Kinetics of procalcitonin, C-reactive protein and interleukin-6 in cardiogenic shock – Insights from the CardShock study

Qdaisat

et al. 2021

Cancers

Cancer patients have increased risk of infections, and often present to emergency departments with infection-related problems where physicians must make decisions based on a snapshot of the patient’s condition. Although C-reactive protein, procalcitonin, and lactate are popular biomarkers of sepsis, their use in guiding emergency care of cancer patients with infections is unclear. Using these biomarkers, we created a prediction model for short-term mortality in cancer patients with suspected infection. We retrospectively analyzed all consecutive patients who visited the emergency department of MD Anderson Cancer Center between 1 April 2018 and 30 April 2019. A clinical decision model was developed using multiple logistic regression for various clinical and laboratory biomarkers; coefficients were used to generate a prediction score stratifying patients into four groups according to their 14-day mortality risk. The prediction score had an area under the receiver operating characteristic curve value of 0.88 (95% confidence interval 0.85–0.91) in predicting 14-day mortality. The prediction score also accurately predicted intensive care unit admission and 30-day mortality. Our simple new scoring system for mortality prediction, based on readily available clinical and laboratory data, including procalcitonin, C-reactive protein, and lactate, can be used in emergency departments for cancer patients with suspected infection.

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Procalcitonin, C-Reactive Protein, and Lactate Levels in Emergency Evaluation of Cancer Patients with Suspected Infection

Qdaisat

et al. 2021

Cancers

“…We used pre-designed multiplex flow cytometry beads-based assay panels (LEGENDplex TM BioLegend, San Diego, CA, USA) to measure blood circulating levels of cytokines and chemokine from isolated plasma fractions. We used the Human Th cytokines panel 12-plex kit (IL-2, 4, 5, 6, 9, 10, 13, 17A, 17F, 21 and 22, IFN and TNF) and the Human proinflammatory chemokine Panel 1 12-plex kit (CCL2, 3,4,11,17,20. CXCL1,5,8,9,10 and 11) plus a separate CCL5 1-plex kit, according to manufacturer instruction.…”

Section: Measurement Of Biomarkers In Human Plasma Fractionsmentioning

confidence: 99%

“…Among the multitude of biomarkers evaluated in the past two decades 9 , only procalcitonin (PCT), C-reactive protein (CRP) and the cytokine Interleukin 6 (IL-6) have shown some diagnostic and prognostic value. Although the levels of these three soluble inflammatory markers in blood can provide information on the severity of infection, their performance in differentiating bacterial from viral sepsis or non-infectious conditions with systemic inflammatory response syndrome (SIRS) is limited 10, 11 . It may be possible that widening the range of biomarkers studied would help define unique signatures distinguishing between these different conditions 12, 13, 14 .…”

Section: Introductionmentioning

confidence: 99%

Blood immune profiles reveal a CXCR3/CCR5 axis of dysregulation in early sepsis

Kealy,

Wilson,

Jaconelli

et al. 2024

Preprint

Sepsis is defined as a systemic inflammatory host response syndrome after serious microbial infection, which requires prompt treatment to lower the risk of complications and death. However, early sepsis recognition can be a challenge at presentation when patients show symptoms difficult to distinguish from other acute conditions.We designed a pilot study to explore whether blood immune signatures could reveal early specific indicator profiles for patients meeting sepsis criteria upon admission at the hospital Emergency Department. We analysed blood samples from study-recruited sepsis-suspected patients (N=20) and of age-spanning healthy volunteers (N=12), using flow cytometry-based assays. 25 circulating inflammatory cytokines and chemokines (CCs) were measured from blood plasma, while freshly isolated unfixed blood leukocytes were immunophenotyped to ascertain major cell subsets representation and expression of activation markers, including chemokine receptors. We found that beside IL-6 and sCD14, blood levels of CXCL9 and CXCL10 (two ligands of CXCR3) show good separation between healthy controls and sepsis-suspected patients. The abundance of CD4+T cells was significantly reduced while the expression of chemokine receptors was altered on monocytes, B and all T cells from patients. In particular, we report substantial losses of CCR5-expressing monocytes and CXCR3/CCR5 double positive T cells. Full dataset analysis and post-hoc subgrouping of patients according to their diagnosis on discharge (confirmed or unconfirmed sepsis), identified CXCR3/CCR5 double expression on T cells as a separating characteristic within the study. Overall, our observational study suggests a new CCR5 and CXCL9-10/CXCR3 axis of dysregulation in early sepsis.

“…These works, mainly small-sized and focused on acute heart failure, nevertheless seem to find a similar prognostic impact. Interestingly, high IL-6 concentrations in these non-septic patients appeared to be associated with the onset of vasoplegic shock, systemic hypoperfusion, and multiple organ failure ( 9 – 11 ). Conversely, the prognostic value of CRP, although routinely used as a marker of systemic inflammation, has been poorly investigated so far.…”

Section: Introductionmentioning

confidence: 95%

Systemic Inflammation Evaluated by Interleukin-6 or C-Reactive Protein in Critically Ill Patients: Results From the FROG-ICU Study

et al. 2022

Self Cite

BackgroundThe prognostic impact of high concentration of interleukin-6 (IL-6) or C-reactive protein (CRP), two routinely available markers of systemic inflammation in the general population of critically ill patients, remains unclear. In a large cohort of critically ill patients including septic and non-septic patients, we assessed the relationship between baseline IL-6 or CRP and mortality, organ dysfunction, and the need for organ support.MethodsThis was an ancillary analysis of the prospective French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) study including patients with a requirement for invasive mechanical ventilation and/or vasoactive drug support for more than 24 h following intensive care unit (ICU) admission. The primary objective was to determine the association between baseline IL-6 or CRP concentration and survival until day 90. Secondary outcomes included organ dysfunction as evaluated by the Sequential Organ Failure Assessment (SOFA) score, and the need for organ support, including vasopressors/inotropes and/or renal replacement therapy (RRT).ResultsMedian IL-6 and CRP concentrations (n = 2,076) at baseline were 100.9 pg/ml (IQR 43.5–261.7) and 143.7 mg/L (IQR 78.6–219.8), respectively. Day-90 mortality was 30%. High IL-6 or CRP was associated with worse 90-day survival (hazard ratios 1.92 [1.63–2.26] and 1.21 [1.03–1.41], respectively), after adjustment on the Simplified Acute Physiology Score II (SAPS-II). High IL-6 was also associated with the need for organ-support therapies, such as vasopressors/inotropes (OR 2.67 [2.15–3.31]) and RRT (OR 1.55 [1.26–1.91]), including when considering only patients independent from those supports at the time of IL-6 measurement. Associations between high CRP and organ support were inconsistent.ConclusionIL-6 appears to be preferred over CRP to evaluate critically ill patients’ prognoses.