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U ovome radu istraživana je korelacija feritina, troponina, laktatdehidrogenaze, C-reaktivnog proteina, prokalcitonina i D-dimera s kliničkim ishodom bolesnika na Odsjeku za intenzivno liječenje- COVID Opće bolnice Zadar. Cilj rada bio je istražiti povezanost između: feritina, troponina, laktatdehidrogenaze, C-reaktivnog proteina, prokalcitonina i D-dimera s kliničkim ishodom bolesnika oboljelih od COVID-19 na Odsjeku za intenzivno liječenje- COVID Opće bolnice Zadar. Hipoteza je pretpostavka poremećaja korelacije nalaza feritina, troponina, laktat-dehidrogenaze, C-reaktivnog proteina, prokalcitonina i D-dimera s kliničkim ishodom bolesnika na Odsjeku za intenzivno liječenje- COVID u Općoj bolnici Zadar. Učinjena je retrospektivna analiza prospektivne baze laboratorijskih podataka bolesnika oboljelih od COVID-19 na Odsjeku za intenzivno liječenje- COVID Opće bolnice Zadar. U razdoblju od 1. siječnja 2020. do 31. prosinca. 2021. godine liječeno je 177 bolesnika. U spolnoj strukturi je 126 muškaraca (71 %), a žena je 51 (29 %). U dobnoj strukturi najviše je bolesnika bilo između 65 i 75 godina njih 76 (88 %). U ishodu bolesnika vidljivo je da je umrlo 127 osoba, odnosno njih 72 %, a preživjelo je 50 osoba odnosno njih 28 %. Za mjerene varijable izračunata je deskriptivna statistika, za prvi nalaz, zadnji nalaz, kao i za stopu promjene. Hi-kvadrat testom ispitana je zavisnost između šest mjerenih varijabla. S obzirom da je za svaku varijablu izvršen prvi nalaz i zadnji nalaz, provedeno je ukupno 12 analiza. Za C-reaktivni protein dobiven je statistički značajan rezultat povezanosti prvog nalaza s ishodom i dobiven je statistički značajan rezultat povezanosti zadnjeg nalaza s ishodom. Dobiven je statistički značajan rezultat povezanosti prvog nalaza troponina s ishodom te je dobiven statistički značajan rezultat povezanosti zadnjeg nalaza s ishodom In this paper a research was conducted to determine the correlation of ferritin, troponin, lactate dehydrogenase, C-reactive protein, procalcitonin and D-dimer with the clinical outcome of patients in the Intensive Care Unit at Zadar General Hospital. The aim of this study was to examine the correlation of ferritin, troponin, lactate dehydrogenase, C-reactive protein, procalcitonin and D-dimer with the clinical outcome of patients with COVID-19 in the Intensive Care Unit– COVID at Zadar General Hospital. The hypothesis is that there is a disorder in the correlation of the test results of ferritin, troponin, lactate dehydrogenase, C-reactive protein, procalcitonin and Ddimer with the clinical outcome of patients in the Intensive Care Unit- COVID at Zadar General Hospital. A retrospective analysis of the prospectively collected data on laboratory test results of patients with COVID-19 in the Intensive Care Unit- COVID at Zadar General Hospital was carried out. 177 patients were treated in the period from 1 January 2020 until 31 December 2021. In gender specific analysis there were 126 men, that is 71%, and 51 women, or 29 %. By looking at the age group, most patients, that is 76 of them or 88 % of them, were between 65 and 75 years old. The outcome of the patients shows that 127 patients, that is, 72 % of them died, and 50 patients, that is, 28 % of them survived. The descriptive statistics were calculated for the measured variables, for the first finding, the last finding, as well as for the rate of change. The dependence between the six measured variables was examined by the chisquare test. Since the first finding and the last finding were made for each variable, there was a total of 12 analyses. For C-reactive protein, a statistically significant result of the correlation of the first finding with the outcome was obtained, as well as a statistically significant result of the correlation of the last finding with the outcome. A statistically significant result of the correlation of the first troponin finding with the outcome was obtained, as well as a statistically significant result of the correlation of the last finding with the outcome.

Decembra 2019 se je na Kitajskem prvič pojavil nov sev koronavirusa, imenovan SARSCoV-2. Virus se je hitro razširil čez celoten svet ter povzročil več milijonov okužb in smrti. Bolezen COVID-19 je lahko asimptomatska ali simptomatska z najpogosteje izraženim kašljem, vročino, oteženim dihanjem ter izgubo vonja in okusa. Pojavi pa se lahko tudi težja oblika bolezni, kjer je potrebno zdravljenje na intenzivni enoti. Za prepoznavanje kritično bolnih, spremljanje poteka bolezni, napovedovanje izida bolezni ter ocenjevanje uspešnosti zdravljenja je pomembna uporaba rutinskih laboratorijskih testov. V okviru magistrske naloge smo želeli preučiti pomen prokalcitonina pri pacientih okuženih s SARS-CoV-2. Meritve PCT smo izvajali na analizatorju Pathfast in Advia Centaur XP na 112 vzorcih serumske krvi pacientov, hospitaliziranih na oddelku intenzivne enote diagnostično terapevtskega servisa. 71 % vzorcev je imelo koncentracijo PCT povišano nad referenčno območje (0,1 µg/L). Povprečna koncentracija PCT, izmerjena na analizatorju Pathfast je bila 2,3798 µg/L in 2,8446 µg/L na analizatorju Advia Centaur XP. Podrobneje smo preučili dva pacienta, kjer smo opazovali potek krvnih parametrov glede na datum odvzema vzorca. Vrednosti PCT so se spreminjale s potekom bolezni, ob zapletih so se poviševale, ob izboljšanju zdravstvenega stanja pa zniževale. Ob bakterijski okužbi sta bila povišana predvsem PCT in CRP, ki sta se ob ustreznem antibiotičnem zdravljenju zniževala. Pred dodajanjem kisika sta bili povišani predvsem vrednosti IL-6 in CRP. PCT najbolje korelira s CRP, sledi IL-6 in najslabše z D-dimerom (Spearmanov koeficient: 0,507, 0,437 in 0,194). Zaključimo lahko, da je PCT v kombinaciji z ostalimi v pomoč pri diagnosticiranju ter napovedovanju prognoze bolezni. Z napredovanjem tehnologije se je uveljavilo testiranje ob pacientu (POCT), ki je še posebej pomembno v enotah intenzivne medicine, saj omogoča takojšnjo razpoložljivost rezultata. Ujemanje rezultatov meritev PCT med POCT (analizator Pathfast) in klasično laboratorijsko metodo (analizator Advia Centaur XP) smo preverili s Passing-Bablok regresijsko analizo in Bland-Altmanovo analizo v programu MedCalc. Spearmanov korelacijski koeficient med metodama znaša 0,986, kar označuje odlično korelacijo. Analizator Pathfast izmeri povprečno za 0,3527 µg/L nižje rezultate, do razlik med meritvama prihaja predvsem ob višjih koncentracijah. Metodi sta medsebojno primerljivi in zamenljivi. In December 2019, a new strain of coronavirus called SARS-CoV-2 first appeared in China. The virus has spread rapidly around the world, causing millions of infections and deaths. The COVID-19 disease can be asymptomatic or symptomatic, with the most common symptoms being cough, fever, shortness of breath, and loss of smell and taste. A more severe form of the disease may also occur, requiring treatment in an intensive care unit. The use of routine laboratory tests is important to identify critically ill patients, monitor the course of the disease, predict the outcome of the disease and evaluate the effectiveness of treatment. As part of the master's thesis, we aimed to study the significance of procalcitonin in patients infected with SARS-CoV-2. Procalcitonin measurements were performed using a Pathfast and Advia Centaur XP analyzer on 112 serum blood samples from patients hospitalized in the intensive care unit of the diagnostic and therapeutic service. In 71 % of the samples, the concentration of PCT was above the reference range (0.1 µg / L). The mean PCT concentration measured on the Pathfast analyzer was 2.3798 µg / L and 2.8446 µg / L on the Advia Centaur XP analyzer. We observed more closely two patients in whom we observed changes in blood parameters depending on the date of sampling. Values of the PCT changed with the progression of the disease, increasing as a result of complications and decreasing when the health condition improved. In the presence of bacterial infection, PCT and CRP were elevated, but decreased with appropriate antibiotic treatment. Elevated IL-6 and CRP levels indicated oxygen demands. The highest correlation is between PCT and CRP, followed by correlation with IL-6 and, finally, the lowest correlation with D-dimer (Spearman coefficient: 0.507, 0.437 and 0.194). We can conclude that PCT in combination with other blood parameters is helpful in diagnosis and prediction of the disease prognosis. POCT is especially important in intensive care units, where it allows immediate availability of the result. We have confirmed the agreement of PCT measurements between POCT and the classical laboratory method with the Passing-Bablok regression analysis and BlandAltman analysis. The Spearman's correlation coefficient between the methods is 0.986, indicating an excellent correlation. The Pathfast analyzer measures on average 0.3527 µg / L lower results, the differences between the measurements occur mainly at higher concentrations. The methods are comparable and interchangeable.

This study aimed to investigate the clinical significance of serum C-reactive protein (CRP) and procalcitonin (PCT) concentrations in dogs with degenerative mitral valve disease (DMVD) and infective endocarditis. It also aimed to evaluate whether there is a relationship between the degree of disease and serum PCT and CRP concentrations. A total of 100 dogs with MVD were prospectively recruited into the study. According to clinical/laboratory signs and echocardiography, the dogs were divided into infective and degenerative groups. The degenerative group was also classified into four stages based on the American College of Veterinary Internal Medicine (ACVIM) guidelines (Stages A-D). Serum PCT and CRP concentrations were determined with dog-specific commercial test kits. The serum CRP (P, Cilj rada bio je istražiti kliničku važnost serumskih koncentracija C-reaktivnog proteina (CRP) i prokalcitonina (PCT) u pasa s degenerativnom bolešću mitralnog zaliska (DMVD) i infektivnim endokarditisom. Također, cilj je bio i procijeniti postoji li povezanost između stupnja bolesti i serumskih koncentracija PCT-a i CRP-a. U prospektivno istraživanje uključeno je ukupno je 100 pasa s MVD-om. Prema kliničko laboratorijskim znakovima i ehokardiografiji psi su podijeljeni u skupinu s infektivnom i skupinu s degenerativnom bolešću. Psi s degenerativnom bolešću razvrstani su u četiri stadija (A-D) prema smjernicama American College of Veterinary Internal Medicine (ACVIM). Koncentracije serumskog PCT-a i CRP-a određene su komercijalnim testnim setovima specifičnima za pse. Koncentracije serumskog CRP-a i PCT-a u skupini pasa s infektivnom bolešću bile su znakovito više (P

Uloga laboratorijske dijagnostike je ključna u suzbijanju i praćenju bolesti COVID-19 upotrebom već dobro poznatih laboratorijskih parametara kao vrlo važnih u praćenju liječenja pacijenata, osobito za rano prepoznavanje komplikacija bolesti COVID-19. Tu je potrebno posebno navesti upalne parametre koji su ključni u praćenju razvoja bolesti poput CRP-a, feritina i PCT-a. CRP je osjetljiv sistemski pokazatelj akutne upale, infekcije i oštećenja tkiva. Serumska koncentracija proporcionalna je jačini upalnog odgovora, pa praćenje porasta tijekom razvoja bolesti predstavlja značajan pokazatelj težine bolesti i razvoja komplikacija. Prokalcitonin ima ulogu u razlikovanju bakterijskih od virusnih uzročnika infekcije jer je u virusnim infekcijama suprimirano otpuštanje prokalcitonina i vrijednosti su mu ispod graničnih. U teškom obliku bolesti COVID-19, zbog lošeg općeg stanja, vrijednosti su mu povišene i koristi se prvenstveno za isključivanje bakterijske koinfekcije. Zabilježeno je da su rutinski biokemijski i hematološki testovi korisni u stratifikaciji i prognozi pacijenata s dijagnosticiranom koronavirusnom bolešću (COVID-19), u korelaciji s lošim ishodima kao što su potreba za mehaničkom ventilacijom ili intenzivnom njegom, napredovanje do višesustavnih organa neuspjeh i/ili smrt. Iako su ovi testovi već dobro uspostavljeni u većini kliničkih laboratorija, još uvijek postoji rasprava o njihovoj kliničkoj vrijednosti u liječenju COVID-19, kao i o vrijednosti ocjena kliničkog rizika u predviđanju bolesti COVID-19. The role of laboratory diagnostics is crucial in the control and monitoring of COVID-19 disease using already well-known laboratory parameters as very important in monitoring the treatment of patients, especially for early detection of complications of COVID-19 disease. Here it is necessary to specify the inflammatory parameters that are crucial in monitoring the development of diseases such as CRP, ferritin and PCT. CRP is a sensitive systemic indicator of acute inflammation, infection, and tissue damage. Serum concentration is proportional to the strength of the inflammatory response, so monitoring the increase during disease development is a significant indicator of disease severity and the development of complications. Procalcitonin has a role in distinguishing bacterial from viral causes of infection because in viral infections the release of procalcitonin is suppressed and its values are below the limit. In the severe form of the disease COVID-19, due to its poor general condition, its values are elevated and it is used primarily to exclude bacterial coinfection. Routine biochemical and hematological tests have been reported to be useful in stratification and prognosis of patients diagnosed with coronavirus disease (COVID-19), correlated with poor outcomes such as the need for mechanical ventilation or intensive care, progression to multisystem organs, failure and / or death. Although these tests are already well established in most clinical laboratories, there is still debate about their clinical value in the treatment of COVID-19, as well as the value of clinical risk assessments in predicting COVID-19 disease.

Vpeljava novih analiznih metod je poleg nenehnega zagotavljanja kakovosti eden izmed ključnih dejavnosti v medicinskih laboratorijih. Pomembno je, da izbiramo izključno znanstveno preizkušene metode. Pri uvajanju nove metode v rutinsko uporabo moramo predhodno opraviti overjanje (verifikacijo) merilnega postopka, s katero primerjamo različne analizne metode oz. analizatorje. V našem primeru smo se odločili za primerjalno določanje dveh zdravilnih učinkovin, in sicer vankomicina in digoksina, z dvema različnima analizatorjema. Osnovni cilj magistrske naloge je bil dokazati primerljivost rezultatov vzporednih analiz koncentracij vankomicina in digoksina v serumskih vzorcih, opravljenih z dvema različnima analizatorjema, lociranima v Splošni bolnišnici Novo mesto in Zdravstvenem domu Krško, pri čemer pa oba za metodo detekcije uporabljata kemiluminiscenco. Z izbranimi statističnimi testi smo ugotavljali primerljivost rezultatov ter tako preverili ustreznost preskušanih metod. Uporabili smo linearno regresijsko analizo, Passing-Bablokovo regresijo ter Bland-Altmanovo metodo. Hkrati smo določali še meritveno natančnost in pravilnost z eksperimentalnim modelom 5x5. Ugotovili smo dobro primerljivost meritev ter potrdili uporabnost rezultatov, ne glede na to, s katerim analizatorjem smo jih pridobili. Z eksperimentalnim modelom 5x5 smo dokazali, da metodi za določanje vankomicina in digoksina ne odstopata od priporočenih referenčnih vrednosti. Poleg tega smo podrobneje analizirali in predstavili 6 kliničnih primerov bolnikov, ki so se zdravili z vankomicinom in pri katerih smo sočasno določali tako serumske koncentracije zdravilne učinkovine kot tudi vrednosti vnetnih parametrov, C-reaktivnega proteina (CRP) in prokalcitonina (PCT). Oba vnetna parametra sta uporabna pri spremljanju uspešnosti terapije z vankomicinom. The introduction of new analytical methods is one of the key activities in medical laborato-ries, in addition to continuous quality assurance. It is important that we choose only scien-tifically proven methods. When introducing a new method into routine use, we must first perform verification of the measurement procedure, comparing different methods of analy-sis or analyzers. In our case, we decided to benchmark two active substances, vancomycin and digoxin, with two different analyzers. The main aim of the master's thesis was to prove the comparability of the results of the parallel analyzes of vancomycin and digoxin concentrations in the same serum samples, carried out with two different analyzers located at the General Hospital Novo mesto and Krško Health Center, both using chemiluminescence for the detection method. Selected statistical tests were used to determine the comparability of the results and thus to check the adequacy of the tested methods. We used linear regression analysis, Pass-Bablok re-gression and Bland Altman method. At the same time, we determined the measurement accuracy and correctness with the experimental 5x5 model. We found good comparability of measurements and confirmed the usefulness of the re-sults, regardless of which analyzer we obtained them from. Using the 5x5 experimental model, we demonstrated that the methods for the determination of vancomycin and digoxin do not deviate from the recommended reference values. In addition, we analyzed and presented in greater detail 6 clinical cases of vancomycin-treated patients in which both serum concentrations of the active substance and values of inflammatory parameters, C-reactive protein (CRP) and procalcitonin (PCT) were simultaneously determined. Both inflammatory parameters are useful in monitoring the success of vancomycin therapy.

Sepsis is a worldwide health condition. It is caused by disproportionatly large immunity system response for patogene presence. Fast and accurate diagnosis of sepsis can make difference between life and death. For clinical diagnosis of sepsis is used serum protein procalcitonin (PCT) as biomarker. Procalcitonin concentration level in patient bloodstream increases up to thousand times in short time period. Severity of sepsis can be determined by correlation with its concentration in bloodstream. To determine PCT level in patient bloodstream a broad variety of specialized instrument is used. All methods have same principle of measurement - PCT-antibody interaction. Procalcitonin level is then quantified by calibration curve method. During these measurements non-specific protein-antibody interactions can occur and distort the quantification of PCT level. Mass spectrometry due to its properties comes into consideration as an alternative method, that can be used for PCT determination. Aim of this diploma thesis was in situ enrichment of PCT on surface modified affinity carriers with immobilized antibody against PCT. These carriers are compatible with matrix assisted laser desorption/ionization time of flight mass spectrometry. Mass spectrometry provides mass spectrum, where PCT and other signals...

Uvod: Sepsa, klinički sindrom koji se javlja kao poslijedica neuravnoteženog odgovora organizma na infekciju, vodeći je uzrok pobola i smrtnosti u cijelome svijetu bez obzira na stupanj razvijenosti. Cilj rada bio je istražiti mogućnost poboljšanja dijagnostičke točnosti ranog otkrivanja sepse u hitnih abdominalnih kirurških bolesnika dodavanjem triju biokemijskih biljega upale/infekcije početnom SOFA sustavu bodovanja (iSOFA): presepsina (PSEP) kao predstavnika nove generacije, te prokalcitonina (PCT) i C-reaktivnog proteina (CRP) kao predstavnika rutinskih biljega. Materijali i metode: Ispitivanu populaciju činila su 72 hitna bolesnika s radnom dijagnozom akutnog abdomena, podvrgnuta hitnomu kirurškom zahvatu. Istraživanje je ispitalo dijagnostičku točnost pojedinih biljega u razlikovanju dviju skupina ispitanika: s postavljenom dijagnozom sepse i bez sepse. Ispitivana je i prediktivna vrijednost dvaju modela u ranom postavljanju dijagnoze sepse: prvi, koji uključuje samo iSOFA i drugi, koji predstavlja kombinaciju triju navedenih biljega i iSOFA. Rezultati: iSOFA je pokazao najveću dijagnostičku točnost u razlikovanju septičnih od neseptičnih bolesnika s AUC=0,967. Slijede PSEP s AUC=0,738 te PCT s AUC=0,694. CRP s AUC=0,606 se pokazao kao biljeg s najmanjom dijagnostičkom točnošću razlikovanja septični od neseptičnih bolesnika. Logistička regresijska analiza obaju modela pokazala je da se upotrebom prvog modela koji uključuje samo iSOFA, u bolesnika s povećanjem vrijednosti ovog parametra, vjerojatnost za sepsu povećava dvostruko. Drugi model, koji osim iSOFA uključuje i biokemijske biljege PSEP, PCT i CRP, pokazuje da se uz povećanje vrijednosti iSOFA i povećanje koncentracija navedenih biokemijskih biljega, ova vjerojatnost povećava tri puta. Zaključak: Iako je SOFA sustav bodovanja prihvaćen kao temelj postavljanja dijagnoze sepse pokazalo se da su PSEP i PCT, dobri neovisni biljezi sa statistički značajno većim koncentracijama u septičnih nego u neseptičnih bolesnika. CRP, kao neovisni biljeg, se nije pokazao statistički značajno različit između septičnih i neseptičnih bolesnika. Ispitivanje dijagnostičke točnosti biokemijskih biljega PSEP, PCT i CRP kao neovisnih parametara je pokazalo da PSEP ima veću dijagnostičku specifičnost (33%) od PCT-a (17%) i CRP-a (14%). Također se pokazalo da biljezi PSEP i PCT ne doprinose statistički značajno ispitivanom modelu s iSOFA. Međutim, CRP je jedini biljeg koji ima statistički značajan doprinos u ispitivanom modelu s iSOFA. Buduća istraživanja trebala bi ispitati dijagnostičku vrijednost dinamičkih promjena ovih triju biokemijskih biljega u predviđanju i ranom postavljanju dijagnoze sepse. Background: Sepsis, a clinical syndrome occurring as consequence of dysregulated host response to infenction, is a leading cause of morbidity and mortality worldwide, regardless low or high-income country. This study examined whether the addition of biomarkers presepsin (PSEP), procalcitonin (PCT) and C-reactive protein (CRP) to the initial SOFA (iSOFA) score can improve diagnostic accuracy of early sepsis diagnosis in emergency abdominal surgery patients. Materials and Methods: Seventy-two study subjects had the diagnosis of acute abdomen due to gastrointestinal disturbances. The study evaluated diagnostic accuracy and predictive value of two models (iSOFA only and iSOFA combined with three biomarkers) for sepsis diagnosis. Results: iSOFA has shown highest diagnosic accuracy in distinguishing septic from non-septic patients with AUC=0,738. Following are PSEP with AUC = 0.738 and PCT with AUC = 0.694. Logistic regression analysis of both models has shown that by using the first model including only iSOFA, the patients with increasing iSOFA have the probability of sepsis two times higher then the patients with low iSOFA value. The second model, which includes biomarkers PSEP, PCT, and CRP in addition to iSOFA, shows that with increasing iSOFA values and increasing concentrations of these biomarkers, this probability increases three times. Conclusion: Although the SOFA scoring system has been accepted as key parameter in sepsis diagnosis, it has beeen shown that PSEP and PCT are good independent markers with statistically significant higher concentrations in septic than in non-septic patients. CRP, as an independent marker, has not shown statistically significantly different between septic and non-septic patients. Examination of diagnostic accuracy of biomarkers PSEP, PCT and CRP as independent parameters has shown that PSEP has a higher diagnostic specificity (33%) than PCT (17%) and CRP-a (14%). It has also been shown that PSEP and PCT do not contribute statistically significantly to the examined model with iSOFA. CRP is the only one with a statistically significant contrbution to the model wih iSOFA. Future investigations should examine the diagnostic value of dynamic changes of the three biomarkers in the prognosis and the early diagnosis of sepsis.

Procalcitonin (PCT) is increasingly recognized as an important diagnostic tool in clinical practice. High plasma levels are observed in patients with severe sepsis or septic shock moreover, there is a good correlation between PCT, inflammation activity and severity of sepsis. Local limited bacterial infections induce only a slight increase of PCT serum concentration. On the other hand, viral infections, neoplastic and autoimmune disorders usually do not have any influence on PCT serum level. Non-specific induction of PCT synthesis may occur after major surgery, multiple trauma or in newborn infants during the first days of life. Determination of PCT has diagnostic, prognostic and in some situations also therapeutic value.

Sepsa je sindrom koji je u stalnom porastu, a podrazumijeva skup simptoma koji nastaju kao odgovor tijela na infekciju. Glavni klinički znakovi sepse su porast ili pad temperature, poremećaj svijesti, ubrzano disanje i frekvencija srca, u težim oblicima se pridružuju znakovi višeorganskog zatajenja, a u stadiju šoka dolazi do pada tlaka. Zbog visoke smrtnosti, iznimno je važno njeno brzo prepoznavanje i pravodobno liječenje. U dijagnostici težine sepse si možemo pomoći i sa C reaktivnim proteinom, reaktantom akutne faze koji označava aktivno stanje upalnog procesa, zatim prokalcitoninom, koji nas može uputiti na bakterijsku i gljivičnu etiologiju upale, te laktatima, koji upućuju na težu progresiju septičkog progresa, i posebno nas mogu upozoriti na razvoj stanja septičkog šoka. U ovom diplomskom radu svrha je bila istražiti povezanost između C reaktivnog proteina, laktata i prokalcitonina sa ishodom u liječenju pacijenata sa sepsom. Analizirani su podaci uzeti od 155 pacijenta koji su tokom 2017. godine bili hospitalizirani na Jedinicama intenzivnog liječenja KBC-a Rijeka. Izvađeni su sljedeći podaci - dob, spol, mikrobiološki nalaz, uzrok sepse, najnepovoljnije izvađene vrijednosti CRP-a, prokalcitonina i laktata, antibiotska terapija, trajanje hospitalizacije te ishod. Statističkom obradom podataka pokazala se pozitivna statistička povezanost viših vrijednosti laktata sa nepovoljnijim ishodom, dok za prokalcitonin i CRP te povezanosti nije bilo. Dobiveni rezultati su u skladu sa dosadašnjim istraživanjima, koja su pokazala povezanost visine laktata sa težim oblicima sepse i posebno sa razvojem septičkog šoka, posljedično sa većim mortalitetom. Sepsis is a syndrome which has a constant incidence rise, and it entailes a collection of symptoms which arise as the body's response to sistemic inflammation. The main clinical signs of sepsis are a rise or fall in body temperature, altered state of consciousness, increased heart and respiration rates. With more severe forms of the septic process, these symptoms can be accompanied by signs of multiple organ failure, and a fall in blood pressure as a sign of shock. Because this is a condition with a high mortality rate, it is extremely important to recognize it and treat it quickly. When diagnosing the gravity of sepsis, we can help ourselves by testing the levels of C reactive protein, an acute phase reactant which indicates an active state of the inflammatory process, the levels od procalcitonin, which can indicate a bacterial or fungal infection, and the levels of lactates, which indicate a more severe progression of the septic process, including the development of septic shock. The purpose of this thesis was to explore the connection between C reactive protein, lactates and procalcitonin and the type of outcome in treating patients with sepsis. The analyzed data was taken from 155 patients who were hospitalized in the Intensive care units of Clinical hospital centre Rijeka during the year 2017. The following sets of data were collected: gender, age, microbiological findings, cause of sepsis, the most unfavorable values of CRP, procalcitonin and lactates, antibiotic therapy, duration of hospitalization and outcome. The statistic analysis showed a positive statistic connection of higher values of lactates with a less favorable outcome, while the correlation was lacking for CRP and procalcitonin. The obtained results are in line with other research conducted on thistopic, which have shown the connection of high levels of lactates with more grave forms of sepsis and the development of septic shock and a higher mortality as a direct consequence.

A possibility to develop sever systemic complications of acute pancreatitis(AP) demands timely assessment of the severity of the disease in order to make an optimal therapeutic approach and a correct prognosis of the disease. The aim of the study was to establish the role of certain individual inflammatory biomarkers and coagulation parameters in the prediction of AP severity, and also to propose a mathematical formula which allows there combined use for the same purpose. Methods. The prospective study included 92 patients with AP. The patients were divided into groups: mild, moderate and severe AP. Results. Based on the results of Mann-Whitney,s test, it can be concluded that a statistically significant difference between groups A(mild) and B(moderate and severe) for CRP (p

U ovome radu su prikazani rezultati istaživanja analize koncntracije prokalcitonina, laktata i C reaktivnoga proteina kao predskazatelja ishoda bolesnika sa sepsom.

Ciljevi: PCT ima visoku specifičnost i senzitivnost u predviđanju sistemske bakterijske infekcije. Vrijednosti PCT-a koreliraju s težinom sistemske bakterijske infekcije i bakterijemije. Razlika u koncentraciji PCT-a postoji i s obzirom i na vrstu bakterijskog patogena. Medijan vrijednosti PCT-a kod gram-negativne sepse značajno je veći nego kod gram-pozitivnih ili gljivicama uzrokovanih sepsi. Značajno više razine PCT-a pronađene su kod bolesnika s izolatima Escherichia, Klebsiella i Acinetobacter spp. u hemokulturama. Izolacija Candida, Enterococcus i Staphylococcus spp. povezana je s manjom indukcijom sinteze PCT-a. Serumska razina PCT je stoga koristan biomarker u indentifikaciji patogena kod bolesnika sa sepsom, čija vrijednost može ubrzati izbor odgovarajuće empirijske antimikrobne terapije. Cilj planiranog istraživanja je utvrditi dinamiku kojom se mijenja serumska koncentracija PCT-a u bolesnika s gram-pozitivnom sepsom u odnosu na promjene toga pokazatelja u oboljelih s gram- negativnom sepsom. Osim toga, utvrditi će se može li praćenje tih promjena poslužiti u razlučivanju sepse izazvane gram-pozitivnim bakterijama od sepse izazvane gram-negativnim uzročnicima, te utječe li serumska razina PCT-a na preskripciju antimikrobnih lijekova. Metode: Istraživanje će biti ustrojeno kao retrospektivno, opservacijsko istraživanje. Ispitanici su bolesnici oba spola, stariji od 18 godina i liječeni u Zavodu za intenzivnu medicinu KBC-a Osijek tijekom dvogodišnjega razdoblja, pod dijagnozom sepse. Demografski i klinički podaci o bolesnicima i rezultati laboratorijskih pretraga biti će prikupljeni iz povijesti bolesti, a podaci o uzročnim mikroorganizmima iz mikrobiološkog protokola. Očekivani stručni doprinos: U ovoj studiji evaluirati ćemo dijagnostičku točnost PCT-a u razlikovanju sepse uzrokovane različitim patogenima, te utjecaj razine PCT-a na konačni ishod liječenja.

Sekundarni peritonitis je hirurško stanje koje iziskuje neodložno operativno lečenje. Često je praćen sepsom sa relativno visokom incidencom i stopom smrtnosti. Intraabdominalna infekcija kao izvor sepse aktivira zapaljenje tokom kog brojni medijatori određuju patogenetski tok i ishod sekundarnog peritonitisa. U ovoj doktorskoj disertaciji smo istraživali povezanost nivoa HMGB1 (engl. high mobility group box 1) proteina preoperativno i postoperativno do otpusta iz bolnice, kao i akutne markere inflamacije: serum amiloid A (SAA) i češće ispitivane markere, kao što su C-reaktivni protein (CRP) i prokalcitonin (PCT), sa razvojem sindroma sistemskog inflamatornog odgovora (SIRS) i sepse kod pacijenata sa sekundarnim peritonitisom. Uticaj operativnog lečenja na kinetiku ovih markera je poređen sa nivoima kod pacijenata sa preponskim kilama bez znakova inflamacije. Nađene su značajno više preoperativne vrednosti svih ispitivanih markera u grupi sa peritonitisom u odnosu na pacijente sa kilama. U grupi sa peritonitisom, preoperativne vrednosti i vremenski obrazac promene HMGB1 su se značajno visoko razlikovale u grupi pacijenata koji su razvili sepsu, u odnosu na grupu kod koje SIRS nije bio praćen infekcijom. Kod septičnih pacijenata, vrednosti HMGB1 su blago opadale prvih dana posle operacije, dosežući najnižu tačku trećeg dana praćenja. Potom su rasle do sedmog postoperativnog dana, da bi nakon toga vrednosti opadale. Sa druge strane, u grupi SIRS, najniže vrednosti se registruju već prvog postoperativnog dana praćenja, da bi potom postepeno porasle, sa maksimumom u trećem postoperativnom danu i oscilirale između te dve vrednosti do kraja perioda praćenja. Preoperativne vrednosti SAA se nisu razlikovale kod septičnih pacijenata i pacijenata sa SIRS-om, ali se obrazac promene SAA postoperativno značajno razlikovao među ovim grupama. Kod septičnih pacijenata su vrednosti vrlo značajno porasle nakon prvog postoperativnog dana, a zatim kontinuirano opadale do kraja perioda hospitalizacije. Nasuprot tome, kod pacijenata sa SIRS-om, vrednosti su opadale u odnosu na preoperativnu vrednost, što je bilo visoko značajno različito, u odnosu na grupu septičnih pacijenata. Preoperativne vrednosti CRP-a i PCT-a su bile značajno više u grupi septičnih pacijenata u odnosu na grupu sa SIRS-om. Vrednosti CRP-a dostižu maksimalne vrednosti drugog postopertivnog dana, a PCT-a prvog postoperativnog dana... Secondary peritonitis is a surgical condition requiring immediate surgical treatment. It is often accompanied by sepsis with a relatively high incidence and mortality. Intraabdominal infection as a sepsis source triggers inflammation during which a number of pathogenic mediators determine the course and the outcome of the secondary peritonitis. In this doctoral thesis we investigated the correlation of the level of high mobility group box 1 protein (HMGB1), preoperatively and postoperatively until discharge from the hospital, as well as acute inflammatory markers: serum amyloid A (SAA), and more frequently assessed serological markers such as C-reactive protein (CRP) and procalcitonin (PCT), with the development of systemic inflammatory response syndrome (SIRS) and sepsis in patients with secondary peritonitis. The effect of operative treatment on the kinetics of these markers was compared with levels in patients with inguinal hernia without signs of inflammation. All investigated markers had significantly higher preoperative values in the group with peritonitis compared to patients with hernias. Whitin the peritonitis group, preoperative values and the pattern changes of HMGB1 were highly significantly different in the group of patients who developed sepsis compared to the group in which SIRS was not accompanied by infection. In septic patients HMGB1 levels slightly declined in the first days after surgery, reaching the lowest point on the third day of the follow-up. Then they rose to seventh postoperative day, and after that value declined. On the other hand, in the group of SIRS lowest values are recorded on the first postoperative day of follow-up, but then gradually increased to a peak in the third postoperative day, oscillating between these two values until the end of the observation period. Preoperative SAA did not differ in septic patients and patients with SIRS, but the pattern of changes of SAA postoperatively was significantly different among these groups. In septic patients, SAA values increased significantly after the first postoperative day, and then continuously declined until the end of the period of hospitalization. By contrast, in patients with SIRS, values declined compared to the baseline, which was highly significantly different compared to the group of septic patients. Preoperative CRP and PCT were significantly higher in the group of septic patients compared to the group with SIRS. CRP value reached the maximum value of the second postopertive day and PCT on the first postoperative day...

Introduction: Procalcitonin (PCT) is a 13 kD protein with a chain of 116 amino acids. It consists of parafollicularcells of the thyroid gland. Inflammatory procalcitonin is made up of 114 amino acids. Procalcitonin from plasma in the course of inflammatory process, does not consistof C-cells of the thyroid gland but it is generatedin the liver, and, to a lesser extent, in the lungs, kidneys, testes, prostate and small intestine. Objectives: 1. To compare the levels and the dynamics of C-reactive protein (CRP) and procalcitonin in the inflammatory process. in three patients with different diagnoses. To compare the number of examined PCT according to indicated VFN (General University Hospital) departments in the years 2009, 2012 and 2015. 3. To study the dynamics of the number of examined PCT in the years 2001- 2016. Methods: The levels of CRP and PCT were measured in the ÚLBLD laboratory of the General University Hospital in Prague in the period from May 20to June 17, 2016. The CRP was measured by immunoturbidimetricanalyzerUnicelDxC 880i. The PCT was measured by theCobas analyser using the electrochemiluminescence technology. In order to evaluate the data, graphs were processed with levels of bothanalytesfor 3 patients. Further, data needed for the evaluation of the above mentioned objectives no. 2...

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Severity assessment is a crucial component in the management of patients with community-acquired pneumonia (CAP). Recommended Pneumonia Severity Index (PSI) is an accurate predicting model, but not so easily applicable in clinical practice. The aim of the study was to determine whether some biomarkers of inflammation and coagulation, correlate with severity of CAP and can predict mortality risk better than standard biomarkers and recommended PSI. The study included 129 patients with CAP, an overall median age of 64.83 ± 13.32 y (77 males and 52 females). There were 55 (43.63%) patients with severe CAP. We were found a good linear correlation between severity of CAP and procalcitonin (r = 0.427; p < 0.001) and between D dimer (r = 0.5106; p < 0.0001). Serum amiloid A, WBC and CRP have poor linear correlation. In diagnosis of severe CAP best diagnostic value have procalcitonin (AUC = 0.813) and D-dimer (AUC = 0.789). Thirteen patients were died (10.7%), and 16 patients have complications (12.4%). In predicting of mortality risk PSI for cut of > PSI III showed sensitivity of 0.92, specificity 0.62 and AUC 0.868. Serum amiloid A, WBC and CRP were not in correlation with the risk of mortality. In non surviving patients D-dimer (2498.38 ng/mL) and procalcitonin (3.14 ng/mL) were significantly higher than in surviving patients. In predicting mortality risk, D-dimer (cut of >1538 ng/mL) showed sensitivity 0.84, specificity 0.86 and AUC 0.859. Procalcitonin, for cut of value > 0.93 ng/mL, in predicting of mortality risk showed sensitivity of 1.0, specifity of 0.64 and AUC 0.844. There was no statistical difference between AUC of PSI and D-dimer (p = 0.9005), and PSI and procalcitonin (p = 0.6135) in predicting mortality risk. This study pointed out that: serum amilod A correlates poor with severity of disease; and that high D-dimer and procalcitonin level correlate with severity of disease (better than CRP and WBC) and mortality risk (similar as recommended PSI). D-dimer and procalcitonin could be useful biomarkers for predicting severity of disease and clinical outcome in patients with CAP.

Canine babesiosis is a multisystemic protozoan disease, considered as sepsis with a wide range of clinical signs, which can result in various outcomes, from mild to fatal. In veterinary medicine there are still no specific biomarkers for sepsis, therefore the aim of this study was to investigate markers widely used in human medicine, but poorly in veterinary medicine and never in canine babesiosis. Ninety-seven dogs were included in this study, among which 72 were diagnosed for babesiosis and 25 were healthy and used as the control group. Concentrations of procalcitonin (PCT) and the amino-terminal portion of C-type pronatriuretic peptide (NT-pCNP) were determined for each dog. There was a significant difference in PCT concentrations between the healthy and the babesiosis group before and after the antibabesial treatment, but there were no significant differences between the dogs that survived and the dogs that died. In contrast, there was no significant difference in NT-pCNP concentrations between the healthy and babesiosis groups before and after the antibabesial treatment, but there were significant differences between the dogs that survived and the dogs that died. It may be concluded that as in human medicine, PCT is most probably a good marker for both detection and grading of SIRS complications developed only in bacterial induced systemic infections, whereas NT-pCNP can be considered a good prognostic pro-inflammatory marker of outcome in canine babesiosis., Babezioza pasa je multisistemska protozojska sepsa sa širokim rasponom kliničkih znakova od blagih do onih sa smrtnim ishodom. U veterinarskoj medicini još uvijek nisu pronađeni specifični biomarkeri sepse pa je stoga cilj ovog istraživanja bio ispitati markere koji se obilno koriste u humanoj medicini, ali su slabo istraženi u veterinarskoj medicini, a nikada kod babezioze pasa. U ovo istraživanje bilo je uključeno 97 pasa od kojih je u 72 psa dijagnosticirana babezioza dok je preostalih 25 bilo zdravo i korišteno kao kontrolna skupina. Kod svakog psa određene su koncentracije prokalcitonina (PCT) i aminoterminalnog dijela C-tip pronatrijuretičkog peptida (NT-pCNP). Zabilježena je statistički značajna razlika u koncentraciji PCT-a između zdravih pasa i bolesnih pasa prije i nakon antibabezijske terapije, no nije bilo statistički značajne razlike između preživjelih i uginulih. Naprotiv, nije zabilježena statistički značajna razlika u koncentraciji NT-pCNP-a između zdravih i bolesnih pasa, ali je nađena statistički značajna razlika između preživjelih i uginulih. Zaključno, PCT se kao i u humanoj medicini vjerojatno može smatrati dobrim markerom za otkrivanje i stupnjevanje SIRS-a samo u bakterijskim infekcijama, dok se NT-pCNP pokazao kao dobar prognostički marker ishoda babezioze pasa.

The aim of this thesis was to determinate the levels of procalcitonin and Creactive protein in the serum of patients who met the criteria of sepsis diagnosis and the comparison with positive blood cultures that is the exact confirmation of infectious etiology of SIRS (Systemic Inflammatory Response Syndrome). Powered by TCPDF (www.tcpdf.org)

U radu su prikazani klasifikacijski, dijagnostički i laboratorijski pokazatelji novorođenačke sepse - klinička i dijagnostička značajnost određivanja diferencijalne krvne slike, C-reaktivnosg proteina, prokalcitonina i citokina u dijagnostici novorođenačke sepse.

The purpose of the bachelor thesis is to evaluate serum amyloid (SAA) as a diagnostic marker in selected patient groups and to compare the results of SAA with those of C-reactive protein (CRP) and procalcitonin (PCT). SAA, CRP and PCT are acute-phase proteins, whose blood concentration significantly increases within a few hours after an inflammatory stimulus. The synthesis, caused by proinflammatory cytokines, takes place in the liver. CRP is the most and longest used acute-phase reactant in routine practice. As indicators of inflammation, SAA and especially procalcitonin have been used more lately. Although SAA is an acute-phase reactant as sensitive as CRP, it is not employed so often in the diagnosis since a method suitable for routine diagnosis was not developed until recently. Briefly describing the acute-phase proteins, the theoretical part elaborates on the characterization and comparison of SAA, CRP and PCT. It further outlines methods for the determination of individual analytes. The experimental part focuses on defining selected patient groups and the immunonephelometric method for measuring SAA by the Immage 800 biochemical analyzer. The data obtained in three selected patient groups have been statistically evaluated. The aim of the thesis has been to evaluate the correlation of inflammatory...

The Master thesis gives an overview of sepsis, its causes, manifestation and diagnostics. The role of procalcitonin as a sepsis marker is dicussed. In the experimental part, case records of 106 were examined and the determination of procalcitonin as a sepsis marker was evaluated. Based on the evaluation, a recommendation about timing of the procalcitonin level analyses with septic patients were made.

Prokalcitonin är ett prohormon på 116 aminosyror som normalt produceras i tyroideas c-celler och i neuroendokrina celler i lungorna som svar på hyperkalcemi. Vid sepsis och andra bakteriella infektioner stimulerar bakterielipopolysackarider (LPS) och olika cytokiner produktionen av prokalcitonin i celler i hela kroppen. Flera studier har gjorts för att utvärdera hur prokalcitoninmätningar kan användas, dels för att skilja bakteriella infektioner från icke-bakteriella, dels för att anpassa antibiotikabehandlingen individuellt. I dessa studier har antibiotikaanvändningen kunnat minskas, vilket kan leda till minskat selektivt tryck och minskad resistens hos bakterier, samt sänker kostnaden för behandling. Syftet med denna studie är att sätta upp en ny metod för prokalcitoninanalys. Metoden är en automatiserad, immunologisk metod på befintligt instrument i Kristianstad. Prover dels från Lund, som använder samma metod, dels från Malmö, som använder en annan automatiserad metod, jämfördes med mätningar på Kristianstads instrument. Resultatet visade god överensstämmelse mellan Kristianstads och Lunds mätningar och något sämre mellan Kristianstads och Malmös mätningar. Mellandagsprecisionen var tillfredsställande, totalt 4,5 % på den låga kontrollen och 1,9 % på den höga kontrollen. Inomserieprecisionen var utmärkt, 1,4 % i genomsnitt. Procalcitonin is a 116 amino acid prohormone, normally produced in the thyroid c-cells and in the neuroendocrine cells in the lungs, in response to hypercalcemia. In infections and sepsis bacterial lipopolysaccharides and different cytokines stimulate cells throughout the body to produce procalcitonin. Several trials have been carried out to evaluate how measurements of procalcitonin can be used, partly to separate bacterial infections from non-bacterial, and partly to guide individual treatment with antibiotics. In these studies the use of antibiotics could be reduced, reducing the risk of developing bacterial resistance and the cost of treatment. The purpose of this trial is to investigate a new method for procalcitonin assay. The method is an automated immunoassay on an existing instrument in the department of Clinical chemistry in Kristianstad. Blood specimens from the departments of Clinical chemistry in Lund, who uses the same method and Malmö, who uses another automated immunoassay, were compared to the present method. Good agreement was found between Kristianstad and Lund, while the relationship between Kristianstad and Malmö was slightly weaker. Precision between days was satisfactory, totalling 4,5 % on the low control and 1,9 % on the high control. Precision within series was excellent, 1,4 % on average.

Unatoč nedavnim iskoracima u ispitivanju etiopatogeneze akutnog pankreatitisa (AP), još uvijek nisu objašnjeni svi čimbenici koji određuju nastup i tijek te bolesti. Istraživači se usredotočuju na ispitivanje čimbenika koji uvjetuju razvoj teškog AP, te razmatraju genetičku predispoziciju, vrstu mogućih odgovornih čimbenika kao i istodobno prisutna oboljenja. Najbitnija zadaća preostaje, međutim, procjena osjetljivosti i specifičnosti biokemijskih i seroloških biljega u dijagnozi i prognozi razvoja teškog APte njihova klinička dostupnost. Aktivnost lipaze u serumu je pouzdaniji dijagnostički biljeg AP, nego aktivnost serumske amilaze. Tripsinogen-aktivacijski peptid (TAP) omogućava ranu dijagnozu AP. Korisni predskazatelji težine bolesti mogu uključivati prokalcitonin i TAP u mokraći, interleukine 6 i 8 u serumu, 24-satnu polimorfonuklearnu elastazu, te 48-satni C-reaktivni protein. Istraživači se usredotočuju na potragu za najboljim mogućim prognostičkim čimbenikom AP. U kliničkoj se praksi, međutim, dijagnoza temelji na biološkim biljezima, kliničkoj procjeni i drugim laboratorijskim rezultatima koji su uključeni u Ransonovu ljestvicu ili APACHEII, te na slikovnim pretragama koje se koriste za određivanje pokazatelja težine bolesti kompjutorskom tomografijom (engl. computertomographyseverityindex, CTSI). Točnu prognozu tijeka AP nije moguće načiniti sve dok nisu određeni svi ti parametri kako bi se moglo započeti s najboljom mogućom terapijom., Despite recent advances in research on etiopathogenesis of acute pancreatitis (AP), not all factors that determine the onset and course of the disease have been explained. Researchers concentrate on investigating the factors conditioning the development of severe AP. They consider genetic predisposition, the type of possible responsible factors, and comorbidities. The most essential task, however, remains to be the assessment of sensitivity and specificity of biochemical and serological markers in diagnosis and prognosis of developing severe AP and their clinical availability. Serum lipase is a more reliable diagnostic marker of AP than serum amylase. Trypsinogen activation peptide (TAP) ensures early diagnosis of AP. Useful predictors of severity may include serum procalcitonin and urinary TAP, serum interleukins-6 and -8 and polymorphonuclear elastase at 24 h, and serum C-reactive protein (CRP) at 48h. Researchers concentrate on searching for the best possible prognostic factor of AP. In clinical practice, though diagnosis is based on biological markers, clinical assessment and other laboratory results included in Ranson scale or APACHE II and imaging investigations used to define computer tomography severity index (CTSI). Accurate prognosis of AP course cannot be made until all those parameters have been determined so that the best possible treatment can be undertaken.

Sepsis and its complications are currently the most frequent cause of death owing to multi organ failure at intensive care units. The aim of this thesis was to evaluate the most suitable usable marker with sufficient diagnostic sensitivity and specificity for early catch of sepsis development. For my thesis a chosen data collection patients of intensive care units and patients of neonatology department in Nemocnice a.s. (Hospital Inc.) in České Budějovice was used. In patients, determinations of following concentration parameters were carried out: PCT, CRP, IL-6. For diagnosis and evaluation of clinical state change in relation to sepsis PCT is convenient. For monitoring of steady course and clinical state it is useful and sufficient to watch dynamics of CRP. In newborns the sensitivity PCT decreases in sepsis probably due to immaturity of liver and immunity system. That is why according to experience gained in Nemocnice a.s. (Hospital Inc.) České Budějovice it is more convenient to determine IL-6 instead of PCT.

Cilj rada je provjeriti kvalitetu nove metode (Biomerieux) određivanja prokalcitonina u odnosu na postojeću korištenu metodu (Brahms).