Diagnostic and Prognostic Value of Inflammatory Parameters Including Neopterin in the Setting of Pneumonia,COPD, and Acute Exacerbations

Acute exacerbations and community-acquired pneumonia (CAP) are severe complications in patients with chronic obstructive pulmonary disease (COPD). In this study, we analyzed inflammatory parameters in serum including C-reactive protein (CRP), procalcitonin (PCT), and serum neopterin (NPT) to determine their potential to differentiate between patients with CAP+COPD and with acute exacerbations of COPD (AECOPD) without pneumonia. 102 (39 women and 63 men) patients were included in this retrospective study, of whom 48 presented with CAP without underlying COPD, 20 with CAP+COPD and 34 with AECOPD. CRP, PCT, and blood counts were determined by routine automated tests, and NPT concentrations were determined by ELISA. The ratios of CRP to NPT levels were calculated. Upon patient admission, CRP, PCT, and NPT levels were significantly higher in patients with CAP compared to those in AECOPD patients. CRP/NPT ratio was lower in AECOPD compared to CAP (+/?COPD) patients. Positive correlations were found between duration of hospitalization and CRP levels and the CRP/NPT ratio at study entry. Patients who were readmitted within 30 days tended to have higher NPT levels at initial presentation. Patients under ongoing corticosteroid treatment presented with lower inflammatory parameters. The CRP/NPT-ratio was suited well to discriminate between AECOPD and CAP on the basis of COPD, a CRP/NPT cutoff of 0.346 provided a sensitivity of 65% and a specificity of 79%. The combinatory use of inflammatory patterns might help to differentiate patients with AECOPD from those with CAP on the basis of COPD.     

Elevated procalcitonin and C‐reactive protein as potential biomarkers of sepsis in a subpopulation of thrombotic microangiopathy patients

Thrombotic microangiopathy (TMA) comprises a group of microvascular thrombosis syndromes associated with multiple pathogenic factors. Deficient activity of ADAMTS13 is a pathogenic factor in a subset of TMA patients that provides a strong rationale for plasma exchange treatment. However, the subset of TMA patients with normal ADAMTS13 activity remains a heterogeneous group of patients in which the appropriate treatment is not well understood. In addition to the common forms of TMA thrombotic thrombocytopenic purpura and the hemolytic uremic syndrome, the differential diagnosis of TMA may include sepsis, autoimmune disorders, and disseminated intravascular coagulation. Optimal treatment of TMA depends on timely recognition of treatable pathogenic factors. We hypothesized that sepsis is a rapidly identifiable pathogenic factor in a subset of TMA patients. To test this hypothesis, we retrospectively measured the rapid biomarkers of sepsis C‐reactive protein (CRP) and procalcitonin (PCT), in a repository of pretreatment plasma samples from 61 TMA patients treated with plasma exchange. Levels were analyzed in 31 severely ADAMTS13‐deficient and 30 ADAMTS13‐normal patients. None of the 31 patients with severe deficiency of ADAMTS13 had elevated PCT. However, 11 of 30 (37%) non‐ADAMTS13‐deficient patient samples were strongly positive for PCT. These patient samples also had a >10‐fold higher median CRP level than patients with normal PCT. We conclude that rapid assays may help identify sepsis in a subset of TMA patients. J. Clin. Apheresis, 2009. © 2009 Wiley‐Liss, Inc.     

Study of coagulation function in thawed apheresis plasma for photochemical treatment by amotosalen and UVA

Background and Objectives  Photochemical treatment (PCT) based on amotosalen and ultraviolet A light (UVA) demonstrated a wide range of pathogen inactivation. However, coagulation proteins are affected by this treatment. The aim of this study was to evaluate the coagulation parameters in apheresis plasma units after thawing and processing by PCT.
Materials and Methods  Thirty apheresis plasma units were rapidly frozen at ≤ –30°C after collection. Plasma units were thawed after 7 days for PCT with amotosalen and UVA light. Treated apheresis units were refrozen and stored at ≤ –30°C for 1 month. Samples were collected for each plasma units at several times of process. Coagulation times (prothrombin time, activated partial thromboplastin time), coagulation factors (fibrinogen, Factor [F] II, FV, FVII, FVIII, FIX, FX, FXI), prothrombin fragments 1 and 2, antithrombotic proteins (protein C, protein S, antithrombin) and total protein content were measured. Functionality of ADAMTS-13 was also tested.
Results  After thawing, coagulation times were slightly increased and a decrease of FV, FVIII and protein C activity was found. The mean recovery for all proteins, except one, ranged from 81% to 97% of the baseline activity in plasma units after thawing and PCT. FVIII was more affected with a mean recovery of 69 ± 8%. ADAMTS-13 function was also preserved after the whole process. The effect of an additional 1-month frozen storage on coagulation parameters was minimum.
Conclusion  Coagulation protein levels after thawing and processing of plasma by PCT with amotosalen and UVA were preserved well in the physiological ranges.     

Serum procalcitonin (PCT): a valuable biochemical parameter for the post-mortem diagnosis of sepsis

The aim of this prospective study was to investigate whether serum procalcitonin (PCT) can be used as a post-mortem marker of sepsis and to determine whether this biochemical parameter can be employed in the forensic elucidation of death due to sepsis. At least three blood samples were collected between 0.3 and 139 h post-mortem from sepsis-related fatalities (n = 8) and control individuals (n = 53, where death was due to various natural and unnatural causes). Additionally one ante-mortem blood sample was collected shortly before death from the patients in the sepsis group. In the sepsis group, serum PCT concentrations, determined by using an immunoluminometric assay, were elevated in all patients for the whole observation period, whereas in the control group serum PCT was not detectable in 94% of the cases. Measurement of PCT levels seems reasonable until at least approximately 140 h postmortem, depending on the ante-mortem levels. A linear regression model is presented that allows the serum PCT concentration of an individual at the time of death to be estimated on condition that at least two positive post-mortem PCT values have been determined. Ante-mortem PCT values correlated well with the predicted PCT values at the time of death in the sepsis group using the standardized PCT logarithms. According to the results of the present study, PCT is a valuable biochemical parameter for the post-mortem discrimination between sepsis and underlying non-septic causes of death. Received: 29 March 2000 / Accepted: 12 June 2000     

Procalcitonin may help differentiate disseminated herpes simplex viral infection from bacterial sepsis in neonates

Disseminated herpes simplex virus infection is a potentially fatal condition which may be difficult to differentiate from bacterial sepsis. We report the case of a neonate with overwhelming herpes simplex (type 2) viraemia who presented with `septic shock'. Conclusion A low procalcitonin level (1.6 ng/ml), inconsistent with bacteraemia, suggests an alternative aetiology and may strengthen the case for antiviral therapy. Received: 28 March 1999 / Accepted: 10 August 1999     

Uroporphyrin accumulation in hepatoma cells expressing human or mouse CYP1A2: relation to the role of CYP1A2 in human porphyria cutanea tarda

In experimental animals, CYP1A2 is absolutely required for the development of uroporphyria induced by treatment with polyhalogenated aromatic compounds or other compounds. Although the role of this CYP in clinical uroporphyria, porphyria cutanea tarda (PCT), is not clear, Cyp1a2(-/-) mice are resistant to the development of uroporphyria. Here, we compared the abilities of human and mouse CYP1A2 expressed in mouse hepatoma Hepa-1 cells to: (i) catalyze CYP1A2-dependent methoxyresorufin demethylase (MROD), and (ii) support uroporphyrin (URO) accumulation. Both CYP1A2 orthologs were expressed at similar levels as indicated by immunodetectable CYP1A2 proteins and MROD activities. URO accumulation was increased in cultures expressing either ortholog when supplemented with 5-aminolevulinic acid, the porphyrin precursor. Cells expressing mouse CYP1A2 produced more URO than cells expressing human CYP1A2. The results indicate that human CYP1A2 can support URO accumulation in hepatoma cells and thus may play a role in human PCT.     

前降钙素、血清C反应蛋白联合测定对诊断新生儿早期细菌感染的意义

目的探讨前降钙素（PCT）、C反应蛋白（CRP）联合测定在新生儿早期细菌感染诊断中的意义。方法采用散射比浊法测定100例发生细菌感染的新生儿（感染组）、50例正常足月新生儿（对照组）和72例非感染病症新生儿（未感染组）的血清PCT和CRP水平。结果对照组PCT和CRP值分别为（1．5±O．07）ng／ml和（1．00±0．29）mg／L；感染组PCT和CRP值分别为（30．25±20．71）ng／ml和（45．19±25．79）mg／L，均较对照组明显升高（P〈0．005）；未感染组PCT值为（0．85±0．07）ng／ml，与对照组比较，差异无统计学意义（P〉0．05），与感染组比较，差异有统计学意义（P〈0．005），RP值为（39．09±18．37）mg／L，与对照组比较，差异有统计学意义（P〈0．005），与感染组比较，差异无统计学意义（P〉0．05）。结论血清PCT与CRP联合测定可作为诊断新生儿早期细菌感染的指标。     

降钙素原指导脓毒血症患者抗感染治疗的研究

目的观察降钙素原(PCT)指导ICU中的脓毒血症患者的抗生素治疗是否能减少抗生素的使用。方法选择符合脓毒血症诊断标准的患者51例,前瞻、随机分为PCT指导治疗组(24例)和标准治疗组(27例)。分别使用PCT指导抗生素使用和标准治疗。记录病人住ICU天数、抗生素使用天数、抗生素相关副作用。结果降钙素原指导治疗组抗生素使用时间同标准治疗组比较明显减少(8.9±2.4[n=24]vs 12.4±2.8[n=27]d,P<0.05);抗生素相关副作用的发生PCT组均较对照组明显改善(21.1%[n=24],vs 29.8%[n=27],P<0.05);两组患者ICU住院天数没有显著差异(9.7±2.6[n=24]vs 10.5±2.7[n=27]d,,P>0.05)。结论降钙素原指导脓毒血症患者的抗感染治疗可以减少抗生素的疗程及副作用。     

卒中相关性肺炎的临床特点及预测因子

目的探讨卒中相关性肺炎的临床特点和预测因子。方法选择2011年9～12月在我科治疗的脑卒中患者143例作为研究对象,回顾性分析其临床资料,从患者的基础状态、与卒中相关的因素、入院后相关治疗、入院当日首次血清降钙素原(PCT)、C-反应蛋白(CRP)、临床肺部感染评分(CPIS)等方面探讨卒中相关性肺炎的临床特点和预测因子。结果年龄>70岁,既往有脑卒中病史,合并有糖尿病、缺血性心脏病,出血性脑卒中,小脑和脑干卒中,出现吞咽困难、昏迷,使用胃黏膜保护剂,预防性使用抗生素、气管侵入性操作均与卒中相关性肺炎有相关性,PCT、CRP和CPIS可以作为SAP的预测因子(P均<0.01)。结论临床治疗中,应尽量避免过多的或不必要的侵入性操作,入院时的PCT、CRP和CPIS可以作为SAP的预测因子。     

前降钙素在儿科社区感染性肺炎的检测及临床意义

目的评价血清前降钙素在儿科鉴别细菌感染性肺炎中的作用。方法应用入院时进行血清前降钙素水平测定,并比较血清CRP、白细胞计数,旨在评价PCT在小儿肺炎病原学辅助诊断中的价值。结果34例细菌感染性肺炎血清前降钙素水平轻中度升高,28例病毒感染性肺炎及25例支原体或沙眼衣原体肺炎血清前降钙素基本正常,细菌性肺炎及病毒性肺炎两组患者血清CRP升高有一重叠带,而PCT检测值在两组中无交叉对照组血清前降钙素正常。结论血清前降钙素是早期鉴别细菌感染性肺炎重要指标。