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G Iapichino,
S Marzorati,
M Umbrello,
R Baccalini, A Barassi,
M Cainarca,
F Colombo Pavini,
E Mantovani,
A Mauri,
B Moroni,
A Noto,
G V Melzi D'Eril,
M Langer
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ABSTRACT: Diagnosis/grading of infection and the systemic response to infection may be difficult on admission to the intensive care unit, but it is even more complicated for severely ill patients with long intensive care stays. The ACCP-SCCM criteria are difficult to apply for such patients, and objective, validated biomarkers would be of great use in this setting.
Long-term (>6 days) critically ill patients in the general ICU of University Hospital were prospectively enrolled in the study. All patients were assessed daily by the attending physician using the ACCP-SCCM classification. C-reactive protein (CRP, mg/dL), procalcitonin (PCT, ng/mL), and interleukin-6 (IL-6, pg/mL) of daily stored sera were measured after each patient's discharge. After discharge, an independent, overall clinical evaluation and an a posteriori ACCP-SCCM classification were chosen as the reference standard for all comparisons. The assessor was aware of the patient's clinical course but was blinded to levels of biomarkers.
We studied clinical variables and biomarkers of 26 patients over a total of 592 patient days. The day-by-day ACCP-SCCM classification of the attending physician overestimated the severity of the inflammatory response to infection. The diagnostic discriminative ability of severe-sepsis/septic-shock for PCT was high (ROC area 0.952 [0.931-0.973]) and had a best threshold value of 1.58 (83.7% sensitivity, 94.6 % specificity). IL-6 had better discriminative ability than CRP, but both were worse than PCT.
PCT > 0.43 ng/mL could add to the clinical propensity for sepsis vs. SIRS not related to infection. Values higher than 1.58 ng/mL may support the bedside clinical diagnosis of severe-sepsis. PCT between 0.5 and 1.0 suggest tight daily monitoring of clinical conditions and re-evaluation of PCT.
Minerva anestesiologica 10/2010; 76(10):814-23. · 2.66 Impact Factor
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ABSTRACT: BACKGROUND We investigated the role of the Clinical Pulmonary Infection Score (CPIS), serum levels of Procalcitonin (PCT), C-Reactive Protein (CRP), and Serum Amyloid A (SAA) in the detection of patients who developed early Ventilator Associated Pneumonia (early VAP). METHODS Observational study in an University Hospital. In 58 severe brain injured mechanically ventilated patients, CPIS, PCT, CRP and SAA were evaluated at Intensive Care Unit entry and at the day 3-4 of hospital stay for VAP diagnosis (confirmed by endotracheal aspirate or broncho-alveolar lavage cultures). RESULTS We found that: 1) PCT at entry was increased in patients who later developed early VAP (25 patients) compared to no VAP [1.4 (0.14-0.78) vs 0.2 (0.76-2.4) ng/mL (median, 25(th)-75(th) percentiles), P<0.001; sensitivity 76% and specificity 75%); 2) CPIS score increased at the day of VAP diagnosis, compared to entry (6.6+/-1.1 vs 1.5+/-1.1, P<0.001; sensitivity 97% and specificity 100%), while other serum inflammatory markers did not change; 3) deterioration in oxygenation and changes in tracheal secretions were the main determinants of CPIS score changes. CONCLUSIONS 1) PCT may be a useful marker to predict which patients subsequently developed early VAP; 2) CPIS score could help as an early way to detect the patients who develop early VAP and who need further diagnostic testing
Chest. 04/2008;
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ABSTRACT: Intra-operative PTH testing in the operating theatre has proven to be an accurate way to verify the removal of all pathological parathyroid tissue in primary hyperparathyroidism. Its limitation is the high cost. An alternative, more cost-effective procedure is proposed: intra-operative PTH dosage at the Central Laboratory.
Fifty-four patients underwent parathyroidectomy with intraoperative dosage of PTH at the Central Laboratory. Three blood samples were taken from each patient: just after the induction of anesthesia, 5 and 10 min after parathyroidectomy. The samples were sent to the Central Laboratory and analysed simultaneously. The results were phoned back to the theatre. The procedure was considered effective when PTH drop was >/=50% from basal value, 10 min after parathyroidectomy.
98.1% of patients proved recovered (average follow- up 31.1 months). The procedure had 3 false negatives, 1 false positive, with sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 94.0%, 75.0%, 92.6%, 97.9%, and 50.0%, respectively.
The main disadvantage of the presented procedure is the long waiting time. Nevertheless this time is the same as that required for results from intra-operative histological examination, the only alternative to determine surgery effectiveness in centres where portable instrumentation for intra-operative PTH dosage in the operating theatre is not available. The advantage of intra-operative PTH at the Central Laboratory is the very low cost. If results in terms of sensitivity, specificity, accuracy, and cost are taken into consideration, intra-operative dosage of PTH at the Central Laboratory may be deemed a viable alternative to the operating theatre.
Journal of endocrinological investigation 02/2008; 31(1):62-7. · 1.57 Impact Factor
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ABSTRACT: Multiple sclerosis and celiac disease are both considered immune-mediated diseases. Recently, improved serological screening methods provided a higher prevalence of celiac disease (CD) in the general population worldwide and also demonstrated gastrointestinal symptoms may be lacking. The aim of this study was to determine the prevalence of (CD) in an unselected group of 95 adults with multiple sclerosis using transglutaminase antibodies. No patients showed pathological values. Different immune and genetic basis between the two diseases may represent crucial insights to explain our results.
Multiple Sclerosis 01/2005; 10(6):711-2. · 4.26 Impact Factor
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ABSTRACT: Monoaminergic G protein-coupled receptors (GPCRs) are highly expressed in the CNS at the cerebrocortical level, where they support a variety of behavioural responses. To elucidate possible intracellular signalling pathways coupled to these receptors, we have studied their ability to activate extracellular signal-regulated kinases (ERKs) in cultured cortical neurons. An increase in ERK activity was observed after stimulation of neurons with dopamine or serotonin, and with agonists selective for various GPCRs. In addition, ERK activation was also observed following treatment with phorbol dibutyrate (PdBu) and forskolin, activators of protein kinase C (PKC) and protein kinase A (PKA), respectively. Concomitant with ERK activation, all the monoaminergic agonists tested also increased the level of active Ras (Ras-GTP). Surprisingly, Ras activation was also observed after activation of cAMP pathway, and this effect was at least in part mediated by PKA. Ras activation by cAMP was unique for neurons, since in PC12 cells forskolin caused activation of ERK but did not increase Ras-GTP level. These results highlight the relevance of Ras as a target for multiple signalling cascades leading to activation of the ERK pathway in neurons.
Molecular Brain Research 02/2000; 75(1):54-60. · 2.00 Impact Factor
