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1. Clinical characteristics, management and outcome of patients with invasive candidiasis hospitalized in Internal Medicine Units: findings from a registry by the Italian Scientific Society FADOI

Author

Pieralli, F., Dentali, F., Giusti, M., Ciarambino, T., Mazzone, A., Concia, E., Sanguinetti, M., Nallino, M. G., Morana, I., Santini, C., Gussoni, G., Zagarri, E., Manfellotto, D., Antonielli, E., Marchionni, L., Ariaudo, S., Benedetti, V., Sgroi, C., Pistella, E., Belfiore, A., Tedesco, A., Carrara, D., Magnani, E., Landini, F., Colagrande, P., Gerloni, R., Balbi, G., Gino, M., Limido, E., and Norbiato, C.

Subjects
0301 basic medicine, Microbiology (medical), Societies, Scientific, medicine.medical_specialty, Registry, Antifungal Agents, 030106 microbiology, Candida, Infection, Internal Medicine Units, Invasive candidiasis, Candida parapsilosis, Settore MED/07 - MICROBIOLOGIA E MICROBIOLOGIA CLINICA, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Candidiasis, Invasive, 030212 general & internal medicine, Registries, Candida albicans, Fluconazole, Aged, biology, Candida glabrata, business.industry, Mortality rate, Incidence (epidemiology), General Medicine, biology.organism_classification, medicine.disease, Infectious Diseases, Italy, Concomitant, Bacteremia, business, medicine.drug
Abstract

Invasive candidiasis (IC) is a challenging clinical condition, burdened by relevant mortality and morbidity. There is limited knowledge on the occurrence and management of IC in Internal Medicine Units (IMUs). Aim of this study was to provide real-world data on this topic. Consecutive objectively diagnosed cases of IC were collected in this prospective registry, which involved 18 IMUs in Italy. Patients were followed-up to 90 days from the diagnosis of candidemia. A total of 111 patients were observed (median age 78, IQR 67–83) for an overall incidence of infection of 1.89 cases/1000 hospital admissions. Candida albicans was the most frequent isolated species (62%), followed by Candida parapsilosis (17%) and Candida glabrata (13%). Echinocandins and fluconazole were used as initial therapy in 56.8 and 43.2% of patients, respectively. Antifungal therapy was started within 24 h in 18.9% of patients, in 40.6% in the period 1–3 days, and in 40.5% of patients more than 3 days after blood cultures. Death rate was 19.8% at 30 days and 40.5% at 90 days. At multivariable analysis concomitant bacteremia (i.e. polymicrobial sepsis), and fluconazole as the initial therapy were associated with an increased risk of death at 90 days. The incidence of IC is not negligible, and our registry confirmed that these patients have a relevant mortality rate at 90 days. Concomitant bacteremia, featuring polymicrobial sepsis, and starting antifungal treatment with fluconazole instead of echinocandins independently increase the risk of death. Efforts are needed to improve the awareness and management of IC in IMUs.

Published
2021

5. Poster session 4

Author

Parisi, V, Ferro, G, Bevilacqua, A, Caruso, A, Grimaldi, G, Rengo, G, Leosco, D, Ferrara, N, Yan, B P Y, Lai, KH, Chan, MYT, Lam, DYY, Fong, KNY, Chau, C, Fok, MHL, Kam, K, Tam, GM, Lee, PW, Takeuchi, H, Angelis, A, Aggeli, K, Ioakeimidis, N, Felekos, I, Abdelrasoul, M, Aznaouridis, K, Rokas, K, Vlachopoulos, C, Tousoulis, D, Cano Carrizal, R, Casanova Rodriguez, C, Prieto Moriche, E, Iglesias Del Valle, D, Cadenas Chamorro, R, De Juan Baguda, J, Martin-Penato Molina, A, Paredes Gonzalez, B, Garcia Garcia, A, Plaza Perez, I, Caiani, EG, Arbeille, P, Massabuau, P, Colombo, F, Ferri, G, Kasswat, C, Medvedofsky, D, Lang, RM, Vaida, P, Kuznetsov, VA, Yaroslavskaya, EI, Krinochkin, DV, Pushkarev, GS, Gorbatenko, EA, Bruno, RM, Bianchini, E, Di Lascio, N, Stea, F, Ujka, K, Marabotti, A, D’angelo, GS, Ghiadoni, L, Pratali, L, Zemedkun, M, Wang, Z, Asch, FM, Niki, K, Sugawara, M, Yauchi, S, Inoue, K, Yagawa, M, Takamisawa, I, Umemura, J, Yoshikawa, T, Sumiyoshi, T, Tomoike, H, Christov, G, Saundankar, J, Perdreau, E, Mukasa, T, Shah, V, Klein, N, Brogan, P, Marek, J, Batalli, A, Ibrahimi, P, Ahmeti, A, Haliti, E, Bytyci, I, Poniku, A, Henein, MY, Bajraktari, G, Luo, XX, Fang, F, Gan, SF, Ma, Z, Yu, CM, Gonella, A, Conte, E, Morena, L, Riva, L, Civelli, D, Losardo, L, Canepari, ME, Castellino, C, Grasso, M, Margaria, F, Massoure, P L, Camus, O, Gabaudan, C, Desmots, F, Fourcade, L, Jacquier, A, Divchev, D, Weippert, M, Schmidt, P, Gettel, H, Neugebauer, A, Behrens, K, Braumann, K-M, Wolfarth, B, Nienaber, CA, Rodriguez Gonzalez, E, Monivas Palomero, V, Mingo Santos, S, Restrepo Cordoba, MA, Goirigolzarri Artaza, J, Gomez Bueno, M, Garcia Izquierdo, E, Serrano Fiz, S, Gonzalez Roman, A, Segovia Cubero, J, Pila-On, SASTRA, Atmadikoesoemah, C, Soesanto, A, Andriantoro, H, Kowallick, J T, Morton, G, Lamata, P, Jogiya, R, Kutty, S, Lotz, J, Hasenfuss, G, Nagel, E, Chiribiri, A, Schuster, A, Jung, IH, Moon, JG, Byun, YS, Kim, TH, Park, SH, Seo, HS, Wellnhofer, E, Kriatselis, C, Gerds-Li, JH, Kropf, M, Pieske, B, Graefe, M, Eldeep, M, Marghany, K, Mokarrab, M, Albaz, M, Marcos-Alberca Moreno, P, Perez-Isla, L, Palacios, J, Gomez De Diego, JJ, De Agustin, JA, Luaces, M, Mahia, P, Arrazola, J, Garcia-Fernandez, MA, Macaya, C, Attenhofer Jost, C H, Mueller, P, Naegeli, B, Levis, P, Amann, FW, Seifert, B, Maurer, D, Bertel, O, Caspar, T, Samet, H, Jesel, L, Petit-Eisenmann, H, Trinh, A, Talha, S, Morel, O, Ohlmann, P, Leao, S, Cordeiro, F, Magalhaes, P, Moz, M, Trigo, J, Mateus, P, Fontes, P, Moreira, I, Sharif, D, Matanis, W, Sharif-Rasslan, A, Sharif, Y, Rosenschein, U, Faustino, M, Bravo Baptista, S, Freitas, A, Bicho Augusto, J, Leal, P, Nedio, M, Antunes, C, Farto E Abreu, P, Gil, V, Morais, C, Nguyen, VT, Cimadevilla, C, Arangalage, D, Dehoux, M, Dreyfus, J, Codogno, I, Duval, X, Huart, V, Vahanian, A, Messika-Zeitoun, D, Cakmak, HA, Aslan, S, Erturk, M, Ornek, V, Tosu, AR, Kalkan, AK, Ozturk, D, Tasbulak, O, Avci, Y, Gul, M, Cioffi, G, Mazzone, C, Di Nora, C, Barbati, G, Ognibene, F, Nistri, S, Tarantini, L, Pulignano, G, Di Lenarda, A, Faggiano, P, Nishimura, S, Izumi, C, Amano, M, Miyake, M, Tamura, T, Kondo, H, Kaitani, K, Nakagawa, Y, Rosa, I, Ancona, F, Stella, S, Marini, C, Spartera, M, Barletta, M, Pavon, AG, Margonato, A, Agricola, E, Arangalage, D, Nguyen, V, Robert, T, Melissopoulou, M, Mathieu, T, Codogno, I, Cimadevilla, C, Dehoux, M, Vahanian, A, Messika-Zeitoun, D, Rahman, MT, Zito, C, Longobardo, L, Cusma Piccione, M, Zucco, M, D'angelo, M, Rivetti, L, Carerj, ML, Boretti, I, Calabro, MP, Carerj, S, Lozano Granero, VC, Rodriguez Munoz, D, Carbonell San Roman, A, Moya Mur, JL, Hinojar, R, Gonzalez, A, Casas, E, Jimenez Nacher, JJ, Fernandez-Golfin, C, Zamorano Gomez, JL, Gripari, P, Tamborini, G, Muratori, M, Ghulam Ali, S, Fusini, L, Alamanni, F, Pepi, M, Keramida, K, Bellamy, M, Dawson, D, Nihoyannopoulos, P, Solowjowa, N, Musayeva, L, Hrytsyna, Y, Knosalla, CH, Falk, V, Muraru, D, Maddalozzo, A, Jenei, C, Dequal, D, Veronesi, F, Aruta, P, Romeo, G, Iliceto, S, Badano, L, Gursoy, MO, Kalcik, M, Ozkan, M, Astarcioglu, MA, Gokdeniz, T, Yesin, M, Karakoyun, S, Gunduz, S, Tuncer, MA, Koksal, C, Cresti, A, Chiavarelli, M, Guerrini, F, D'aiello, N, Albano, A, De Sensi, F, Picchi, A, Cesareo, F, Severi, S, Braga, M, Nascimento, H, Flores, L, Ribeiro, V, Melao, F, Dias, P, Maciel, MJ, Bettencourt, P, Ferreiro Quero, C, Delgado Ortega, M, Puentes Chiachio, M, Mesa Rubio, M D, Ruiz Ortiz, M, Duran Jimenez, E, Sanchez Fernandez, J, Morenate Navio, C, Pan, M, Suarez De Lezo, J, Jansen, R, Agostoni, P, Stella, PR, Nijhoff, F, Ramjankhan, FZ, Suyker, WJ, Chamuleau, SAJ, Scislo, P, Huczek, Z, Kochman, J, Rymuza, B, Kochanowski, J, Scisbisz, A, Piatkowski, R, Opolski, G, Ray, R, Knott, K, Smith, D, Rodriguez, A, Finocchiaro, G, Sharma, R, Veiga, C, Calvo Iglesias, F, Paredes-Galan, E, Pazos, Pablo, Romo, Andres Iniguez, Ageing, Disease, Cardiovascular, Krejci, J, Hude, P, Ozabalova, E, Zampachova, V, Mlejnek, D, Sochorova, D, Spinarova, L, Wess, G, Klueser, L, Holler, PJ, Simak, J, Kuechenhoff, H, Vago, H, Czimbalmos, CS, Toth, A, Csecs, I, Kecskes, K, Suhai, F, Kiss, O, Simor, T, Becker, D, Merkely, B, Hinojar, R, Fernandez-Golfin, C, Portugal, JC, Esteban, A, Megias, A, Ruiz Leria, S, Rincon, LM, Jimenez-Nacher, JJ, Zamorano, JL, Dejgaard, LA, Haland, T, Lie, OH, Massey, R, Edvardsen, T, Haugaa, KH, Pavlyukova, EN, Evtushenko, VA, Smushlyaev, KA, Karpov, RS, Zaroui, A, Asmi, MONIA, Ben Said, RYM, Zidi, WIEM, Wali, SANA, Feki, M, Mourali, MS, Kaabachi, NEZIHZ, Mechmeche, RACHID, Labarre, Q, Garcia, R, Degand, B, Christiaens, L, Coisne, D, Csecs, I, Czimbalmos, CS, Toth, A, Suhai, F I, Pozsonyi, Z, Becker, D, Simor, T, Merkely, B, Vago, H, Maceira Gonzalez, A M, Tuset, L, Ripoll, C, Cosin-Sales, J, Igual, B, Salazar, J, Belloch, V, Coisne, D, Viera, F, Labarre, Q, Garcia, R, Degand, B, Christiaens, L, Rodriguez Gonzalez, E, Monivas Palomero, V, Mingo Santos, S, Restrepo Cordoba, MA, Goirigolzarri Artaza, J, Gomez Bueno, M, Serrano Fiz, S, Gonzalez Roman, A, Garcia Izquierdo Jaen, E, Segovia Cubero, J, Rojek, A, Chrostowska, M, Dudziak, M, Narkiewicz, K, Grapsa, J, Tan, TC, Dawson, D, Nihoyannopoulos, P, Methia, N, Cioffi, G, Viapiana, O, Ognibeni, F, Dalbeni, A, Gatti, D, Di Nora, C, Mazzone, C, Faganello, G, Di Lenarda, A, Rossini, M, Styczynski, G, Milewska, A, Marczewska, M, Sobieraj, P, Sobczynska, M, Dabrowski, M, Kuch-Wocial, A, Szmigielski, C A, Czimbalmos, C, Vago, H, Csecs, I, Toth, A, Suhai, F I, Kiss, O, Sydo, N, Becker, D, Simor, T, Merkely, B, Konopka, M, Burkhard-Jagodzinska, K, Krol, W, Jakubiak, A, Aniol-Strzyzewska, K, Sitkowski, D, Dluzniewski, M, Braksator, W, Sturmberger, T, Eder, V, Ebner, C, Winter, S, Martinek, M, Puererfellner, H, Aichinger, J, Sormani, P, Rusconi, C, Zancanella, M, Peritore, A, De Chiara, B, Spano’, F, Vallerio, P, Cairoli, R, Giannattasio, C, Moreo, A, Siliste, RN, Chitroceanu, A, Ianula, R, Spataru, D, Isacoff, D, Rodrigues, AC, Monaco, C, Guimaraes, L, Cordovil, R, Piveta, R, Franca, L, Fischer, CH, Vieira, M, Lira, E, Morhy, S, Antonielli, E, Pizzuti, A, Dogliani, S, Mabritto, B, Bassignana, A, Pancaldo, D, Doronzo, B, Evdoridis, C, Papasaikas, D, Sergi, E, Papadimitriou, D, Tolios, P, Papagiannis, G, Tzamou, V, Trikas, A, Scali, MC, Bombardini, T, Picano, E, Scali, MC, Bombardini, T, Salvadori, S, Costantino, MF, Picano, E, Scali, MC, Bombardini, T, Salvadori, S, Picano, E, Generati, G, Bandera, F, Pellegrino, M, Labate, V, Carbone, F, Alfonzetti, E, Guazzi, M, Rivetti, L, Cusma Piccione, M, Zito, C, D'angelo, M, Manganaro, R, Pizzino, F, Terrizzi, A, Quattrocchi, S, Ioppolo, A, Carerj, S, Giga, V, Boskovic, N, Stepanovic, J, Beleslin, B, Nedeljkovic, I, Dobric, M, Djordjevic-Dikic, A, Popovic, D, Petrovic, I, Banovic, M, Lasica, R, Pesic, V, Plecas - Solarovic, B, Vidojevic, D, Djordjevic, T, Orovic, M, Vujisic - Tesic, B, Bordonaro, V, Buccheri, S, Bottari, VE, Romano, C, Atanasio, FA, Tamburino, C, Monte, I P, Korchi, F, Kassongo, A, Meimoun, P, De Zuttere, D, Lardoux, HERVE, Zoppellaro, G, Venneri, L, Khattar, RS, Li, W, Senior, R, Casanova Rodriguez, C, Cano Carrizal, R, Cadenas Chamorro, R, Iglesias Del Valle, D, Prieto Moriche, E, Garcia Garcia, A, Martin Penato Molina, A, De Juan Baguda, J, Paredes Gonzalez, B, Plaza Perez, I, Sreekumar, P, Manjunath, CN, Ravindranath, KS, Dhanalakshmi, CD, Ranjbar, S, Karvandi, M, Ranjbar, F, Ghaffaripour Jahromi, M, Hassantash, SA, Foroughi, M, Maurea, N, Coppola, C, Piscopo, G, Galletta, F, Maurea, C, Esposito, E, Barbieri, A, Riccio, G, De Laurentiis, M, De Lorenzo, C, Strachinaru, M, De Jong, N, Geleijnse, ML, Van Dalen, BM, Vos, HJ, Keramida, K, Kouris, N, Dawson, D, Olympios, CD, Nihoyannopoulos, P, Rodriguez Munoz, D, Carbonell San Roman, A, Lozano Granero, C, Moya Mur, JL, Fernandez-Golfin, C, Moreno Planas, J, Casas Rojo, E, Fernandez Santos, S, Hernandez-Madrid, A, Zamorano Gomez, JL, D'auria, F, Leone, R, Itri, F, Del Negro, G, Colombino, M, Masiello, P, Longobardi, A, Rosapepe, F, Iesu, S, Di Benedetto, G, Capotosto, L, D'orazio, S, Ashurov, R, Continanza, G, Mangieri, E, Terzano, C, Vitarelli, A, Seo, J, Cho, IJ, Chang, HJ, Hong, GR, Ha, JW, Chung, NS, Shim, CY, Bianco, F, Cicchitti, V, Radico, F, Conti, M, Bucciarelli, V, Marchetti, M, Tonti, G, De Caterina, R, Di Girolamo, E, Gallina, S, Plokhova, EV, Akasheva, D, Tkacheva, O, Strazhesko, I, Dudinskaya, E, Pokshubina, I, Pykhtina, V, Kruglikova, A, Brailova, N, Boytsov, S, Weng, K-P, Lin, CC, Wahba Hassanein, M, Ashour, Z A, Bakhoum, S W G, Abdel Wahab, A M A, Hussein, EKHLAS, Saad, ZIZI, Malik, RAUOOF, Almasswary, ADEL, Elrawy, M, Lo Iudice, F, Lembo, M, Muscariello, R, Carlomagno, F, Pivonello, R, Colao, A, Trimarco, B, Galderisi, M, Purwowiyoto, S L, Santoso, A, Soesanto, A M, Indonesia), PERKI (Perhimpunan Dokter Spesialis Kardiovaskular, Segura De La Cal, T, Moya Mur, JL, Garcia Martin, A, Carbonell, S, Fraile Sanz, C, Rincon, LM, Rodriguez Munoz, DA, Jimenez Nacher, JJ, Fernandez-Golfin, C, Zamorano, JL, Ongun, A, Habibova, U, Gerede, DM, Dincer, I, Kilickap, M, Erol, C, Nouhravesh, N, Andersen, HU, Jensen, JS, Rossing, P, Jensen, MT, Gasior, Z, Dabek, J, Balys, M, Glogowska-Rygus, J, and Pysz, P

Abstract

Purpose: Epicardial adipose tissue (EAT) thickness, measured by echocardiography, is associated to the presence of coronary artery disease (CAD) and severe aortic stenosis (AS). EAT thickness is commonly referred as the diameter of the echo-free space between the right ventricular wall and the visceral layer of the pericardium in parasternal long axis view, using the aortic annulus as an anatomic landmark (EAT-1). We aimed to demonstrate that the direct measurement of the adipose tissue thickness visualized in the space between the ascending aorta and the right ventricle (EAT-2) might be considered an alternative method. Methods: We measured EAT-1 and EAT-2 in 130 pts with severe cardiac disease referred for cardiac surgery: 53 pts with isolated AS, 49 pts with severe CAD, and 28 pts with both severe AS and CAD (AS+CAD); and in 50 control subjects matched for age, sex and BMI. The two measurements were obtained at end-systole in 3 cardiac cycles (figure). Results. Both EAT-1 and EAT-2 measurements had an excellent reproducibility. With respect to controls pts had significantly increased EAT-1 (2,4 ± 0,5mm vs 6 ± 2mm; p<0,05) and EAT-2 (3 ± 1,2mm vs 12 ± 3mm; p<0,05). EAT-1 and EAT-2 were not statistically different in controls. EAT-2 was significantly higher than EAT-1 in CAD, AS, and AS+CAD pts (p<0,05). Interestingly, EAT-2, but not EAT-1, was significantly increased in AS+CAD pts with respect to EAT-2 of pts with isolated AS and isolated CAD. Conclusions: Our data demonstrate that EAT-2, as well as EAT-1, is a valuable method to measure EAT thickness. Further, EAT-2 seems to better recognize EAT increase, in pts with AS+CAD. Comprehensively, EAT-2 is greater than EAT-1. The larger space between ascending aorta and right ventricle, allowing EAT expansion, could justify our observation.

Published
2015
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6. The challenge of prognostic markers in acute pancreatitis: internist's point of view.

Author

Para O, Caruso L, Savo MT, Antonielli E, Blasi E, Capello F, Ciarambino T, Corbo L, Curto A, Giampieri M, Maddaluni L, Zaccagnini G, and Nozzoli C

Abstract

Acute pancreatitis, the most frequent hospitalization reason in internal medicine ward among gastrointestinal diseases, is burdened by high mortality rate. The disease manifests mainly in a mild form, but about 20-30% patients have a severe progress that requires intensive care. Patients presenting with acute pancreatitis should be clinically evaluated for organ failure signs and symptoms. Stratifying patients in the first days from symptoms onset is essential to determine therapy and care setting. The aim of our study is to evaluate prognostic factors for acute pancreatitis patients, hospitalized in internal medicine wards, and moreover, understanding the role of various prognostic scores validated in intensive care setting in predicting in-hospital mortality and/or admission to intensive care unit. We conducted a retrospective study enrolling all patients with diagnosis of acute pancreatitis admitted took an internal medicine ward between January 2013 and May 2019. Adverse outcome was considered in-hospital mortality and/or admission to intensive care unit. In total, 146 patients (137 with positive outcome and 9 with adverse outcome) were enrolled. The median age was (67.89 ± 16.44), with a slight prevalence of male (55.1%) compared to female (44.9%). C protein reactive (p = 0.02), creatinine (p = 0.01), sodium (p = 0.05), and troponin I (p = 0.013) after 48 h were significantly increased in patients with adverse outcome. In our study, progression in SOFA score independently increases the probability of adverse outcome in patients hospitalized with acute pancreatitis. SOFA score > 5 is highly predictive of in-hospital mortality (O.R. 32.00; C.I. 6.73-152.5; p = 0.001) compared to other scores. The use of an easy tool, validated in intensive care setting such as SOFA score, might help to better stratify the risk of in-hospital mortality and/or clinical worsening in patients hospitalized with acute pancreatitis in internal medicine ward.

Published
2021
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7. Performance of the CHA 2 DS 2 -VASc score in predicting new onset atrial fibrillation during hospitalization for community-acquired pneumonia.

Author

Pieralli F, Biondo B, Vannucchi V, Falcone M, Antonielli E, De Marzi G, Casati C, Maddaluni L, Nozzoli C, and Olivotto I

Subjects
Aged, Aged, 80 and over, Atrial Fibrillation mortality, Female, Humans, Italy epidemiology, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Prospective Studies, ROC Curve, Risk Assessment, Risk Factors, Severity of Illness Index, Survival Analysis, Atrial Fibrillation epidemiology, Community-Acquired Infections complications, Hospital Mortality, Pneumonia complications
Abstract

Background: Cardiovascular events are common during hospitalization for community-acquired pneumonia (CAP), with new onset atrial fibrillation (NOAF) being the second most relevant complication. In this study, we aimed to investigate the role of CHA 2 DS 2 -VASc score in predicting NOAF during hospitalization for CAP., Methods: Patients admitted for CAP were prospectively assessed using CHA 2 DS 2 -VASc. The end-point of the study was the occurrence of any objectively documented episode of NOAF during hospitalization in patients that were in sinus rhythm at hospital admission., Results: Of 468 patients enrolled (median age 76 years), 48 (10.3%) experienced NOAF during hospitalization. They were older, had more comorbidities, more severe pneumonia, and higher CHA 2 DS 2 -VASc than those who remained in sinus rhythm (4.4 ± 1.6 vs 3.4 ± 1.9, respectively; p < .0001). There was a direct relationship between CHA 2 DS 2 -VASc score and risk of NOAF. At ROC curve analysis, a CHA 2 DS 2 -VASc score > 3 was the most accurate cut-off for prediction of NOAF (AUC 0.653; 95% CI 0.577-0.729; p = .001). In two different multivariable models, each CHA 2 DS 2 -VASc point increase and a score > 3 both were independently associated with NOAF (HR 1.3; 95% CI 1.09-1.55; p = .003 and 2.3; 95% CI 1.19-4.44; p = .007, respectively)., Conclusions: CHA 2 DS 2 -VASc score is an accurate and independent predictor of NOAF in patients with CAP, and a score > 3 features a population at high risk of developing the arrhythmia during hospitalization. This simple and effective tool should be incorporated in the evaluation of patients hospitalized for CAP, with implications ranging from arrhythmic prevention to anticoagulation management., (Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Published
2019
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8. Usefulness of procalcitonin in differentiating Candida and bacterial blood stream infections in critically ill septic patients outside the intensive care unit.

Author

Pieralli F, Corbo L, Torrigiani A, Mannini D, Antonielli E, Mancini A, Corradi F, Arena F, Moggi Pignone A, Morettini A, Nozzoli C, and Rossolini GM

Subjects
Aged, Aged, 80 and over, Biomarkers blood, Calcitonin blood, Candida pathogenicity, Candidiasis epidemiology, Case-Control Studies, Critical Illness epidemiology, Female, Humans, Intensive Care Units organization & administration, Intensive Care Units statistics & numerical data, Italy epidemiology, Male, Middle Aged, Retrospective Studies, Sepsis epidemiology, Bacterial Infections diagnosis, Biomarkers analysis, Calcitonin analysis, Candidiasis diagnosis, Sepsis classification
Abstract

We aimed to explore the role of procalcitonin (PCT) for the diagnosis of Candida spp. bloodstream infections in a population of critically ill septic patients admitted to internal medicine units. This is a retrospective case-control study considering all cases of candidemia identified in three internal medicine units, from January 1st 2012 to May 31st 2016. For each case of candidemia, two patients with bacteremic sepsis were included in the study as control cases. The end point of the study was to evaluate the diagnostic performance of PCT for the diagnosis of Candida spp. blood stream infections in patients with objectively documented sepsis. Sixty-four patients with candidemia and 128 controls with bacteremia were enrolled. Median and interquartile range (IQR) PCT values are significantly lower in patients with candidemia (0.73; IQR 0.26-1.85 ng/mL) than in those with bacteremia (4.48; IQR 1.10-18.26 ng/mL). At ROC curve analysis, values of PCT greater than 2.5 ng/mL had a negative predictive value (NPV) of 98.3% with an AUC of 0.76 (0.68-0.84 95% CI) for the identification of Candida spp. from blood cultures. At multivariate analysis, a PCT value <2.5 ng/mL showed an odds ratio of 8.57 (95% CI 3.09-23.70; p < 0.0001) for candidemia. In septic patients at risk of Candida infection, a PCT value lower than 2.5 ng/mL should raise the suspicion of candidemia, adding value for considering prompt initiation of antifungal therapy.

Published
2017
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9. Absence of left atrial stunning after cardioversion of recent-onset atrial fibrillation in patients at low-stroke risk.

Author

Antonielli E, Pizzuti A, Dogliani S, Stasi M, Bassignana A, and Doronzo B

Subjects
Echocardiography, Female, Humans, Male, Middle Aged, Myocardial Stunning diagnostic imaging, Risk Factors, Thromboembolism epidemiology, Atrial Fibrillation therapy, Electric Countershock adverse effects, Heart Atria diagnostic imaging, Heart Atria physiopathology, Myocardial Stunning etiology, Stroke etiology, Thromboembolism etiology
Abstract

Objective: The aim of the present study was to evaluate the presence and degree of spontaneous echo contrast (SEC) in the left atrium and of left atrial appendage (LAA) contractility before and after cardioversion (CV) in patients with recent-onset atrial fibrillation (AF)., Methods: Our study included 56 patients divided into two groups: group 1, comprising 32 clinically stable patients who were admitted to the Emergency Department with less than or equal to 48 h duration AF, and who underwent transoesophageal echocardiography (TEE)-guided CV; and the control group (group 2), comprising 24 patients admitted to the Cardiological Department for elective TEE-guided CV of greater than 48 h AF. All patients underwent repeat TEE within 1 h after successful CV., Results: Patients with recent-onset AF (group 1) showed no thrombogenic milieu at baseline without any evidence of atrial stunning after successful CV. SEC mean grade (0-3 grading) was 0.09±0.3 versus 0.12±0.4 after CV (P=0.98), and LAA flow velocity was 60.7±19.4 versus 56.7±20.5 cm/s after CV (P=0.07). Group 2 patients showed a significantly higher degree of SEC compared with those in group 1 (0.09±0.3 vs. 0.66±0.7, P=0.0093) and significantly lower LAA flow velocities (60.7±19.4 vs. 32.5±12.4, P<0.0001), with significant worsening after successful CV (SEC degree: 0.66±0.9 vs. 1.37±0.9, P=0.0093; LAA flow velocity: 32.5±12.4 vs. 20.4±12.7 cm/s, P<0.0001)., Conclusion: The absence of thrombogenic milieu and of left atrial stunning after CV in patients with recent-onset AF favours early CV without anticoagulation, at least in patients with a low thromboembolic risk profile. These patients could be discharged earlier from urgent care.

Published
2017
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10. Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit.

Author

Pieralli F, Vannucchi V, Mancini A, Antonielli E, Luise F, Sammicheli L, Turchi V, Para O, Bacci F, and Nozzoli C

Abstract

Background: Severe sepsis and septic shock are leading causes of morbidity and mortality among critically ill patients, thus the identification of prognostic factors is crucial to determine their outcome. In this study, we explored the value of procalcitonin (PCT) variation in predicting 30-day mortality in patients with sepsis admitted to an intermediate care unit., Methods: This prospective observational study enrolled 789 consecutive patients with severe sepsis and septic shock admitted to a medical intermediate care unit between November 2012 and February 2014. Kinetics of PCT expressed as percentage were defined by the variation between admission and 72 hours, and 24 and 72 hours; they were defined as Δ-PCT0-72h and Δ-PCT24-72h, respectively., Results: The final study group of 144 patients featured a mean age of 73 ± 14 years, with a high prevalence of comorbidities (Charlson index greater than 6 in 39%). Overall, 30-day mortality was 28.5% (41/144 patients). A receiver-operating-characteristic (ROC) analysis identified a decrease of Δ-PCT0-72h less than 15% (area under the curve: 0.75; 95% confidence interval (CI): 0.67 - 0.82) and a decrease of Δ-PCT24-72h less than 20% (area under the curve: 0.83; 95% CI: 0.74 - 0.92) as the most accurate cut-offs in predicting mortality. Decreases of Δ-PCT0-72h less than 15% (HR: 3.9, 95% CI: 1.6 - 9.5; P < 0.0001) and Δ-PCT24-72h less than 20% (HR: 3.1, 95% CI: 1.2 - 7.9; P < 0.001) were independent predictors of 30-day mortality., Conclusions: Evaluation of PCT kinetics over the first 72 hours is a useful tool for predicting 30-day mortality in patients with severe sepsis and septic shock admitted to an intermediate care unit.

Published
2015
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