scholarly journals Diagnosis Value of Procalcitonin Variation on Early Pneumonia after Adult Cardiac Surgery

2021 ◽  
Vol 24 (4) ◽  
pp. E734-E740
Author(s):  
Hua Jin ◽  
Su-Ping Gu ◽  
Yan Wang ◽  
Ke Pan ◽  
Zhong Chen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
White Blood Cells ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Postoperative Pneumonia ◽  
Diagnostic Significance ◽  
Reactive Protein ◽  
Wbc Count ◽  
Age And Sex ◽  
Adult Cardiac Surgery

Background: Postoperative pneumonia (PP) is a complication after cardiac surgery. This study aimed to investigate the ability of procalcitonin (PCT) variation to diagnose postoperative pneumonia. Method: In this prospective observational study, patients with PP and age- and sex-matched cases in our center from October 10, 2020, to January 31, 2021, were included. Patients diagnosed with PP in this study met both clinical and microbiological diagnostic criteria. Blood samples were collected in all patients from the first postoperative day (POD1) to POD5 to measure PCT, white blood cells (WBCs), and C-reactive protein (CRP). PCT variation was calculated by the equation: (PCTdelayed – PCTPOD1)/PCTPOD1. The receiver operating characteristic and area under the curve (AUC) analyses were used to evaluate the diagnostic performance of different biomarkers. Results: Our study enrolled 272 patients, including 24 patients with PP and 248 age- and sex-matched cases. From POD1 to POD5, the absolute value of PCT showed diagnostic significance for pneumonia (P < .05), WBC showed no differences, and CRP had no diagnostic value until POD4. Furthermore, PCT variation showed the best diagnostic value among those biomarkers (AUC 0.84, 95% confidence interval [CI] 0.71, 0.91). Multivariable logistic regression showed that PCT variation on POD2 had significant value to predict PP (odds ratio 5.602, 95% CI 2.178, 14.409, P < .01). Conclusion: Compared with PCT level, WBC count, and CRP level, PCT variation had the best diagnostic value in predicting PP.

scholarly journals Diagnostic Value of Procalcitonin and Interleukin-6 on Early Postoperative Pneumonia after Adult Cardiac Surgery: A Prospective Observational Study

2022 ◽  
Vol 25 (1) ◽  
pp. E020-E029
Author(s):  
Man Xie ◽  
Ya Ting Chen ◽  
He Zhang ◽  
Hai Tao Zhang ◽  
Ke Pan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Diagnostic Value ◽  
Postoperative Pneumonia ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Reactive Protein ◽  
Adult Cardiac Surgery

Background: Postoperative pneumonia (PP) is the most common primary infection after cardiac surgery, increasing the hospitalization expense and causing the consumption of healthcare resources. This study aimed to investigate the diagnostic value of procalcitonin (PCT) and interleukin-6 (IL-6) on early postoperative pneumonia after adult cardiac surgery. Methods: In this prospective observational study, patients with pneumonia and age- and sex-matched cases in our center from October 10, 2020 to January 31, 2021 were included. Patients diagnosed with pneumonia in this study needed meet both clinical and microbiological diagnostic criteria. Blood samples were collected in all patients from postoperative day (POD) 1 to postoperative day 5 to detect PCT, IL-6, white blood cell count, and C-reactive protein. The diagnostic performance of different biomarkers was evaluated by the receiver operating characteristic curves and the area under the curves. Results: Our study enrolled 272 patients, including 24 patients with postoperative pneumonia and 248 age- and sex-matched cases. From POD1 to POD5, the absolute value of PCT and PCT variations showed diagnostic significance for pneumonia (P < .05); the diagnostic value of the absolute value of IL-6 and IL-6 variations was not satisfying. White blood cell count showed no differences; C-reactive protein had no diagnostic value before POD4. Multivariable logistic regression showed that PCT variation and IL-6 variation from POD3 to POD1 were the strongest risk factors for postoperative pneumonia [OR:12.50, 95% CI: (3.40-45.5); OR:13.71, 95% CI: (1.11-168.47)]. According to the above results, we defined the PL Index. PL Index showed the best diagnostic value among those biomarkers in POD3 [AUC: 0.90, 95% CI: (0.79-0.95)]. Multivariable logistic regression showed PL Index POD3 has significant correlation with postoperative pneumonia [OR:1.23, 95% CI: (1.11-1.37), P = .041]. Conclusions: PCT variation and IL-6 were more accurate than C-reactive protein and white blood cell count to predict early postoperative pneumonia, but the diagnostic properties of PCT could not be observed during the first three postoperative days due to the inflammatory process. By combining the variations of PCT and IL-6, we defined the PL Index, which shows the best diagnostic ability on early postoperative pneumonia after adult cardiac surgery.

scholarly journals Procalcitonin may not be a differential diagnostic marker for bacterial infection in febrile patients with chronic gouty arthritis

2018 ◽  
Vol 46 (10) ◽  
pp. 4197-4206 ◽  
Author(s):  
Jing Zhang ◽  
Cheng Zhao ◽  
Tong Wu ◽  
Jiang Su ◽  
Xiaodan Wu ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Operating Characteristic ◽  
Gouty Arthritis ◽  
White Blood Cells ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Receiver Operating Characteristic Curves ◽  
Reactive Protein ◽  
Diagnostic Values ◽  
Wbc Count

Objective This study aimed to examine the diagnostic value of serum procalcitonin (PCT) levels for identifying bacterial infection in febrile patients with chronic gouty arthritis. Methods Sixty-six febrile patients with chronic gouty arthritis were divided into non-bacterial infection (n = 45) and bacterial infection groups (n = 21). PCT levels were measured by an immunoassay. Other laboratory parameters, including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), and the neutrophil ratio were extracted from medical records. Receiver-operating characteristic curves were used to evaluate diagnostic values and accuracy. Results Serum PCT levels, the ESR, CRP levels, WBC count, and neutrophil ratio were not different between the groups. To assess the ability of PCT to discriminate bacterial infection in febrile patients with chronic gouty arthritis (cut-off value: 0.5 ng/mL), the sensitivity and specificity of PCT were 22.2% and 61.5%, respectively. The area under the curve (AUC) of serum PCT levels was 0.526. The AUCs of related inflammatory indicators were 0.530 for the ESR, 0.635 for CRP, 0.577 for the WBC count, and 0.712 for the neutrophil ratio. Conclusion Serum PCT levels may not be a good biomarker for bacterial infection in febrile patients with chronic gouty arthritis.

scholarly journals Serum levels of CXCL-8, IL-10, and TNF-alpha in ankylosing spondylitis patients

Biomedicine ◽  
2021 ◽  
Vol 41 (3) ◽  
Author(s):  
Dhuha Karim
Keyword(s):  
Disease Severity ◽  
Functional Disability ◽  
White Blood Cells ◽  
Age Groups ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Hla B27 ◽  
Diagnostic Significance ◽  
Significant Difference ◽  
Wbc Count

The mean age of AS patients was (35.0 ± 9.8) years.When the patients and control subjects were divided into different age groups (>40, 30-40, <30 years), the differences were not significantin terms of disease prevalence. The results also showed that the percentage of male patients is higher than that of females. There was no significant difference (P?0.05) between patients and controls in the distribution of males and females.Most of the patients had the disease for a period of 5 years or higher, with a disease severity of ? 2.1 and functional disability degree of I, II. The resultsshoweddifferent patterns of distribution for the three tested cytokines. A significant increase in the level of TNF-?, anon-significantincrease in the level of CXCL-8, and a significant decrease in the level of IL-10 were observed in the sera of patients with AS compared with the control.The patients also demonstrated significant decreases in the serum ALT and AST enzyme levels, hemoglobin (Hb) level, white blood cells (WBC) count, and erythrocyte sedimentation rate (ESR) (P?0.05).The percentage of HLA-B27-positive Iraqi patients was lower than that of the HLA-B27-negative patients. Some of these patterns were also exposed to changes related to some determinants in patients, which included age, sex, disease duration, disease severity, functional disability, and HLA-B27 positivity,along with association with clinical subtypes of AS.The area under the curve was determined for the parameters of ESR, IL-10, TNF-? and CXCL-8.The most significant factor was found to beESR, followed by IL-10, and then TNF-?, with the presence of significant differences, while there was no diagnostic significance for CXCL-8 ,which showed no significant difference (p?0.05).  

scholarly journals Diagnostic Value of C-Reactive Protein in Discrimination between Uncomplicated and Complicated Parapneumonic Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 829
Author(s):  
Yana Kogan ◽  
Edmond Sabo ◽  
Majed Odeh
Keyword(s):  
Area Under The Curve ◽  
Diagnostic Value ◽  
Parapneumonic Effusion ◽  
C Reactive Protein ◽  
Diagnostic Efficacy ◽  
Reactive Protein ◽  
Significant Difference ◽  
Study Population ◽  
Complicated Parapneumonic Effusion

Objectives: The role of serum C-reactive protein (CRPs) and pleural fluid CRP (CRPpf) in discriminating uncomplicated parapneumonic effusion (UCPPE) from complicated parapneumonic effusion (CPPE) is yet to be validated since most of the previous studies were on small cohorts and with variable results. The role of CRPs and CRPpf gradient (CRPg) and of their ratio (CRPr) in this discrimination has not been previously reported. The study aims to assess the diagnostic efficacy of CRPs, CRPpf, CRPr, and CRPg in discriminating UCPPE from CPPE in a relatively large cohort. Methods: The study population included 146 patients with PPE, 86 with UCPPE and 60 with CPPE. Levels of CRPs and CRPpf were measured, and the CRPg and CRPr were calculated. The values are presented as mean ± SD. Results: Mean levels of CRPs, CRPpf, CRPg, and CRPr of the UCPPE group were 145.3 ± 67.6 mg/L, 58.5 ± 38.5 mg/L, 86.8 ± 37.3 mg/L, and 0.39 ± 0.11, respectively, and for the CPPE group were 302.2 ± 75.6 mg/L, 112 ± 65 mg/L, 188.3 ± 62.3 mg/L, and 0.36 ± 0.19, respectively. Levels of CRPs, CRPpf, and CRPg were significantly higher in the CPPE than in the UCPPE group (p < 0.0001). No significant difference was found between the two groups for levels of CRPr (p = 0.26). The best cut-off value calculated by the receiver operating characteristic (ROC) analysis for discriminating UCPPE from CPPE was for CRPs, 211.5 mg/L with area under the curve (AUC) = 94% and p < 0.0001, for CRPpf, 90.5 mg/L with AUC = 76.3% and p < 0.0001, and for CRPg, 142 mg/L with AUC = 91% and p < 0.0001. Conclusions: CRPs, CRPpf, and CRPg are strong markers for discrimination between UCPPE and CPPE, while CRPr has no role in this discrimination.

scholarly journals Diagnostic value of 12-zone lung ultrasound protocol for diagnosing COVID-19-associated pneumonia in outpatients

2021 ◽  
Vol 21 (87) ◽  
pp. 271-276
Author(s):  
Dzmitry Haurylenka ◽  
◽  
Victar Damantsevich ◽  
Andrey Filustsin ◽  
Anna Damantsevich ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Quantitative Assessment ◽  
Lung Ultrasound ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Outpatient Setting ◽  
Diagnostic Significance ◽  
Decisive Importance ◽  
Sensitivity Specificity ◽  
B Lines

Introduction: In the SARS-CoV-2 pandemic, lung ultrasound can be of decisive importance for planning further treatment approach in patients with infection. There is still no clear priority for the choice of lung ultrasound protocol in an outpatient setting. Aim: The objective of the study was to evaluate the applicability of 12-zone protocol lung ultrasound for the diagnosis of COVID- 19 associated pneumonia in outpatients. Materials and methods: We examined 39 outpatients meeting the diagnostic criteria of COVID-19 infection (17 men and 22 women) aged 31–75 years (median 49 years). All patients underwent lung ultrasound immediately after chest computed tomography performed by a blinded specialist. Correlation analysis of the results of a quantitative assessment of the detected signs, assessment of the diagnostic significance of lung ultrasound for identifying signs of pneumonia were performed. Results: Pneumonia was diagnosed by computed tomography in 25 (64%; 95% CI 47–79) out of 39 patients. At the same time, ultrasound signs of interstitial abnormalities were detected in 31 patients. Multiple (narrow) B-lines, confluent (wide) B-lines, as well as areas of subpleural consolidation and “white lung” were the most common lung ultrasound abnormalities. When evaluating the method, the optimal sensitivity/ specificity ratio was obtained for a value of ≥2 points, the area under the curve = 0.970 (95% CI 0.858–0.999; p <0.0001). The score of lung ultrasound significantly correlated with computed tomography quantitative assessment (r = 0.928, p <0.001). Conclusion: Despite some limitations, lung ultrasound can be extremely useful in primary care settings, also in the case of a significant number of admitted patients, to detect features of COVID-19 associated pneumonia.

scholarly journals Predictive Value of Lymphocyte Percentage and CRP Level for Early Detection of Deep Surgical Site Infection Following Posterior Lumbar Spinal Surgery

2021 ◽  
Author(s):  
Wenbo Wei ◽  
Shajie Dang ◽  
Dapeng Duan ◽  
Liqun Gong ◽  
Ling Wei ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Differential Count ◽  
Reactive Protein ◽  
Diagnostic Thresholds ◽  
Deep Surgical Site Infection ◽  
Lumbar Spinal Surgery ◽  
Wbc Count ◽  
Lumbar Spinal

Abstract Objective: To investigate the predictive value of laboratory predictors, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and WBC differential count, for the early diagnosis of deep surgical site infection (SSI) after posterior lumbar spinal surgery. We also sought to determine the diagnostic thresholds for these markers.Methods: A total of 243 patients participated in the study: 11 patients who developed deep SSI after lumbar spinal surgery (SSI group) and 232 non-SSI patients as controls (non-SSI group). White blood cell (WBC) count, WBC differential count, CRP level, and ESR were determined 1 day before surgery and on postoperative day (POD) 1, POD3, and POD7. The diagnostic thresholds for these markers were determined with the receiver operating characteristic curve.Results: CRP, ESR, and WBC were significantly higher in the SSI group than in the non-SSI group on POD3 and POD7 ( P < 0.05). The lymphocyte percentage was significantly lower in the SSI group, compared with the non-SSI group, on POD3 ( P < 0.05). Analysis of the receiver operating characteristic curve revealed that lymphocyte percentage < 11.5% on POD3 (sensitivity 90.9%, specificity 75.4%, area under the curve [AUC] 0.919), and C-reactive protein level > 26 mg/L on POD7 (sensitivity 90.9%, specificity 87.7%, area under the curve [AUC] 0.954) were significant laboratory predictors for the early detection of SSI.Conclusion: Lymphocyte percentage < 11.5% on POD3 and CRP levels > 26.5 mg/L on POD7 are reliable predictors for SSI after posterior lumbar spinal surgery.

scholarly journals Clozapine-induced myocarditis: electronic health register analysis of incidence, timing, clinical markers and diagnostic accuracy

2021 ◽  
pp. 1-8
Author(s):  
Aviv Segev ◽  
Ehtesham Iqbal ◽  
Theresa A. McDonagh ◽  
Cecilia Casetta ◽  
Ebenezer Oloyede ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Language Processing ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Area Under The Curve ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Clinical Markers ◽  
Reactive Protein ◽  
Increased Risk

Background Clozapine is associated with increased risk of myocarditis. However, many common side-effects of clozapine overlap with the clinical manifestations of myocarditis. As a result, there is uncertainty about which signs, symptoms and investigations are important in distinguishing myocarditis from benign adverse effects of clozapine. Clarity on this issue is important, since missing a diagnosis of myocarditis or discontinuing clozapine unnecessarily may both have devastating consequences. Aims To examine the clinical characteristics of clozapine-induced myocarditis and to identify which signs and symptoms distinguish true myocarditis from other clozapine adverse effects. Method A retrospective analysis of the record database for 247 621 patients was performed. A natural language processing algorithm identified the instances of patients in which myocarditis was suspected. The anonymised case notes for the patients of each suspected instance were then manually examined, and those whose instances were ambiguous were referred for an independent assessment by up to three cardiologists. Patients with suspected instances were classified as having confirmed myocarditis, myocarditis ruled out or undetermined. Results Of 254 instances in 228 patients with suspected myocarditis, 11.4% (n = 29 instances) were confirmed as probable myocarditis. Troponin and C-reactive protein (CRP) had excellent diagnostic value (area under the curve 0.975 and 0.896, respectively), whereas tachycardia was of little diagnostic value. All confirmed instances occurred within 42 days of clozapine initiation. Conclusions Suspicion of myocarditis can lead to unnecessary discontinuation of clozapine. The ‘critical period’ for myocarditis emergence is the first 6 weeks, and clinical signs including tachycardia are of low specificity. Elevated CRP and troponin are the best markers for the need for further evaluation.

scholarly journals Pre-analytical and analytical confounders of serum calprotectin as a biomarker in rheumatoid arthritis

2019 ◽  
Vol 58 (1) ◽  
pp. 40-49
Author(s):  
Lieve Van Hoovels ◽  
Bert Vander Cruyssen ◽  
Laura Bogaert ◽  
Stefanie Van den Bremt ◽  
Xavier Bossuyt
Keyword(s):  
Rheumatoid Arthritis ◽  
Infectious Disease ◽  
Disease Activity ◽  
Clinical Performance ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Healthy Controls ◽  
Reactive Protein ◽  
Diagnosis And Prognosis ◽  
Edta Plasma

Abstract Background There is a need for additional biomarkers to assist in the diagnosis and prognosis of rheumatoid arthritis (RA). The aim of our study was to evaluate the (pre-analytical, analytical and clinical) performance of serum calprotectin as a marker of inflammation in RA. Methods The study population included 463 rheumatologic patients (including 111 RA patients and 352 controls) who for the first time consulted a rheumatologist, 20 healthy controls and 27 patients with an infectious disease. Calprotectin was measured (using four different assays) in serum or in serum and EDTA plasma (healthy controls and infectious disease group). For rheumatologic patients, results for C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) were available. Results Results for blood calprotectin were assay- and matrix-dependent, with higher values found in serum than in plasma. Serum calprotectin was higher in RA patients than in rheumatologic diseased controls and in healthy controls. Serum calprotectin was lower in RA patients than in patients with an infectious disease. Serum calprotectin was associated with disease activity (DAS score). The area under the curve (AUC) to discriminate RA from controls was 0.756 for CRP, 0.714 for ESR and 0.726–0.783 for calprotectin. Conclusions Our data document that calprotectin measurement is assay- and matrix-dependent. Serum calprotectin is associated with disease activity. Additional (prospective) studies are warranted to further evaluate the prognostic and diagnostic value of blood calprotectin measurements.

scholarly journals Is combining serum interleukin-6 and C-reactive protein a reliable diagnostic tool in periprosthetic joint infections?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Cheng Li ◽  
Christina Ojeda Thies ◽  
Chi Xu ◽  
Andrej Trampuz
Keyword(s):  
Meta Analysis ◽  
Joint Infection ◽  
Protein A ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Combined Method ◽  
C Reactive Protein ◽  
Single Marker Analysis ◽  
Gold Standard Method ◽  
Reactive Protein

Abstract Background Because there is no single gold standard method for the diagnosis of periprosthetic joint infection (PJI), the combination of valuable methods to evaluate infection appears to achieve a better diagnostic result. The objective of the present study was to evaluate the diagnostic value of serum interleukin (IL)-6 and C-reactive protein (CRP) for the diagnosis of PJI. Methods PubMed, Embase, and the Web of Science databases were searched for articles describing PJI diagnosis using serum IL-6 and CRP published between January 1990 and December 2019. Results Eight studies were included in the meta-analysis. The pooled sensitivity was 0.84 (95% confidence interval [CI], 0.80−0.88) for the combined method (serum IL-6 and CRP) in series and parallel approaches, 0.87 (95% CI, 0.82−0.90) for IL-6, and 0.84 (95% CI, 0.79−0.88) for CRP. The pooled specificity was 0.85 (95% CI, 0.82−0.88) for the combined method, 0.83 (95% CI, 0.79−0.87) for IL-6, and 0.83 (95% CI, 0.79−0.87) for CRP. The combined method had the highest value for the area under the curve (0.9453), followed by IL-6 (0.9237) and CRP (0.9074). Subgroup analyses showed that the sensitivity of the combined method in parallel tests was higher than that in IL-6 or CRP (94% vs. 89% and 84%, respectively). Serial testing of the combined method showed increased specificity compared to a single indicator (96% vs. 83% and 80%). Conclusion The combination of serum IL-6 and CRP was a reliable tool for the diagnosis of periprosthetic hip and knee infection, demonstrating a better diagnostic accuracy than single marker analysis.

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