Objective To evaluate systematically the effectiveness and safety of procalcitonin ( PCT) -guided therapy in comparison with standard therapy in patients with suspected or confirmed severe bacterial infections in intensive care unit ( ICU) . Methods Five randomized controlled trials ( 927 patients) were included for statistical analysis by the cochrane collaboration′s RevMan5. 0 software. Results PCT-guided therapy was associated with a significant reduction in duration of antibiotic therapy [ MD =- 2. 01, 95% CI ( - 2. 37, - 1. 64) , P lt;0. 00001] , but the mortality [ OR =1. 11, 95% CI ( 0. 83, 1. 49) ,P =0. 47] and length of ICU stay[ MD = 0. 49, 95% CI( - 1. 44, 2. 42) , P = 0. 62] were not significantly different. Conclusions An algorithmbased on serial PCT measurements would allow a more judicious use of antibiotics than currently traditional treatment of patients with severe infections in ICU. It can reduce the use of antibiotics and appears to be safe.
Objective To explore the expression differences of procalcitonin (PCT) in different infection sites and bacterial strains, and to provide the evidence for early differential diagnosis of infectious diseases with PCT as a biomarker. Methods The patients with various kinds of infections diagnosed in West China Hospital of Sichuan University between January 2012 and June 2016 were retrospectively included. The expression differences of PCT in various infection sites and bacterial strains were analyzed. Results A total of 1 005 patients were include in this study, including 259 with systemic infection and 746 with local infection. The median PCT level in the systemic infection group was higher than that in the local infection group (8.57 vs. 0.10 ng/mL, P<0.05). In the 779 patients with pulmonary infection, the median PCT level of the patients with sepsis caused by pulmonary infection was higher than that of the ones without sepsis (4.61vs. 0.10 ng/mL, P<0.05), and the median PCT level of the patients with positive sputum culture was higher than that of the ones with negative sputum culture (0.28vs. 0.08 ng/mL, P<0.05). In the 48 patients with urinary tract infection, the median PCT level of the patients with sepsis caused by urinary tract infection was higher than that of the ones without sepsis (12.00vs. 0.42 ng/mL, P<0.05), and the median PCT level of the patients with complicated urinary tract infection was higher than that of the patients with simplex urinary tract infection (19.15vs. 5.02 ng/mL, P<0.05). In the 259 patients with systemic infection, the median PCT level of the patients with infective shock was higher than that of the ones without infective shock (40.26vs. 3.83 ng/mL, P<0.05); the mean PCT level of patients with infection of Gram-negative bacteria, Gram-positive bacteria and fungi was 13.66, 0.99, and 3.30 ng/mL with a significant difference (P<0.05). Conclusion The PCT level has unique advantages in identifying different sites of the infection, early diagnosing complicated urinary tract infection, and evaluating the severity of infection, which could provide evidence in early identification for sepsis caused by various kinds of infectious pathogens.
Objective To evaluate the effects and safety of procalcitonin(PCT)-guided algorithms of antibiotic therapy in critically ill patients in intensive care unit (ICU). Methods Literatures in English and Chinese concerning randomized controlled trials(RCTs) on PCT-guided algorithms of antibiotic therapy in critically ill patients was retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results Eight RCTs involving 2708 ICU patients were included, with 1360 patients in the PCT-guided group and 1348 patients in the control group. Compared with the control group, PCT-guided algorithms were associated with a significant reduction in the duration of antibiotic therapy (MD -2.44 days, 95%CI -3.25 to -1.62, P < 0.00001), and the occurrence of adverse reaction of antibiotics was also lower (RR=0.74, 95%CI 0.56 to 0.97, P=0.03), however the mortality exhibited no difference between the PCT-guided group and the control group (RR=1.00, 95%CI 0.89 to 1.13, P=0.99). Conclusion PCT-guided algorithms can shorten the duration of antibiotic therapy and reduce the occurrence of adverse reaction in critically ill patients without significant effect on mortality.
ObjectiveTo explore the value of procalcitonin-to-albumin (PAR) in patients with acute respiratory distress syndrome (ARDS).MethodsA retrospective study was carried on patients diagnosed with ARDS from December 2016 to March 2018. The receiver-operating characteristics (ROC) curve was used to identify the cutoff value of PAR. The association of PAR and 28-day mortality was evaluated using univariate and multivariable Cox regression.ResultsIn the final analysis, there were a total of 255 patients included. Of whom 164 (64.3%) was male, 91 (35.7%) was female and the mean age was 52.1±14.5 years old. The 28-day mortality of all the patients was 32.9% (n=84). ROC curve revealed that the cutoff value of PAR was 0.039 (specificity: 0.714, sensitivity: 0.702) and area under the curve was 0.793 (95%CI: 0.735 - 0.850, P<0.001). The following variables were considered for multivariable adjustment: age, body mass index, pneumonia, aspiration, sepsis, surgery, PaO2/FiO2, red blood cell counts and PAR (P<0.01 in univariate analysis). After multivariable analysis, only age (HR: 1.033, 95%CI: 1.009 - 1.059, P=0.008), PaO2/FiO2 (HR: 0.992, 95%CI: 0.985 - 1.000, P=0.044) and PAR (HR: 4.899, 95%CI: 2.148 - 11.174, P<0.001) remained independently associated with 28-day mortality (P<0.05).ConclusionHigh PAR predicts a poor outcome in ARDS patients, therefore it appears to be a prognostic biomarker of outcomes in patients with ARDS.
ObjectiveTo investigate the clinical value of serum proadrenomedullin (pro-ADM) for diagnosis of ventilator-associated pneumonia(VAP). MethodsA prospective study was carried out in eighty-nine patients with clinically suspected diagnosis of VAP who underwent invasive mechanical ventilation between June 2014 and July 2015.The patients were divided into a VAP group (n=52) and a non-VAP group (n=37) according to clinical and microbiological culture results.The levels of serum pro-ADM were measured by sandwich ELISA on 1st, 3rd and 5th day of VAP suspicion.The diagnostic value of pro-ADM for VAP was assessed by receiver operating characteristic (ROC) curve analysis. ResultsOn 1st day, 3rd day and 5th day, the pro-ADM levels [3.10(2.21, 4.61) nmol/L, 3.01(2.04, 4.75)nmol/L and 1.85(1.12, 3.54)nmol/L, respectively] in the VAP group were significantly higher than those in the non-VAP group [1.53(1.07, 2.24)nmol/L, 1.52(1.05, 2.17) nmol/L and 1.26(1.02, 2.17) nmol/L, respectively] (all P < 0.05).For diagnosis of VAP, the area under the ROC curve (AUC) for pro-ADM on 1st, 3rd and 5th were 0.896 (95%CI 0.799-0.940), 0.863(95%CI 0.791-0.935) and 0.651 (95%CI 0.538-0.765), respectively.When using 2.53 nmol/L as the best cutoff on 1st day, pro-ADM had 84.6% sensitivity and 86.5% specificity.When using 2.40 nmol/L as the best cutoff on 3rd day, pro-ADM had 82.7% sensitivity and 83.8% specificity. ConclusionSerum level of pro-ADM in the diagnosis of VAP has good sensitivity and specificity, which may be used as a marker to diagnose VAP early.
Objective To explore the clinical significances of serum procalcitonin ( PCT) and Creactive protein( CRP) in diagnosis and severity assessment of sepsis. Methods A total of 72 patients with different severities of sepsis admitted to Wenzhou Second People’s Hospital from June 2005 to September 2007, including 22 cases of sepsis, 26 cases of severe sepsis, and 24 cases of sepsis shock. Meanwhile, twenty non-sepsis patients were enrolled as control group. The differences of serum PCT and CRP levels, acute physiology and chronic health evaluation Ⅱ ( APACHEⅡ) scores and sepsis related organ failure assessment ( SOFA) scores were compared in controls and the septic patients with different severities and different prognosis. Results The PCT levels of patients with sepsis, severe sepsis and sepsis shock were significantly higher than that in the non-sepsis group [ ( 1. 51 ±1. 57) , ( 5. 62 ±3. 78) and ( 13. 56 ±8. 16) vs ( 0. 12 ± 0. 33) μg/L, P lt;0. 05 or P lt; 0. 01, respectively] . The CRP level, APACHEⅡ and SOFA were also increased in septic patients compared to control and progressively elavated by the severities of sepsis patients ( P lt; 0. 05 or P lt; 0. 01) , however, CRP levels were not significant different ( P gt; 0. 05) . The PCT levels, APACHEⅡ and SOFA of the patients with good prognosis were lower than those with poor prognosis( all P lt; 0. 01) , but the CRP levels was not significant different( P gt;0. 05) . Conclusion The serumlevel of PCT is superior to serumlevel of CRP in severity classification and prognosis assessment.
ObjectiveTo systematically review the diagnostic value of procalcitonin (PCT) for tuberculous pleural effusion. MethodsWe electronically searched CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase from inception to April, 2013, to collect the literature about the diagnostic value of PCT for tuberculous pleural effusion compared with gold standard (positive outcomes of mycobacterium tuberculosis culture). Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDiSc 1.4 were used to conduct the meta-analysis. ResultsEight studies were finally included. The results of meta-analysis showed the pooled sensitivity and specificity were 0.63 (95%CI 0.58 to 0.68) and 0.76 (95%CI 0.70 to 0.81), respectively. The positive likelihood ratio and negative likelihood ratio were 2.72 (95%CI 1.48 to 5.02) and 0.49 (95%CI 0.29 to 0.82), respectively. The diagnostic odds ratio (DOR) was 5.77 (95%CI 1.89 to 17.58). And the SROC AUC was 0.79. Heterogeneity was mainly derived from the QUADAS score and Begg's test showed there was no presence of publication bias. ConclusionPCT is a potential marker in the diagnosis of benign and tuberculous pleural effusion, which can be used to determine diagnosis identification of tuberculous pleural effusion.
ObjectiveTo compare the clinical characteristics of inpatients with different influenza subtypes, so as to identify the subtypes at an early stage.MethodsA retrospective case study was conducted, using influenza surveillance data from January 1st, 2016 to December 31st, 2018 at a tertiary surveillance outpost hospital in Chengdu. Patients diagnosed with different subtypes of influenza by nucleic acid testing or virus isolation and culture were investigated, and their clinical characteristics, laboratory test results, and prognosis were analyzed and compared among the four subtypes including H1N1, H3N2, Victoria (BV), and Yamagata (BY).ResultsThere were 127 inpatients with laboratory-confirmed influenza. Among the confirmed influenza patients, 85.8% (109/127) had low or normal white blood cell counts, and 78.8% (89/113) had abnormally high procalcitonin levels. Among the patients with different subtypes, statistical differences existed in age (P<0.001), low or normal white blood cell count (P=0.041), positive bacteria/fungus/mycoplasma/chlamydia culture (P=0.001), kidney damage (P=0.013), outcome at discharge (P<0.001), and hospitalization expenses (P=0.016). However, there was no statistical difference in gender, clinical symptoms, liver damage, cardiac damage, or length of hospital stay (P>0.05).ConclusionThe infection of influenza can lead to severe clinical complications or even death. The outcomes of patients with influenza A may be more severe. An elevated procalcitonin level can be detected in quite a few patients with influenza.
Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associatedpneumonia ( VAP) .Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved. Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.
ObjectiveTo explore the clinical value of the soluble urokinase type plasminogen activator receptor (suPAR) level in bronchoalveolar lavage fluid (BALF) for evaluateting the disease severity and prognosis of severe community-acquired pneumonia (SCAP). MethodsEighty-four patients with SCAP were recruited as a SCAP group from the respiratory department, ICU and RICU between April 2014 and April 2016. According to their organ dysfunction, the SCAP patients were subdivided into a MODS group and a non-MODS group. Depending on the treatment response on the 7th day of treatment, they were subdivided into an effective group and an ineffective group. According to the survival condition within 28 days, they were subdivided into a survival group and a death group. Meanwhile, 50 cases with non-severe common community acquired pneumonia were recruited as a control group. On the admission day, all cases were evaluated by PSI score and APACHE Ⅱscore. The serum suPAR level were detected by ELISA on the 1st day in hospital. The suPAR and procalcitonin (PCT) levels in the patient's BALF and serum were detected on the 1st, 3rd, 7th day, discharge or death day. The symptoms and signs, biochemical and pulmonary imaging changes were also observed. ResultsThere were no differences in the sex, age, body weight, duration of pneumonia, or complicated diseases such as hypertension, coronary heart disease and cerebral vascular diseases between the SCAP group and the control group (all P > 0.05). The suPAR levels in serum and BALF of the SCAP group were higher than those of the control group with significant differences (all P < 0.05). The suPAR level in BALF was obviously higher than that in serum in the SCAP group with significant difference (P < 0.05), and slightly higher than that in serum in the control group with no significant difference (P > 0.05). The level of suPAR in BALF of the MODS group was significantly higher than that in the non-MODS group with significant difference (P < 0.05), but there was no significant difference in the PCT level between the two groups (P > 0.05). The suPAR level in the ineffective treatment group was significantly higher than that in the effective treatment group on the 7th day in hospital with significant difference (P < 0.05). The suPAR levels in BALF of the death group were higher than those in the survival group at each time point after admittion with significant difference (all P < 0.05), and the PCT levels had no significant difference between the two groups within 1 week of each time point (all P > 0.05). The suPAR level in BALF of the SCAP group was positively correlated with APACHEⅡ score and PSI score (r=0.578, P=0.0085; r=0.565, P=0.0071), and plasma PCT level was weakly correlated with the APACHEⅡ score and PSI score (r1=-0.0137, r2=-0.0152). ConclusionThe SuPAR level in BALF of patients with SCAP is closely related to the severity and prognosis, and can be used as an index to assess the severity and prognosis.