BACKGROUND: Assessment of kidney function in emergency settings is essential across all medical subspecialties. Daily assessment of patient creatinine results from emergency medical services showed that some deviated from expected values, implying drug-related interference. METHODS: Real-time clinical evaluation of an enzyme method (Roche CREP2) in comparison with the Jaffé gen. 2 method (Roche CREJ2) was performed. During the period of December 2022 and January 2023, we analyzed 8,498 patient samples, where 5,524 were heavily medicated STAT patient specimens, 500 were pediatric specimens, and 2,474 were from a distant general population in a different region using the same methods. RESULTS: In 109 out of 5,524 hospital specimens (1.97%, p < 0.001), the CREP2 value was apparently (25% or more) lower than CREJ2. Suspect interfering medication was found in a sample of 43 out of 46 reviewed patients where medication data were available. This phenomenon was not observed in the general population. CONCLUSION: In a polymedicated urgent care hospital population, a creatinine enzyme method produces unreliable results, apparently due to multiple drug-related interferences.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: The aim of this prospective study was to evaluate the role of serum IL-6 as a potential predictive biomarker of postoperative complications (POC) in elective colorectal surgery. METHOD: A total of 115 patients underwent colorectal surgery for malignancy. IL-6 was measured on the first and third postoperative days (POD1, POD3), and C-reactive protein (CRP) was measured on the POD3. POC was analysed in subgroups according to Clavien‒Dindo (CD), antibiotic (ATB) treatment, intensive care unit (ICU) and hospital length of stay. The predictive power of variables for evaluated endpoints was analysed using receiver-operating characteristic (ROC) analysis and described by area under the curve (AUC). ROC analysis was adopted for the identification of optimal cut-offs. Histological analysis was performed to verify IL-6 production by the tumour. RESULTS: Out of 115 patients who were analysed, 42% had POC. Patients with POC had significantly higher serum levels of IL-6 on POD1 (p < 0.001) and POD3 (p < 0.001). IL-6 early on POD1 as a predictor of antibiotic treatment, ICU stay and hospital stay (AUC 0.818; 0.811; 0.771) did not significantly differ from the AUC of CRP late on POD3 (0.879; 0.838, 0.752). A cut-off IL-6 value of 113 pg/ml on POD1 and 180.5 pg/ml on POD3 in severe complications (CD > 3a) resulted in 75% and 72% sensitivity, 78.6% and 99% specificity, negative predictive value 96.4% and 97% and positive predictive value 29% and 88.9%. CONCLUSION: The serum level of interleukin-6 can predict severe (CD > 3a) POC early on POD1. On POD3, IL-6 is superior to CRP in terms of high positive predictive power of severe POC. Interestingly, the advantage of IL-6 on POD1 is early prediction of the need for antibiotic treatment, ICU stay and hospital stay, which is comparable to the CRP serum level late on the third POD.
Beta-lactam antibiotics remain one of the most preferred groups of antibiotics in critical care due to their excellent safety profiles and their activity against a wide spectrum of pathogens. The cornerstone of appropriate therapy with beta-lactams is to achieve an adequate plasmatic concentration of a given antibiotic, which is derived primarily from the minimum inhibitory concentration (MIC) of the specific pathogen. In a critically ill patient, the plasmatic levels of drugs could be affected by many significant changes in the patient's physiology, such as hypoalbuminemia, endothelial dysfunction with the leakage of intravascular fluid into interstitial space and acute kidney injury. Predicting antibiotic concentration from models based on non-critically ill populations may be misleading. Therapeutic drug monitoring (TDM) has been shown to be effective in achieving adequate concentrations of many drugs, including beta-lactam antibiotics. Reliable methods, such as high-performance liquid chromatography, provide the accurate testing of a wide range of beta-lactam antibiotics. Long turnaround times remain the main drawback limiting their widespread use, although progress has been made recently in the implementation of different novel methods of antibiotic testing. However, whether the TDM approach can effectively improve clinically relevant patient outcomes must be proved in future clinical trials.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Cíl studie: srovnání různých metod stanovení albuminu v likvoru a séru za účelem výpočtu albuminového kvocientu (Q ALB) a intrathekální (ith.) syntézy IgG Typ studie: prospektivní studie Materiál a metody: U vybraných vzorků byl stanoven albumin a IgG v séru a albumin v likvoru různými metodami a byly srovnávány výsledné hodnoty Q ALB a výpočtu ith. syntézy IgG. U 226 po sobě následujících vzorků byl srovnán výsledek výpočtu ith. syntézy IgG s výsledkem detekce oligoklonálních IgG pásů. Výsledky: Stanovení albuminu v séru metodou s bromkrezolovou zelení (BCG) bylo identifikováno jako hlavní příčina falešně pozitivních výsledků výpočtu ith. syntézy IgG. Tato metoda poskytovala významně vyšší koncentrace ve srovnání s ostatními postupy - bromkrezolovým purpurem (BCP), imunonefelometrií (IN), imunoturbidimetrií (IT). Měřené koncentrace albuminu v likvoru i séru byly významně vyšší při použití IT na analyzátoru Optilite než při použití IN na analyzátoru Immage 800. Průměr hodnot Q ALB se však mezi oběma systémy významně nelišil. Q ALB vypočtený ze sérových koncentrací stanovených metodou s BCP byl významně nižší při stanovení albuminu v likvoru IN – průměrně o 12,8 % oproti IT. Při stanovení albuminu v séru imunochemickou metodou na analyzátoru použitém pro stanovení v likvoru klesl počet falešně pozitivních výsledků výpočtu významné (>10 %) ith. syntézy IgG z 9 % na 2 %. Závěr: Stanovení albuminu v likvoru a séru by mělo být prováděno stejnou metodou na stejném analyzátoru. Metodu s BCG považujeme pro stanovení albuminu za účelem výpočtu Q ALB a ith. syntézy imunoglobulinů za obzvlášť nevhodnou.
Objective: comparison of multiple methods of albumin determination in CSF and serum for the purpose of the calculation of albumin quotient (Q ALB) and intrathecal (ith.) IgG synthesis. Design: prospective study Material and Methods: In selected samples, albumin and IgG in CSF and serum were determined by multiple methods and a comparison was made among methods for Q ALB and ith. IgG synthesis calculation as well. In 226 consecutive samples, ith. IgG synthesis calculation was compared with the result of oligoclonal IgG detection. Results: Determination of serum albumin by a bromocresol green (BCG) method has been identified as the main cause of false positive ith. IgG synthesis calculation. This method gave significantly higher values compared to immunoturbidimetry (IT), immunonephelometry (IN) or bromocresol purple (BCP). CSF and serum albumin concentrations measured by IT in an Optilite analyzer were significantly higher compared to those obtained in an Image 800 nephelometer, yet no significant difference of the mean was observed for Q ALB. Using BCP method in serum for the calculation of Q ALB, values obtained using IN for CSF albumin were on average by 12.8% lower compared to IT. Using IN method for both CSF and serum, the number of false positive significant (>10%) ith. IgG synthesis calculations decreased from 9% to 2%. Conclusion: CSF and serum albumin determination shall be performed using the same methods on the same analyzer. In particular, BCG method for serum albumin shall not be used for the purpose of Q ALB and ith. immunoglobulin synthesis calculations.
- Publikační typ
- abstrakt z konference MeSH
- MeSH
- biologické markery analýza MeSH
- diferenciální diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- normotenzní hydrocefalus * diagnostické zobrazování mozkomíšní mok patologie MeSH
- senioři MeSH
- spinální punkce MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- MeSH
- amyloidní beta-protein analýza MeSH
- indikátory a reagencie * MeSH
- klinické laboratorní techniky * metody přístrojové vybavení MeSH
- lidé MeSH
- proteiny tau analýza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
