Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study
Güntülü ŞıkAysegul InamlıkNihal AkçaySelman KesiciFatih AygünTanıl KendirliGürkan AtayÖzlem Saraç SandalFatih VarolPınar YazıcıMuhterem DuyuAhmet Ziya BırbılenSerhan ÖzcanGazi ArslanMurat KanğınSüleyman BayraktarÜmit AltuğAyşe Berna AnılMerve HavanAyşe Filiz YetimakmanTahir DalkıranNeslihan ZengınArzu OtoHasan Serdar KıhtırFeyza İnceköy GırgınLeyla TelhanDinçer YıldızdaşNazik YenerUfuk YükselmişMehmet AlakayaMehmet KılınçMehmet ÇeleğenAdem DursunFatih BattalFerhat SarıMurat ÖzkaleSevgi TopalÇelebi KocaoğluAbdullah YazarNuri AlacakırÇağlar ÖdekAyhan YamanAgop Çıtakİbrahim BingölAgageldi AnnayevEsra ŞevketoğluBanu KatlanCansu DurakEmrah GünSeher ErdoğanPınar SevenEbru ŞahinHatice Feray ArıMerve BoyrazFatih DurakSerhat EmeksızGöktuğ ÖzdemirMurat DumanMehmet Nur TalayGülçin Otar YenerDoga LuleyapSezer HarmanogullarıEviç Zeynep BaşarMehmet MercanAlkan BalNevin KılıçEbru Atike OngunMakbule ÖztürkFaruk EkıncıMuhammed ÜdürgücüAli Ertuğ ArslanköylüNurettin Onur KutluAyşegül BükülmezSerkan ÖzsoyluTaylan ÇelikYasemin ÖzkaleAhmet Osman Kılıç
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Sepsis is a critical patient condition with high mortality rate caused by a complex and inadequate host response to infection. Since early identification and start of antibiotic therapy in the first few hours after sepsis development dramatically improves outcomes, it is of utter importance to offer fast, reliable and specific early laboratory biomarkers to help clinicians in sepsis recognition. On the other hand, the biomarkers should also be helpful in excluding sepsis and/or confirming therapy effectiveness, and thus prevent overprescribing of antibiotics. In this paper, we discuss the significance and relative merits of three currently available protein biomarkers: C-reactive protein, procalcitonin and presepsin. Although useful, none of these biomarkers has been shown to completely fulfill the roles mentioned above.
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Procalcitonin (PCT) and C-reactive protein (CRP) are already known predictive markers in serious bacterial infections, and it is emphasized that these biomarkers can be used as a marker of increased mortality in critically ill patients. Herein, we aimed to evaluate the initial serum PCT and CRP levels on the outcome of patients in pediatric intensive care units (PICUs) and find out if these biomarkers can be used to predict mortality.The relationship between the initial serum PCT and CRP levels and invasive mechanical ventilation (IMV) and noninvasive mechanical ventilation (NIV) support, inotropic drug need, acute renal kidney injury (AKI), continuous renal replacement therapy (CRRT), mortality, and hospitalization period was investigated retrospectively.In total, 418 suitable patients (226 males and 192 females) were included in the study. Age distributions of patients ranged from 1 month to 17 years. There was a statistically significant relationship between PCT levels in the first biochemical analysis performed during admission and MV support, inotropic drug use, mortality, ARF, hospitalization in the intensive care unit, CRRT and blood component transfusion. There was a statistically significant relationship between CRP levels and MV support, NIV, inotropic drug use, mortality, AKI, hospitalization in the intensive care unit, CRRT, and blood component transfusion.We suggest that the initial PCT and CRP levels during admission can be used to predict the outcome of patients in PICU.
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Objective To compare the clinical informative value of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations in the detection of infection and sepsis and in the assessment of severity of sepsis. Design Prospective study. Setting Medicosurgical intensive care unit. Patients Seventy consecutive adult patients who were admitted to the intensive care unit for an expected stay >24 hrs. Interventions None. Measurements PCT and CRP plasma concentrations were measured daily during the intensive care unit stay. Each patient was examined daily for signs and symptoms of infection and was classified daily in one of the following four categories according to the American College of Chest Physicians/Society of Critical Care Medicine criteria: negative, systemic inflammatory response syndrome, localized infection, and sepsis group (sepsis, severe sepsis, or septic shock). The severity of sepsis-related organ failure was assessed by the sepsis-related organ failure assessment score. Main Results A total of 800 patient days were classified into the four categories. The median plasma PCT concentrations in noninfected (systemic inflammatory response syndrome) and localized-infection patient days were 0.4 and 1.4 ng/mL (p < .0001), respectively; the median CRP plasma concentrations were 79.9 and 85.3 mg/L (p = .08), respectively. The area under the receiver operating characteristic curve was 0.756 for PCT (95% confidence interval [CI], 0.675–0.836), compared with 0.580 for CRP (95% CI, 0.488–0.672) (p < .01). The median plasma PCT concentrations in nonseptic (systemic inflammatory response syndrome) and septic (sepsis, severe sepsis, or septic shock) patient days were 0.4 and 3.65 ng/mL (p < .0001), respectively, whereas those for CRP were 79.9 and 115.6 mg/L (p < .0001), respectively. The area under the receiver operating characteristic curve was 0.925 for PCT (95% CI, 0.899–0.952), compared with 0.677 for CRP (95% CI, 0.622–0.733) (p < .0001). The linear correlation between PCT plasma concentrations and the four categories was much stronger than in the case of CRP (Spearman's rho, 0.73 vs. 0.41;p < .05). A rise in sepsis-related organ failure assessment score was related to a higher median value of PCT but not CRP. Conclusion PCT is a better marker of sepsis than CRP. The course of PCT shows a closer correlation than that of CRP with the severity of infection and organ dysfunction.
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To evaluate the potential value of serum procalcitonin and serum ferritin levels in patients with clinically suspected and proven sepsis and their comparison with established inflammatory markers like C-reactive protein (CRP) and total leukocyte count.A total of 60 clinically suspected cases of sepsis were included in this study and each patient was investigated for serum S. ferritin, procalcitonin, and CRP and blood cultures using the BacT/Alert system.Serum procalcitonin at a cut-off value of >2 ng/ml is a valuable biomarker for early diagnosis in sepsis patients due to bacterial infection and has a greater predictive value than serum ferritin, CRP, or any other biomarkers.
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Serum Procalcitonin(PCT) has become useful as a biomarker to assist in the diagnosis of sepsis, as well as related infectious or inammatory conditions. It is a soluble protein liberated into the circulation of patients in response to severe systemic inammation, in particular by bacterial infection. The aim of this study was to evaluate the usefulness of Procalcitonin as a biomarker of sepsis in the early stratication of adult patients admitted to the intensive care unit with suspected infection.Patients are randomly divided into two groups , Group-1: comprising those patients with a bacterial infection (SIRS with Sepsis) and Group -2: comprising patients without a bacterial infection (SIRS without Sepsis). we found that elevated PCT concentrations (> 0.5ng/ml) were detected in a signicantly higher proportion of patients with SIRS with sepsis compared to those with SIRS without sepsis so we concluded that PCT is an excellent marker providing the additive effect to improve the predictive power for diagnosing sepsis, for assessing severity of sepsis, and also for predicting the outcome/prognosis.
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Sepsis is the leading cause of morbidity and mortality in patients with burn injury and emerges as a clinical challenge for both emergency specialists and critical care staff. Since early diagnosis and appropriate treatment are known to be the milestones of sepsis management, use of biomarkers in diagnosis is highly recommended in the initial stage of sepsis. Although currently used Procalcitonin, as a traditional marker, may accurately indicate the presence of a systemic inflammation in burn patients, there is a need for more accurate markers of sepsis in burn patients. For now, use of a combination of markers may be suggested for a more accurate diagnosis. In the near future, gene therapy may make not only early prediction, but also appropriate treatment of sepsis in burn patients possible. In this article, we aimed to clarify roles of current biomarkers in early diagnosis of sepsis in burn patients and make future reflections in this growing field.
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