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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

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]

Medullary thyroid cancer (MTC) shows a relatively poor prognosis among thyroid cancers. Though calcitonin has been used as a diagnostic marker for MTC, it has disadvantages including poor sample stability and discrepancies among results by assay. This study aimed to compare the usefulness of preoperative calcitonin and procalcitonin (PCT) in the diagnosis of MTC. Serum calcitonin and PCT levels were measured before thyroidectomy from MTC (n = 23) and other types of thyroid cancers in patients (n = 1308). Diagnostic performances of calcitonin and PCT for discerning MTC were estimated. In a multivariate analysis, preoperative calcitonin level was independently associated with the diagnosis of MTC, whereas PCT was not. Calcitonin and PCT, respectively, exhibited area under the curve values of 0.997 and 0.979 for the diagnosis of MTC, without significant differences. For calcitonin, the sensitivity, specificity, and positive and negative predictive values were 0.957, 0.992, 0.688, and 0.999, respectively, at a cut-off of 7.2 pg/mL. The corresponding values for PCT were 0.913, 0.995, 0.778, and 0.998 at a cut-off of 0.19 ng/mL. Preoperative calcitonin and PCT showed similar diagnostic utility for MTC. Depending on the patient's clinical status and laboratory environment, these tests can be used as complementary methods for detecting MTC. [ABSTRACT FROM AUTHOR]

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To explore the usefulness of neutrophil-to-lymphocyte count ratio (NLR), procalcitonin (PCT), and interleukin-6 (IL-6) for the severity assessment of bacterial sepsis. This study enrolled 100 patients with bacterial sepsis (disease group) who presented to Jinhua Central Hospital between March 2022 and March 2023 and 90 healthy individuals (control group). The patients were categorized into sepsis (64 cases), severe sepsis (18 cases), and septic shock (18 cases) groups according to the disease severity. The groups were compared in terms of the NLR, PCT, and IL-6, as well as the usefulness of these parameters, both alone and in combination, for the severity assessment of bacterial sepsis. The NLR, PCT, and IL-6 levels were significantly different among the three groups, with increasing values corresponding with disease aggravation. The area under the curve (AUC) values of the combinations of NLR, PCT, and IL-6 levels were higher than those of single markers. The sensitivity and AUC value of the combination of PCT and IL-6 levels were the highest (0.87), with a similar AUC value of the combination of NLR, PCT, and IL-6 (0.865); however, the specificity was significantly improved with the latter (0.938 vs. 0.859). NLR, PCT, and IL-6 levels are significantly increased in bacterial sepsis, and the combination of PCT, and IL-6 levels can improve the sensitivity of the evaluation ability for severe sepsis, and is more economical. [ABSTRACT FROM AUTHOR]

Objective: This study sought to assess the sensitivity, specificity, and predictive utility of serum procalcitonin (PCT) in the diagnosis of pediatric osteomyelitis. Methods: A systematic computer-based search was conducted for eligible literature focusing on PCT for the diagnosis of osteomyelitis in children. Records were manually screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analysis was performed using Review Manager software 5.3, Meta-disc software1.4, STATA 12.0, and R 3.4 software. Result: A total of 5 investigations were included. Of these, 148 children with osteomyelitis were tested for bacterial cultures in PCT. For PCT in the diagnosis of pediatric osteomyelitis, diagnostic meta-analysis revealed a pooled sensitivity and specificity of 0.58 (95% confidence interval (CI): 0.49 to 0.68) and 0.92 (95% CI: 0.90 to 0.93) respectively. The PCT had the greatest area under the curve (AUC) at 0.80 for the diagnosis of osteomyelitis in children. The Deeks' regression test for asymmetry results indicated that there was no publication bias when evaluating publication bias (P = 0.90). Concusion: This study provided a comprehensive review of the literature on the use of PCT in pediatric osteomyelitis diagnosis. PCT may be used as a biomarker for osteomyelitis diagnosis; however, its sensitivity was low. It still needs to be validated by a large sample study. [ABSTRACT FROM AUTHOR]

Severe acute respiratory infections, such as community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, constitute frequent and lethal pulmonary infections in the intensive care unit (ICU). Despite optimal management with early appropriate empiric antimicrobial therapy and adequate supportive care, mortality remains high, in part attributable to the aging, growing number of comorbidities, and rising rates of multidrug resistance pathogens. Biomarkers have the potential to offer additional information that may further improve the management and outcome of pulmonary infections. Available pathogen-specific biomarkers, for example, Streptococcus pneumoniae urinary antigen test and galactomannan, can be helpful in the microbiologic diagnosis of pulmonary infection in ICU patients, improving the timing and appropriateness of empiric antimicrobial therapy since these tests have a short turnaround time in comparison to classic microbiology. On the other hand, host-response biomarkers, for example, C-reactive protein and procalcitonin, used in conjunction with the clinical data, may be useful in the diagnosis and prediction of pulmonary infections, monitoring the response to treatment, and guiding duration of antimicrobial therapy. The assessment of serial measurements overtime, kinetics of biomarkers, is more informative than a single value. The appropriate utilization of accurate pathogen-specific and host-response biomarkers may benefit clinical decision-making at the bedside and optimize antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Background/aim: Early detection and prognosis of sepsis in critically ill children is crucial. The aim of this research was to investigate the prognostic ability of pancreatic stone protein (PSP) in validating sepsis and predicting mortality in a prospective observational study. Materials and methods: In a single-center study, pediatric intensive care unit patients were divided into cohorts of confirmed and suspected sepsis, as well as survivors and nonsurvivors. Patients with positive blood culture growth were considered to have confirmed sepsis, while their negative counterparts were considered to have suspected sepsis. Comparisons were made between complete blood counts, laboratory parameters, mortality indices, and C-reactive protein (CRP), procalcitonin (PCT), and PSP levels. The correlations between PSP and alternative inflammatory markers and mortality indices were then analyzed. The diagnostic and prognostic applicability of PSP for sepsis confirmation and mortality prediction was assessed using receiver operating characteristic curve analysis. Results: PSP levels were significantly elevated in patients with confirmed sepsis and within the nonsurvivor segment. In confirming sepsis and predicting mortality, PSP outperformed CRP and PCT in terms of sensitivity. It had sensitivity of 95% in diagnosing sepsis at a cut-off level of 50 ng/L, with an area under the curve (AUC) of 0.67 (95% CI: 0.52-0.81), and sensitivity of 92% in predicting mortality, with an AUC of 0.71 (95% CI: 0.56-0.83). In addition, PSP showed significant correlations with CRP, PCT, and mortality scores. Conclusion: PSP is emerging as a highly sensitive marker for confirming sepsis and predicting mortality in critically ill pediatric patients. Incorporating the PSP biomarker into routine clinical practice could potentially improve the management of pediatric sepsis. [ABSTRACT FROM AUTHOR]

Background: Bacterial meningoencephalitis presents significant diagnostic and therapeutic challenges with high morbidity and mortality in pediatric populations worldwide. The early and precise identification of the etiology of these infections is essential for effective treatment and better patient results. Traditional diagnostic methods, while effective, can be time-consuming. This manuscript aims to evaluate the accuracy of serum procalcitonin (PCT), cerebrospinal fluid (CSF) neutrophil-to-lymphocyte ratio (NLR), and CSF lactate as biomarkers in pediatric bacterial meningoencephalitis. Methods: From March 2021 to November 2023, a cross-sectional study was conducted at Dr. Sardjito General Hospital, a tertiary referral hospital in Yogyakarta, Indonesia. One hundred ninety-seven patients underwent complete clinical and laboratory examinations before being divided into bacterial and non-bacterial groups based on CSF culture results and cytochemical profiles. The diagnostic accuracy was evaluated by the receiver operating characteristic curve using Statistical Package for the Social Sciences. Results: Serum PCT, CSF NLR, and CSF lactate levels showed a notable increase in the bacterial meningoencephalitis group (mean = 4.63 ± 5.52 ng/ml, 4.39 ± 6.68, and 3.59 ± 2.38 mmol/l, respectively) compared to the viral/aseptic group (mean = 0.51 ± 0.88 ng/ml, 0.33 ± 0.95, and 2.25 ± 2.33 mmol/l, respectively) (P < 0.001). Serum PCT and CSF NLR combined measurement had high sensitivity (86.4%) and specificity (88.6%), with an area under the curve of 0.929 (95% confidence interval, 0.873--0.985), surpassing other tested biomarkers. Conclusion: The findings suggest that combining serum PCT and CSF NLR could be beneficial for early diagnosis, potentially allowing timely, targeted treatment and differentiating between bacterial and non-bacterial infections, ultimately improving patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the presepsin and procalcitonin significance in cord blood and compare with lactate and C-Reactive protein for early prediction of neonatal sepsis. Study Design: Case Control Study. Setting: Military Hospital Rawalpindi. Period: Sep 2018 to July 2019. Methods: Mothers, having deliveries with early or prolonged rupture of membrane, preterm, dai handled, meconium and failure of induction have been included. Out of 60 neonates, nineteen were cases with a clearly documented suspicion of sepsis and confirmed by neonatologists, remaining were control. Mean and Standard Deviation were calculated. The difference in all biochemical markers levels among case and control groups were assessed by independent t-test. Sensitivity, specificity, accuracy, and predictive value of both markers were calculated by medcalc diagnostic calculator. Regression analysis to access the strength. Receiver Operating Characteristics curve for most accurate cut off values and Area Under the Curve was calculated. Results: Independent sample t test revealed the strong association of procalcitonin and presepsin with neonatal sepsis. Presepsin has higher positive predictive value 83.33% and negative predictive value 90.48% with 88.33% accuracy while procalcitonin has positive predictive value 62.50%, negative predictive value 88.89% and accuracy 78.33%. Stepwise regression analysis showed better in combination than single in predication of neonatal sepsis. The cutoff value for procalcitonin was 0.4ng/ml (AUC of 84.5%.) and for presepsin was 305pg/ml (AUC of 86.5%). Conclusion: In comparison to lactate and CRP, a prediction model that incorporates two biochemical indicators, procalcitonin and presepsin, can reduce infant mortality and morbidity by spotting neonatal sepsis early. [ABSTRACT FROM AUTHOR]

Introduction: Early antibiotic discontinuation in clinically suspected ventilator-associated pneumonia (VAP) may lead to infection relapse/recurrence and increase mortality. This study aimed to evaluate the incidence and potential predictors of treatment failure with this approach. Methodology: A retrospective observational study was conducted between September 2014 and November 2016 in a mixed intensive care unit. We included clinically suspected VAP patients whose quantitative sputum cultures from endotracheal aspirate were negative, allowing antibiotic discontinuation within 24 hours. Patients were monitored for signs and symptoms of recurrent VAP. Incidence and risk factors for treatment failure, defined as pneumonia recurrence, were determined using univariate logistic regression analysis and receiver operating characteristic (ROC) curves. Results: Forty-three patients met the inclusion criteria. The incidence of treatment failure among culture-negative VAP following early antibiotic discontinuation was 27.9% (12 patients). There were no significant differences in procalcitonin levels, leukocyte counts or body temperature between the two groups, except for the modified clinical pulmonary infection score (mCPIS) (5.42 ± 2.19 versus 3.9 ± 1.54, p = 0.014). Procalcitonin levels at VAP diagnosis and antibiotic cessation both showed low predictive capacity for treatment failure (AUC 0.56, CI 95% 0.36--0.76 and AUC 0.57, CI 95% 0.37--0.76, respectively). However, combining mCPIS with procalcitonin improved the predictive value for treatment failure (AUC 0.765, CI 95% 0.56--0.96). Conclusions: Early antibiotic discontinuation may lead to a high incidence of treatment failure among culture-negative VAP patients. Procalcitonin alone should not guide antibiotic discontinuation decisions while combining mCPIS and procalcitonin enhances predictive accuracy for treatment failure. [ABSTRACT FROM AUTHOR]

Introduction: Comparison of the marker kinetics procalcitonin, presepsin, and endotoxin during extracorporeal hemoperfusion with polymyxin-B adsorbing cartridge (PMX-HA) has never been described in abdominal sepsis. We aimed to compare the trend of three biomarkers in septic post-surgical abdominal patients in intensive care unit (ICU) treated with PMX-HA and their prognostic value. Methods: Ninety abdominal post-surgical patients were enrolled into different groups according to the evidence of postoperative sepsis or not. Non-septic patients admitted in the surgical ward were included in C group (control group). ICU septic shock patients with endotoxin levels <0.6 EAA receiving conventional therapy were addressed in S group and those with endotoxin levels ≥0.6 EAA receiving treatment with PMX-HA, besides conventional therapy, were included in SPB group. Presepsin, procalcitonin, endotoxin and other clinical data were recorded at 24 h (T0), 72 h (T1) and 7 days (T2) after surgery. Clinical follow-up was performed on day 30. Results: SPB group showed reduced levels of the three biomarkers on T2 versus T0 (p < 0.001); presepsin, procalcitonin and endotoxin levels decreased, respectively, by 25%, 11%, and 2% on T1 versus T0, and 40%, 41%, and 26% on T2 versus T0. All patients in C group, 73% of patients in SPB group versus 37% of patients in S group survived at follow-up. Moreover, procalcitonin had the highest predictive value for mortality at 30 days, followed by presepsin. Conclusion: The present study showed the reliability of presepsin in monitoring PMX-HA treatment in septic shock patients. Procalcitonin showed better predicting power for the mortality riSsk. [ABSTRACT FROM AUTHOR]

The occurrence of bacteremia is critically important for the survival of cancer patients. Therefore, our study aims to evaluate the efficacy of procalcitonin (PCT) and the procalcitonin to albumin ratio (PAR) in predicting bacteremia among this population. In this retrospective test-negative case-control study, we included 903 hospitalized cancer patients, divided into two groups: the bacteremia-positive group (BSI group, n = 384) and the bacteremia-negative group (non-BSI group, n = 519). We assessed the diagnostic significance of PCT and PAR through receiver operating characteristic (ROC) analysis and determined the optimal cut-off values using Youden's index. Both the duration of hospital stay and the 30-day mortality rate were significantly higher in the BSI group. The areas under the curve (AUC) for PAR and PCT were 0.749 (95% CI: 0.715-0.782) and 0.742 (95% CI: 0.708-0.776), respectively, indicating higher levels in the BSI group. The optimal cut-off values for predicting bacteremia were 0.72 for PAR and 1.32 for PCT. PAR showed the highest specificity (92.7%) and positive predictive value (PPV = 83.4%), while PCT demonstrated the highest sensitivity (51.3%) and negative predictive value (NPV = 71.6%). This study is the first in the literature to suggest that PAR and PCT are valuable biomarkers for diagnosing bacteremia in cancer patients. The identified cut-off values offer practical thresholds for bacteremia diagnosis. [ABSTRACT FROM AUTHOR]

The use of procalcitonin (PCT) has grown over the past decade with increasing reliance on the test to rule out bacterial infection. We retrospectively reviewed the medical records of children <18 years old hospitalized at a tertiary care children's hospital from 2017 to 2019 who had PCT testing performed during their admission. Of 4135 PCT levels collected on 1530 children, 982 (23.7%) were diagnostically low and 1993 (48.1%) were diagnostically elevated. Pediatric intensive care, with 6% of total hospital patients, obtained 41.4% of tests. Thirty-one (2%) patients had an average of 27 PCT levels per patient, accounting for 20% of all tests. Many children had symptoms for which testing is not indicated (eg, skin complaints). The differences in PCT testing by service, inappropriate patterns of repeat testing, and testing performed in patients for whom it is not indicated may identify targets for diagnostic stewardship. [ABSTRACT FROM AUTHOR]

Introduction: Anastomotic leak (AF) is a surgical complication, with an incidence of 2-14% and a mortality rate of 5-22%. The diagnosis is based on clinical and radiological criteria; it is associated with re-interventions, longer hospital stay and costs. Aim: To evaluate the use of C-reactive protein (CRP) and procalcitonin (PCT) as early predictors of anastomotic leak (AL) in elective colon surgery. Material and Method Prospective observational study. 107 patients who underwent a partial colectomy for cancer with elective primary anastomosis in the Hospital Hernán Henríquez Aravena surgery unit in Temuco from April 2019 to April 2022. CRP and PCT were measured in all patients in the first 4 postoperative days. The primary measurement outcome was to determine the sensitivity, specificity, and negative predictive value (NPV) of CRP and PCT for AF. Results: 7.4% of the total presented AL. The PCT and CRP values were high in all the patients tending to normalization on the fourth postoperative day, except in the presence of a postoperative complication. The ROC curve analysis showed an area under the curve of 93% and 75% for CRP and PCT respectively on the third postoperative day, with this being the best combination. Conclusion Both PCT and CRP are useful predictors of AL, with a high NPV on the third postoperative day. These precede the clinic and require an imaging study to confirm the diagnosis and act immediately to reduce the morbidity and mortality associated with this complication. [ABSTRACT FROM AUTHOR]

Objective: To determine the factors associated with the procalcitonin levels in newborns with hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia (TH). Materials and Methods: The neonates, who had moderate/severe HIE and were treated with TH, were included. The neonates were arranged into 2 groups by procalcitonin (PCT) level after rewarming was completed. The neonates who had a procalcitonin level of < 2.5 ng/ml constituted Group 1 and the ones who had a procalcitonin level of ≥ 2.5 ng/ml constituted Group 2. Univariate and multivariate logistic regression was used to assess the factors related with PCT level. Results: The first group included 123 (87.9%) neonates and the second group included 17 (12.1%) neonates. The median gestational age was 38 (36-39) weeks and the mean birth weight was 3081.7 ± 552.8 grams. In group 2, the rates for severe HIE, cesarean section, antibiotic switch, convulsion, inotrope use and mortality were higher, and duration of hospitalization was longer, whereas Apgar scores were lower (P < .05). The risk of a high procalcitonin level was found to be 6-fold (95% CI 1.9-19.1) higher in severe HIE and 5.2-fold higher (95% CI 1.7-16) in cesarean delivery. Conclusion: In neonates with HIE/TH, high post-rewarming procalcitonin levels were related with severe HIE and cesarean delivery. Some other clinical and laboratory findings, which may reflect worse clinical status, were also associated with high procalcitonin levels. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess through of machine learning classification algorithms the predictive value of inflammation biomarkers for fatal outcomes in patients with different severity by COVID-19. MATERIALS AND METHODS: A retrospective, observational study evaluated clinical records of Mexican patients from March 2021 to January 2022 using a systematic sampling method. Demographic and clinical values including D-dimer, procalcitonin, ferritin and fibrinogen of each patient were used as predictors. RESULTS: There were included 191 patients. Analysis of different machine learning algorithms showed that the kernel support vector machine algorithm showed the better performance achieving 0.80 accuracy, 0.06 standard deviation and 0.71 sensitivity. Additionally, D-dimer (OR: 1.0032 [1.0130, 1.7230], p < 0.05; ROC: 0.580), ferritin (OR: 1.023 [1.019, 1.843], p < 0.05; ROC: 0.885), and ferritin/procalcitonin ratio (OR: 1.324 [1.012, 1.478], p < 0.05; ROC: 0.859) were potential predictors of progression and fatal events due to COVID-19. CONCLUSIONS: The machine learning classification algorithms could be useful to the prediction of the severity and fatal events in infectious outbreaks. In this study, it was shown that D-dimer is a good predictor of severity and fatal outcomes due to COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we investigated the correlation and clinical significance of peripheral blood leukocytes, neutrophils, C-reactive protein (CRP), and procalcitonin (PCT) in patients with acute urticaria. Methods: Complete blood count with differential, CRP, and PCT tests were conducted on patients with acute urticaria. A total of 614 patients with acute urticaria were divided into three groups: the first group consisted of patients with elevated leukocyte and neutrophil count, the second group consisted of patients with normal leukocyte and neutrophil count, and the third group consisted of patients with abnormal leukocyte and neutrophil count. A correlation analysis was conducted to investigate the levels of leukocytes, neutrophils, CRP, and PCT in the three groups. Results: The results of Kruskal-Wallis' nonparametric test revealed statistically significant variations in leukocytes, neutrophils, CRP, and PCT among the three groups (p < 0.001). However, CRP and PCT showed no statistically significant differences between the second and third groups (p < 0.001, p = 0.0041, p = 0.0032). Additional multiple comparisons in Spearman correlation analysis indicated statistically significant differences (p = 0.55). Across all groups, there was a statistically significant difference in the correlation between CRP-PCT and leukocytes-neutrophils (p = 0.53). Conclusion: Leukocytes and neutrophils are sensitive to the impact of medications and stress on the body. Combining CRP and PCT, as well as routine blood test, may be a comprehensive assessment of infection presence and severity in patients, providing guidance for antibiotic treatment. [ABSTRACT FROM AUTHOR]

Objective: To explore the evaluation value of peripheral blood red blood cell distribution width (RDW), procalcitonin (PCT) and lactic acid for severity of neonatal septicemia (NS). Methods: A total of 132 children with NS admitted to the hospital were enrolled as the research objects between May 2019 and December 2022. According to neonatal critical illness score (NCIS), children were divided into non-critical group(>90 points, 94 cases) and critical group (70-90 points, 38 cases). The levels of peripheral blood RDW, PCT and lactic acid in the two groups were compared. The diagnostic value of the above three indexes for critical NS was evaluated by receiver operating characteristic (ROC) curves, and their correlation with disease severity was analyzed by Spearman analysis. Results: The proportion of gestational age <37 weeks in critical group was higher than that in non-critical group, while birth weight was lower than that in non-critical group (P<0.05). The levels of peripheral blood RDW, PCT and lactic acid in critical group were higher than those in non-critical group (P<0.05). The results of ROC curves analysis showed that area under the curve (AUC) values of RDW, PCT, lactic acid and combined detection for evaluating critical NS were 0.844, 0.645, 0.643 and 0.874, respectively(P<0.05). Spearman analysis showed that RDW, PCT and lactic acid were positively correlated with disease severity in NS children (P<0.05). Conclusion: The peripheral blood RDW, PCT and lactic acid are closely related to disease severity in NS children. Clinically, combined detection of the three indexes can be applied to evaluate disease severity in NS children. [ABSTRACT FROM AUTHOR]

Objective: To explore the therapeutic effect of bacterial dissolution product capsules on children with bronchial asthma (BA) and their impact on levels of serum C-reactive protein (CRP), amyloid A (SAA), procalcitonin (PCT), and exhaled nitric oxide (FeNO). Methods: The research subjects were selected from children with BA who were treated in our hospital from December 2021 to July 2023. A total of 80 cases were included and divided into the group A and the group B, with 40 cases in each group. The grouping method was random number table method. Both groups were given routine symptomatic treatment, using inhaled budesonide suspension to treat the group A patients. On the basis of treatment for the group A patients, bacterial dissolution product capsules were used to treat the group B patients. The clinical efficacy, recovery progress, lower respiratory tract infection, upper respiratory tract infection, frequency of asthma attacks during treatment, lung function, levels of serum CRP, SAA, PCT, FeNO before and after 3 months of treatment, and evaluate the safety during treatment between two groups were compared. Results: After 3 months of treatment, the rate of total effective in the group B was 95.00%, which was higher than 77.50% of the group A(P<0.05). Compared with the the group A, the relief and disappearance time of cough in the group B were shorter; During treatment, The frequency of lower respiratory tract infections, upper respiratory tract infections, and asthma attacks in the group B were all lower than those in the group A (P<0.05). Compared with before treatment, after 3 months of treatment, the lung function indicators of both groups increased, and compared with the the group A, the group B was higher(P<0.05). Compared with before treatment, after 3 months of treatment, the levels of serum CRP, SAA, PCT, and FeNO in both groups decreased, and compared with the the group A, the group B was lower (P<0.05). During the treatment period, there was no significant difference in the incidence of adverse reactions between the group B and the group A (22.50% vs 17.50%, P>0.05). Conclusion: Bacterial dissolution product capsules could significantly promote the relief of asthma and respiratory infection symptoms in children with BA, improve lung function, alleviate inflammatory reactions in children, and thus improve treatment effectiveness with good safety. [ABSTRACT FROM AUTHOR]

Objective: To investigate the changes of serum brain natriuretic peptide (BNP), procalcitonin (PCT) and recombinant single Ig IL1 related receptor (SIGIRR) in patients with emergency abdominal infection-related sepsis and their relationship with prognosis. Methods: 318 patients with emergency abdominal infection who were received by our hospital from January 2020 to October 2023 were divided into simple infection group (n=233) and sepsis group (n=85) according to whether sepsis occurred. The baseline data and serum BNP, PCT and SIGIRR levels were compared between groups. Pearson correlation analysis was used to explore the correlation between serum indicators and clinical data. The patients in sepsis group were classified into survival group (n=56) and death group (n=29) by means of survival status within 28 days, and the baseline data, serum BNP, PCT and SIGIRR were compared. Binary logistics equation was used to analyze the related influencing factors of prognosis of patients with sepsis. ROC curve was adopted to analyze the diagnostic value of serum BNP, PCT and SIGIRR levels on prognosis of sepsis group. Results: There were significant differences in pathogen types, WBC, CRP, ALB, APACHE II score and SOFA score between simple infection group and sepsis group (P<0.05). The levels of serum BNP, PCT and SIGIRR in simple infection group were significantly lower than those in sepsis group (P<0.05). Pearson correlation analysis showed that the levels of BNP, PCT and SIGIRR in sepsis group were positively correlated with WBC, CRP, APACHE II score and SOFA score (P<0.05), and were negatively correlated with ALB (P<0.05). Among patients with sepsis, the levels of serum BNP, PCT and SIGIRR were significantly higher in death group than those in survival group(P<0.05). Binary logistics regression analysis showed that serum BNP, PCT and SIGIRR levels were associated with poor prognosis in patients with sepsis(P<0.05). ROC curve revealed that the AUCs of serum BNP, PCT, SIGIRR alone and in combination in predicting the poor prognosis in patients with sepsis were 0.876, 0.826, 0.779 and 0.976, the sensitivities were 86.21%, 82.76%, 75.86% and 96.55%, and the specificities were 75%, 75%, 71.43% and 69.64% respectively, and the combined diagnostic value was higher. Conclusion: BNP, PCT and SIGIRR have a certain correlation with patients with abdominal infection-related sepsis, and can be used as reference indicators for clinical diagnosis, treatment and prognosis evaluation. [ABSTRACT FROM AUTHOR]

Aim: To assess the hypothesized that platelet activation markers triggered by common infections may help predicting occurrence of sepsis in specific ICU patient populations. Material and Methods: The present prospective study was conducted in patients >18 years of age, admitted at P.D. Hinduja Hospital and Medical Research Center in the Intensive care unit (ICU) with acute febrile illness. Any patient fulfilling the inclusion criteria, admitted as an in-patient to this hospital during a period of 12 consecutive months was included in the study. Group I Patients Admitted in ICU with fever and proven to have sepsis (confirmed by positive blood culture) Group II Patients admitted in ICU with fever and having no proven sepsis (blood culture is negative), The q-SOFA score was recorded with IPF was compared with PCT and blood culture. q-SOFA score was compared in both the groups. Results:q - SOFA score comparison- group I,q - SOFA = 2 or > 2( 83.60 ./.) as compared to group II q - sofa =1 (91.9./.) with statistically significant. P value = 0.001 All the parameters of SIRS criteria viz. temperature (°C), HR (beats/min), breath rate (/min), WBC (x10³/ul) and immature forms (%) were comparable among the study groups as p>0.05. Sensitivity, specificity, negative predictive value and positive predictive value in diagnosis of sepsis (considering culture as gold standard) was 77 %,76%,75%,70.5%respectively. Conclusion: Using IPF initially to recognize patients of sepsis, can lead to reduction in morbidity and mortality of these patients. Measurement of the IPF is simple, and cost-effective. It can be done as part of a CBC on most automated hematology analyzers. [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]

Background: This study aims to investigate the early kinetics of interleukin 6 (IL‐6), procalcitonin (PCT), and C‐reactive protein (CRP) on initial antibiotic efficacy in hematological disorder patients with febrile neutropenia (FN). Methods: A total of 40 patients with 43 episodes of FN were enrolled and divided into initial antibiotic effective group (IAE group, n = 24) and initial antibiotic ineffective group (IAI group, n = 19). The levels of IL‐6, PCT, and CRP before antibacterial treatment (T0), and 12 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4) post‐antibacterial treatment were determined, respectively. Furthermore, the receiver operating characteristic curve (ROC) analysis was performed to evaluate the clinical value of indicators. Results: In IAE group, the IL‐6 levels gradually decreased from T0 to T4, and the CRP levels significantly decreased at 48 to 72 h, whereas both IL‐6 and CRP remained at high levels in the IAI group. The PCT levels in both groups increased at the early stage of anti‐infection (T1–T2) and reached to peak at T1–T2 in effective group. ROC curve analysis identified IL‐6 as a predictive biomarker for initial antibiotic efficacy at 12, 48, and 72 h after treatment, with the AUC of 0.698, 0.744, and 0.821, respectively. In addition, CRP demonstrated predictive ability of initial antibiotics against infection at 24, 48, and 72 h after therapy, with the AUC of 0.724, 0.741, and 0.797, respectively. ROC curve analysis of percentage changes demonstrated that IL‐6 percentage change showed predictive ability of antibiotic efficacy at the early stage, and both the IL‐6 and CRP percentage changes showed the predictive ability of antibiotic efficacy 48 or 72 h after antibiotics therapy. Conclusion: This study confirmed IL‐6 and CRP levels, and the percentage change in IL‐6 as the biomarkers for initial antibiotic efficacy prediction in hematological disorder patients with FN. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to evaluate the combined diagnostic value of procalcitonin (PCT), C-reactive protein (CRP), and serum amyloid A (SAA) in sepsis caused by urinary tract infection. Method: A total of 80 patients with urosepsis who were hospitalized were included in the study group, and 80 patients with urinary tract infection without sepsis were included in the control group. We collected the PCT, SAA, and CRP levels of patients following admission. Subsequently, we conducted a comparative analysis to assess the specificity, accuracy, and sensitivity of combined diagnostic approaches in contrast to individual diagnostic methods for blood PCT, SAA, and CRP. Results: The levels of PCT, SAA, and CRP in the study group were significantly higher than those in the control group, and the differences were statistically significant (P < 0.01). Multi-factor logistic regression analysis revealed that the levels of PCT (P = 0.003) and SAA (P = 0.014) were associated with urosepsis. The sensitivity of PCT was 87.133% and the specificity was 93.066%, which were higher than that of SAA and CRP. The specificity of the combined detection of the three was 95.670%, which was higher than that of PCT, SAA, and CRP alone. Correlation analysis revealed that PCT had a significant positive correlation with CRP and SAA (P < 0.01), and a weak correlation with white blood cell count (WBC) and fibrinogen (FIB) (P = 0.03 for WBC, P = 0.04 for FIB). Conclusion: PCT, SAA, and CRP indicators in patients with urosepsis are significantly elevated, and all three are valuable in the diagnosis of urosepsis. PCT alone has good diagnostic efficiency for urosepsis, and a certain correlation with other inflammatory factors. The diagnostic efficacy of the three indicators in combination is better than that of any one of the three, and is worthy of widespread clinical application. [ABSTRACT FROM AUTHOR]

Introduction: The number of elderly patients who require surgery as their primary treatment has increased rapidly in recent years. Among 300 million people globally who underwent surgery every year, patients aged 65 years and over accounted for more than 30% of cases. Despite medical advances, older patients remain at higher risk of postoperative complications. Early diagnosis and effective prediction are essential requirements for preventing serious postoperative complications. In this study, we aim to provide new biomarker combinations to predict the incidence of postoperative intensive care unit (ICU) admissions > 24 h in elderly patients. Methods: This investigation was conducted as a nested case–control study, incorporating 413 participants aged ≥ 65 years who underwent non-cardiac, non-urological elective surgeries. These individuals underwent a 30-day postoperative follow-up. Before surgery, peripheral venous blood was collected for analyzing serum creatinine (Scr), procalcitonin (PCT), C-reactive protein (CRP), and high-sensitivity CRP (hsCRP). The efficacy of these biomarkers in predicting postoperative complications was evaluated using receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) values. Results: Postoperatively, 10 patients (2.42%) required ICU admission. Regarding ICU admissions, the AUCs with 95% confidence intervals (CIs) for the biomarker combinations of Scr × PCT and Scr × CRP were 0.750 (0.655–0.845, P = 0.007) and 0.724 (0.567–0.882, P = 0.015), respectively. Furthermore, cardiovascular events were observed in 14 patients (3.39%). The AUC with a 95% CI for the combination of Scr × CRP in predicting cardiovascular events was 0.688 (0.560–0.817, P = 0.017). Conclusion: The innovative combinations of biomarkers (Scr × PCT and Scr × CRP) demonstrated efficacy as predictors for postoperative ICU admissions in elderly patients. Additionally, the Scr × CRP also had a moderate predictive value for postoperative cardiovascular events. Trial Registration: China Clinical Trial Registry, ChiCTR1900026223. [ABSTRACT FROM AUTHOR]

Objective: Despite the successful application of spinal instrumentation surgery, the development of surgical site infections (SSIs) remains inevitable even in the most experienced neurosurgery clinics. The aim of this study was to analyze potential risk factors, reassess diagnosis and treatment, and discuss outcomes in line with the literature. Materials and Methods: The records of 1564 patients who underwent spinal instrumentation surgery between 2016 and 2023 were retrospectively reviewed. Among these patients, 297 developed superficial or deep SSIs in the postoperative period. Diagnosis was based on postoperative positive wound cultures, intraoperative cultures, serum procalcitonin and C-reactive protein (CRP) levels measured in the postoperative period, and gadolinium-enhanced magnetic resonance imaging (MRI) and computed tomography scan. Demographic characteristics and preoperative risk factors of the patients were analyzed. Results: SSIs were observed in 297 (18.9%) out of 1564 patients who underwent spinal instrumentation surgery. Multiple risk factors for spinal infections following spinal instrumentation surgery, which can manifest in both the early and delayed postoperative periods, were identified. Early diagnosis and prompt initiation of appropriate treatment were associated with better prognosis in 215 patients. Among the 82 patients diagnosed late, all underwent revision surgery for spinal implant removal due to failed medical treatment, with clinical outcomes in 23 of these patients not meeting post-operative expectations. The relationship between early and delayed diagnosis and the need for reoperation were statistically significant (p<0.001). Reoperation was required in 92.7% of patients with delayed diagnosis compared with 15.3% of patients with early diagnosis, indicating an approximately 11.6-fold higher risk of reoperation in patients with delayed diagnosis. Conclusion: Intraoperative culture results are the gold standard for diagnosing SSIs after spinal instrumentation surgery and are also valuable for selecting antimicrobial agents. Monitoring procalcitonin and CRP levels, along with MRI, is highly beneficial for diagnosis. Early detection requires fewer surgical interventions and improves clinical outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: The impact of inflammation on voriconazole exposure in oncohematological pediatric patients represents a debated issue. We aimed to investigate the impact of serum C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels on voriconazole exposure in oncohematological pediatric patients requiring allogeneic hematopoietic stem cell transplantation (HCT). (2) Methods: Pediatric patients undergoing allogeneic HCT and receiving therapeutic drug monitoring (TDM)-guided voriconazole as primary antifungal prophylaxis between January 2021 and December 2023 were included. The ratio between concentration and dose (C/D) of voriconazole was used as a surrogate marker of total clearance. A receiving operating characteristic curve analysis was performed by using CRP, PCT, or IL-6 values as the test variable and voriconazole C/D ratio > 0.188 or >0.375 (corresponding to a trough concentration value [Cmin] of 3 mg/L normalized to the maintenance dose of 16 mg/kg/day in patients of age < 12 years and of 8 mg/kg/day in those ≥12 years, respectively) as the state variable. Area under the curve (AUC) and 95% confidence interval (CI) were calculated. (3) Results: Overall, 39 patients were included. The median (IQR) voriconazole Cmin was 1.7 (0.7–3.0) mg/L. A CRP value > 8.49 mg/dL (AUC = 0.72; 95%CI 0.68–0.76; p < 0.0001), a PCT value > 2.6 ng/mL (AUC = 0.71; 95%CI 0.63–0.77; p < 0.0001), and an IL-6 value > 27.9 pg/mL (AUC = 0.80; 95%CI 0.71–0.88; p < 0.0001) were significantly associated with voriconazole overexposure. Consistent results were found in patients aged <12 and ≥12 years. (4) Conclusions: A single specific threshold of inflammatory biomarkers may be linked to a significantly higher risk of voriconazole exposure in oncohematological pediatric patients after HCT, irrespective of age. Adopting a TDM-guided strategy could be useful for minimizing the risk of voriconazole overexposure. [ABSTRACT FROM AUTHOR]

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

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: Bacterial meningoencephalitis presents significant diagnostic and therapeutic challenges with high morbidity and mortality in pediatric populations worldwide. The early and precise identification of the etiology of these infections is essential for effective treatment and better patient results. Traditional diagnostic methods, while effective, can be time-consuming. This manuscript aims to evaluate the accuracy of serum procalcitonin (PCT), cerebrospinal fluid (CSF) neutrophil-to-lymphocyte ratio (NLR), and CSF lactate as biomarkers in pediatric bacterial meningoencephalitis. Methods: From March 2021 to November 2023, a cross-sectional study was conducted at Dr. Sardjito General Hospital, a tertiary referral hospital in Yogyakarta, Indonesia. One hundred ninety-seven patients underwent complete clinical and laboratory examinations before being divided into bacterial and non-bacterial groups based on CSF culture results and cytochemical profiles. The diagnostic accuracy was evaluated by the receiver operating characteristic curve using Statistical Package for the Social Sciences. Results: Serum PCT, CSF NLR, and CSF lactate levels showed a notable increase in the bacterial meningoencephalitis group (mean = 4.63 ± 5.52 ng/ml, 4.39 ± 6.68, and 3.59 ± 2.38 mmol/l, respectively) compared to the viral/aseptic group (mean = 0.51 ± 0.88 ng/ml, 0.33 ± 0.95, and 2.25 ± 2.33 mmol/l, respectively) (P < 0.001). Serum PCT and CSF NLR combined measurement had high sensitivity (86.4%) and specificity (88.6%), with an area under the curve of 0.929 (95% confidence interval, 0.873–0.985), surpassing other tested biomarkers. Conclusion: The findings suggest that combining serum PCT and CSF NLR could be beneficial for early diagnosis, potentially allowing timely, targeted treatment and differentiating between bacterial and non-bacterial infections, ultimately improving patient outcomes.

Abstract Background Previous studies on PCT for urinary tract infections (UTI) have focused primarily on minors. This study investigated the predictive value of the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) level and procalcitonin (PCT) level in adult patients with bacteriuria in IUC. Methods This case‒control study included 85 patients with bacteriuria (PB) in the ICU from March 2021 to Jan 2024 based on positive urine culture results and a control group (n = 136) from Jan 2024 to March 2024. Patient data were collected using a hospital information management system. ROC curves of the NLR, CRP and PCT were use to predict the PB. Results The AUCs of the NLR, CRP and PCT for the prediction of PB in ICU were 0.711 (95% CI 0.644–0.772), 0.855 (95% CI 0.800–0.900), and 0.884 (95% CI 0.832–0.924), respectively; the optimal thresholds were 8.02, 18.52 mg/L, and 0.215 ng/mL, respectively; the sensitivities were 69.0 (95% CI 56.9–79.5), 90.1 (95% CI 80.7–95.9), and 83.1 (95% CI 72.3–91.0), respectively; and the specificities were 67.6 (95% CI 59.1–75.4), 68.4 (95% CI 59.9–76.1), and 80.9 (95% CI 73.3–87.1), respectively. The negative predictive value (NPV) of CRP is greater than that of PCT. In bacteriuria caused by Candida infections, CRP and PCT have higher sensitivity and NPV. Conclusions Combined CRP and PCT testing is more helpful for diagnosing bacteriuria. CRP and PCT have higher sensitivity and NPV in diagnosing bacteriuria caused by Candida infection.

Abstract Background to detect the role of procalcitonin, erythrocyte sedimentation rate to c-reactive protein (ESR/CRP) ratio, neutrophils-to-lymphocyte ratio (NLR), and platelets-to-lymphocyte ratio (PLR) in the diagnosis of infection in systemic lupus erythematosus (SLE) patients with fever, their diagnostic value to differentiate between infection and disease activity, and their correlation with disease activity. Methods Forty SLE patients and forty healthy control cases were included in the study. Disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K), and quality of life was assessed by Lupus QoL. A bacterial infection was detected by clinical symptoms and positive culture results. Laboratory tests were done for all patients and controls: complete blood count (CBC), ESR, CRP, and procalcitonin (PCT). NLR, PLR, and ESR/CRP ratios were calculated. Results There was a statistically significant difference between infected SLE patients and non-infected SLE patients regarding PCT (p

Introduction: Neonatal sepsis is a major cause of mortality in developing countries. Accurate and quick diagnosis are difficult because clinical presentation are non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Serum procalcitonin (PCT) has been proposed as an early marker of infections in neonates. Objectives: This study investigated the value of PCT in the diagnosis of Neonatal Sepsis. Methods: Neonates undergoing sepsis evaluation at the Special Baby Care Unit, Federal Medical Centre, Abeokuta, Nigeria between January and April 2013 were included. Blood samples were obtained for white cell count, blood cultures, serum CRP and PCT analysis. Neonates were categorised into Proven Sepsis,Suspected Sepsis and Clinical Sepsis groups on the basis of laboratory findings and risk factors. A control group with no clinical and biological data of infection was also included. Predictive values and area under the receiver operating characteristic curve (AUC) of PCT were evaluated. Result: Of the 85 neonates, 19 (22.4%) had positive blood culture. PCT level was significantly higher in neonates in all sepsis groups in comparison with those in the control group (P< 0.05). At a cut-off of 0.5 ng/ml, the negative predictive value (NPV) of PCT was 80% and the positive predictive value (PPV) 39%. There were no significant statistical difference between the AUC values of PCT in Early onset and Late nset sepsis, as well between AUC in Preterm and term cases. A higher percentage of neonates who died (96%) had elevated PCT levels compared to those who survived (46%). Conclusion: These findings support the usefulness of the PCT in diagnosis of Neonatal sepsis.

Background and Aims: Early diagnosis of sepsis is crucial. The primary objective of this study was to explore the role of uncoupling protein 2 (UCP2) in diagnosing sepsis and septic shock. Methods: This prospective observational study was conducted over 19 months. All adult patients aged more than 18 years with a diagnosis of sepsis or septic shock based on quick sequential organ failure assessment (qSOFA) score were enroled. Blood was drawn for procalcitonin (PCT) and UCP2 on days 0, 3, 7 and 28. Blood samples from 50 healthy volunteers were used as controls. An electrochemiluminescence test was done for PCT. A quantitative enzyme-linked immune sorbent assay was used for UCP2. The Chi-square test was used for qualitative variables and the independent t-test for quantitative variables. The receiver operator characteristic curve was used to evaluate the diagnostic efficacy of UCP2. Results: A total of 128 subjects were included in the study. Out of these, 78 patients (qSOFA score ≥2) were subcategorised into the infection group, sepsis or septic shock group based on the PCT levels. The UCP2 levels in the infection, sepsis or septic shock group were significantly higher than in the control group (P > 0.001). The UCP2 levels correlated with PCT on admission, day 3 and day 7. Conclusion: The UCP2 levels were significantly higher in sepsis and septic shock groups compared to controls and hence could be a potential diagnostic biomarker of sepsis.

Community-acquired pneumonia (CAP) poses a significant global health threat, particularly affecting vulnerable populations. Biomarkers and scoring systems play a crucial role in diagnosing, assessing severity, and guiding treatment decisions for CAP patients. Biomarkers like C reactive protein, procalcitonin, and the neutrophil-to-lymphocyte ratio aid in diagnosis and severity assessment, while scoring systems such as CURB-65 and Pneumonia Severity Index classify patients into risk categories. Emerging biomarkers (uremia, elevated respiratory rate, hypotension, and age ≥ 65) like serum amyloid A and S100 proteins show promise in predicting disease severity and prognosis. However, further research is needed to determine their precise roles and clinical utility in CAP management.

Abstract Objective This study sought to assess the sensitivity, specificity, and predictive utility of serum procalcitonin (PCT) in the diagnosis of pediatric osteomyelitis. Methods A systematic computer-based search was conducted for eligible literature focusing on PCT for the diagnosis of osteomyelitis in children. Records were manually screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Statistical analysis was performed using Review Manager software 5.3, Meta-disc software1.4, STATA 12.0, and R 3.4 software. Result A total of 5 investigations were included. Of these, 148 children with osteomyelitis were tested for bacterial cultures in PCT. For PCT in the diagnosis of pediatric osteomyelitis, diagnostic meta-analysis revealed a pooled sensitivity and specificity of 0.58 (95% confidence interval (CI): 0.49 to 0.68) and 0.92 (95% CI: 0.90 to 0.93) respectively. The PCT had the greatest area under the curve (AUC) at 0.80 for the diagnosis of osteomyelitis in children. The Deeks’ regression test for asymmetry results indicated that there was no publication bias when evaluating publication bias (P = 0.90). Concusion This study provided a comprehensive review of the literature on the use of PCT in pediatric osteomyelitis diagnosis. PCT may be used as a biomarker for osteomyelitis diagnosis; however, its sensitivity was low. It still needs to be validated by a large sample study.

Abstract Severe acute respiratory infections, such as community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, constitute frequent and lethal pulmonary infections in the intensive care unit (ICU). Despite optimal management with early appropriate empiric antimicrobial therapy and adequate supportive care, mortality remains high, in part attributable to the aging, growing number of comorbidities, and rising rates of multidrug resistance pathogens. Biomarkers have the potential to offer additional information that may further improve the management and outcome of pulmonary infections. Available pathogen-specific biomarkers, for example, Streptococcus pneumoniae urinary antigen test and galactomannan, can be helpful in the microbiologic diagnosis of pulmonary infection in ICU patients, improving the timing and appropriateness of empiric antimicrobial therapy since these tests have a short turnaround time in comparison to classic microbiology. On the other hand, host-response biomarkers, for example, C-reactive protein and procalcitonin, used in conjunction with the clinical data, may be useful in the diagnosis and prediction of pulmonary infections, monitoring the response to treatment, and guiding duration of antimicrobial therapy. The assessment of serial measurements overtime, kinetics of biomarkers, is more informative than a single value. The appropriate utilization of accurate pathogen-specific and host-response biomarkers may benefit clinical decision-making at the bedside and optimize antimicrobial stewardship.

Background: Sepsis is a fatal condition with high treatment costs, early identification of sepsis is mandatory to avoid lethal complications. The objective of this study was to compare the predictive capabilities of platelets to lymphocytes ratio (PLR) and procalcitonin (PCT) in determining the outcome of sepsis. Methods: This study was a prospective cross-sectional study and fifty-four individuals diagnosed with sepsis were involved. The participants were between the ages of twenty-one and sixty-five and had been admitted to ICU for more than twenty-four hours. The measurement of whole blood count and PCT serum levels was conducted at time of diagnosis, as well as on days three, seven, and fourteen following the onset of sepsis while SOFA score was conducted at time of admission. Results: There was important elevation in platelet to lymphocytes ratio value and PCT in non survivors group compared to survivors group at day one, three, and seven of diagnosis of sepsis (p value ≤ 0.05), and day fourteen there were no data in non survivors group. The Sequential Organ Failure Assessment (SOFA) score was found to be the most effective in mortality prediction [area under the curve (AUC) = 0.982] second effective was PCT (AUC = 0.977) and PLR was third (AUC = 0.945). Conclusions: In adult patients diagnosed with sepsis PLR with cutoff value > 228.89 demonstrates efficacy as a reliable prognostic indicator for predicting outcomes in sepsis. Although PLR may have a lower predictive power compared to PCT and SOFA score, it possesses the advantage of being a readily available and cost-effective technology. [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 To establish a model that can predict the occurrence of acute kidney injury (AKI) in elderly patients with HBV-related acute-on-chronic liver failure (HBV-ACLF), and to conduct a preliminary evaluation of the performance of the model. Methods A total of 276 patients with HBV-ACLF hospitalised in The First Affiliated Hospital of Harbin Medical University from January 2020 to January 2023 were retrospectively included and divided into 72 (26.09%) in the AKI group and 204 (73.91%) in the non AKI group, according to whether AKI occurred during hospitalisation. The clinical data of all patients were extracted and screened for independent risk factors for AKI during hospitalisation using multivariate logistic regression. A prediction model was constructed accordingly, and then the efficacy of the prediction model was evaluated using ROC curves. Results Multivariate logistic regression analysis showed that age ＞70 years (OR=1.404, 95%CI: 1.134～1.737), procalcitonin＞1 ng/L (OR=1.473, 95%CI: 1.074～2.019), model for end stage liver disease (MELD) score ＞34 (OR=1.702, 95%CI: 1.254～2.311), and combined upper gastrointestinal bleeding (OR=1.516, 95%CI: 1.123～2.047) were independent risk factors for the occurrence of AKI in HBV-ACLF patients during hospitalisation (P＜0.05). A prediction model for the occurrence of AKI in HBV-ACLF patients during hospitalisation was established based on the above four parameters, and the ROC curve showed that the AUC predicted by the model was 0.882 (95%CI: 0.838～0.917), with a sensitivity of 66.67%, a specificity of 93.14% and an accuracy of 86.23%. Conclusion Elderly, high MELD score and procalcitonin level, and concomitant upper gastrointestinal bleeding are independent risk factors for AKI in patients with HBV-ACLF during hospitalisation, and the model constructed accordingly can predict the risk of AKI, thus assisting clinical disease management.

Biomarkers are playing an increasingly important role in antimicrobial stewardship. Their applications have included use in algorithms that evaluate suspected bacterial infections or provide guidance on when to start or stop antibiotic therapy, or when therapy should be repeated over a short period (6–12 h). Diseases in which biomarkers are used as complementary tools to determine the initiation of antibiotics include sepsis, lower respiratory tract infection (LRTI), COVID-19, acute heart failure, infectious endocarditis, acute coronary syndrome, and acute pancreatitis. In addition, cut-off values of biomarkers have been used to inform the decision to discontinue antibiotics for diseases such as sepsis, LRTI, and febrile neutropenia. The biomarkers used in antimicrobial stewardship include procalcitonin (PCT), C-reactive protein (CRP), presepsin, and interleukin (IL)-1β/IL-8. The cut-off values vary depending on the disease and study, with a range of 0.25–1.0 ng/mL for PCT and 8–50 mg/L for CRP. Biomarkers can complement clinical diagnosis, but further studies of microbiological biomarkers are needed to ensure appropriate antibiotic selection.

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. [Med-Science 2024; 13(3.000): 649-53]

Sepsis is the major cause of morbidity and mortality for patients admitted to an intensive care unit worldwide. Currently, procalcitonin (PCT) is a widely used prognostic marker for sepsis. The high cost of estimating Procalcitonin limits its utility in all health facilities. Lipid profile, being a frequently done routine investigation, is studied in sepsis patients to predict the prognosis of sepsis. This study was aimed to assess the association between lipid profile parameters, procalcitonin and clinical outcomes in patients with sepsis.

Background: Respiratory infections are common infections reported among human beings. Infections involving the respiratory tract can be mild and transient and people tend to neglect them. The chief cause of lower respiratory tract infections (LRTIs) can be attributed to hospitalization. Materials and Methods: We conducted a retrospective, cross-sectional study from January 2021 to April 2021. The clinical, demographic, and microbiological characteristics of the patients admitted to adult respiratory ward (ARW), pediatric ward (PW), and medicine intensive care unit (MICU) were extracted from the electronic records and laboratory registers for this study. Results: We included 788 patients in this study from January 2021 to April 2021. The mean age of patients was 52.67 ± 20.15 years with a male predominance in ARW (248/383, 64.75%) and MICU (252/369, 68.29%) and a female predominance in PW (28/36, 77.78%). Most patients were admitted to the ARW (383/788, 48.60%) followed by the MICU (369/788, 46.83%). Bacterial growth was seen in 358 (358/788, 38.89%) respiratory samples. Blood culture was positive in 188 (188/788, 23.86%) samples. The most common microorganism causing LRTI and bloodstream infection was Klebsiella pneumoniae with an infection rate of 32.68% (117/358, 32.68%) and 25.53% (48/188, 25.53%), respectively. Total leukocyte count (P < 0.0001) and procalcitonin (P = 0.0113) were statistically significant diagnostic parameters associated with MDR isolates. Conclusion: This study establishes the range of bacteria obtained from the respiratory samples of LRTI patients and guides the clinicians in the administration of appropriate antibiotics according to the antibiotic susceptibility pattern to eliminate MDR.