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Background: Pneumonia is an infectious disease with high mortality rates despite early diagnosis and adequate treatment. Therefore, the use of biological infection parameters is expected to improve patients' clinical outcome prognostic accuracy. In this study, we proposed a combination of decreased procalcitonin (PCT) and C-reactive protein (CRP) to predict the clinical outcome of severe pneumonia. Methods: This was a prospective cohort study of severe pneumonia patients treated in the single-center Intensive Care Unit (ICU) of Dr. Soetomo General Hospital from December 2023 to February 2024. Subjects who met the inclusion and exclusion criteria were examined for PCT and CRP within the first 24 hours of admission and repeated 96 hours later (day five). Clinical outcomes, including acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), septic shock, and 30-day mortality, were observed. Results: Thirty-five patients were enrolled for this study. Five subjects did not survive until the fifth day, and 30 subjects were eligible for analysis. A decrease of PCT >50% within five days was associated with a reduction of 30-day mortality (p=0.013) and septic shock incidence (p=0.005), whereas the decrease in CRP alone did not show any significant relationship towards any clinical outcome. The combination of a decreased PCT >50% and decreased CRP within five days could increase the prognostic specificity up to 88.9% in predicting 30-day mortality. Conclusion: Decreased PCT by more than 50% within 96 hours may predict the 30-day mortality rate and septic shock incidence in patients with severe pneumonia, while combining it with a decreased CRP expression would elevate prognostic specificity for severe pneumonia. [ABSTRACT FROM AUTHOR]

Severe COVID-19 infection management for a recipient of kidney transplant has debatable prognosis and treatment. We described the case of a COVID-19 infected 70 year old female, previously had renal transplantation in 2017. The patient took immunosuppressive agents as routine drugs for transplant recipient status and received lopinavir/ritonavir, hydroxychloroquine, and dexamethasone daily at the hospitalization. Specific question arises about renal transplant recipients being infected by COVID-19 – whether the infection will get worse compared to those without immunosuppresive agent. In this case, author decided to stop the immunosuppressive agent followed administration of combination lopinavir/ritonavir, hydroxychloroquine, and dexamethasone that gives a good clinical impact change to patient’s condition after once getting worsened and mechanically ventilated. Nevertheless, the assessment of risk and benefit in continuing immunosuppressive drugs is concurrently essential due to the prevention of transplant rejection. [ABSTRACT FROM AUTHOR]

Background: The incidence of hyperlactatemia due to hypoperfusion during cardiopulmonary bypass (CPB) increases morbidity. Carbon dioxide production during CPB is one of the lactate production markers, in addition to other markers such as delivery oxygen (DO2), oxygen consumption (VO2), mixed vein oxygen saturation (SvO2), and oxygen extraction ratio (O2ER)., Method: This observational analytic study was conducted on 40 adult cardiac surgery patients using a CPB machine. Initial lactate is taken when entering CPB and final lactate is examined 15 min after coming off bypass. The values of DO2, VO2, SvO2, VCO2, respiratory quotient (RQ), DO2/VCO2, PvCO2 × Ve/Q were calculated from the results of blood and venous gas analysis 1 h after entering CPB in the nadir of core temperature and lowest pump flow., Result: The multivariate test showed that the value of PvCO2 × Ve/Q was more effective than other oxygenation and carbon dioxide parameters in predicting an increase in the percentage of lactate. Each increase of 1 mmHg PvCO2 ×× Ve/Q can predict a final lactate increase of 29% from the initial lactate. The high PvCO2 × Ve/Q value is also the strongest correlation factor for the incidence of hyperlactatemia after CPB (final lactate >3 mmol/L). The cutoff value of this marker is >19.3 mmHg, which has a sensitivity of 100% and a specificity of 55.6% with a strong correlation value., Conclusion: The PvCO2 × Ve/Q value proved to be one of the significant markers in predicting hyperlactatemia during cardiac surgery using CPB., (Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.)