Innovative haematological parameters for early diagnosis of sepsis in adult patients admitted in intensive care unit

2017 ◽  
Vol 71 (4) ◽  
pp. 330-335 ◽  
Author(s):  
Sabrina Buoro ◽  
Barbara Manenti ◽  
Michela Seghezzi ◽  
Paola Dominoni ◽  
Tiziano Barbui ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Diagnosis ◽  
Area Under The Curve ◽  
Clinical Information ◽  
Operating Characteristics ◽  
Early Management ◽  
Reactive Protein ◽  
Icu Stay ◽  
Immature Platelet Fraction

AimsThis study was aimed to investigate the role of erythrocyte, platelet and reticulocyte (RET) parameters, measured by new haematological analyser Sysmex XN and C reactive protein (CRP), for early diagnosis of sepsis during intensive care unit (ICU) stay.MethodsThe study population consisted of 62 ICU patients, 21 of whom developed sepsis during ICU stay and 41 who did not. The performance for early diagnosing of sepsis was calculated as area under the curve (AUC) of receiver operating characteristics curves analysis.ResultsCompared with CRP (AUC 0.81), immature platelet fraction (IPF) (AUC 0.82) showed comparable efficiency for identifying the onset of sepsis. The association with the risk of developing sepsis during ICU stay was also assessed. One day before the onset of sepsis, a decreased of RET% was significantly associated with the risk of developing sepsis (OR=0.35, 95% CI 0.14 to 0.87), whereas an increased of IPF absolute value (IPF#) was significantly associated with the risk of developing sepsis (OR=1.13, 95% CI 1.03 to 1.24) 2 days before the onset of sepsis. The value of CRP was not predictive of sepsis at either time points.ConclusionsIPF# and RET% may provide valuable clinical information for predicting the risk of developing sepsis, thus allowing early management of patients before the onset of clinically evident systemic infections.

scholarly journals Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 402
Author(s):  
Renée Blaauw ◽  
Daan G. Nel ◽  
Gunter K. Schleicher
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Area Under The Curve ◽  
Threshold Value ◽  
High Plasma ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Proxy Indicators

Low and high plasma glutamine levels are associated with increased mortality. This study aimed to measure glutamine levels in critically ill patients admitted to the intensive care unit (ICU), correlate the glutamine values with clinical outcomes, and identify proxy indicators of abnormal glutamine levels. Patients were enrolled from three ICUs in South Africa, provided they met the inclusion criteria. Clinical and biochemical data were collected. Plasma glutamine was categorized as low (<420 µmol/L), normal (420–700 µmol/L), or high (>700 µmol/L). Three hundred and thirty patients (median age 46.8 years, 56.4% male) were enrolled (median APACHE II score) 18.0 and SOFA) score 7.0). On admission, 58.5% had low (median 299.5 µmol/L) and 14.2% high (median 898.9 µmol/L) plasma glutamine levels. Patients with a diagnosis of polytrauma and sepsis on ICU admission presented with the lowest, and those with liver failure had the highest glutamine levels. Admission low plasma glutamine was associated with higher APACHE II scores (p = 0.003), SOFA scores (p = 0.003), C-reactive protein (CRP) values (p < 0.001), serum urea (p = 0.008), and serum creatinine (p = 0.023) and lower serum albumin (p < 0.001). Low plasma glutamine was also associated with requiring mechanical ventilation and receiving nutritional support. However, it was not significantly associated with length of stay or mortality. ROC curve analysis revealed a CRP threshold value of 87.9 mg/L to be indicative of low plasma glutamine levels (area under the curve (AUC) 0.7, p < 0.001). Fifty-nine percent of ICU patients had low plasma glutamine on admission, with significant differences found between diagnostic groupings. Markers of infection and disease severity were significant indicators of low plasma glutamine.

Ventilator-Associated Tracheobronchitis Increases the Length of Intensive Care Unit Stay

2013 ◽  
Vol 34 (8) ◽  
pp. 800-808 ◽  
Author(s):  
Marios Karvouniaris ◽  
Demosthenes Makris ◽  
Efstratios Manoulakas ◽  
Paris Zygoulis ◽  
Konstantinos Mantzarlis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Protein Level ◽  
Significant Risk ◽  
University Hospital ◽  
C Reactive Protein ◽  
Prolonged Stay ◽  
Reactive Protein ◽  
Icu Stay ◽  
The Impact

Objective.To investigate prospectively the clinical course and risk factors for ventilator-associated tracheobronchitis (VAT) and the impact of VAT on intensive care unit (ICU) morbidity and mortality.Design.Prospective cohort study.Setting.University Hospital Larissa, Larissa, GreecePatients.Critical care patients who received mechanical ventilation for more than 48 hours were prospectively studied between 2009 and 2011.Methods.The modified Clinical Pulmonary Infection Score, white blood cell count, and C-reactive protein level were systematically assessed every 2 days for the first 2 weeks of ICU stay. Bronchial secretions were assessed daily. Quantitative cultures of endotracheal secretions were performed on the first ICU day for every patient and every 2 days thereafter for the first 2 weeks or more at the discretion of the attending physicians. Definition of VAT was based on previously published criteria.Results.A total of 236 patients were observed; 42 patients (18%) presented with VAT. Gram-negative pathogens, which were usually multidrug resistant, were responsible for 92.9% of cases. Patients with a neurosurgical admission presented with VAT significantly more often than did other ICU patients (28.5% vs 14.1%; P = .02). The occurrence of VAT was a significant risk factor for increased duration of ICU stay (OR [95% CI], 3.04 [1.35-6.85]; P = .01). Age (OR [95% CI], 1.04 [1.015-1.06]; P = .02), Acute Physiology and Chronic Health Evaluation II score (OR [95% CI], 1.08 [1.015-1.16]; P = .02), and C-reactive protein level at admission (OR [95% CI], 1.05 [1.011.1]; P = .02) were independent factors for ICU mortality.Conclusions.VAT is a nosocomial infection that might be associated with prolonged stay in the ICU, especially in neurocritical patients. VAT was not associated with increased mortality in our study.

scholarly journals C-reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit

2012 ◽  
Vol 7 ◽  
Author(s):  
Özkan Devran ◽  
Zuhal Karakurt ◽  
Nalan Adıgüzel ◽  
Gökay Güngör ◽  
Özlem Yazıcıoğlu Moçin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Mortality Rate ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Icu Patients ◽  
Predictors Of Mortality ◽  
Reactive Protein ◽  
Chest Disease

Background: Severe sepsis is a primary cause of morbidity and mortality in the intensive care unit (ICU). Numerous biomarkers have been assessed to predict outcome and CRP is widely used. However, the relevance for mortality risk of the CRP level and the day when it is measured have not been well studied. We aimed to assess whether initial and/or third dayCRP values are as good predictors of mortality in ICU patients with severe sepsis as other well-known complex predictors of mortality, i.e., SOFA scores. Methods: An observational cohort study was performed in a 20-bed respiratory ICU in a chest disease center. Patients with severe sepsis due to respiratory disease were enrolled in the study. SOFA scores, CRP values on admission and on the third day of hospital stay, and mortality rate were recorded. ROC curves for SOFA scores and CRP values were calculated. Results: The study included 314 ICU patients with sepsis admitted between January 2009 and March 2010. The mortality rate was 14.2% (n = 45). The area under the curve (AUC) for CRP values and SOFA scores on admission and on the 3rd day in ICU were calculated as 0.57 (CI: 0.48-0.66); 0.72 (CI: 0.63-0.80); 0.72 (CI: 0.64-0.81); and 0.76 (CI: 0.67-0.86), respectively. Sepsis due to nosocomial infection, a CRP value > 100 mg/L and higher SOFA scores on 3rd day, were found to be risk factors for mortality (odds ratio [OR]: 3.76, confidence interval [CI]: 1.68-8.40, p < 0.001, OR: 2.70, CI: 1.41-2.01, p < 0.013, and OR: 1.68, CI: 1.41-2.01, p < 0.0001, respectively). Conclusions: The risk of sepsis related mortality appears to be increased when the 3rd day CRP value is greater than 100 mg/dL. Thus, CRP appears to be as valuable a predictor of mortality as the SOFA score.

scholarly journals Bedeutung der Desorientierung bei der Delireinschätzung

2021 ◽  
Author(s):  
Ulf Guenther ◽  
Mirko Wolke ◽  
Hans-Christian Hansen ◽  
Nicole Feldmann ◽  
Anja Diers ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Area Under The Curve ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Receiver Operating Characteristics ◽  
Sich Eine ◽  
Operating Characteristics ◽  
Fand Sich ◽  
Confusion Assessment

ZusammenfassungDesorientierung kann ein frühes Merkmal eines Delirs sein. Für die Überwachung eines Delirs testet die im deutschsprachigen Raum weit verbreitete „Confusion Assessment Method for Intensive Care Unit“ (CAM-ICU) die Orientierung nicht, da intubierte Intensivpatienten sich nicht verbal äußern können. Die Mehrheit der Patienten auf deutschen Intensivstationen ist aber nicht beatmet, sie könnten hinsichtlich ihrer Orientiertheit befragt werden. Die vorliegende Studie untersuchte, ob sich durch das Kriterium „Desorientierung“ bei extubierten Patienten im Vergleich zur CAM-ICU divergierende Befunde ergeben und ob sich die Sensitivität der CAM-ICU durch Kombination mit dem Merkmal „Desorientierung“ („CAM-IMC“) erhöhen lassen. Insgesamt 86 gepaarte Untersuchungen fanden bei 50 extubierten Patienten statt. Ein Delir fand sich bei 19,8 % (n = 17) aller Untersuchungen. Die CAM-ICU hatte eine Sensitivität von 71 % (95%-KI: 44–90 %) und eine Spezifität von 100 % (95–100 %). Für „Desorientierung“ als alleiniges Delir-Merkmal fand sich eine Sensitivität von 77 % (50–93 %) und eine Spezifität von 93 % (89–100 %). Die CAM-IMC erreichte eine Sensitivität von 88 % (64–99 %) bei einer Spezifität von 100 % (95–100 %). Die „Receiver-Operating-Characteristics(ROC)-Analyse“ fand mit einer „area under the curve“ (AUC) von 0,941 (95%-KI: 0,851–1,000) für die CAM-IMC den höchsten Wert im Vergleich zu den anderen Delir-Tests (CAM-ICU, AUC 0,853 [0,720–0,986]; Desorientierung, AUC 0,868 [0,745–0,991]). Diese Arbeit unterstreicht die Wertigkeit des Merkmals „Desorientierung“ für Delir-Tests bei verbal kommunikationsfähigen Patienten und erklärt einige diskrepante Beurteilungen schwierig einzuschätzender Patienten in der täglichen Praxis. Die CAM-IMC scheint als Delir-Test für extubierte Patienten günstigere Eigenschaften als die CAM-ICU zu haben und sollte eingehender überprüft werden.

C-reactive Protein Is a More Sensitive and Specific Marker for Diagnosing Bacterial Infections in Systemic Lupus Erythematosus Compared to S100A8/A9 and Procalcitonin

2012 ◽  
Vol 39 (4) ◽  
pp. 728-734 ◽  
Author(s):  
HYOUN-AH KIM ◽  
JA-YOUNG JEON ◽  
JEONG-MI AN ◽  
BO-RAM KOH ◽  
CHANG-HEE SUH
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Bacterial Infections ◽  
Area Under The Curve ◽  
Specific Marker ◽  
Operating Characteristics ◽  
C Reactive Protein ◽  
Systemic Lupus ◽  
Serum Samples ◽  
Reactive Protein

Objective.C-reactive protein (CRP), S100A8/A9, and procalcitonin have been suggested as markers of infection in patients with systemic lupus erythematosus (SLE). We investigated the clinical significance of these factors for indication of infection in SLE.Methods.Blood samples were prospectively collected from 34 patients with SLE who had bacterial infections and 39 patients with SLE who had disease flares and no evidence of infection. A second set of serum samples was collected after the infections or flares were resolved.Results.CRP levels of SLE patients with infections were higher than those with flares [5.9 mg/dl (IQR 2.42, 10.53) vs 0.06 mg/dl (IQR 0.03, 0.15), p < 0.001] and decreased after the infection was resolved. S100A8/A9 and procalcitonin levels of SLE patients with infection were also higher [4.69 μg/ml (IQR 2.25, 12.07) vs 1.07 (IQR 0.49, 3.05) (p < 0.001) and 0 ng/ml (IQR 0–0.38) vs 0 (0–0) (p < 0.001), respectively]; these levels were also reduced once the infection disappeared. In the receiver-operating characteristics analysis of CRP, S100A8/A9, and procalcitonin, the area under the curve was 0.966 (95% CI 0.925–1.007), 0.732 (95% CI 0.61–0.854), and 0.667 (95% CI 0.534–0.799), respectively. CRP indicated the presence of an infection with a sensitivity of 100% and a specificity of 90%, with a cutoff value of 1.35 mg/dl.Conclusion.Our data suggest that CRP is the most sensitive and specific marker for diagnosing bacterial infections in SLE.

scholarly journals Incidence of Delirium in Critically Ill Cancer Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Luis A. Sánchez-Hurtado ◽  
Nancy Hernández-Sánchez ◽  
Mario Del Moral-Armengol ◽  
Humberto Guevara-García ◽  
Francisco J. García-Guillén ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cancer Patients ◽  
Critically Ill ◽  
Potential Risk ◽  
Assessment Method ◽  
Icu Stay ◽  
Potential Risk Factors

Objective. The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods. This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient’s ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results. There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99–1.13;p=0.07). Conclusion. Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

Urinary biomarkers to predict severe fluid overload after cardiac surgery: a pilot study

2021 ◽  
Author(s):  
Saban Elitok ◽  
Berend Isermann ◽  
Sabine Westphal ◽  
Prasad Devarajan ◽  
Christian Albert ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Pilot Study ◽  
Intensive Care Unit Admission ◽  
Fluid Overload ◽  
Predictive Ability ◽  
Urinary Biomarkers ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Reactive Protein

Aim: To assess the predictive ability of urinary and plasma biomarkers and clinical routine parameters for subsequent severe fluid overload. Patients & methods: In a pilot study, we studied 100 adult patients after cardiac surgery. On intensive care unit admission, we measured biomarkers in urine (midkine, IL-6, neutrophil gelatinase-associated lipocalin [NGAL], hepcidin-25) and plasma (creatinine, urea, B-type natriuretic peptide, lactate, C-reactive protein, leukocytes, IL-6, NGAL, hepcidin-25) to predict postoperative severe fluid overload. Results: Urinary midkine, IL-6, NGAL and hepcidin-25 (all AUCs ≥0.79) predicted postoperative severe fluid overload (N = 5 patients). Urinary NGAL/hepcidin-25 ratio (AUC 0.867) predicted postoperative severe fluid overload after adjustment to EuroScore and need for norepinephrine on surgery day (odds ratio: 2.4). Conclusion: Urinary biomarkers on intensive care unit admission might be helpful to predict subsequent severe fluid overload after cardiac surgery.

The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

2021 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lactate Dehydrogenase ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group 2 ◽  
D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

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