Predictive Factors of Severe Sepsis and Septic Shock in Patients with Hematological Malignancies and Pseudomonas Infections.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4552-4552
Author(s):  
Ramzi Jeddi ◽  
Hèla Ghédira ◽  
Ramzi ben Amor ◽  
Lamia Aissaoui ◽  
Karima Kacem ◽  
...  
Keyword(s):  
Septic Shock ◽  
Multivariate Analysis ◽  
Severe Sepsis ◽  
Neutrophil Count ◽  
Hematological Malignancies ◽  
Univariate Analysis ◽  
Skin Lesions ◽  
Hemoglobin Level ◽  
C Reactive Protein ◽  
Reactive Protein

Abstract Abstract 4552 Background Pseudomonas aeruginosa is a leading cause of nosocomial infections usually associated with high mortality. The aim of this study was to determine the predictive factors of severe sepsis or septic shock in patients with hematological malignancies and pseudomonas infections. Methods This study was conducted in a teaching hospital (Aziza Othmana University Hospital, Tunis, Tunisia) to evaluate the clinical profile of infections due to Pseudomonas species and to determine risk factors for severe sepsis or septic shock defined according to the criteria of the ACCP/SCCM. Pearson test was used for univariate analysis, and logistic regression for multivariate analysis. Results Between 2004 and 2009,a total of 73 pseudomonas isolates (70 P, aeruginosa) was collected in 60 patients : 47 with acute leukemia (78%), 7 with lymphoma (12%), and 6 with others hematological disorders (10%).The median age was 29 yrs (range, 2-64). Most common sites of the isolates were from bloodstream (45%), and skin lesions (31.5%). At least 11 patients (18%) had 2 or more infections due to Pseudomonas. The most common clinical signs observed were isolated fever (18%), respiratory symptoms (15%), diarrhea (21%), and skin lesions (29%).Susceptibility to major anti-pseudomonas antibiotics revealed that isolates tested were resistant to:piperacillin/tazobactam (40%), cefatazidim (28%), ciprofloxacin (20.5%), imipenem (22%), and amikacin (22%).Severe sepsis or septic shock occurred in 49% of episodes. Crude mortality was (18%, 11 of the 60 patients) all caused by septic shock. In univariate analysis factors associated with severe sepsis or septic shock were: Isolates from more than one site (p=0.04), Absolute neutrophil count < 0.1 × 109/l (p=0.003), concomitant infection with other microorganism (p=0.019), fever lasting for more than 3 days in patients with antibiotherapy (p=0.003), C-reactive protein > 100 mg/l (p <0.0001), serum lactate >2.2 mmol/l (p< 0.0001), serum bicarbonate < 19 mmol/l (p=0.002), hemoglobin level < 70g/l (p<0.0001), renal failure (p=0.006), hypophosphatemia <0.8mmol/l (p=0.003), total bilirubin > 50 μmol/l (p=0.03), and hypoproteinemia <64g/l (p<0.0001). By multivariate analysis, antibiotherapy for more than 3 days (p=0.025,OR=0.217, 95%CI:0.05-0.82), absolute neutrophil count <0.1× 109/l (p=0.046,OR=170;95% CI:1-267), C-reactive protein >100 (p=0.04,OR=15,95%CI: 1,1-219,8), hemoglobin level <70g/l (p=0.037,OR=17,95%CI: 1,1- 243), and hypophosphatemia (p=0.02,OR=148,95%CI:2.2-942) remained as independent predictors of severe sepsis or septic shock. Conclusions This study revealed that several factors such as level of neutrophil count, C-reactive protein, hemoglobin level, severe hypophosphatemia, and antibiotherapy > 72 h before microbiological documentation may play a significant and independent role for the development of severe sepsis/septic shock and increase mortality of Pseudomonas infections in patients with hematological malignancies. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Prognostic Value of A Preoperative Lymphocyte Count and C-Reactive Protein Ratio In Osteosarcoma

2021 ◽  
Author(s):  
Shu-Yu Ji ◽  
Hai-Jun Tang ◽  
Xiao-Ting Luo ◽  
Wei-Feng Liang ◽  
Xian-Ying Huang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Lymphocyte Count ◽  
Tumor Metastasis ◽  
Univariate Analysis ◽  
White Blood Cells ◽  
C Reactive Protein ◽  
Optimal Cutoff ◽  
Reactive Protein ◽  
Cutoff Values ◽  
Enneking Stage

Abstract Background: Systemic inflammatory response and nutritional status are closely related to tumor development, and both have been recognized as predictors of tumors. Our study investigated the effect on the prognosis of osteosarcoma by analyzing the ratio of lymphocytes to C-reactive protein (LCR) before surgery.Methods: Patients who were diagnosed with osteosarcoma and underwent surgery in the First Affiliated Hospital of Guangxi Medical University from 2012 to 2019 were included in this retrospective study. The albumin (g/L) +5 × total lymphocyte count (PNI), neutrophil/lymphocyte count (NLR), platelet/lymphocyte count (PLR) and platelet × neutrophil/lymphocyte count (SII) were calculated from preoperative peripheral white blood cells, C-reactive protein and serum albumin. The optimal cutoff values of LCR, PNI, NLR, PLR and SII were determined by receiver operating characteristic (ROC) analysis. According to the Optimal cutoff values, LCR, PNI, NLR, PLR and SII were divided into high and low groups. The Kaplan-Meier method was used to compare the overall survival (OS) between the high and low LCR groups. Univariate analysis was used to determine the influence of age, gender, tumor size, Enneking stage and neoadjuvant chemotherapy on the prognosis of osteosarcoma.The independent predictors of OS were determined by Cox multivariate analysis.Results: The optimal cutoff values for LCR, PNI, NLR, PLR and SII were 0.093, 48.4, 1.23, 157.03 and 314.27, respectively. A low preoperative LCR was significantly correlated with tumor metastasis, stage, NLR, PLR and SII. However, a low preoperative PNI was significantly associated with tumor metastasis, stage, and PLR.Kaplan-Meier survival analysis indicated that the postoperative OS was significantly correlated with preoperative LCR and PNI (P < 0.05). Univariate analysis showed that Enneking stage, metastasis and preoperative LCR, PNI, NLR, PLR and SII were important factors affecting OS (P < 0.05). For multivariate analysis, the results revealed that the preoperative LCR (HR, 0.401; 95% CI, 0.199-0.807; P = 0.01) and Enneking stage (HR, 2.717; 95%CI, 1.067-6.919; P = 0.036) is an independent prognostic factor affecting the postoperative OS of osteosarcoma.Conclusions: The high preoperative LCR is strongly associated with longer survival time in patients with osteosarcoma. Enneking stage and preoperative LCR may be important parameters for the prognosis of osteosarcoma.

scholarly journals Evaluation of eosinophil count and neutrophil-lymphocyte count ratio versus C-reactive protein levels in patients with sepsis

2017 ◽  
Vol 5 (11) ◽  
pp. 4754
Author(s):  
Rahul Khajuria ◽  
Vinu Jamwal ◽  
Anil K. Gupta ◽  
Abhinav Gupta
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Critically Ill Patients ◽  
Eosinophil Count ◽  
Lymphocyte Count ◽  
Sepsis Group ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Count Ratio

Background: One major problem encountered in the intensive care unit is differentiating the inflammatory response from an infective process. Clinical and standard laboratory tests are not very helpful because most critically ill patients develop some degree of inflammatory response, whether or not they have sepsis. Numerous biomarkers have been evaluated to predict mortality in critically ill patients, although none have proved entirely useful. Objective of the study was to evaluate eosinophil count and neutrophil-lymphocyte count ratio with C-reactive protein levels in patients with sepsis.Methods: 71 patients >18 years of age of either sex with a diagnosis of sepsis were enrolled in this one-year observational study. Patients were classified according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine into sepsis group (n=50) and no sepsis group (n=21). Sepsis group were further divided into subgroups: sepsis (n=19), severe sepsis (n=16) and septic shock (n=15). Absolute eosinophil cell, neutrophil and lymphocyte counts for first 4 consecutive days and then on alternate days up to one week were also noted down. C-reactive protein levels on day 3 were also noted down.Results: In the sepsis group, mean eosinophil count was significantly (p<0.0001) low, mean neutrophil/lymphocyte count ratio was significantly (p<0.0001) high, mean CRP count was significantly (p=0.019) more as compared to that of no sepsis group. Among 16 mortalities, significant (p<0.05) decrease was noted in mean eosinophil count from day 3 onwards in patients of sepsis and septic shock subgroups. Mean N/L ratio showed no significant difference in patients of sepsis, severe sepsis or septic shock. Mean CRP count showed significant (p<0.05) increase in severe sepsis patients and mean Apache II score showed significant (p<0.05) deterioration in patients of septic shock.Conclusions: Neutrophil/lymphocyte count ratio (NLCR) and absolute eosinophil count (AEC) came out as better independent biomarker of sepsis in critically ill patients with infection admitted in intensive care unit. Diagnostic performance was better in these two diagnostic markers as compared to CRP marker. NLCR presented with sensitivity of 89.58%, AEC with 82.35% and CRP with 80.77%. Outcomes of NLCR and AEC were quick, easy and economical in establishing diagnosis of sepsis.

scholarly journals Can we find accessible and relevant markers for sepsis outcome?

2017 ◽  
Vol 25 (1) ◽  
pp. 91-100
Author(s):  
Andreea Paula Cioară ◽  
Mirela Flonta ◽  
Astrid Binder ◽  
Andreea Pop ◽  
Violeta Siladi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Mortality Rate ◽  
Serum Levels ◽  
Serum Glucose ◽  
Serum Lactate ◽  
C Reactive Protein ◽  
Chi Square ◽  
Reactive Protein ◽  
Chi Square Test

Abstract Background and Aim: Sepsis is a life-threatening disease with high mortality, therefore establishing early diagnostic and finding reliable prognostic biomarkers is vital. We aimed to investigate the prognostic role, as a single value, of serum procalcitonin, C-reactive protein, serum lactate, platelets number and serum glucose level in septic patients, all measured in the first 24 hours after hospital admittance. Materials and methods: This retrospective study included 241 adult patients with sepsis, severe sepsis or septic shock. We use data from patients observation sheets. Data that were collected include: demographic parameters, comorbidities, necessity of mechanical ventilation and laboratory variables. We performed the statistical analysis with the chi square test for nonparametric data and to analyse the accuracy of prediction we used the receiver - operator curves with the level of significance set at p < 0.05. Results: From 241 patients with a median age of 68 years, 127 (52.69%) were male.113 patients had severe sepsis. 89 patients (36.9%) died and male had an increase mortality rate. Most cases were respiratory sepsis (45.20%). The highest mortality rate was in septic shock (51.2%). Procalcitonin, C-reactive protein and glucose serum level at admittance were not correlated with mortality. The serum levels of creatinine >1.67 mg/dL and serum lactate >1.9 mmol/L at admittance were correlated with mortality (p < 0.01). The cutoff value of 121×103/uL platelets number was also correlated with mortality (p < 0.01). Conclusions: Our findings suggest that serum creatinine, serum lactate and the platelets number could be used as prognostic markers in septic patients at admittance.

scholarly journals Soluble membrane receptors, interleukin 6, procalcitonin and C reactive protein as prognostic markers in patients with severe sepsis and septic shock

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0175254 ◽  
Author(s):  
Juan-Jesús Ríos-Toro ◽  
Mercedes Márquez-Coello ◽  
José-María García-Álvarez ◽  
Andrés Martín-Aspas ◽  
Ricardo Rivera-Fernández ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Interleukin 6 ◽  
Prognostic Markers ◽  
Membrane Receptors ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Sepsis And Septic Shock

scholarly journals Platelet-to-lymphocyte ratio and C-reactive protein as markers for colorectal polyp histological type

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rui Chen ◽  
Liguang Wang ◽  
Qi Zhao ◽  
Zhen Li ◽  
Man Chen ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Colorectal Polyp ◽  
Histological Type ◽  
Endoscopic Polypectomy ◽  
Tumor Diameter ◽  
C Reactive Protein ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Reactive Protein

Abstract Background The platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) level are markers that have been reported to predict the histological type of various tumors, and here, we evaluated their utility in predicting colorectal polyp histological types. Methods We retrospectively reviewed 172 patients with colorectal polyps who underwent endoscopic polypectomy. The associations between histological type and clinicopathologic parameters were assessed by multivariate analysis. Results The optimal PLR and CRP cut-off values were 113.32 and 0.39, respectively. The PLR (P = 0.002) and CRP (P = 0.009) values were associated with the histological type according to the univariate analysis, whereas low PLR (P ≤ 0.001) and CRP (P = 0.017) values were independent risk factors in the multivariate analysis together with maximum tumor diameter (P ≤ 0.001) and tumor number (P = 0.0014). Conclusions Preoperative PLR and CRP are correlated with the colorectal polyp histological type.

Διαταραχές στον άξονα της αυξητικής ορμόνης σε ασθενείς της μονάδας εντατικής θεραπείας με σήψη

2013 ◽  
Author(s):  
Χρυσούλα Παπαστάθη
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Growth Factor ◽  
Interleukin 6 ◽  
Insulin Like Growth Factor ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Septic Episode ◽  
Igf I ◽  
Igfbp 3

Objective: To investigate the Growth Hormone (GH)/Insulin-like Growth Factor-I (IGF-I)axis and identify the factors that determine IGF-I levels in adult septic patients of variable severity,i.e., with sepsis, severe sepsis or septic shock, in the acute phase of disease.Design: Prospective study comparing septic patients treated in a general intensive care unitand healthy volunteers.Methods: In 107 consecutive septic patients (44 with sepsis, 13 with severe sepsis, and 50with septic shock), GH, IGF-I, Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), insulin,cortisol, albumin, thyroid hormones, C-reactive protein and interleukin-6 serum levels weremeasured once within 48 hrs after onset of a septic episode. Twenty-nine healthy volunteers servedas controls.Results: IGF-I and IGFBP-3 levels were decreased in patients with sepsis and severe sepsis(versus controls), decreasing further in patients with septic shock (versus sepsis). IGF-I levels were positively related to IGFBP-3, albumin, triiodothyronine and thyroxine, and inversely related to cortisol, sepsis severity, C-reactive protein, interleukin-6 and age. In multiple regression analysis, IGF-I levels were independently related to IGFBP-3 and albumin (lower in patients with decreasedIGFBP-3 and albumin levels) (p<0.001 and p=0.01, respectively), and cortisol (lower in patientswith increased cortisol levels) (p=0.04). IGFBP-3 accounted for most of the variance explained bythe model (R2=0.519). GH levels were not related to IGF-I levels or mortality. IGF-I and IGFBP-3levels were associated with mortality.Conclusions: The GH/IGF-I axis is severely disrupted in septic patients. IGFBP-3 is themajor determinant of IGF-I levels, whereas albumin and cortisol are secondary determinants.

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