Diagnostic and prognostic value of serum procalcitonin concentrations in primary lung cancers

ObjectivesProcalcitonin (PCT) is widely used for the diagnosis of bacterial infections. The aim of this study was to evaluate PCT as a tumor and as a prognostic marker in patients with primary lung cancer.Design and methodsWe retrospectively performed a PCT dosage in the frozen serum samples of 147 patients with pulmonary neoplasia for whom a test of neuron-specific enolase (NSE) had been conducted at the time of diagnosis.ResultsWe show that a PCT serum level above 0.15 ng/mL was independently linked to the presence of a neuroendocrine component in the tumor (HR = 5.809 95% CI [1.695–19.908] p: 0005). Thus, median PCT serum levels were significantly more elevated in small-cell lung cancers than in pulmonary adenocarcinomas: 0.33 ng/mL versus 0.07 ng/mL (p < 0.001). However, the diagnostic value of serum PCT levels for diagnosing carcinoma with a neuroendocrine component remains low (sensitivity 63.8%; specificity 71.9%). In this series, serum PCT levels were significantly more elevated in the presence of liver metastases: 0.37 ng/mL versus 0.09 ng/mL in the absence of liver metastasis (p < 0.001). In uni- and multivariate analyses, a serum PCT level above 0.15 ng/mL and the presence of metastases and of sepsis at the time of diagnosis were independent factors of unfavorable prognosis.ConclusionsSerum PCT is elevated in patients with lung cancer with neuroendocrine component or with liver metastases. As a consequence, in this population, PCT has a poor specificity for bacterial infection. At diagnosis, an elevated serum PCT is an independent predictive factor of bad prognosis.     

Diagnostic and prognostic value of procalcitonin in patients with septic shock

OBJECTIVE: To determine whether procalcitonin is a reliable diagnostic and prognostic marker in septic shock compared with nonseptic shock. DESIGN: Prospective controlled trial. SETTING: Intensive care unit of the Avicenne Teaching Hospital, Bobigny, France. PATIENTS: All patients admitted to our intensive care unit over a 12-month period with clinical evidence of shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Echocardiography or pulmonary artery flotation catheter measurements were used to assess hemodynamics, and multiple specimens were obtained for microbiological studies. Standard criteria were used to diagnose septic shock. Serum concentrations of procalcitonin, C-reactive protein, and lactate were determined on the day of shock onset (day 1) and on days 3, 7, and 10. Seventy-five patients were included, 62 in the septic shock group and 13 in the cardiogenic shock group. Serum procalcitonin on day 1 was significantly higher in patients with than without septic shock (median, 14 [0.3-767] ng/mL vs. 1 [0.5-36] ng/mL, p < .01). A cutoff value of 1 ng/mL had 95% sensitivity and 54% specificity for separating patients with and without sepsis. C-reactive protein failed to discriminate between these two groups. Among patients with sepsis, procalcitonin concentrations were significantly higher in those who died than in the survivors, at all four measurement time points (median, 16 [0.15-767] ng/mL vs. 6 [0.2-123] ng/mL, p = .045 on day 1; 6.5 [0.3-135] ng/mL vs. 1.05 [0.11-53] ng/mL, p = .02 on day 10). A cutoff value of 6 ng/mL on day 1 separated patients who died from those who survived with 87.5% sensitivity and 45% specificity. C-reactive protein was not helpful for predicting mortality. Serum lactate was a nonspecific prognostic marker. CONCLUSIONS: These data indicate that procalcitonin may be a valuable early diagnostic and prognostic marker in patients with septic shock.     

Risk factors for delirium after on-pump cardiac surgery: a systematic review

IntroductionAs evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments need to be made for confounding variables. This review aims to systematically identify risk factors for delirium after cardiac surgery and to grade the evidence supporting these associations.MethodA prior registered systematic review was performed using EMBASE, CINAHL, MEDLINE and Cochrane from 1990 till January 2015 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007371). All studies evaluating patients for delirium after cardiac surgery with cardiopulmonary bypass (CPB) using either randomization or multivariable data analyses were included. Data was extracted and quality was scored in duplicate. Heterogeneity impaired pooling of the data; instead a semi-quantitative approach was used in which the strength of the evidence was graded based on the number of investigations, the quality of studies, and the consistency of the association reported across studies.ResultsIn total 1462 unique references were screened and 34 were included in this review, of which 16 (47 %) were graded as high quality. A strong level of evidence for an association with the occurrence of postoperative delirium was found for age, previous psychiatric conditions, cerebrovascular disease, pre-existent cognitive impairment, type of surgery, peri-operative blood product transfusion, administration of risperidone, postoperative atrial fibrillation and mechanical ventilation time. Postoperative oxygen saturation and renal insufficiency were supported by a moderate level of evidence, and there is no evidence that gender, education, CPB duration, pre-existent cardiac disease or heart failure are risk factors.ConclusionOf many potential risk factors for delirium after cardiac surgery, for only 11 there is a strong or moderate level of evidence. These risk factors should be taken in consideration when designing future delirium prevention strategies trials or when controlling for confounding in future etiological studies.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-1060-0) contains supplementary material, which is available to authorized users.     

Diagnostic value of serum squamous cell carcinoma antigen for hepatocellular carcinoma: a systematic review and meta-analysis

The aim of this study was to ascertain the diagnostic value of serum squamous cell carcinoma antigen (SCCA) and SCCA-IgM for hepatocellular carcinoma (HCC). After a comprehensive search of PubMed and Web of Science databases, we identified eligible studies on the diagnostic value serum SCCAs for HCC. The quality of the eligible studies was assessed using the revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tool. The overall diagnostic value of SCCAs for HCC was pooled using a bivariate model. Twelve studies were included in this systematic review and meta-analysis. The pooled sensitivities for SCCA and SCCA-IgM were 0.61 (95% confidence interval [CI], 0.37–0.81) and 0.70 (95% CI, 0.55–0.82), respectively. The corresponding specificities were 0.80 (95% CI, 0.52–0.94) and 0.62 (95% CI, 0.51–0.72), respectively. The areas under summary receiver operating characteristic (sROC) curves for SCCA and SCCA-IgM were 0.76 (95% CI, 0.72–0.80) and 0.70 (95% CI, 0.66–0.74), respectively. Major design deficiencies of the included studies were two-gate design and partial verification bias. Therefore, we concluded that both serum SCCA and SCCA-IgM have a fair diagnostic value for HCC.     

The prognostic value of end tidal carbon dioxide during cardiac arrest: A systematic review

Introduction

Cardiac arrest is a common presentation to the emergency care system. The decision to terminate CPR is often challenging to heath care providers. An accurate, early predictor of the outcome of resuscitation is needed. The purpose of this systematic review is to evaluate the prognostic value of ETCO₂ during cardiac arrest and to explore whether ETCO₂ values could be utilised as a tool to predict the outcome of resuscitation.

Method

Literature search was performed using Medline and EMBASE databases to identify studies that evaluated the relationship between ETCO₂ during cardiac arrest and outcome. Studies were thoroughly evaluated and appraised. Summary of evidence and conclusions were drawn from this systematic literature review.

Results

23 observational studies were included. The majority of studies showed that ETCO₂ values during CPR were significantly higher in patients who later developed ROSC compared to patients who did not. Several studies suggested that initial ETCO₂ value of more than 1.33 kPa is 100% sensitive for predicting survival making ETCO₂ value below 1.33 kPa a strong predictor of mortality. These studies however had several limitations and the 100% sensitivity for predicting survival was not consistent among all studies.

Conclusion

ETCO₂ values during CPR do correlate with the likelihood of ROSC and survival and therefore have prognostic value. Although certain ETCO₂ cut-off values appears to be a strong predictor of mortality, the utility of ETCO₂ cut-off values during CPR to accurately predict the outcome of resuscitation is not fully established. Therefore, ETCO₂ values cannot be used as a mortality predictor in isolation.     

Diagnostic accuracy and prognostic relevance of the measurement of cardiac natriuretic peptides: a review

BACKGROUND: The pathophysiologic and clinical relevance of cardiac natriuretic hormone (CNH) assays has been investigated in numerous experimental and clinical studies. Authors have sought to evaluate the diagnostic accuracy and prognostic relevance of the measurement of CNHs according to evidence-based laboratory medicine principles. METHODS: In June 2003, we ran a computerized literature search on National Library of Medicine using keywords "ANP" and "BNP" and found more than 12 300 and 1200 articles, respectively. A more refined search with keywords "ANP or BNP assay" extracted approximately 7000 and 800 articles, respectively. Only studies specifically designed to evaluate the diagnostic accuracy and prognostic relevance of CNH measurements were selected from this huge mass of articles to be discussed in this review. Content: Several studies suggested that CNH assays may be clinically useful for the screening and classification of patients with heart failure, as a prognostic marker in cardiovascular disease, in the follow-up of patients with heart failure, and because they may reduce the need for further cardiac investigation. However, it is difficult to compare even the best-designed studies because not only did the authors evaluate different populations, they also used different gold standards. CONCLUSIONS: CNH assays and conventional diagnostic work-ups provide complementary information for evaluation of the presence and severity of cardiac dysfunction and clinical disease. Several aspects of CNH assays are still to be elucidated, and further work is needed to carefully assess their diagnostic accuracy and prognostic value in cardiac disease.     

Motor recovery after stroke: a systematic review of the literature

OBJECTIVE: To collect and integrate existing data concerning the occurrence, extent, time course, and prognostic determinants of motor recovery after stroke using a systematic methodologic approach. DATA SOURCES: A computer-aided search in bibliographic databases was done of longitudinal cohort studies, original prognostic studies, and randomized controlled trials published in the period 1966 to November 2001, which was expanded by references from retrieved articles and narrative reviews. STUDY SELECTION: After a preliminary screening, internal, external, and statistical validity was assessed by a priori methodologic criteria, with special emphasis on the internal validity. DATA EXTRACTION: The studies finally selected were discussed, based on the quantitative analysis of the outcome measures and prognostic determinants. Meta-analysis was pursued, but was not possible because of substantial heterogeneity. DATA SYNTHESIS: The search resulted in 174 potentially relevant studies, of which 80 passed the preliminary screening and were subjected to further methodologic assessment; 14 studies were finally selected. Approximately 65% of the hospitalized stroke survivors with initial motor deficits of the lower extremity showed some degree of motor recovery. In the case of paralysis, complete motor recovery occurred in less than 15% of the patients, both for the upper and lower extremities. Hospitalized patients with small lacunar strokes showed relatively good motor recovery. The recovery period in patients with severe stroke was twice as long as in patients with mild stroke. The initial grade of paresis was the most important predictor for motor recovery (odds ratios [OR], >4). Objective analysis of the motor pathways by motor-evoked potentials (MEPs) showed even higher ORs (ORs, >20). CONCLUSIONS: Our knowledge of motor recovery after stroke in more accurate, quantitative, and qualitive terms is still limited. Nevertheless, our data synthesis and quantitative analysis comprises data from many methodologically robust studies, which may support the clinician in the management of stroke patients. With respect to early prognosis of motor recovery, our review confirms clinical experience that the initial grade of paresis (as measured on admission in the hospital) is the most important predictor, although the accuracy of prediction rapidly improves during the first few days after stroke. Initial paralysis implies the worst prognosis for subsequent motor recovery. Remarkably, the prognostic accuracy of MEPs appears much higher than that of clinical examination for different subgroups of patients.     

血清降钙素原定量在血流感染诊断中的临床价值

目的探讨血清降钙素原定量在血流感染诊断中的临床价值。方法采取前瞻性研究方法,根据病例入选标准和血流感染的诊断标准,收集血流感染和非血流感染患者各30例,采用t检验比较血流感染组和非血流感染组患者间血清PCT水平差异是否存在统计学意义,应用ROC曲线分析方法评估血清PCT水平在血流感染诊断中的临床价值。结果血清PCT水平在血流感染组和非血流感染组患者间的差异有统计学意义(P<0.01),血清PCT诊断血流感染的ROC曲线下的面积为0.911(95%的置信区间:0.841～0.981),以1.92ng/mL作为诊断临界值时,血清PCT对血流感染最具诊断价值,诊断灵敏度、特异性、阳性预测值、阴性预测值分别为96.7%、73.3%、80.6%、96.8%。结论血清PCT水平可作为一个有价值的血流感染实验室诊断指标。     

血清降钙素原在早期诊断脓毒症中的临床研究

目的 观察危重病人在脓毒症及全身性炎症反应综合征(SIRS)时血清降钙素原(PCT)水平的变化及临床意义。方法 38例入选患者分为脓毒症组和SIRS组,分别采用BRAHMS快速半定量法(PCT-Q)和免疫比浊法测定血清PCT、C-反应蛋白(CRP)浓度,同时比较两组间最高体温(BT)、白细胞计数(WBC计数)及中性粒细胞分类,评价PCT、CRP、WBC计数及中性粒细胞分类、BT在SIRS患者中对脓毒症的诊断价值。结果 RCT在脓毒症组较SIRS组显著升高(x±s分别是2.72±1.07分和1.55±0.76分,P=0.001),两组间CRP、WBC计数及中性粒细胞分类、BT比较无差异,对脓毒症的诊断价值由高到低分别为PCT、CRP、BT、中性粒细胞分类和白细胞计数(AUC分别是0.80、0.64、0.64、0.61、0.43)。结论 PCT可以作为早期诊断脓毒症的可靠指标,其他传统炎症指标在区分感染性与非感染性SIRS中的意义有限。     

Cognitive deficits following cardiac surgery: a brief review of the literature.

Cognitive deficits are far too common after cardiac surgery and are believed to be related to the use of cardiopulmonary bypass. This article presents a brief review of the literature related to this topic.     

定量检测血清降钙素原对肺部感染患者的诊断意义

目的探讨血清降钙素原(PCT)检测在肺部感染诊断中的意义。方法采用PCT双抗体夹心定量荧光免疫分析仪,对60例肺感染患者和30例健康体检者进行PCT定量检测,并作相关比较分析。结果患者组PCT明显高于健康对照组,与胸部X线诊断符合率为83%,与细菌培养阳性结果符合率为62%,与WBC升高符合率达100%。荧光双抗体夹心定量PCT检测可用于细菌感染的早期诊断,该检测快速方便,早于传统细菌培养、胸部X线检查和C-反应蛋白检测。结论血清降钙素原是临床鉴定细菌感染的新指标并可指导临床合理使用抗生素。     

前降钙素在感染和败血症诊断中的临床价值

目的探讨血清前降钙素（PCT）检测对进人重症监护病房（ICU）患者发生严重感染和败血症的诊断价值。方法选择ICU患者121例，其中无感染患者24例作对照组，全身炎症反应综合征（SIRS）患者31例，败血症患者26例，重症败血症患者25例和败血症休克患者15例。检测血清PCT水平，应用受试者工作特征曲线（ROC）进行评价。结果败血症组（平均2．39ng／mL）、重症败血症组（4．64ng／mL）和败血症休克组（5．86ng／mL）与对照组（0．59ng／mL）相比，PCT水平有显著差异，并且随感染程度加重有升高趋势，差异有统计学意义（P〈0．05）。感染组（败血症组＋重症败血症＋败血症休克组）PCT水平高于非感染组（对照组＋SIRS组），差异有统计学意义（P〈0．05）。PCT水平在ROC曲线下的面积为0．897，临床诊断的临界点是1．0ng／mL，灵敏度和特异度分别为85．84％和80．00％。结论经ROC曲线评价，PCT可以作为ICU患者感染和败血症的鉴别诊断指标。     

Touchless interaction with software in interventional radiology and surgery: a systematic literature review

Purpose

In this article, we systematically examine the current state of research of systems that focus on touchless human–computer interaction in operating rooms and interventional radiology suites. We further discuss the drawbacks of current solutions and underline promising technologies for future development.

Methods

A systematic literature search of scientific papers that deal with touchless control of medical software in the immediate environment of the operation room and interventional radiology suite was performed. This includes methods for touchless gesture interaction, voice control and eye tracking.

Results

Fifty-five research papers were identified and analyzed in detail including 33 journal publications. Most of the identified literature (62 %) deals with the control of medical image viewers. The others present interaction techniques for laparoscopic assistance (13 %), telerobotic assistance and operating room control (9 % each) as well as for robotic operating room assistance and intraoperative registration (3.5 % each). Only 8 systems (14.5 %) were tested in a real clinical environment, and 7 (12.7 %) were not evaluated at all.

Conclusion

In the last 10 years, many advancements have led to robust touchless interaction approaches. However, only a few have been systematically evaluated in real operating room settings. Further research is required to cope with current limitations of touchless software interfaces in clinical environments. The main challenges for future research are the improvement and evaluation of usability and intuitiveness of touchless human–computer interaction and the full integration into productive systems as well as the reduction of necessary interaction steps and further development of hands-free interaction.

     

Cathodal bands in electrophoretograms of creatine kinase isoenzymes in serum collected after cardiac surgery: a poor prognostic sign

Of 708 patients who had undergone cardiac surgery, the serum of 23 showed one or two enzyme bands cathodal to CK-MM in creatine kinase (CK) isoenzyme electrophoretograms. Postoperative mortality rate during hospitalization was: no bands, 8.8%; one band, 13%, two bands, 63% (p less than 0.001). Patients whose sera showed cathodal bands were slightly older than those without, and their postoperative serum lactate dehydrogenase (LD) activity was greater, with very high proportions of LD 5. The two cathodal bands in patients who died differed in cathodal electrophoretic mobility from the two bands in survivors, implying that different enzyme forms were involved. All cathodal bands were inhibited by reagent containing diadenosine pentaphosphate, as was adenylate kinase from erythrocytes and liver cytoplasm. Mitochondrial CK from liver and presumed mitochondrial CK in serum from a patient with malignancy were not inhibited. We conclude that the appearance of two enzyme bands cathodal to CK-MM, probably representing adenylate kinase and possibly originating from various tissues, is associated with a poor prognosis in patients after cardiac surgery.     

Sexuality and amputation: a systematic literature review

Purpose. To systematically examine the state of research on sexuality and amputees.

Methods. A total of five publication databases were searched: Pubmed, Cinahl, Embase, Psychinfo and Recall.

Results. A total of 11 eligible studies was found. The studies were characterised by a diversity of study populations, sampling methods, gender and age distributions, assessment methods, and outcomes measures. The use of the terminology regarding sexuality was ambiguous. All studies found an impact of the amputation of a limb on some part of sexual functioning (or concerns about) to some degree.

Conclusions. Studies on sexuality and amputees are very diverse and terminology is ambiguous. Amputation of a limb has an impact on sexual functioning. Amputees complain that there is little support from professionals. The authors recommend the use of the ICF terminology. Suggestions for future research are given.     

Feeding and dementia: a systematic literature review

AIM: This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. BACKGROUND: Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. METHOD: A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms 'feeding', 'eating' and 'dementia' combined as follows: '(feeding or eating) and (dementia)'. A second search was carried out combining the search terms 'mealtimes' and 'dementia' as follows: 'mealtimes and dementia'. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. RESULTS: Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. CONCLUSIONS: Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis.