Impact of Bedside Tracheostomy on Procalcitonin Kinetics in Critically Ill Patients

2017 ◽  
Vol 34 (3) ◽  
pp. 245-251 ◽  
Author(s):  
Koji Sato ◽  
Masaki Okajima ◽  
Toru Noda ◽  
Takumi Taniguchi
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Operating Characteristic ◽  
University Hospital ◽  
Septic Complication ◽  
C Reactive Protein ◽  
Septic Complications ◽  
Receiver Operating Characteristic Curves ◽  
Japanese University ◽  
Reactive Protein

Background: Critically ill patients are particularly vulnerable to invasive procedures and complications; however, tracheostomy is frequently performed in the intensive care unit (ICU). We analyzed the effects of tracheostomy on procalcitonin (PCT) kinetics and investigated whether PCT could reliably predict septic complications after tracheostomy. Methods: We retrospectively identified 134 patients who underwent bedside tracheostomy during their ICU stay at a Japanese university hospital from October 2010 to December 2015. We extracted PCT data from the day of the procedure (day 0) to postoperative day 2 and defined alert PCT as a PCT level ≥0.5 ng/mL, which had not decreased from the previous day. We divided patients into the following groups: nonevent, aseptic complication, and septic complication. Results: Twelve (9.2%) patients developed acute aseptic complications, and 12 (9.2%) patients developed septic complications. In the nonevent group, the PCT value decreased continuously in the initial PCT ≥ 0.5 ng/mL subgroup ( P < .001, P <.001 for trend). In contrast, significant changes were not observed in the initial PCT < 0.5 ng/mL subgroup. Significant differences and an upward trend in alert PCT incidence rate existed between the groups ( P < .001, P < .001 for trend): nonevent group, 5.5%; aseptic complication group, 41.7%; and septic complication group, 66.7%. In a multivariate linear regression model, septic complications were independently associated with PCT change at postoperative days 1 and 2 (adjusted β = 3.58, P < .001; adjusted β = 9.84, P < .001, respectively). Procalcitonin predicted septic complications more accurately than C-reactive protein, with the area under the receiver operating characteristic curves of 0.8 versus 0.63 ( P = .058) and 0.91 versus 0.69 ( P = .036) at postoperative days 1 and 2, respectively. Conclusion: Our results demonstrated that PCT was not elevated after uncomplicated surgical tracheostomy in critically ill patients.

scholarly journals A Comparison of Eosinopenia and C-Reactive Protein as a Marker of Bloodstream Infections in Critically Ill Patients: A Case Control Study

2009 ◽  
Vol 37 (3) ◽  
pp. 450-456 ◽  
Author(s):  
K. M. Ho ◽  
S. C. Towler
Keyword(s):  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Bloodstream Infections ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Receiver Operating

Diagnosis of bloodstream infections in critically ill patients is difficult. This case control study involved a total of 22 patients with confirmed bloodstream infections and 44 concurrent controls from an intensive care unit in Western Australia. We aimed to assess whether eosinopenia and C-reactive protein are useful markers of bloodstream infections in critically ill patients. The patients with bloodstream infections had a more severe disease and a longer length of intensive care unit (10.7 vs 4.0 days, P=0.001) and hospital stay (40.9 vs 17.9 days, P=0.015) than the controls. Univariate analyses showed that C-reactive protein (area under the receiver operating characteristic curve 0.847, 95% confidence internal (CI) 0.721 to 0.973), eosinophil counts (area under the receiver operating characteristic curve 0.849, 95% CI 0.738 to 0.961) and fibrinogen concentrations (area under the receiver operating characteristic curve 0.730, 95% CI 0.578 to 0.882) were significant markers of bloodstream infections. C-reactive protein concentration was, however, the only significant predictor in the multivariate analysis (odds ratio 1.21 per 10 mgH increment, 95% CI 1.01 to 1.39, P=0.007). C-reactive protein concentration appears to be a better marker of bloodstream infections than eosinopenia in critically ill patients. A large prospective cohort study is needed to assess whether eosinopenia is useful in addition to C-reactive protein concentrations as a marker of bloodstream infections.

scholarly journals Usefulness of sialic acid for diagnosis of sepsis in critically ill patients: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bo Yao ◽  
Wen-juan Liu ◽  
Di Liu ◽  
Jin-yan Xing ◽  
Li-juan Zhang
Keyword(s):  
Sialic Acid ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Incomplete Data ◽  
Acid Level ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Diagnostic Efficacy ◽  
Receiver Operating Characteristic Curves ◽  
Sensitivity Specificity

Abstract Background Early diagnosis of sepsis is very important. It is necessary to find effective and adequate biomarkers in order to diagnose sepsis. In this study, we compared the value of sialic acid and procalcitonin for diagnosing sepsis. Methods Newly admitted intensive care unit patients were enrolled from January 2019 to June 2019. We retrospectively collected patient data, including presence of sepsis or not, procalcitonin level and sialic acid level. Receiver operating characteristic curves for the ability of sialic acid, procalcitonin and combination of sialic acid and procalcitonin to diagnose sepsis were carried out. Results A total of 644 patients were admitted to our department from January 2019 to June 2019. The incomplete data were found in 147 patients. Finally, 497 patients data were analyzed. The sensitivity, specificity and area under the curve for the diagnosis of sepsis with sialic acid, procalcitonin and combination of sialic acid and procalcitonin were 64.2, 78.3%, 0.763; 67.9, 84.0%, 0.816 and 75.2, 84.6%, 0.854. Moreover, sialic acid had good values for diagnosing septic patients with viral infection, with 87.5% sensitivity, 82.2% specificity, and 0.882 the area under the curve. Conclusions Compared to procalcitonin, sialic acid had a lower diagnostic efficacy for diagnosing sepsis in critically ill patients. However, the combination of sialic acid and procalcitonin had a higher diagnostic efficacy for sepsis. Moreover, sialic acid had good value for diagnosing virus-induced sepsis.

scholarly journals A novel procalcitonin-based score for detecting sepsis among critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245748
Author(s):  
Tung-Lin Tsui ◽  
Ya-Ting Huang ◽  
Wei-Chih Kan ◽  
Mao-Sheng Huang ◽  
Min-Yu Lai ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Validation Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Sepsis Group ◽  
C Reactive Protein ◽  
Multivariate Logistic Regression ◽  
Reactive Protein

Background Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. Methods We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. Results A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, “serum PCT level,” “albumin level” and “neutrophil-lymphocyte ratio” at ICU admission, along with “diabetes mellitus,” and “with vasopressor.” We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74–0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69–0.90; sensitivity 0.64; specificity 0.87). Conclusions We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.

scholarly journals Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers

2020 ◽  
Author(s):  
Isabela Nascimento Borges ◽  
Rafael Carneiro ◽  
Rafael Bergo ◽  
Larissa Martins ◽  
Enrico Colosimo ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Critically Ill ◽  
Antibiotic Treatment ◽  
Median Duration ◽  
Critically Ill Patients ◽  
Treatment Time ◽  
C Reactive Protein ◽  
Daily Monitoring ◽  
Reactive Protein ◽  
To Receive

Abstract Background: The rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance . We therefore sought to evaluate the effectiveness of a C reactive protein-based protocol in reducing antibiotic treatment time in critically ill patients.Methods: A randomized, open-label, controlled clinical trial conducted in two intensive care units of a university hospital in Brazil. Critically ill infected adult patients were randomly allocated to: i) intervention to receive antibiotics guided by daily monitoring of CRP levels, and ii) control to receive antibiotics according to the best practices for rational use of antibiotics.Results : 130 patients were included in the CRP (n=64) and control (n=66) groups. In the intention to treat analysis, the median duration of antibiotic therapy for the index infectious episode was 7.0 (5.0-8.8) days in the CRP and 7.0 (7.0-11.3) days in the control (p = 0.011) groups. A significant difference in the treatment time between the two groups was identified in the curve of cumulative suspension of antibiotics, with less exposure in the CRP group (p = 0.007). In the per protocol analysis, involving 59 patients in each group, the median duration of antibiotic treatment was 6.0 (5.0-8.0) days for the CRP and 7.0 (7.0- 10.0) days for the control (p = 0.011) groups. Conclusions: Daily monitoring of CRP levels may aid in the reduction of antibiotic treatment time of critically ill patients, even in a scenario of judicious use of antimicrobials. Trial Registry : ClinicalTrials.gov Identifier: NCT02987790. Registered 09 December 2016, https://clinicaltrials.gov/ct2/show/NCT02987790 .

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.

scholarly journals Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients

Critical Care ◽  
2011 ◽  
Vol 15 (2) ◽  
pp. R78 ◽  
Author(s):  
Stuart McGrane ◽  
Timothy D Girard ◽  
Jennifer L Thompson ◽  
Ayumi K Shintani ◽  
Alison Woodworth ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Brain Dysfunction ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Acute Brain Dysfunction
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