The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism

Abstract Context Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis. Objective To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism. Design and Methods This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured. Results We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively. Conclusions Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.

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Plasma interleukin-6 levels correlate with survival in patients with bacterial sepsis and septic shock

Interventional Medicine and Applied Science ◽

10.1556/1646.2020.00006 ◽

2021 ◽

Vol 11 (4) ◽

pp. 224-230

Author(s):

Monica Chavez Vivas ◽

Hector Fabio Villamarin Guerrero ◽

Antonio Jose Tascon ◽

Augusto Valderrama-Aguirre

Keyword(s):

Septic Shock ◽

Cox Regression ◽

Serum Levels ◽

Significant Decline ◽

Bacterial Sepsis ◽

Inflammatory Biomarker ◽

Statistical Program ◽

Sepsis And Septic Shock ◽

Time Of Admission ◽

Admission Variables

AbstractIn this study, IL-6 levels were assessed as inflammatory biomarker of bacterial sepsis in patients hospitalized at the ICU of the hospital of Colombia.Materials and methodsProspective study on 62 patients diagnosed with sepsis and septic shock. An ELISA assay was used to test serum levels of IL-6 at admission and 48 h after admission. Variables were analyzed by χ2 test (alfa <0.05). Multivariable Cox regression was used to determine the survival with the statistical program SPSS v23.00.ResultsPatient's median age was 53 years old and 59.7% were male. Lung was the most common primary site of infection (43.5%), and hypertension comorbidity with higher prevalence (40%). Infection by Gram negative bacteria were significantly more frequent among patients than Gram positive (P = 0.037). Overall, survival analysis showed that 10 (16.1%) patients died with a survival median of 7.00 +4.874 (2–3) days. In patients with sepsis we detected a significant decline in the average of IL-6 serum levels after 48 h of admission [7.50 (SD: 7.00–68.00) pg/mL vs. 68.00 [SD: 7.00–300.00] pg/mL (P = 0.000). Only 25% of patients with septic shock who presented high levels of IL-6 at the time of admission and at 48 h had a survival up to 15 days (P = 0.005).ConclusionWe found significant differences between the plasma levels of IL-6 during the first 48 h after admission to the ICU among patients with sepsis and septic shock. Patients with sepsis had a significant decline in IL-6 levels, whereas in patients who developed septic shock, levels of this cytokine remained high and have a lower survival compared to those who maintained low levels of IL-6.

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SOFA Score, Hemodynamics and Body Temperature Allow Early Discrimination between Porcine Peritonitis-Induced Sepsis and Peritonitis-Induced Septic Shock

Journal of Personalized Medicine ◽

10.3390/jpm11030164 ◽

2021 ◽

Vol 11 (3) ◽

pp. 164

Author(s):

Mahmoud Al-Obeidallah ◽

Dagmar Jarkovská ◽

Lenka Valešová ◽

Jan Horák ◽

Jan Jedlička ◽

...

Keyword(s):

Septic Shock ◽

Body Temperature ◽

Sofa Score ◽

Porcine Model ◽

Venous Blood ◽

Mixed Venous Blood ◽

Mechanically Ventilated ◽

Multiple Parameters ◽

Failure Assessment ◽

Sepsis And Septic Shock

Porcine model of peritonitis-induced sepsis is a well-established clinically relevant model of human disease. Interindividual variability of the response often complicates the interpretation of findings. To better understand the biological basis of the disease variability, the progression of the disease was compared between animals with sepsis and septic shock. Peritonitis was induced by inoculation of autologous feces in fifteen anesthetized, mechanically ventilated and surgically instrumented pigs and continued for 24 h. Cardiovascular and biochemical parameters were collected at baseline (just before peritonitis induction), 12 h, 18 h and 24 h (end of the experiment) after induction of peritonitis. Analysis of multiple parameters revealed the earliest significant differences between sepsis and septic shock groups in the sequential organ failure assessment (SOFA) score, systemic vascular resistance, partial pressure of oxygen in mixed venous blood and body temperature. Other significant functional differences developed later in the course of the disease. The data indicate that SOFA score, hemodynamical parameters and body temperature discriminate early between sepsis and septic shock in a clinically relevant porcine model. Early pronounced alterations of these parameters may herald a progression of the disease toward irreversible septic shock.

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Elimination of glycopeptide antibiotics by cytokine hemoadsorption in patients with septic shock: A study of three cases

The International Journal of Artificial Organs ◽

10.1177/0391398820917151 ◽

2020 ◽

Vol 43 (12) ◽

pp. 753-757 ◽

Cited By ~ 1

Author(s):

Thomas Dimski ◽

Timo Brandenburger ◽

Colin MacKenzie ◽

Detlef Kindgen-Milles

Keyword(s):

Septic Shock ◽

Clinical Practice ◽

Continuous Infusion ◽

Clinical Course ◽

Serum Levels ◽

Metabolic Effects ◽

Adsorptive Capacity ◽

Therapeutic Drug ◽

Glycopeptide Antibiotics ◽

Sepsis And Septic Shock

Sepsis and septic shock are characterized by a release of cytokines into the circulation. These mediators contribute to the detrimental hemodynamic and metabolic effects in the early phase of septic shock. Recently, a new polystyrene-based hemoadsorption device was introduced into clinical practice (CytoSorb®). The adsorber binds a variety of molecules including cytokines and removes them from the circulation. Studies in septic patients have shown an improved clinical course following hemoadsorption but no increased survival. We hypothesize that not only cytokines but also antibiotics may be removed which potentially may negate any beneficial effect of the adsorber. To test this hypothesis, we performed polystyrene-based hemoadsorption in three patients in septic shock and analysed glycopeptide elimination by measuring serum levels pre- and post-adsorber. We administered both teicoplanin and vancomycin via a 60-min infusion and vancomycin via continuous infusion, additionally. When applied as 60 min infusion, vancomycin and teicoplanin were removed immediately by the adsorber. However, the adsorptive capacity of the device was saturable. Serum levels of vancomycin, but not teicoplanin, decreased to subtherapeutic levels. With continuous infusion of vancomycin, removal was less and serum levels remained in the therapeutic range. In conclusion, we show effective glycopeptide adsorption using a polystyrene-based hemoadsorber in septic patients. The dose of these antibiotics should be adjusted appropriately and early therapeutic drug monitoring is highly recommended.

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Interleukin-6 kinetics can be useful for early treatment monitoring of severe bacterial sepsis and septic shock

Infectious Disease Reports ◽

10.4081/idr.2016.6213 ◽

2016 ◽

Vol 8 (1) ◽

Cited By ~ 3

Author(s):

Thomas Klag ◽

Giulio Cantara ◽

Udo Sechtem ◽

Anastasios Athanasiadis

Keyword(s):

Septic Shock ◽

Interleukin 6 ◽

Early Treatment ◽

Treatment Monitoring ◽

Bacterial Sepsis ◽

Case Histories ◽

Sepsis And Septic Shock ◽

Kinetics Of

Early appropriate anti-microbial therapy is necessary to improve outcomes of septic patients. We describe 20 case histories of patients with severe bacterial sepsis regarding kinetics of several biomarkers. We found that interleukin-6 is able to predict survival and might be able to evaluate appropriateness of anti-microbial therapy.

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Circulating miR-147b as a diagnostic marker for patients with bacterial sepsis and septic shock

PLoS ONE ◽

10.1371/journal.pone.0261228 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261228

Author(s):

Ngo Tat Trung ◽

Tran Thi Lien ◽

Vu Viet Sang ◽

Nghiem Xuan Hoan ◽

Nguyen Dang Manh ◽

...

Keyword(s):

Septic Shock ◽

Diagnostic Marker ◽

Antimicrobial Treatment ◽

Patient Stratification ◽

Circulating Biomarkers ◽

Bacterial Sepsis ◽

Diagnostic Potential ◽

Sepsis And Septic Shock ◽

Plasma Mirnas ◽

Subsequent Patient

Background Early diagnosis, precise antimicrobial treatment and subsequent patient stratification can improve sepsis outcomes. Circulating biomarkers such as plasma microRNAs (miRNAs) have proven to be surrogates for diagnosis, severity and case management of infections. The expression of four selected miRNAs (miR-146-3p, miR-147b, miR-155 and miR-223) was validated for their prognostic and diagnostic potential in a clinically defined cohort of patients with sepsis and septic shock. Methods The expression of plasma miRNAs was quantified by quantitative PCR (qPCR) in patients with bacterial sepsis (n = 78), in patients with septic shock (n = 52) and in patients with dengue haemorrhagic fever (DHF; n = 69) and in healthy controls (n = 82). Results The expression of studied miRNA was significantly increased in patients with bacterial sepsis and septic shock. The plasma miR-147b was able to differentiate bacterial sepsis from non-sepsis and septic shock (AUC = 0.77 and 0.8, respectively, p≤ 0.05), while the combination of plasma miR-147b and procalcitonin (PCT) predicted septic shock (AUC = 0.86, p≤ 0.05). Conclusions The plasma miR-147b may be an useful biomarker independently or in combination with PCT to support clinical diagnosis of sepsis and equally prognosis of patients with septic shock.

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diagnosis and trEatmEnt of patiEnts in sEptiC shoCK

New Medicine ◽

10.5604/01.3001.0009.7846 ◽

2017 ◽

Vol 21 (1) ◽

pp. 31-36

Author(s):

Jacek wadełek

Keyword(s):

Septic Shock ◽

Organ Dysfunction ◽

Host Response ◽

Signs And Symptoms ◽

Intravenous Fluids ◽

Failure Assessment ◽

Acute Change ◽

Life Threatening ◽

Sepsis And Septic Shock ◽

Clinical Emergency

sepsis and septic shock are a clinical emergency. sepsis is defined as a life-threatening organ dysfunction due to a dysregulated host response to infection, and organ dysfunction is defined as an acute change in sequential organ failure assessment (sofa) score greater than 2 points secondary to an infectious cause. septic shock is defined as sepsis with persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm hg or higher, and blood lactate level greater than 2 mmol/l (18 mg/dl) despite adequate volume resuscitation. the diagnosis of septic shock begins with medical history and physical examination focused on the signs and symptoms of infection, with the aim of recognizing complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of antibiotics, vasopressors and intravenous fluids aimed at restoring adequate circulation. they should also be aware of the limitations of the protocol-based therapy.

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Mannose-binding lectin serum levels in neonatal sepsis and septic shock

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.3109/14767058.2011.582903 ◽

2011 ◽

Vol 25 (4) ◽

pp. 411-414 ◽

Cited By ~ 18

Author(s):

Walid Abdel Wahab Mohamed ◽

Mohamed Abdullatif Saeed

Keyword(s):

Septic Shock ◽

Neonatal Sepsis ◽

Serum Levels ◽

Mannose Binding Lectin ◽

Mannose Binding ◽

Sepsis And Septic Shock ◽

Binding Lectin

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Thyroid Hormone Levels and their Relationship to Survival in Children with Bacterial Sepsis and Septic Shock

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem.2004.17.10.1435 ◽

2004 ◽

Vol 17 (10) ◽

Cited By ~ 28

Author(s):

D. Yıldızdaş ◽

N. Önenli-Mungan ◽

Η. Yapıcıoğlu ◽

A.K. Topaloglu ◽

Y. Sertdemir ◽

...

Keyword(s):

Septic Shock ◽

Thyroid Hormone ◽

Bacterial Sepsis ◽

Hormone Levels ◽

Thyroid Hormone Levels ◽

Sepsis And Septic Shock

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Receptors, Mediators, and Mechanisms Involved in Bacterial Sepsis and Septic Shock

Clinical Microbiology Reviews ◽

10.1128/cmr.16.3.379-414.2003 ◽

2003 ◽

Vol 16 (3) ◽

pp. 379-414 ◽

Cited By ~ 468

Author(s):

Edwin S. Van Amersfoort ◽

Theo J. C. Van Berkel ◽

Johan Kuiper

Keyword(s):

Septic Shock ◽

Mononuclear Cells ◽

Lipoteichoic Acid ◽

The Body ◽

Plasma Lipoproteins ◽

Bacterial Sepsis ◽

Proinflammatory Mediators ◽

Sepsis And Septic Shock ◽

Bacterial Constituents

SUMMARY Bacterial sepsis and septic shock result from the overproduction of inflammatory mediators as a consequence of the interaction of the immune system with bacteria and bacterial wall constituents in the body. Bacterial cell wall constituents such as lipopolysaccharide, peptidoglycans, and lipoteichoic acid are particularly responsible for the deleterious effects of bacteria. These constituents interact in the body with a large number of proteins and receptors, and this interaction determines the eventual inflammatory effect of the compounds. Within the circulation bacterial constituents interact with proteins such as plasma lipoproteins and lipopolysaccharide binding protein. The interaction of the bacterial constituents with receptors on the surface of mononuclear cells is mainly responsible for the induction of proinflammatory mediators by the bacterial constituents. The role of individual receptors such as the toll-like receptors and CD14 in the induction of proinflammatory cytokines and adhesion molecules is discussed in detail. In addition, the roles of a number of other receptors that bind bacterial compounds such as scavenger receptors and their modulating role in inflammation are described. Finally, the therapies for the treatment of bacterial sepsis and septic shock are discussed in relation to the action of the aforementioned receptors and proteins.

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