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OBJECTIVE: Severe COVID-19 is characterized by a dysregulated immune response in which neutrophils play a critical role. Calprotectin reflects neutrophil activation and is involved in the self-amplifying thrombo-inflammatory storm in severe COVID-19. We aimed to evaluate the role of calprotectin in early prediction of severity in COVID-19 patients. METHODS: This was a multicenter prospective observational study enrolling consecutive adult COVID-19 patients. On arrival to emergency department, blood samples were collected for laboratory tests, including serum calprotectin. The primary outcome was severe respiratory failure requiring invasive mechanical ventilation and the secondary outcome was need for Intensive Care Unit (ICU) admission. RESULTS: Study population included 395 patients, 57 (14.4%) required invasive mechanical ventilation and 100 (25.3%) were admitted to ICU. Median serum calprotectin levels were significantly higher in intubated (3.73mg/L vs. 2.63mg/L; p

Early risk stratification of acute pancreatitis is crucial to improve clinical outcomes. The objective of this study was to evaluate the ability of pancreatic stone protein (PSP) to predict acute pancreatitis severity and to compare it with the biomarkers and severity scores currently used for that purpose. Prospective single-center observational study enrolling 268 adult patients with acute pancreatitis. Biomarkers including PSP were measured upon admission to the Emergency Department and severity scores as SOFA, PANC-3, and BISAP were computed. Patients were classified into mild-moderate (non-severe) and severe acute pancreatitis according to the Determinant-Based Classification Criteria. Area under the curve (AUC) and regression analysis were used to analyze the discrimination abilities and the association of biomarkers and scores with severity. Two hundred and thirty-five patients (87.7%) were classified as non-severe and 33 (12.3%) as severe acute pancreatitis. Median [IQR] PSP was increased in patients with severe acute pancreatitis (890 μg/L [559–1142] vs. 279 μg/L [141–496]; p

Objectives Paracetamol intoxication is one of the causes of elevated procalcitonin concentrations unrelated to infection. We report a case series of two patients intoxicated with paracetamol whose laboratory data revealed a significant elevation of serum procalcitonin concentrations without clinical, radiological and/or biological evidence of infection. The underlying mechanism by which paracetamol triggers an increase in procalcitonin concentrations is still unclear. Case presentation We report two cases of paracetamol intoxication. Both patients were admitted to the Emergency Department (ED) and subsequently transferred to the Intensive Care Unit (ICU). The patients exhibited elevated procalcitonin levels during the first hours of admission without clinical and/or microbiological evidence of infection that could explain such increase. Notably, only Case 1 developed liver injury, with alterations in alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin and esterified bilirubin concentrations, which were not observed in Case 2. Conclusions The two patients showed elevated procalcitonin concentrations resulting from paracetamol intoxication, although only a patient exhibited signs of liver injury. These findings suggest that increased procalcitonin levels induced by a paracetamol overdose cannot be fully explained by hepatocyte injury alone, but other mechanisms involving other organs and tissues may also be associated. In any case, although this mechanism is not well understood, it is important to be aware of this limitation when using procalcitonin as a biomarker of infection in patients intoxicated with paracetamol.

Resumen Objetivos La intoxicación por paracetamol es una de las causas no infecciosas asociada al incremento de la concentración de procalcitonina. Presentamos dos casos de pacientes ingresados por intoxicación por paracetamol en el que los datos analíticos revelaron un aumento significativo de procalcitonina sin datos clínicos, radiológicos y/o microbiológicos de infección. El mecanismo que explicaría este incremento no ha sido aclarado. Caso clínico Se presentan dos casos correspondientes a dos pacientes atendidos en el Servicio de Urgencias por intoxicación por paracetamol requiriendo ambos el ingreso en la Unidad de Cuidados Intensivos (UCI). Ambos mostraron un incremento de procalcitonina en las primeras horas de ingreso, sin evidencia clínica y/o microbiológica de infección que justificase dicho incremento. De forma llamativa, sólo el paciente 1 presentó disfunción hepática, con alteración de las concentraciones de alanino aminotransferasa (ALT), aspartato aminotransferasa (AST), bilirrubina y bilirrubina esterificada, hallazgos no observados en la paciente 2. Conclusiones los pacientes presentados en este caso clínico mostraron un aumento de procalcitonina asociado a la intoxicación por paracetamol, pero sólo uno de ellos mostró signos de disfunción hepática. Ello sugiere que en la intoxicación por este fármaco la secreción del biomarcador no estaría solamente ligado al daño sobre el hepatocito, sino que otros mecanismos en los que estarían implicados otros órganos y tejidos contribuirían al aumento de procalcitonina. En cualquier caso, y aunque el mecanismo no ha sido perfectamente aclarado, es importante conocer esta limitación para el uso de procalcitonina como marcador de infección en pacientes intoxicados por paracetamol.

To explore the significance of SAA in evaluating the severity and prognosis of COVID-19.A total of 132 patients with confirmed COVID-19 who were admitted to a designated COVID-19 hospital in Wuhan, China from January 18, 2020 to February 26, 2020 were collected. The dynamic changes of blood SAA, CRP, PCT, WBC, Lymphocyte (L), PLT, CT imaging, and disease progression were studied. All patients completed at least twice laboratory data collection and clinical condition assessment at three time points indicated for this study; The length of hospital stay was longer than 14 days prior to February 26, 2020.COVID-19 patients had significantly increased SAA and CRP levels, while L count decreased, and PCT, WBC, and PLT were in the normal range. As disease progressed from mild to critically severe, SAA and CRP gradually increased, while L decreased, and PLT, WBC, and PCT had no significant changes; ROC curve analysis suggests that SAA/L, CRP, SAA, and L count are valuable in evaluating the severity of COVID-19 and distinguishing critically ill patients from mild ones; Patients with SAA consistently trending down during the course of disease have better prognosis, compared with the patients with SAA continuously rising; The initial SAA level is positively correlated with the dynamic changes of the serial CT scans. Patient with higher initial SAA level are more likely to have poor CT imaging.SAA and L are sensitive indicators in evaluating the severity and prognosis of COVID-19. Monitoring dynamic changes of SAA, combined with CT imaging could be valuable in diagnosis and treatment of COVID-19.

Growth differentiation factor 15 (GDF-15) has been suggested as a prognostic biomarker for bleeding and mortality in atrial fibrillation (AF). To date, serum and EDTA matrices are standardized for the GDF-15 assay but it is unclear if it can be measured also in citrate. In this study, we aim to investigate if the Elecsys GDF-15 assay (Roche Diagnostics, Mannheim, Germany) can be determined accurately in citrate samples in a cohort of 10 patients with AF and 10 healthy controls. From January 2018 to March 2018, we included healthy controls and patients with AF under vitamin K antagonists in a tertiary hospital. Blood samples were drawn in both groups. We included 10 controls (50% males, mean age 36.4±8.9 years) and 10 patients with AF (80% males, mean age 76.5±16.6 years). The mean GDF-15 levels were increased in patients with AF in comparison to healthy controls, as expected by the presence of a heart-related condition and the higher age of this population. In healthy controls, GDF-15 levels showed an optimal correlation between EDTA-serum (r=0.975; p

Introduction: The COVID-19 pandemic reflects liver damage. A study carried out in China (Guan WJ et al. N Engl J Med. 2020) reported that in more than 21% of cases there was an elevation of liver enzymes (ELE), with only 2.1% of them having previous liver disease. ELE is frequent in anticoagulated patients and is associated with an increased cardiovascular risk and bleeding complications2,3. It is necessary to evaluate the impact of ELE in patients with atrial fibrillation (AF) and COVID-19 Methods: Multicenter, retrospective and observational study that consecutively included patients admitted with COVID-19 during the months of March and April 2020. The patients were followed were followed up until 30 days after discharge or death. termino en inglés ¿??Anticoagulation was chosen at the clinical discretion. The main variables investigated were the value of liver enzymes (AST, ALT, GGT) at admission, during the first week (peak value) and at hospital discharge. Patients who achieved a 3-fold higher level of ELE(> 120UI) were described as high-risk transaminasemia (HRT). The number of bleedings, thromboembolic events, as well as all-cause mortality were evaluated. Statistical analysis was performed with SPSS 21.0 (SPSS Inc., Chicago, IL). Results: A total of 235 patients were included. The mean age was 79 years [standard deviation (SD) 7.9. years]. The demographic characteristics of the patients with and without HRT are summarized in Table 1. The median follow-up was 59 days (SD 29 days). In AF patients, ELE values rose significantly on admission with respect to discharge p Disclosures Olivera: Daiichi Sankyo:Consultancy, Speakers Bureau;BAYER:Consultancy;Boehringer Ingelheim:Consultancy, Speakers Bureau;Pfizer:Consultancy, Speakers Bureau.Campoy Castaño:Boehringer Ingelheim:Consultancy;Daiichi Sankyo:Speakers Bureau.Sierra:Astellas:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Novartis:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals:Research Funding;Pfizer:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Daiichi Sankyo:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Roche:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Gilead-Kite:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.