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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

\nCLINICAL SIGNIFICANCEPurposeChimeric antigen receptor (CAR) T-cell CD19 therapy has changed the treatment paradigm for patients with relapsed/refractory B-cell acute lymphoblastic leukemia. It is frequently associated with potentially severe toxicities: cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), and admission to PICU is often required. Some biomarkers seem to correlate with CRS severity. Our goal is to elucidate the role of procalcitonin (PCT), C-reactive protein (CRP) and ferritin in the context of CRS following CAR T-cell infusion to predict its severity and PICU admission.MethodsProspective observational study (2016-2022) in children and young adult who received CAR T-cell therapy (Tisagenlecleucel/ARI-0001). We collected epidemiologic data, specific CAR T-cell toxicities, PICU admission, biomarker results (procalcitonin, CRP and ferritin), length of stay and mortality. Biomarkers were analyzed considering two values: the highest value during ward admission, and the highest overall value including PICU admission.ResultsSeventy-seven patients were included. Median age at infusion was 9.1 years (IQR 6-13), 49.4% were females. Before CAR T-cell infusion, the median bone marrow blast was 9% (IQR 0-59). The most frequent toxicity was CRS in 62 patients (80.5%), it was severe in 18 cases (23.4%). Fourteen patients (18.1%) had ICANS. Thirty-one patients (40.3%) required admission to the PICU. PCT and ferritin were higher in patients admitted to PICU (PCT 0.8 ng/ml vs 0.15 ng/ml, p < 0.001, ferritin 5490 vs. 2900 ug/l, p < 0.019). The proposed cut-off for PCT to predict admission to PICU is 0.55 ng/mL, presenting a sensitivity of 67.7% and a specificity of 86.7%. The maximum value of the three biomarkers was higher in those who presented any primary outcome: development of a severe CRS, the need for admission to PICU, and in-hospital mortality. Biomarkers were higher in those who needed inotropic or respiratory support.ConclusionsPCT levels increase after CAR-T cell therapy in the setting of systemic inflammation and could be a predictor of PICU admission and evolution to death. Further research studying its role in the context of CRS and the differential diagnosis between infection and CRS is needed to better understand the biology of this biomarker and to define its value in clinical practice.Several biomarkers seem to correlate with CRS severity, however some of them are not widely available in the daily practice. In this study, we found that procalcitonin, a widely used biomarker for bacterial infection, increases after CAR T-cell therapy in the setting of systemic inflammation and could be a predictor for PICU admission and death. Therefore, we shown that PCT levels correlate with PICU admission and mortality more accurately than other biomarkers such as ferritin and C-reactive protein and that their use can have an impact in the daily practice. [ABSTRACT FROM AUTHOR]

Background: Extubation failure is associated with an increased morbidity, emphasizing the need to identify factors to further optimize extubation practices. The role of biomarkers in the prediction of extubation failure is currently limited. The aim of this study was to investigate the prognostic value of cardiac (N-terminal pro–B-type natriuretic peptide (NT-proBNP), High-sensitivity Troponin T (Hs-TnT)) and inflammatory biomarkers (Interleukin-6 (IL-6) and Procalcitonin (PCT)) for extubation failure in patients with COVID-19 Acute Respiratory Distress Syndrome (C-ARDS). Materials and methods: In this single-center retrospective cohort study, patient characteristics and laboratory measurements were extracted from electronic medical records. Patients were eligible for inclusion if they were extubated after mechanical ventilation. The primary endpoint was extubation failure, defined as the need for reintubation or death within the next seven days after extubation, regardless of whether post-extubation respiratory support was used. Uni- and multivariable logistic regression was performed to investigate the association between biomarkers and extubation failure. Biomarkers were log2 transformed. Results: Of the 297 patients included, 21.5% experienced extubation failure. In univariable analysis, NT-proBNP (OR 1.24, 95% CI 1.06–1.47), Hs-TnT (OR 1.72, 95% CI 1.37–2.19) and PCT (OR 1.38, 95% CI 1.16–1.65) measured on the day of extubation were significantly associated with extubation failure. After multivariable adjustment for clinical variables (age, duration of mechanical ventilation, SOFA score), Hs-TnT was the only biomarker that was independently associated with extubation failure (adjusted OR 1.38, 95% CI 1.02–1.90). Patients with both elevated Hs-TnT (≥ 14 ng/mL) and elevated PCT (≥ 0.25 ng/mL) carried the highest risk of extubation failure (46%), while in patients with normal Hs-TnT and PCT values, only 13% experienced extubation failure. Conclusions: Hs-TnT, NT-proBNP and PCT measured on the day of extubation are associated with extubation failure in mechanically ventilated patients with C-ARDS. Since Hs-TnT is the only biomarker that is independently associated with extubation failure, Hs-TnT could offer additional objective measures for assessing readiness for extubation. Future studies should focus on an integrative approach of biomarkers combined with relevant clinical factors to predict extubation failure. [ABSTRACT FROM AUTHOR]

Background: The morbidity, mortality, and quality of life of people with chronic obstructive pulmonary disease (COPD) are significantly impacted by exacerbations. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), which act as an amplifier of the innate immune response, procalcitonin (PCT) is a polypeptide that normally produced by para follicular cells (C cells) of the thyroid and by neuroendocrine cells of the lung and intestine could be used to determine the severity of inflammation. Objective: The aim of this study was to assess levels of sTREM-1 and PCT in COPD and evaluate the role of them in diagnosis of acute exacerbation of COPD (AECOPD) due to bacterial infections. Patients and methods: The study was conducted on 60 individuals divided into group I (exacerbation group): included 20 patients. Group II (stable COPD group): included 20 patients. Group III (control group): included 20 individuals, apparently healthy and matched for age and sex. Assessment of sTREM-1 and serum PCT levels by enzyme-linked immunosorbent assay in addition to complete blood count, erythrocyte sedimentation rate, renal function tests, C-reactive protein, and sputum culture. Results: sTREM-1, PCT, and neutrophil/lymphocyte ratio (NLR) were higher in the AECOPD group than in other groups. In AECOPD: the result of sputum cultures revealed; 65% Gram-negative bacteria and 35% Gram-positive bacteria, while in stable COPD: the growth of normal upper respiratory tract flora is 65% then Gram-positive bacteria (20%) then Gram-negative bacteria (15%). PCT, sTREM-1, and NLR showed a higher level in patients who had Gram-negative infection than those with Gram-positive infection, and the lowest level in those who showed growth of normal flora. Pseudomonas is the most commone causative organism of exacerbated COPD (35%), followed by Staphylococcus aureus (25%). Conclusion: sTREM-1, NLR, and PCT level can be considered as an appropriate diagnostic marker in patients with exacerbated COPD due to bacterial infection and in differentiating them from stable COPD patients and may be used to guide medication and target management in patients with AECOPD. [ABSTRACT FROM AUTHOR]

Background: Fulminant virus-associated encephalopathy (VAE) is a rare complication of viral infection that presents as acute brain dysfunction and requires respiratory support and/or vasoactive agents. However, the mechanism of VAE is undetermined. The mortality rate is high since there is no specific treatment for fulminant VAE. The aim of this study was to identify risk factors for children with fulminant VAE on the basis of clinical data since timely recognition and treatment might be needed to improve the poor prognosis. Methods: This retrospective study included children with fulminant VAE who were diagnosed between June 2018 and October 2023 in the PICU of Guangdong Women and Children Hospital. Clinical data were analyzed, and receiver operating characteristic (ROC) curve analysis was performed to determine the prognostic value of the selected variables. Results: Twenty-three children with fulminant VAE were included and divided into a survival group (n = 16) and a nonsurvival group (n = 7). The mortality rate of patients with fulminant VAE was 30.8%. Compared with the survival group, the nonsurvival group had higher incidences of shock 48 h after onset, a higher acute necrotizing encephalopathy severity score (ANE-SS), higher procalcitonin (PCT) levels, and lower platelet counts (p < 0.05). The serum PCT level was significantly higher in the children with shock than in those without shock (p = 0.015). The serum PCT concentration was positively correlated with the ANE-SS (correlation coefficient 0.544, p < 0.039). Combined immunotherapies might help to decrease PCT levels in some children. Low PCT levels might be related to a good outcome. The area under the curve (AUC) for PCT used to predict death in patients with fulminant VAEs was 0.821 (95% CI 0.626–1.00). The sensitivity and specificity of PCT > 101.58 ng/ml for predicting death in patients with fulminant VAE were 57.1% and 100.0%, respectively. Conclusions: Patients with fulminant VAE deteriorate rapidly and are at high risk of death if they develop shock within 48 h after onset, exhibit extremely elevated serum PCT levels, or have decreased platelet counts. The serum PCT level might predict the death outcome of patients with fulminant VAE. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to analyze the behaviors of inflammatory markers, such as procalcitonin and C-reactive protein (CRP), during treatment with obinotuzumab (an anti-CD20 antibody). Methods: Our non-randomized observational study prospectively evaluated a cohort of 22 adult patients with lymphoproliferative neoplasms, chronic lymphocytic leukemia (CLL), and follicular lymphoma (FL) with indications for obinotuzumab therapy. Results: All patients had their blood drawn to determine blood counts, CRP, and procalcitonin, as well as body temperature measurements and blood cultures performed for bacterial infections on day 0 before administration of the anti-CD20 antibody. Subsequently, on days 1 to 7 after administration, blood was drawn daily at a fixed time of 8:00 a.m. for blood counts and CRP and PCT values, and blood cultures were performed. In addition, on days 1 to 7, body temperature was measured at fixed times (i.e., 8:00 a.m. and 8:00 p.m.). In all of these patients, significant increases in inflammatory markers, such as CRP and procalcitonin, were observed shortly after drug infusion. There was a statistically significant change in the serum PCT concentration (p < 0.0001), which significantly increased on days 1 to 4 compared to the initial measurement 0. Conclusions: The increases in inflammatory markers shortly after obinotuzumab (anti-CD20 antibody) administration can be significantly high but are most often not related to the onset of infection and do not lead to any ill consequences in the treatment of lymphoproliferative disease. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing chimeric antigen receptor (CAR) T-cell therapy are vulnerable to infection and sepsis. Treatment course is frequently complicated by cytokine release syndrome which is often clinically and biochemically indistinguishable from sepsis. Procalcitonin (PCT) levels have been examined as a promising biomarker for infection in this cohort of patients. Methods: In this study, we measured daily PCT levels for patients for fourteen days (or hospital discharge) after receiving CAR T-cells to determine threshold PCT values specific for infection compared to those without infection. Results: We present preliminary results of our enrolled cohort to date (sixteen patients). Infection was present in only 12.5% of patients. However, those diagnosed with sepsis had elevated PCT levels with a peak mean of 2.6 µg/L observed on the seventh day post-treatment compared to those without infection remaining below 0.5 µg/L. Furthermore, we observed a trend for early and liberal antibiotic administration within our cohort. Conclusion: Our study highlights the challenges of antimicrobial stewardship in managing CAR T-cell therapy recipients. Our preliminary results underscore the utility of PCT in the risk-stratification and diagnosis of those patients at high risk for infectious complications after receiving CAR T-cell therapy and continue to advocate for a PCT threshold of 1.5 µg/L for diagnosing sepsis. Additionally, in the setting of CRS and lymphodepletion, where white cell count and CRP value are unreliable, a PCT value of < 0.5 µg/L may help exclude sepsis. [ABSTRACT FROM AUTHOR]

The purpose of this narrative review is to analyze the most recent studies about the role of C-reactive protein (CRP) and procalcitonin (PCT), two of the main biomarkers of infection, in distinguishing viral from bacterial etiology, in predicting the severity of infection and in guiding antibiotic stewardship in children with community-acquired pneumonia (CAP). The studies examined reveal that both CRP and PCT play a valuable role in diagnosing pediatric CAP, though each has limitations. CRP has moderate accuracy in distinguishing bacterial from viral infections, but its elevated levels are not exclusive to bacterial infections; PCT, however, shows higher specificity for bacterial CAP, with studies confirming its ability to differentiate bacterial causes, especially in severe cases. When integrated with clinical findings, CRP and PCT improve the sensitivity of pneumonia diagnoses and help in predicting severe outcomes such as sepsis and empyema; furthermore, both biomarkers prove useful in guiding antibiotic therapy, with PCT showing a more dynamic response to treatment. However, even though CRP and PCT offer valuable insights into the diagnosis and management of pediatric CAP, their application should be always integrated with clinical assessment rather than used in isolation. More studies are needed to define standardized thresholds and decision algorithms that incorporate these biomarkers. [ABSTRACT FROM AUTHOR]

Procalcitonin (PCT) is a peptide precursor of calcitonin, considered as an infection marker in many settings. Recently, a few studies reported its rise in some inflammatory processes such as still’s disease, anaphylactic shock and Kawasaki disease. To investigate the serum level of PCT in patients with pemphigus vulgaris (PV) and examine the relationship between serum level of PCT and the severity of disease. A cross-sectional study was conducted on 50 patients with PV, visited at a tertiary care hospital from August 2021 to May 2023. After recording the demographic and clinical characteristics of patients, PCT level as well as CRP and ESR levels were measured and analyzed. The median ESR, CRP and procalcitonin serum level for the patients was 6.40 mm/hr, 11.00 mg/dL and 0.025 ng/ml, respectively. Considering the mean serum PCT level of normal population which is reported as < 0.1 ng/ml, its level among our patients was in a normal range. A significant and positive correlation was observed between procalcitonin and ESR, as well as CRP. In opposite to PCT, CRP and ESR levels showed a significant and positive correlation with disease severity (P values: 0.002 and < 0.001, respectively). Our findings suggest that PCT might not be useful as a biomarker of inflammatory milieu or prognostic factor in patients with PV without any infection. [ABSTRACT FROM AUTHOR]

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]

Background: We compared the diagnostic accuracy of procalcitonin, C-reactive protein (CRP), and ferritin in differentiating an infectious aetiology versus disease flare in children with systemic juvenile idiopathic arthritis (sJIA). Methods: This prospective diagnostic accuracy study included 52 consecutive hospitalisations of 25 children diagnosed with sJIA (International League of Associations for Rheumatology 2001) presenting with a fever to the rheumatology department of a quaternary care centre. We categorised children post-discharge as infectious versus sJIA flare, depending on the clinical course. A subset of sJIA flare developed macrophage activation syndrome (MAS). We compared the area-under-curve (AUC) with its 95% confidence interval (95%CI) of the three biomarkers. Results: The median age of the children was 7 ± 7 years. We categorised 12 hospitalisations (23.1%) as infectious and 40 hospitalisations (76.9%) as sJIA flare. Thirteen hospitalisations (32.5%) with sJIA flare developed MAS. Neither procalcitonin (AUC = 0.584 ± 0.101, 95% CI: 0.387–0.782) nor CRP (AUC = 0.363 ± 0.096, 95% CI: 0.174–0.551) nor ferritin (AUC = 0.419 ± 0.093, 95% CI: 0.236–0.602) discriminated infectious aetiology from sJIA flare adequately. Both serum procalcitonin (AUC = 0.828, 95% CI: 0.694–0.961) and ferritin (AUC = 0.937, 95% CI: 0.862–1) demonstrated higher diagnostic accuracy in ascertaining MAS in sJIA flares, compared to CRP (AUC = 0.709, 95% CI: 0.543–0.876). Conclusion: Procalcitonin can be elevated in children in sJIA flare with MAS, even without an infectious aetiology. Clinicians should continue to rely on clinical history and examinations to discern infectious versus non-infectious fevers in children with sJIA. [ABSTRACT FROM AUTHOR]

Background: Use of serum procalcitonin (PCT), an inflammatory biomarker for bacterial infections, has shown promising results for early stopping antibiotic treatment among patients with respiratory infections and sepsis. There is need for additional data regarding effectiveness and safety of this concept among patients with cancer. Methods: Individual data of patients with a documented diagnosis of cancer and proven or suspected respiratory infection and/or sepsis were extracted from previous trials where adult patients were randomized to receive antibiotic treatment based on a PCT protocol or usual care (control group). The primary efficacy and safety endpoints were antibiotic exposure and 28-day all-cause mortality. Results: This individual-patient data meta-analysis included 777 patients with a diagnosis of cancer from 15 randomized-controlled trials. Regarding efficacy, there was a 18% reduction in antibiotic exposure in patients randomized to PCT-guided care compared to usual care ([days] 8.2 ± 6.6 vs. 9.8 ± 7.3; adjusted difference, − 1.77 [95% CI, − 2.74 to − 0.80]; p < 0.001). Regarding safety, there were 72 deaths in 379 patients in the PCT-guided group (19.0%) compared to 91 deaths in 398 participants in the usual care group (22.9%) resulting in an adjusted OR of 0.78 (95% CI, 0.60 to 1.02). A subgroup analysis showed a significant reduction in mortality in patients younger than 70 years (adjusted OR, 0.58 [95% CI, 0.40 to 0.86]). Conclusion: Result of this individual patient meta-analysis from 15 previous trials suggests that among patients with cancer and suspected or proven respiratory infection or sepsis, use of PCT to guide antibiotic treatment decisions results in reduced antibiotic exposure with a possible reduction in mortality, particularly among younger patients. [ABSTRACT FROM AUTHOR]

Background: Severe alcoholic hepatitis is a catastrophic disease with a mortality rate of up to 35–50% at 30 days. Bacterial infection is an important prognostic factor in patients with severe alcoholic hepatitis, but it is difficult to detect the presence of infection immediately. Procalcitonin (PCT) is a well-known inflammatory marker that can detect bacterial infections in various diseases early. Therefore, we aimed to evaluate the diagnostic accuracy of PCT for bacterial infection in severe alcoholic hepatitis. Methods: We prospectively enrolled patients with severe alcoholic hepatitis, defined as modified Maddrey's Discriminant Function ≥ 32, from 10 medical centers. At admission, we performed an initial evaluation including physical examination, laboratory test, radiology, blood and urine culture, PCT, and C-reactive protein (CRP). We compared the receiver operating characteristic (ROC) curves of PCT and CRP for bacterial infection, systemic inflammatory response syndrome (SIRS), and sepsis among total patients. Results: A total of 108 patients with severe alcoholic hepatitis were enrolled. The number of bacterial infections, SIRS, and sepsis were 31 (28.7%), 41 (38.0%), and 19 (17.6%), respectively. The patients with bacterial infection had significantly higher MELD scores (24.0 vs. 15.0), PCT levels (1.5 vs. 0.4 ng/mL), and CRP levels (4.9 vs. 2.5 mg/dL) compared to those without bacterial infection. The area under the ROC curve (AUROC) of PCT vs. CRP for bacterial infection was 0.752 and 0.655, respectively (P = 0.113). The AUROC of PCT vs. CRP for SIRS was 0.699 and 0.662, respectively (P = 0.490). The AUROC of PCT vs. CRP for sepsis was 0.780 and 0.630, respectively (P = 0.027). Conclusions: Among patients with severe alcoholic hepatitis, PCT showed a trend of superior diagnostic performance in the early detection of bacterial infection and sepsis compared to CRP. Although PCT might have better potential to diagnose sepsis in the setting of severe alcoholic hepatitis, it is necessary to find more reliable diagnostic markers. [ABSTRACT FROM AUTHOR]

Infection is one of the leading causes of death in patients with hematologic cancers. Hematologic cancer patients with compromised immune systems are already susceptible to infections, which come on even more rapidly and are difficult to control after they develop neutrophil deficiencies from high-dose chemotherapy. After patients have developed an infection, the determination of the type of infection becomes a priority for clinicians. In this review, we summarize the biomarkers currently used for the prediction of infections in patients with hematologic cancers; procalcitonin, CD64, cytokines, and CD14 et al. can be used to determine bacterial infections, and (1-3)-β-D-glucan and galactomannan et al. can be used as a determination of fungal infections. We have also focused on the use of metagenomic next-generation sequencing in infections in patients with hematologic cancers, which has excellent clinical value in infection prediction and can detect microorganisms that cannot be detected by conventional testing methods such as blood cultures. Of course, we also focused on infection biomarkers that are not yet used in blood cancer patients but could be used as a future research direction, e.g., human neutrophil lipocalin, serum amyloid A, and heparin-binding protein et al. Finally, clinicians need to combine multiple infection biomarkers, the patient's clinical condition, local susceptibility to the type of infection, and many other factors to make a determination of the type of infection. [ABSTRACT FROM AUTHOR]

Despite infection and sepsis being a major public health challenge, early detection and timely management are often hindered by several factors. These includes the similarity of clinical presentations between infectious and non-infectious conditisons, as well as limitations of current diagnostic methods such as lengthy turnaround times and low sensitivity. Consequently, there is increasing interest in identifying biomarkers that can quickly and accurately differentiate bacterial sepsis from other inflammatory processes, whether infectious or non-infectious. Procalcitonin has emerged as one of the most extensively studied and utilized biomarkers in managing infection and sepsis, especially within the framework of antibiotic stewardship. This review aims to examine the role of Procalcitonin in guiding antibiotic stewardship. It explores the production and release of procalcitonin and its relevance in the context of infection and sepsis. The discussion focus on the clinical and economic impacts of using procalcitonin to guide the initiation and discontinuation of antibiotics in managing these conditions. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the oxidative stress status in patients requiring intensive care unit (ICU) admission before initiating ICU treatment, by measuring the total oxidant level (TOS) and total antioxidant level (TAS) and oxidative stress index (OSI) levels. Additionally, we aim to explore the correlation between these oxidative stress markers and biochemical and hematological parameters. Materials and Methods: A total of 153 patients treated in intensive care units were included in the study. Patients who met the patient admission criteria of the ethics committee of the intensive care medicine association were included in the study. Blood samples were taken at the first moment the patients were admitted to the intensive care unit (before starting treatment). In total, 60 healthy volunteers who were compatible with the patient group in terms of age and gender were included in the study as a control group. Patients who had previously received antioxidant treatment and cancer patients were excluded from the study. Results: The TOS was significantly higher in the patient group (13.4 ± 7.5) compared to controls (1.8 ± 4.4) (p = 0.021). TOS > 12.00 means a "very high oxidant level". OSI was significantly higher in the patient group (689.8 ± 693.9) compared to the control group (521.7 ± 546.6) (p = 0.035). Ferritin levels were significantly higher in the patient group (546.5 ± 440.8 ng/mL) compared to controls (45.5 ± 46.5 ng/mL) (p < 0.001). Patients had significantly higher levels of C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBCs), immature granulocytes (IGs), zinc, and copper compared to the control group, indicating elevated inflammation and oxidative stress. CRP levels were 76.6 ± 85.9 mg/L in patients versus 5.6 ± 15.1 mg/L in controls (p < 0.001). PCT levels were 15.8 ± 8.6 ng/L in patients versus 2.3 ± 7.2 ng/L in controls (p = 0.012). Zinc and copper were also significantly elevated (p = 0.012 and p = 0.002, respectively). Conclusions: Our study provides valuable insights into the relationship between oxidative stress, inflammation, and trace elements, contributing to the growing understanding of oxidative stress as a prognostic tool in critical care. This could help to tailor therapeutic strategies aimed at reducing oxidative damage in ICU patients, enhancing patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis. Methods: A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C‐reactive protein to albumin ratio, procalcitonin, and lactate. Results: A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP‐to‐albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively. Conclusions: Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED. Clinical Relevance: Early identification of sepsis since the emergency department (ED) triage is challengingImplementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88) [ABSTRACT FROM AUTHOR]

Objective: To analyze the prognostic role of serum procalcitonin in neonatal sepsis at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: Neonates of both genders aged between 1 to 28 days having confirmed neonatal sepsis were included. At baseline, demographic characteristics were noted and necessary laboratory investigations were performed. At baseline, serum procalcitonin levels were evaluated in all neonates. The prognostic value of baseline PCT was assessed by comparing its association with the mortality. Other outcome variables like need for noninvasive ventilation, mechanical ventilation, need for inotropics, and acute kidney injury were also documented. Results: In a total of 131 neonates, 76 (58.0%) were male. The median age was 2.00 days (IQR=1-7 days). The median baseline procalcitonin level was 3.17 ng/ml (IQR=0.55 to 10.34 ng/ml). Need for non-invasive ventilation, and mechanical ventilation was noted in 93 (71.0%), and 19 (14.5%) neonates, respectively. Need for inotropics was documented in 23 (17.6%) neonates. The median duration of NICU stay was 3.00 (2.00-5.00 days). Among neonates who died, procalcitonin levels were significantly higher than those who survived (p=0.015). Mortality was found to have significant association with need for mechanical ventilation (p<0.001), and need for inotropics (p<0.001). Conclusion: High serum procalcitonin was found to be a significant predictor of mortality in neonatal sepsis. Mortality was significantly associated with need for mechanical ventilation, and need for inotropics. [ABSTRACT FROM AUTHOR]

Background/Objectives: This retrospective study analyzed soluble urokinase plasminogen activator receptor (suPAR) plasma levels alongside routine inflammatory markers, including the neutrophil-to-lymphocyte count ratio, C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and D-dimers in COVID-19 patients hospitalized during the Omicron wave of the pandemic. Methods: We measured plasma suPAR levels using a suPARnostic® Quick Triage kit. We divided COVID-19 patients into two groups based on the severity of SARS-CoV-2 infection according to the National Institutes of Health (NIH) criteria. The logistic regression analysis tested the predictive value of the biomarkers. Results: We evaluated 160 consecutive COVID-19 patients hospitalized between January and August 2022. The cohort exhibited a high incidence of comorbidities, with an in-hospital mortality rate of 5.6%. Upon admission, the median suPAR plasma levels were not significantly different between patients with mild COVID-19 (n = 110) and those with moderate/severe disease (n = 50), with 7.25 ng/mL and 7.55 ng/mL, respectively. We observed significant differences (p < 0.01) between the groups for CRP and IL-6 levels that were higher in moderate/severe disease than in mild infection. Additionally, suPAR plasma levels were above the normal range (0–2.00 ng/mL) in all patients, with a significant positive correlation identified between suPAR levels and serum IL-6, PCT, and creatinine levels. Conclusions: These findings indicate that COVID-19 during the Omicron wave is strongly associated with elevated suPAR levels; however, these levels do not directly correlate with the severity of SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Background Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK. Objectives Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups. Methods Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020. Results Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22–0.64 days, P  < 0.001) and of 0.72 days (95% CI: 0.06–1.38 days, P  = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections. Conclusions Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility. Study registration number ISRCTN66682918. [ABSTRACT FROM AUTHOR]

Neutropenic sepsis (NS) is one of the leading causes of death among patients with hematologic malignancies. Identifying its predictive factors is fundamental for early detection. Few studies have evaluated the predictive factors in relation to microbial infection confirmation, which is clinically important for initiating sepsis treatment. This study aimed to determine whether selected biomarkers (i.e., body temperature, C-reactive protein, albumin, procalcitonin), treatment-related characteristics (i.e., diagnosis, duration of neutropenia, treatment modality), and infection-related characteristics (i.e., infection source, causative organisms) can predict NS in patients with hematologic malignancies. We also aimed to identify the optimal predictive cutoff points for these parameters. This retrospective case–control study used the data from a total of 163 patients (58 in the sepsis group and 105 in the non-sepsis group). We collected data with reference to the day of specimen collection, with which microbial infection was confirmed. Multiple logistic regression was used to determine predictive risk factors and the area under the curve (AUC) of the receiver operating characteristic for the optimal predictive cutoff points. The independent predictors of NS were average body temperature during a fever episode and procalcitonin level. The odds for NS rose by 9.97 times with every 1°C rise in average body temperature (95% confidence interval, CI [1.33, 75.05]) and by 2.09 times with every 1 ng/mL rise in the procalcitonin level (95% CI [1.08, 4.04]). Average body temperature (AUC = 0.77, 95% CI [0.68, 0.87]) and procalcitonin levels (AUC = 0.71, 95% CI [0.59, 0.84]) have fair accuracy for predicting NS, with the optimal cutoff points of 37.9°C and 0.55 ng/mL, respectively. This study found that average body temperature during a fever episode and procalcitonin are useful in predicting NS. Thus, nurses should carefully monitor body temperature and procalcitonin levels in patients with hematologic malignancies to detect the onset of NS. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the role of serum procalcitonin (PCT) as a diagnostic tool to differentiate bacterial sepsis from flare-ups during febrile episodes in children with known rheumatic disorders compared to other inflammatory markers like C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Methods. Previously diagnosed patients with known rheumatic disorders presenting in emergency or outpatient departments with febrile episodes were included in the study. Blood samples were collected upon admission to test for signs of infection, including serum PCT levels with routine laboratory and radiological tests. Patients with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) were stratified using the Juvenile Arthritis Disease Activity Score (JADAS-27) and SLE Disease Activity Index (SLEDAI) respectively. Patients without bacterial focus with high disease activity were included in the flare-up group and the rest in the sepsis cohort. The diagnostic value of PCT was calculated using receiver operating characteristic (ROC) curve analysis. Results. In the study (N=73), 41 (56.2%) patients were previously diagnosed with JIA and 28 (38.3%) had SLE. 38 patients had definite evidence of sepsis and 35 had disease flare-ups as per respective disease activity scores. There was a significant difference in PCT and CRP among the flare-up and sepsis groups. For detecting sepsis, the area under curve (0.959), sensitivity (94.7%), and specificity (74.3%) of PCT at a cut-off of 0.275 ng/mL were significantly better than those of CRP. Conclusion. PCT is a better diagnostic test than CRP or ESR during febrile episodes in differentiating flareups from infection and PCT >0.275 ng/mL indicates bacterial infection with good specificity and sensitivity in children with low disease activity. [ABSTRACT FROM AUTHOR]

Recurrent pericarditis, an inflammatory syndrome with a pathogenesis not fully elucidated, often presents diagnostic challenges. This study aims to assess the correlation of D-Dimer (D-D) and procalcitonin (PCT) levels with clinical, laboratory and imaging features in recurrent idiopathic pericarditis. We analyzed 412 patients with idiopathic recurrent pericarditis from 2019 to 2023 in our referral center. D-D and PCT values were obtained from emergency room in other Italian facilities. Among the cohort, PCT levels were assessed in 50 of 412 patients (12.1%), with only 4 showing marginal elevation. D-D levels were measured in 48 of 412 patients (11.6%), with 33 of them exhibiting elevated values. None of these patients had venous thromboembolism, and elevated D-D levels were significantly associated with pleural effusion, fever, higher CRP, increased white blood cell counts, higher neutrophil counts, reduced relative lymphocyte counts. Multivariate analysis revealed fever as the sole correlate of elevated D-D. PCT elevation was infrequent and unrelated to any variables. In idiopathic recurrent pericarditis unrelated to specific conditions, we observed a close association between elevated D-D levels and non-specific inflammation markers, including fever, increased CRP, and neutrophil leukocytosis. PCT levels were typically normal or mildly elevated. [ABSTRACT FROM AUTHOR]

The purpose of this review is to provide a practical guide for the clinical care of patients with acute pancreatitis (AP) from the management of the early phases of disease to the treatment of local complications. AP is one of the most frequent causes of gastroenterological admission in emergency departments. It is characterized by a dynamic and unpredictable course and in its most severe forms, is associated with organ dysfunction and/or local complications, requiring intensive care with significant morbidity and mortality. Initial therapy includes adequate fluid resuscitation, nutrition, analgesia, and when necessary critical care support. In recent years, the development of minimally invasive tailored treatments for local complications, such as endoscopic drainage, has improved patients' acceptance and outcomes. Despite this, the management of AP remains a challenge for clinicians. The present review was conducted by the authors, who formulated specific questions addressing the most critical and current aspects of the clinical course of AP with the aim of providing key messages. [ABSTRACT FROM AUTHOR]

Objective: Despite being a less-invasive procedure, esophagectomy can cause severe infectious complications, such as pneumonia and anastomotic leakage. Herein, we aimed to clarify the inflammatory characteristics of pneumonia/anastomotic leakage after esophagectomy by assessing the difference between the postoperative trends of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in patients with pneumonia/anastomotic leakage using the values on the consecutive postoperative day (POD). Methods: This study included 439 patients who underwent minimally invasive esophagectomy. Serum CRP and PCT levels were measured on PODs 1–7, 10, and 14. Pneumonia and anastomotic leakage were defined as Clavien–Dindo grades ≥ 2. Results: Pneumonia and anastomotic leakage occurred in 96 and 51 patients, respectively. The CRP and PCT levels peaked on POD 3 (11.6 ± 6.8 mg/dL) and POD 2 (0.69 ± 2.9 ng/mL), respectively. Between PODs 3 and 14, CRP levels were significantly higher in patients with pneumonia and anastomotic leakage than in those without complications (P < 0.001). Between PODs 3 and 14, PCT levels were significantly higher in patients with pneumonia; however, on most PODs, there were no significant differences in PCT levels between patients with and without anastomotic leakage. Conclusion: Inflammatory reactions caused by pneumonia may be more intense than those caused by anastomotic leakage after esophagectomy. Postoperative trends in serum CRP and PCT levels may vary depending on the complication type. Pneumonia and anastomotic leakage after esophagectomy can be potentially distinguished by the postoperative trend of PCT values before detailed examinations, such as computed tomography and endoscopy. [ABSTRACT FROM AUTHOR]

Abstract Background Extubation failure is associated with an increased morbidity, emphasizing the need to identify factors to further optimize extubation practices. The role of biomarkers in the prediction of extubation failure is currently limited. The aim of this study was to investigate the prognostic value of cardiac (N-terminal pro–B-type natriuretic peptide (NT-proBNP), High-sensitivity Troponin T (Hs-TnT)) and inflammatory biomarkers (Interleukin-6 (IL-6) and Procalcitonin (PCT)) for extubation failure in patients with COVID-19 Acute Respiratory Distress Syndrome (C-ARDS). Materials and methods In this single-center retrospective cohort study, patient characteristics and laboratory measurements were extracted from electronic medical records. Patients were eligible for inclusion if they were extubated after mechanical ventilation. The primary endpoint was extubation failure, defined as the need for reintubation or death within the next seven days after extubation, regardless of whether post-extubation respiratory support was used. Uni- and multivariable logistic regression was performed to investigate the association between biomarkers and extubation failure. Biomarkers were log2 transformed. Results Of the 297 patients included, 21.5% experienced extubation failure. In univariable analysis, NT-proBNP (OR 1.24, 95% CI 1.06–1.47), Hs-TnT (OR 1.72, 95% CI 1.37–2.19) and PCT (OR 1.38, 95% CI 1.16–1.65) measured on the day of extubation were significantly associated with extubation failure. After multivariable adjustment for clinical variables (age, duration of mechanical ventilation, SOFA score), Hs-TnT was the only biomarker that was independently associated with extubation failure (adjusted OR 1.38, 95% CI 1.02–1.90). Patients with both elevated Hs-TnT (≥ 14 ng/mL) and elevated PCT (≥ 0.25 ng/mL) carried the highest risk of extubation failure (46%), while in patients with normal Hs-TnT and PCT values, only 13% experienced extubation failure. Conclusions Hs-TnT, NT-proBNP and PCT measured on the day of extubation are associated with extubation failure in mechanically ventilated patients with C-ARDS. Since Hs-TnT is the only biomarker that is independently associated with extubation failure, Hs-TnT could offer additional objective measures for assessing readiness for extubation. Future studies should focus on an integrative approach of biomarkers combined with relevant clinical factors to predict extubation failure.

Abstract Background This study aims to evaluate the diagnostic and prognostic value of heparin-binding protein (HBP) in cerebrospinal fluid (CSF) for patients with intracranial infections. Methods This study included 211 subjects, of whom 138 were diagnosed with intracranial infections, 20 were patients with non-infectious inflammatory encephalopathies, and 53 controls who were eventually excluded from intracranial infections and inflammatory encephalopathies. The levels of HBP and procalcitonin (PCT) in CSF were detected in the subjects, and the diagnostic value of CSF HBP and PCT for intracranial infections was assessed using the receiver operating characteristic (ROC) curves. In addition, CSF HBP levels in patients with intracranial infections were dynamically monitored on days 1, 5, and 9 post-treatment. Results The levels of HBP in CSF were significantly higher in the infection group compared to both the non-infectious inflammatory encephalopathy group and the control group. The area under the ROC curve (AUC) for CSF HBP in diagnosing intracranial infection was 0.916 (95% CI 0.870-0.950), which was significantly higher than that of CSF PCT (AUC: 0.543, 95% CI 0.474-0.612). Furthermore, the combination of CSF HBP and white blood cell (WBC) counts exhibited a significantly higher AUC of 0.957 (95% CI 0.920-0.980) compared to HBP alone (P

Abstract Background Fulminant virus-associated encephalopathy (VAE) is a rare complication of viral infection that presents as acute brain dysfunction and requires respiratory support and/or vasoactive agents. However, the mechanism of VAE is undetermined. The mortality rate is high since there is no specific treatment for fulminant VAE. The aim of this study was to identify risk factors for children with fulminant VAE on the basis of clinical data since timely recognition and treatment might be needed to improve the poor prognosis. Methods This retrospective study included children with fulminant VAE who were diagnosed between June 2018 and October 2023 in the PICU of Guangdong Women and Children Hospital. Clinical data were analyzed, and receiver operating characteristic (ROC) curve analysis was performed to determine the prognostic value of the selected variables. Results Twenty-three children with fulminant VAE were included and divided into a survival group (n = 16) and a nonsurvival group (n = 7). The mortality rate of patients with fulminant VAE was 30.8%. Compared with the survival group, the nonsurvival group had higher incidences of shock 48 h after onset, a higher acute necrotizing encephalopathy severity score (ANE-SS), higher procalcitonin (PCT) levels, and lower platelet counts (p 101.58 ng/ml for predicting death in patients with fulminant VAE were 57.1% and 100.0%, respectively. Conclusions Patients with fulminant VAE deteriorate rapidly and are at high risk of death if they develop shock within 48 h after onset, exhibit extremely elevated serum PCT levels, or have decreased platelet counts. The serum PCT level might predict the death outcome of patients with fulminant VAE.

Background Procalcitonin (PCT) is a crucial biomarker for diagnosing sepsis and managing antibiotic therapy. This study evaluated the analytical performance and comparability of the Access PCT and Elecsys BRAHMS PCT assays. Methods The precision, detection capability, linearity, and reference range of both assays were assessed. A comparative analysis included 182 patient samples categorized into four risk groups to compare the results between Access PCT and Elecsys BRAHMS PCT assays. Results The Access PCT assay demonstrated precision within the manufacturer’s threshold, and its detection capabilities were verified. This assay exhibited excellent linearity and appropriate reference intervals. Comparative analysis indicated that the Access PCT assay reported higher overall PCT levels than the Elecsys BRAHMS assay, with high agreement between the assays (κ=0.941). However, the biases varied across different PCT concentration intervals. Conclusions Both the Access PCT and Elecsys BRAHMS PCT assays performed robustly with notable concordance but varying biases at different concentration intervals. The observed biases require careful consideration in clinical decision-making, especially when adopting novel assay systems. Standardizing the calibration across different platforms is recommended to improve assay comparability.

Surgical outcomes depend on several factors, including the choice of surgical procedure, surgical techniques and experience of medical center. Numerous nationwide population-based studies in Europe have shown an increase in the incidence of infective endocarditis (IE) by 4% per year. An important role in predicting the severity of the disease is played by the systemic inflammatory response, which is manifested by increased levels of inflammatory markers such as C-reactive protein and procalcitonin. The use of a complex of several inflammatory markers can potentially improve the analysis of the inflammatory response system and the assessment of treatment dynamics. The aim. To evaluate the dynamics of systemic inflammatory response markers in patients with IE complicated by acute heart failure undergoing cardiopulmonary bypass surgery. Materials and methods. The study included clinical data of 72 patients with IE complicated by preoperative acute heart failure (AHF) who underwent cardiac surgery at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01/01/2019 to 12/30/2022. The diagnosis of IE was established in accordance with the Duke criteria. All the patients were classified as NYHA class IV. Results. According to the analysis of systemic inflammatory response markers in patients with IE complicated by AHF at the preoperative stage, the leukocyte count was 10.1 × 109/L (8.1; 14.1), while stab cells accounted for 6.0% (4.0; 8.0). Erythrocyte sedimentation rate was elevated – 27.5 mm per hour (17.0; 50.0). The median body temperature on admission was 37.3 °C (37.1; 38.3). In the early postoperative period, there was a sharp increase in the level of procalcitonin to 2.1 ng/mL, as well as increase in C-reactive protein to 69.33 mg/L. At the same time, an increase in lactate level to 2.24 mmol/L was recorded. On the 7th day of the postoperative period, a decrease in the levels of C-reactive protein and procalcitonin was detected – 34.15 mg/L and 0.2 ng/mL, respectively. In contrast, the lactate level increased to 2.43 mmol/L. Evaluation of biochemical markers of inflammation on postoperative day 14 showed a trend towards normalization: C-reactive protein 28.27 mg/L, procalcitonin 0.1 ng/mL, lactate 2.29 mmol/L. Conclusions. Timely assessment of specific markers of organ dysfunction associated with infectious processes is the basis for diagnosis, risk stratification and ensuring the best treatment outcome. A comprehensive analysis of the levels of biochemical markers of inflammation creates the conditions for choosing a management strategy for patients with IE complicated by AHF.

Background and Aim: Sepsis, a life-threatening condition, presents diagnostic challenges due to its heterogeneous nature. Early and accurate diagnosis is essential for timely intervention. Serum biomarkers, such as ferritin and procalcitonin (PCT), have been explored for their potential in sepsis diagnosis, but the outcomes are inconclusive. The current study was an attempt to further explore the usefulness of ferritin and PCT as sepsis biomarkers. Material and Methods: A prospective study involving 149 patients assessed serum ferritin and PCT levels in those with features suggestive of sepsis. Patients were categorized into sepsis and nonsepsis groups based on the clinical judgment of the emergency physicians. Statistical analyses, including the Mann–Whitney U test and receiver operating characteristic (ROC) curves, were conducted to evaluate the diagnostic utility of these biomarkers. Results: Serum ferritin levels did not exhibit a statistically significant difference between sepsis and nonsepsis groups (P = 0.698). In contrast, PCT levels were significantly higher in sepsis cases (P = 0.011). ROC analysis identified an optimal PCT cutoff value of 0.085, offering high sensitivity (92.5) but lower specificity (16.7). Conclusion: PCT proved valuable as a diagnostic marker for sepsis. Serum ferritin, on the other hand, did not demonstrate statistical significance as a diagnostic marker for sepsis, its potential role in specific septic conditions and disease severity monitoring warrants further investigation.

Bovine respiratory disease (BRD) represents a significant challenge in cattle management due to its multifactorial nature and lack of a gold standard diagnostic method. Procalcitonin (PCT) has emerged as a potential biomarker for bacterial infections in various species, including cattle. This study aimed to investigate plasma PCT concentration variations in pre-weaned dairy calves categorized as BRD-positive using clinical scores (WRSC; BRD-positive ≥5), thoracic ultrasonography with two cut-off (TUS; BRD-positive ≥1 or ≥3), or a combination of both methods (WRSC/TUS1cm or WRSC/TUS3cm). Additionally, the accuracy of PCT in diagnosing BRD was evaluated. A cross-sectional study was conducted on a convenience sample of 226 pre-weaned Italian-Friesian female calves. Clinical scoring, TUS, and plasma PCT analysis were performed. Calves were categorized based on TUS findings, clinical scores, or a combination of both methods. Statistical analyses were conducted to assess the differences in PCT concentrations among different groups and to determine the diagnostic accuracy of PCT. Results showed a significant increase in PCT levels in calves with lung consolidation detected by TUS using a 1 cm cutoff. However, the diagnostic accuracy of PCT in discriminating BRD-positive cases was poor (area under the curve 0.62). The optimal cutoff value for PCT was determined to be 86.63 pg/mL, with sensitivity of 49.7%, specificity of 71.8%, positive predictive value of 79.4% and negative predictive value of 39.5%. In conclusion, while PCT showed potential as a biomarker for BRD, its diagnostic accuracy was limited in this study. Future research should focus on integrating PCT measurements with other diagnostic methods and conducting longitudinal cohort studies to better understand its role in BRD diagnosis and management.

Objective To explore the effects of tonsillectomy under general anesthesia on articulatory characteristics and blood levels of procalcitonin (PCT), platelet membrane protein-140 (GMP-140), and T lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Forty-three children with OSAHS who underwent tonsillectomy under general anesthesia in the Department of Otorhinolaryngology Head and Neck Surgery of Xi’an Children’s Hospital, Shaanxi Province from June 2020 to March 2022 were randomly selected for the study. The children were evaluated for articulatory characteristics, blood levels of PCT, GMP-140, and T lymphocyte subsets, as well as sleep status before surgery and at 1 and 3 months after surgery. Results The longest duration of articulating /a/ was significantly prolonged and the second formant was significantly enhanced at 1 and 3 months after surgery (F=43.07,39.65,P

Abstract Background Severe alcoholic hepatitis is a catastrophic disease with a mortality rate of up to 35–50% at 30 days. Bacterial infection is an important prognostic factor in patients with severe alcoholic hepatitis, but it is difficult to detect the presence of infection immediately. Procalcitonin (PCT) is a well-known inflammatory marker that can detect bacterial infections in various diseases early. Therefore, we aimed to evaluate the diagnostic accuracy of PCT for bacterial infection in severe alcoholic hepatitis. Methods We prospectively enrolled patients with severe alcoholic hepatitis, defined as modified Maddrey’s Discriminant Function ≥ 32, from 10 medical centers. At admission, we performed an initial evaluation including physical examination, laboratory test, radiology, blood and urine culture, PCT, and C-reactive protein (CRP). We compared the receiver operating characteristic (ROC) curves of PCT and CRP for bacterial infection, systemic inflammatory response syndrome (SIRS), and sepsis among total patients. Results A total of 108 patients with severe alcoholic hepatitis were enrolled. The number of bacterial infections, SIRS, and sepsis were 31 (28.7%), 41 (38.0%), and 19 (17.6%), respectively. The patients with bacterial infection had significantly higher MELD scores (24.0 vs. 15.0), PCT levels (1.5 vs. 0.4 ng/mL), and CRP levels (4.9 vs. 2.5 mg/dL) compared to those without bacterial infection. The area under the ROC curve (AUROC) of PCT vs. CRP for bacterial infection was 0.752 and 0.655, respectively (P = 0.113). The AUROC of PCT vs. CRP for SIRS was 0.699 and 0.662, respectively (P = 0.490). The AUROC of PCT vs. CRP for sepsis was 0.780 and 0.630, respectively (P = 0.027). Conclusions Among patients with severe alcoholic hepatitis, PCT showed a trend of superior diagnostic performance in the early detection of bacterial infection and sepsis compared to CRP. Although PCT might have better potential to diagnose sepsis in the setting of severe alcoholic hepatitis, it is necessary to find more reliable diagnostic markers.

Abstract Background Use of serum procalcitonin (PCT), an inflammatory biomarker for bacterial infections, has shown promising results for early stopping antibiotic treatment among patients with respiratory infections and sepsis. There is need for additional data regarding effectiveness and safety of this concept among patients with cancer. Methods Individual data of patients with a documented diagnosis of cancer and proven or suspected respiratory infection and/or sepsis were extracted from previous trials where adult patients were randomized to receive antibiotic treatment based on a PCT protocol or usual care (control group). The primary efficacy and safety endpoints were antibiotic exposure and 28-day all-cause mortality. Results This individual-patient data meta-analysis included 777 patients with a diagnosis of cancer from 15 randomized-controlled trials. Regarding efficacy, there was a 18% reduction in antibiotic exposure in patients randomized to PCT-guided care compared to usual care ([days] 8.2 ± 6.6 vs. 9.8 ± 7.3; adjusted difference, − 1.77 [95% CI, − 2.74 to − 0.80]; p

OBJECTIVE: The lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants. STUDY DESIGN: Secondary analysis of a prospective cohort study in 18 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from 2016 to 2019. Febrile (≥38°C) infants aged ≤60 days who received CXRs were included. CXR reports were categorised as no, possible or definite pneumonia. We compared demographics, clinical signs and laboratory tests among infants with and without pneumonias. RESULTS: Of 2612 infants, 568 (21.7%) had CXRs performed; 19 (3.3%) had definite and 34 (6%) had possible pneumonias. Patients with definite (4/19, 21.1%) or possible (11/34, 32.4%) pneumonias more frequently presented with respiratory distress compared with those without (77/515, 15.0%) pneumonias (adjusted OR 2.17; 95% CI 1.04 to 4.51). There were no differences in temperature or HR in infants with and without radiographic pneumonias. The median serum procalcitonin (PCT) level was higher in the definite (0.7 ng/mL (IQR 0.1, 1.5)) vs no pneumonia (0.1 ng/mL (IQR 0.1, 0.3)) groups, as was the median absolute neutrophil count (ANC) (definite, 5.8 K/mcL (IQR 3.9, 6.9) vs no pneumonia, 3.1 K/mcL (IQR 1.9, 5.3)). No infants with pneumonia had bacteraemia. Viral detection was frequent (no pneumonia (309/422, 73.2%), definite pneumonia (11/16, 68.8%), possible pneumonia (25/29, 86.2%)). Respiratory syncytial virus was the predominant pathogen in the pneumonia groups and rhinovirus in infants without pneumonias. CONCLUSIONS: Radiographic pneumonias were uncommon in febrile infants. Viral detection was common. Pneumonia was associated with respiratory distress, but few other factors. Although ANC and PCT levels were elevated in infants with definite pneumonias, further work is necessary to evaluate the role of blood biomarkers in infant pneumonias.

Background. Fetal inflammatory response syndrome (FIRS) is a pathological response to changes in the chorion and is manifested by inadequate cytokine production and endothelial dysfunction. Objective of the study: to investigate laboratory changes in extremely premature newborns depending on the presence of FIRS criteria. Materials and methods. The prevalence of umbilical cord blood leukocytosis and leukopenia, anemia and thrombocytopenia, as well as increased levels of C-reactive protein and procalcitonin in 403 premature newborns was analyzed depending on the presence of FIRS laboratory criteria. Newborns were divided depending on the gestational age (I and II groups – 24–27 weeks, III and IV groups – 28–34 weeks), and the presence of prenatal rupture of the fetal membranes (I and III groups) or the onset of labor with intact membranes (II and IV groups). Results. FIRS increases the frequency of leukopenia, anemia, and thrombocytopenia in extremely premature newborns, and the frequency of leukocytosis and the appearance of young forms of leukocytes in premature infants from early preterm labour. Elevated levels of C-reactive protein and procalcitonin were more common in cases of premature rupture of membranes than in cases of labor with intact amniotic sac. This frequency did not depend on the presence of FIRS in extremely premature newborns; such dependence was outlined for premature infants from early preterm labour. Conclusions. Leukopenia is more often found in premature babies from very early premature births than from early premature births. More than 20 × 109/ml leukocytosis and an increased proportion of young forms of neutrophils of more than 10% were found in the case of premature rupture of the fetal membranes, more often than during childbirth with intact membranes. In extremely premature newborns FIRS was accompanied by an increased frequency of leukopenia, thrombocytopenia, and anemia. FIRS do not increase levels of C-reactive protein and procalcitonin in extremely premature newborns.