increase in any two or all three of CRP, PCT, and leukocyte values was found to be higher in patients with 3-month mortality compared with those who survived (p = 0.004). Conclusions: In patients with pneumoseptic or pneumonia-related septic shock, the persistent elevation and concurrent increase in PCT, CRP, and leukocyte values, along with male gender, advanced age, low BMI, and high CCIS, CURB-65, and APACHE-II scores, were found to be significantly associated with 3-month mortality. [ABSTRACT FROM AUTHOR]

In a prospective cohort study, we evaluated plasma PCT levels in 48 TB lymphadenitis (TBLN) and 41 TB pleuritis (TBPE) patients. Measurements of PCT were done in unstimulated plasma of microbiologically and clinically confirmed TBLN and TBPE patients registered for anti-TB treatment at a tertiary care hospital in Lahore, Pakistan. Plasma levels of PCT were found to be raised in 89% of the patients at baseline with a median of 1.5 ng/ml. Levels were higher (p = 0.001) in TBLN as compared to TBPE (2.69, 0.96 ng/ml). PCT levels were not related to the bacterial burden depicted by culture positivity in these patients. PCT showed a negative correlation with the severity of constitutional symptoms (rho = − 0.238, p = 0.034), and inflammatory biomarkers; ferritin (rho = − 0.43, p < 0.001), INF-γ (rho = − 0.314, p = 0.003), TNF-α (rho = − 0.220, p = 0.039), IL-6 (rho = − 0.224, p = 0.035), and several chemokines of CCL and CCXL group. Raised plasma levels of PCT did not decrease with anti-TB treatment, indicating it is not a good biomarker to monitor treatment response in TBLN and TBPE patients. More studies with a larger number of confirmed EPTB cases are needed to define the role of PCT and its interaction with other biomarkers in EPTB. [ABSTRACT FROM AUTHOR]

Neonatal sepsis, a bloodstream infection in the first 28 days of life, is a leading cause of morbidity and mortality among infants in both developing and developed countries. Additionally, sepsis is distinguished in neonates by unique pathophysiological and presentational factors relating to its development in immature neonatal immune systems. This review focuses on the current understanding of the mechanics and implications of neonatal sepsis, providing a comprehensive overview of the epidemiology, aetiology, pathophysiology, major risk factors, signs and symptoms and recent consensus on the diagnosis and management of both early-onset and late-onset neonatal sepsis. It also includes a discussion on novel biomarkers and upcoming treatment strategies for the condition as well as the potential of COVID-19 infection to progress to sepsis in infants. [ABSTRACT FROM AUTHOR]

Background/Objectives: Pancreatic stone protein (PSP) is an emerging biomarker of sepsis that is secreted from pancreas sensing remote organ damages. We explored the diagnostic and prognostic utilities of PSP in patients with suspected sepsis. Methods: In a total of 285 patients (suspected sepsis, n = 148; sepsis, n = 137), we compared PSP with procalcitonin (PCT) and sequential organ failure assessment (SOFA) score. Sepsis diagnoses were explored using receiver operating characteristic curve analyses with area under the curves (AUCs). Clinical outcomes (in-hospital mortality, 30-day mortality, and kidney replacement therapy [KRT]) were explored using the Kaplan–Meier method and a multivariate analysis with hazard ratio (HR). Results: PCT and PSP were comparable for sepsis diagnosis (AUC = 0.71–0.72, p < 0.001). The sepsis proportion was significantly higher when both biomarkers increased than when either one or both biomarkers did not increase (89.0% vs. 21.3–47.7%, p < 0.001). Each biomarker quartile (Q1–Q4) differed significantly according to their SOFA score (all p < 0.001). Compared with Q1, the Q2–Q4 groups showed worse clinical outcomes (p = 0.002–0.041). Both biomarkers added to the SOFA score showed higher HRs than the SOFA score alone (3.3–9.6 vs. 2.8–4.2, p < 0.001–0.011), with nearly 2.5-fold higher HR (9.6 vs. 4.2) for predicting KRT. Conclusions: Although PCT and PSP did not independently predict clinical outcomes in the multivariate analysis, PSP demonstrated diagnostic and prognostic utilities in patients with suspected sepsis, especially for predicting kidney dysfunction. PSP, alone or in combination with PCT, would be a valuable tool that can be added to clinical assessments. [ABSTRACT FROM AUTHOR]

Inflammation is a potential risk factor of voriconazole (VCZ) overdose, procalcitonin (PCT) is reported to act as a diagnostic marker for bacterial infections. However, the association of PCT with VCZ trough serum concentrations (VCZ-Cmin) is not fully clear. Our study aims to investigate the associations between PCT and VCZ-Cmin. In this retrospective cohort study, we collected the clinical data of 147 patients who received VCZ and monitored the VCZ concentration of them in our hospital from August 2017 to August 2021. All patients underwent routine clinical examinations on the day or the day before VCZ administration. General information and clinical symptoms of these patients were recorded. Multivariate liner analysis showed that PCT was significantly associated with VCZ-Cmin (p < 0.001). Overall, it was shown that VCZ-Cmin was significantly increased by 0.32 µg/mL for each fold increment in PCT in crude model. In the minor adjusted model (Model 1, adjustment for sex, age, albumin, direct bi1irubin, WBC) and fully adjusted model (Model 2, adjustment for sex, age, albumin, direct bilirubin, WBC, AST and ALT), VCZ-Cmin was significantly increased by 0.23 µg/mL and 0.21 µg/mL, respectively, for each fold increment in PCT. In conclusion, this research reveals the correlation between PCT and VCZ-Cmin, indicating that PCT has the potential to serve as a valuable biomarker for drug monitoring in the treatment of VCZ. [ABSTRACT FROM AUTHOR]

Purpose Procalcitonin (PCT) levels may play a role in decreasing the duration of antimicrobial therapy in institutions that have long durations of therapy for management of community-acquired pneumonia. We assessed the impact of the combination of pharmacist stewardship interventions assisted by a clinical decision support (CDS) tool and PCT assessment on the antimicrobial days of therapy (DOT) prescribed for respiratory tract infections (RTIs). Methods We conducted a quasi-experimental study in which patients in the preintervention group were admitted between April and June 2021 and patients in the intervention group were admitted between April and June 2022. In the intervention phase, a CDS tool was utilized to alert clinical pharmacists when patients met specific criteria. This alert was programmed to activate for individual patients when a reported PCT level was less than 0.25 ng/mL and the patient was on antimicrobials prescribed for an RTI as indicated by providers in the electronic health record. Stewardship interventions were made by pharmacists via prospective audit and feedback. The primary endpoint was inpatient antimicrobial DOT for RTIs. Results There were 90 patients in the preintervention group and 104 patients in the intervention group. Although baseline characteristics were not well matched between the groups, favoring the preintervention group, the median DOT was lower in the intervention group, at 3 days (interquartile range [IQR], 2-4 days), compared to 4 days (IQR, 2.8-5 days) in the preintervention group (P = 0.001). Conclusion The results of our study demonstrate the utility of pharmacist interventions coupled with CDS and PCT in reducing antimicrobial DOT prescribed for RTIs. Antimicrobial stewardship programs may benefit from implementing a PCT bundle. [ABSTRACT FROM AUTHOR]

Sepsis is characterized by multiple organ dysfunction, which is now accepted to be due to oxidative damage. The lung is the first organ exposed to this damage, and its injury is one of the leading causes of death. Therefore, many pharmacological strategies are employed to attenuate sepsis. This study aimed to evaluate the in silico and in vitro antibacterial activity of Cicer arietinum extract (CAE) against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa and the in vivo modulatory effect of CAE against sepsis induced by cecal ligation and puncture (CLP) in rats. This study identified seven bioactive components in Cicer arietinum extract, revealing promising interactions between these components and Staphylococcus aureus-PBP2a and Pseudomonas aeruginosa-PBP3 proteins, highlighting their potential as novel antibacterial agents. After ensuring the bactericidal ability of CAE against Staphylococcus aureus and Pseudomonas aeruginosa, an in vivo study was performed. Twenty-four rats were divided into sham-operated rats, CLP-septic rats, CLP rats treated with CAE (500 mg/kg b.wt), and CLP rats treated with hydrocortisone (25 mg/ kg b.wt). CAE was administered orally for 3 days post-operation, and animals were euthanized on the fourth day. Another twenty-four rats were used to study survival for 5 days. This study revealed that CAE, like hydrocortisone, can rescue CLP rats from death by suppressing lung procalcitonin (PCT) and MDA and enhancing SOD, CAT, and GSH levels significantly, as compared with the CLP group. The histopathological results were parallel with the biochemical results since the CLP rats treated with CAE had lower histological/inflammatory scores in the lung like hydrocortisone. The beneficial role of CAE may result from its antibacterial and antioxidant activities, and CAE can be considered as a lung antiseptic extract. This study provides a novel treatment for sepsis-induced ALI. However, the beneficial impact of CAE needs extensive study to obtain evidence. [ABSTRACT FROM AUTHOR]

Anastomotic leak (AL) remains a severe complication following colorectal surgery, leading to increased morbidity and mortality, particularly in cases of delayed diagnosis. Existing diagnostic methods, including computed tomography (CT) scans, contrast enemas, endoscopic examinations, and reoperations can confirm AL but lack strong predictive value. Early detection is crucial for improving patient outcomes, yet a definitive and reliable predictive test, or "gold standard," is still lacking. A comprehensive PubMed review was focused on CT imaging, serum levels of C-reactive protein (CRP), and procalcitonin (PCT) to assess their predictive utility in detecting AL after colorectal resection. Three independent reviewers evaluated eligibility, extracted data, and assessed the methodological quality of the studies. Summarized in detailed tables, our analysis revealed the effectiveness of both CRP and PCT in the early detection of AL during the postoperative period. CT imaging, capable of identifying fluid collection, pneumoperitoneum, extraluminal contrast extravasation, abscess formation, and other early signs of leak, also proved valuable. Considering the variability in findings and statistics across these modalities, our study suggests a personalized, multimodal approach to predicting AL. Integrating CRP and PCT assessments with the diagnostic capabilities of CT imaging provides a nuanced, patient-specific strategy that significantly enhances early detection and management. By tailoring interventions based on individual clinical characteristics, surgeons can optimize patient outcomes, reduce morbidity, and mitigate the consequences associated with AL after colorectal surgery. This approach emphasizes the importance of personalized medicine in surgical care, paving the way for improved patient health outcomes. • Anastomotic leak (AL) after colorectal surgery demands urgent detection. • CRP and PCT show promise as biomarkers for early detection of AL. • Varied diagnostic methods at different postoperative stages enhance AL prediction. • Consider individual patient factors for personalized biomarker interpretation. [ABSTRACT FROM AUTHOR]

Background: The prognostic value of baseline inflammatory markers in sepsis remains controversial, with conflicting evidence regarding their association with mortality. The dynamic changes in these markers over time might offer additional insights into disease progression and patient outcomes. Methods: This retrospective observational study included 138 patients with severe infections. The inflammatory biomarkers procalcitonin (PCT), C-reactive protein (CRP), and lactate (LAC) were measured at three time points: upon hospital admission (baseline), approximately 24–48 h after admission (second measurement; M2), and 48–72 h after admission (third measurement; M3). The primary outcome was 30-day mortality. A Mann–Whitney U test was used to compare the biomarker levels between the survivors and non-survivors. A Spearman's correlation was used to assess the relationships between the baseline parameters. A logistic regression and a receiver operating characteristic (ROC) curve analysis were employed to evaluate the prognostic value of the baseline markers and their dynamic changes. Results: The baseline LAC and SOFA score were significantly associated with 30-day mortality. The percentage decrease in PCT, CRP, and LAC from the baseline to M3 emerged as strong predictors of survival, with the ROC curve analysis demonstrating superior discriminatory ability compared to the baseline values. CRP_Delta exhibited the highest AUC (0.903), followed by PCT_Delta (0.843) and LAC_Delta (0.703). Conclusions: The dynamic changes in these inflammatory biomarkers, particularly PCT, CRP, and LAC, offer valuable prognostic information beyond their baseline levels in predicting 30-day mortality in severe infections. These findings highlight the importance of monitoring biomarker trends for early risk stratification and potential treatment guidance. [ABSTRACT FROM AUTHOR]

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This study aimed to investigate the role of inflammatory markers and progranulin levels in diagnosing cholecystitis, assessing their potential as diagnostic biomarkers. The research involved 54 patients diagnosed with acute cholecystitis in the emergency department. Routine complete blood count and biochemistry analyses were conducted. Blood samples were obtained, centrifuged, and stored at -80°C. Progranulin levels in sera were assessed using a spectrophotometric method. Statistical analysis was carried out using SPSS v.22.0, revealing significant variances between patients and healthy controls. Acute cholecystitis patients exhibited elevated levels of inflammatory markers (white blood cells, C-reactive protein, procalcitonin) and decreased progranulin levels compared to controls. Progranulin showed a high sensitivity (86.5%) and specificity (87.5%) in diagnosing acute cholecystitis. Other markers had varying sensitivity and specificity values. Inflammatory markers, particularly progranulin, show promise in diagnosing cholecystitis. Evaluating these markers together can enhance diagnostic accuracy. Further studies are needed to validate these findings and explore progranulin's specificity to cholecystitis. [ABSTRACT FROM AUTHOR]

Aim Injudicious usage of antibiotics has led to the emergence of antibiotic resistance which is a major health-care problem in developing countries such as India. Our aim was to show how antibiotic therapy based on serial procalcitonin (PCT) assay can help in antibiotic de-escalation in septic patients. Materials and Methods A pre–post interventional study was conducted among 300 septic patients admitted to an intensive care unit (ICU). All septic patients admitted 2 months before and 2 months after the introduction of monitoring of PCT were included and they were divided into Group P (with PCT monitoring) and Group C (without PCT monitoring). The proportion of patients for whom antimicrobials were de-escalated, the average time taken to de-escalate antimicrobials, and the average duration of ICU stay were compared. Proportions and averages with standard deviations were calculated to describe the data. A test of proportions was done to compare the proportion de-escalated and a Student’s t-test was done to compare the average duration of antibiotic therapy. Results The proportion of patients in whom de-escalation of antimicrobials was done was 125 (83.33%) in Group P as compared to 92 (61.33%) in Group C. The time taken to de-escalate was 3.04 ± 0.83 days (95% confidence interval [CI] 2.89–3.18) in Group P compared to 4.7 ± 1.4 days (CI 4.41–4.98) in Group C. The duration of ICU stay was also less in Group P - 3.08 ± 0.91 days (CI 3.08–3.38) as compared to Group C - 5.16 ± 2.17 days (4.80–5.51). Conclusion Serial PCT assay-based antimicrobial therapy helped to wean patients with sepsis off antimicrobials earlier thus reducing the duration of ICU stay.

Abstract Background A severe infection of the skin and soft tissues, Necrotizing Fasciitis (NF), spreads quickly along the deep fascia. This study aimed to characterize the clinicopathological features, analyze the implicated bacteria’s antibiotic sensitivity, evaluate surgical management, and assess the diagnostic accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in Necrotizing Soft Tissue Infection (NST). Methods This single-center prospective observational study was conducted in the Department of General Surgery, Kasturba Medical College, Manipal, with 171 proven cases of NSTI between 2019 and 2021. Clinico-demographic data and laboratory investigation values were collected at two-time points (at admission and 72 h after admission). Imaging data, LRINEC score, culture results, and antibiotic sensitivity were recorded. Appropriate descriptive and analytical statistics were used for the statistical analysis. Results Of the 171 patients, 150 were male (87.7%). The mean age was 57.6 ± 13.1 years. The presenting features in all the cases were pain, swelling, and fever. Diabetes mellitus (DM) is the most common comorbidity. The lower extremities were the most commonly affected sites. Streptococcus pyogenes showed significant growth in 25.41% of the samples. Ceftriaxone sensitivity was seen in 41/141. A score of ≥ 8 was obtained in 118/171 (69%) patients, suggesting a higher severity and significant risk for NSTI. The Area Under the Curve of Receiver Operating characteristic Curve (ROC) for establishing diagnostic accuracy for LRINEC was 0.694. Mortality was significantly higher in the patients with higher LRINEC scores and elevated procalcitonin. The mortality rate was higher in patients who underwent surgery within 12 h. Conclusion Necrotizing fasciitis is a soft tissue infection with a high mortality rate. The clinical features and determinants of mortality in patients with NF are highlighted in this study. At the outset, a high index of suspicion was critical. Using prognostic evaluation techniques in daily clinical practice will assist medical professionals in providing adequate on-time care and significantly lowering mortality. The AUC for LRINEC score, although significant, is low. LRINEC score is not to be used to determine whether surgical intervention should be expedited or anticipated. Its role is to aid in prognosticating the outcome of the individual patient. Our study concludes that early extensive surgical debridement remains the single most crucial intervention in patients diagnosed with necrotizing fasciitis (NF), regardless of disease severity and the LRINEC score.

Abstract Background Sepsis, which is described as a life-threatening organ malfunction brought on by an unbalanced host response to infection, continues to be a significant healthcare issue that affects millions of individuals each year. It is well-known that sepsis can affect anyone around the world, but the employed survey results showed that there are significant regional variations in sepsis incidence as well as mortality rates. Although there are no definite estimates for Egypt, the highest rates were in Low-Middle-Income Countries (LMICs). Procalcitonin (PCT) is a host response marker with high specificity for bacterial infections, unlike C-reactive protein (CRP) or white blood cell count (WBC), which represent the traditional methods of detecting inflammation and infection. Its dynamic profile and superior prognostic prediction make it invaluable for assessing response to antibiotic treatment and improving clinical care for sepsis patients. Our main purpose was to evaluate the cost-effectiveness of PCT guidance compared to no PCT guidance in the antibiotic management of adult sepsis patients according to the Egyptian context. Methods We developed a decision tree model to compare the PCT-guided antibiotic management duration endpoint versus the conventional laboratory culture-based antibiotic management in adult sepsis patients. We employed the“Delphi technique” to reach a satisfactory consensus regarding the resources attributed to each compared alternative. The primary measure of the study was the additional cost associated with each Quality-Adjusted Life Year (QALY) gained by sepsis survivors over a one-year time horizon. Base-case, deterministic and probabilistic sensitivity analyses were conducted using TreeAge, Software. Results Base-case analysis showed no dominance for either alternative and resulted in an Incremental Cost-Effectiveness Ratio (ICER) value of 297,783.57 Egyptian Pounds per Quality Adjusted Life Year (L.E/QALY) in favor of the PCT guidance alternative, Deterministic sensitivity analysis revealed that the highest impact magnitudes on ICER reside with seven input parameters, the top two parameters that had the most significant influence were the costs of ICU stay with and without PCT guidance. The CEAC showed a slightly higher probability in terms of acceptability in favor of the no PCT guidance choice along the WTP scale till reaching equal probabilities at the willingness-to-pay (WTP) value point of 390,000 (state currency) after which the - probability supports the PCT guidance choice. Conclusions In the Egyptian context, PCT guidance has no cost-effectiveness domination over no PCT guidance in Antibiotics management for adult sepsis patients. This may be attributed to the high cost of PCT investigation that shall be resolved by standardization of its cost when applying the approach of DRG cost packages.

Abstract Background Early diagnosis of chronic periprosthetic joint infection (CPJI) is crucial for ensuring effective treatment and improving patient outcomes. However, many auxiliary diagnostic tests are challenging to implement on a large scale due to economic and technical constraints, making CPJI diagnosis difficult. This study aims to design and validate a combined diagnostic model based on commonly used serological tests to evaluate its diagnostic value for CPJI and develop a diagnostic nomogram. Methods A retrospective study from January 2019 to February 2024 involving 170 patients undergoing knee and hip arthroplasty revision for CPJI and aseptic loosening (AL) was conducted across two medical centers. These patients were divided into the training set and validation set. Patients were categorized into CPJI and AL groups based on infection status. Serological tests conducted upon admission were collected, and single-factor and multi-factor logistic regression analyses were used to identify independent diagnostic factors for early infection. These factors were integrated to construct a nomogram model. The model's performance was evaluated using the receiver operating characteristic area under the curve (AUC), Hosmer–Lemeshow test, decision curve analysis (DCA), and calibration curve, with external validation conducted on the validation set. Results Multivariate logistic regression analysis showed that C-reactive protein (CRP), procalcitonin (PCT), and Platelet count/mean platelet volume ratio (PVR) were independent diagnostic factors for CPJI (p

The basis of the pathogenesis of burn disease is a systemic inflammatory response syndrome with episodes of bacteremia and the development of sepsis. An analysis of the literature showed that the existing clinical diagnostic scales for sepsis do not allow a confident diagnosis. The interest in changes in the concentration of procalcitonin in the blood serum is justified by the fact that this prohormone is one of the proinflammatory mediators, the concentration of which quickly increases during local and systemic bacterial and fungal infections. It seems important to consider the possibilities of various scales for determining the criteria for sepsis, analyze the values of procalcitonin and its monitoring for more effective diagnosis and procalcitonin-controlled antibiotic therapy in patients with burns.CONCLUSION. The problem of clinical diagnosis of sepsis in patients with burns has not yet been solved. Procalcitonin is an effective biomarker of bacterial infection, and its monitoring reflects the dynamics of the burn disease, predicts the outcome, indicates the effectiveness of antibiotic therapy and allows for its correction.

Abstract In a prospective cohort study, we evaluated plasma PCT levels in 48 TB lymphadenitis (TBLN) and 41 TB pleuritis (TBPE) patients. Measurements of PCT were done in unstimulated plasma of microbiologically and clinically confirmed TBLN and TBPE patients registered for anti-TB treatment at a tertiary care hospital in Lahore, Pakistan. Plasma levels of PCT were found to be raised in 89% of the patients at baseline with a median of 1.5 ng/ml. Levels were higher (p = 0.001) in TBLN as compared to TBPE (2.69, 0.96 ng/ml). PCT levels were not related to the bacterial burden depicted by culture positivity in these patients. PCT showed a negative correlation with the severity of constitutional symptoms (rho = − 0.238, p = 0.034), and inflammatory biomarkers; ferritin (rho = − 0.43, p

Sepsis is characterized by multiple organ dysfunction, which is now accepted to be due to oxidative damage. The lung is the first organ exposed to this damage, and its injury is one of the leading causes of death. Therefore, many pharmacological strategies are employed to attenuate sepsis. This study aimed to evaluate the in silico and in vitro antibacterial activity of Cicer arietinum extract (CAE) against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa and the in vivo modulatory effect of CAE against sepsis induced by cecal ligation and puncture (CLP) in rats. This study identified seven bioactive components in Cicer arietinum extract, revealing promising interactions between these components and Staphylococcus aureus-PBP2a and Pseudomonas aeruginosa-PBP3 proteins, highlighting their potential as novel antibacterial agents. After ensuring the bactericidal ability of CAE against Staphylococcus aureus and Pseudomonas aeruginosa, an in vivo study was performed. Twenty-four rats were divided into sham-operated rats, CLP-septic rats, CLP rats treated with CAE (500 mg/kg b.wt), and CLP rats treated with hydrocortisone (25 mg/ kg b.wt). CAE was administered orally for 3 days post-operation, and animals were euthanized on the fourth day. Another twenty-four rats were used to study survival for 5 days. This study revealed that CAE, like hydrocortisone, can rescue CLP rats from death by suppressing lung procalcitonin (PCT) and MDA and enhancing SOD, CAT, and GSH levels significantly, as compared with the CLP group. The histopathological results were parallel with the biochemical results since the CLP rats treated with CAE had lower histological/inflammatory scores in the lung like hydrocortisone. The beneficial role of CAE may result from its antibacterial and antioxidant activities, and CAE can be considered as a lung antiseptic extract. This study provides a novel treatment for sepsis-induced ALI. However, the beneficial impact of CAE needs extensive study to obtain evidence.

Abstract Inflammation is a potential risk factor of voriconazole (VCZ) overdose, procalcitonin (PCT) is reported to act as a diagnostic marker for bacterial infections. However, the association of PCT with VCZ trough serum concentrations (VCZ-Cmin) is not fully clear. Our study aims to investigate the associations between PCT and VCZ-Cmin. In this retrospective cohort study, we collected the clinical data of 147 patients who received VCZ and monitored the VCZ concentration of them in our hospital from August 2017 to August 2021. All patients underwent routine clinical examinations on the day or the day before VCZ administration. General information and clinical symptoms of these patients were recorded. Multivariate liner analysis showed that PCT was significantly associated with VCZ-Cmin (p

Background: Sepsis is a clinical syndrome of life-threatening organ dysfunction due to a dysregulated host response to infection. Many biomarkers have been used clinically to assist in diagnosing sepsis. The aim of this study was to assess the blood levels of procalcitonin (PCT) and four inflammation markers, C-reactive protein (CRP), IL-6, IL-8, and TNF-α, with respect to sepsis diagnosis. Methods and Results: This case series study enrolled 188 patients (67 females and 121 males) treated in the University Hospital Centre “Mother Teresa” in Tirana with three different diagnoses: sepsis (n=103), systemic inflammatory response syndrome (SIRS) (n=71), and local bacterial infection (LBI) (n=14). Levels of PCT and serum cytokines TNF-α, IL-6, and IL-8 were measured by enzyme-linked immunosorbent assay (ELISA). Patients with sepsis had higher values of the studied biomarkers than those with SIRS and LBI (PCT: 10.0±18.7 ng/mL, 0.3±0.2 ng/mL, 0.4±0.4 ng/mL, respectively; CRP: 149±100 mg/L, 42.3±45.3 mg/L, and 74.4±75.6 mg/L, respectively; IL-6: 286.8±330.7 pg/mL, 21.0±27.5 pg/mL, and 34.6±75.1 mg/mL, respectively; IL-8: 310.2±292.5 pg/mL, 29.5±32.7 pg/mL, and 111.7±252.3 mg/mL, respectively; TNF-α: 131.2±254.0 pg/mL, 33.6±118.9 pg/mL, and 164.6±355.1 mg/mL, respectively). Multiple comparison tests demonstrated a statistically significant difference between the sepsis and SIRS group in PCT, CRP, IL-6, IL-8, and TNF-α (P

Abstract Background One of the greatest and most effective strategies to decrease the likelihood of discovering antibiotic-resistant bacteria in patients receiving critical care is to shorten the duration of antibiotic therapy. Objectives To assess the utility of procalcitonin compared to traditional inflammation markers like C-reactive protein in an antimicrobial stoppage in patients with septic shock. Methods This was a comparative, prospective, randomized, observer-blind clinical experiment conducted on 60 septic patients hospitalized in intensive care units at Benha University hospitals between May 2021 and May 2022. Groups for PCT and CRP patients were separated. The full clinical history, co-morbidities that were related, and patient history were recorded. The baseline PCT and CRP values were determined on days 4, 7, 10, and 14. They were contrasted with sepsis ratings obtained from the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sepsis-related Organ Failure Assessment (SOFA). Days 4, 7, and 10 were used to evaluate the antibiotic's efficacy. Results There was no correlation between CRP levels and APACHE II and SOFA scores on days 1, 4, and 7, but on days 7 and 10, PCT levels were strongly linked with both (P

BACKGROUND: To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. METHODS: We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. RESULTS: We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count

Objective To explore the effects of tonsillectomy under general anesthesia on articulatory characteristics and blood levels of procalcitonin (PCT), platelet membrane protein-140 (GMP-140), and T lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Forty-three children with OSAHS who underwent tonsillectomy under general anesthesia in the Department of Otorhinolaryngology Head and Neck Surgery of Xi’an Children’s Hospital, Shaanxi Province from June 2020 to March 2022 were randomly selected for the study. The children were evaluated for articulatory characteristics, blood levels of PCT, GMP-140, and T lymphocyte subsets, as well as sleep status before surgery and at 1 and 3 months after surgery. Results The longest duration of articulating /a/ was significantly prolonged and the second formant was significantly enhanced at 1 and 3 months after surgery (F=43.07,39.65,P