The monocyte distribution width (MDW) has emerged as a promising biomarker for accurate and early identification of patients with potentially life-threatening infections. Here we tested the diagnostic performance of MDW in adult patients requiring hospital admission for community-acquired infections and sepsis, evaluated sources of heterogeneity in the estimates of diagnostic accuracy, and assessed the meaning of MDW in a patient population presenting to the emergency department (ED) for acute non-infectious conditions. 1925 consecutive patients were categorized into three groups: non-infection (n = 1507), infection (n = 316), and sepsis/septic shock (n = 102). Diagnostic performance for infection or sepsis of MDW alone or in combination with components of SOFA was tested using AUC of ROC curves, sensitivity, and specificity. The relationship between MDW and different pathogens as well as the impact of non-infectious conditions on MDW values were explored. For the prediction of infection, the AUC/ROC of MDW (0.84) was nearly overlapping that of procalcitonin (0.83), and C-reactive protein (0.89). Statistical optimal cut-off value for MDW was 21 for predicting infection (sensitivity 73%, specificity 82%) and 22 for predicting sepsis (sensitivity 79%, specificity 83%). The best threshold to rule out infection was MDW ≤ 17 (NPV 96.9, 95% CI 88.3-100.0), and ≤ 18 (NPV 99.5, 95% CI 98.3-100.0) to rule out sepsis. The combination of MDW with markers of organ dysfunction (creatinine, bilirubin, platelets) substantially improved the AUC (0.96 (95% CI 0.94-0.97); specificity and sensitivity of 88% and 94%, respectively). In conclusion, MDW has a good diagnostic performance in diagnosing infection and sepsis in patients presenting in ED. Its use as an infection marker even increases when combined with other markers of organ dysfunction. Understanding the impact of interactions of non-infectious conditions and comorbidities on MDW and its diagnostic accuracy requires further elucidation.
- MeSH
- akutní nemoc MeSH
- biologické markery * krev MeSH
- dospělí MeSH
- infekce získané v komunitě diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- monocyty * metabolismus MeSH
- prospektivní studie MeSH
- ROC křivka MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- sepse * diagnóza krev MeSH
- urgentní služby nemocnice * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Multimorbidita – současná přítomnost více chronických onemocnění – je u kriticky nemocných velmi častá. Její preva- lence je zhruba 40–85 % a trendově se dále zvyšuje. Určitá chronická onemocnění, jako např. diabetes mellitus, obezita, chronické onemocnění srdce, plic, jater či ledvin a malignity, jsou asociovány s vyšším rizikem rozvoje závažných akutních komplikací a tedy i případné potřeby intenzivní péče. Tento přehledový článek shrnuje a diskutuje vybraná specifika péče o multimorbidní kriticky nemocné.
Multimorbidity - the simultaneous presence of several chronic diseases - is very common in the critically ill patients. Its prevalence is roughly 40-85 % and continues to increase further. Certain chronic diseases such as diabetes, obesity, chronic heart, pulmonary, liver or kidney disease and malignancy are associated with higher risk of developing serious acute complications and therefore the possible need for intensive care. This review summarizes and discusses selected specifics of critical care for multimorbid patients.
BACKGROUND: Sepsis is a common worldwide health condition with high mortality. It is caused by a dysregulated immune response to the pathogen. Severe infections resulting in sepsis can be also determined by monitoring several bloodstream biomarkers, one of them being pro-hormone procalcitonin (PCT). PCT concentration in the bloodstream correlates well with sepsis and in severe cases increases up to a thousand times from the healthy physiological values in a short time. In this study, we developed a rapid technique for PCT detection by MALDI-TOF mass spectrometry, that uses in-situ enrichment directly on the specialized immuno MALDI chips that are utilized as MALDI plates. The method's ability to detect PCT was confirmed by comparing the results with LC-MS bottom-up workflow. The new method detects intact PCT by its m/z and uncovers its alternations in septic serum. METHODS: The MALDI chips used for the detection of PCT were prepared by ambient ion soft landing of anti-PCT antibody on an ITO glass slide. The chips were used for the development of the rapid MALDI-TOF MS method. A parallel method based on affinity enrichment on magnetic beads followed by LC-MS/MS data-dependent peptide microsequencing was used to prove PCT presence in the sample. All samples were also tested by ELISA to determine PCT concentration prior to analyzing them by mass spectrometry methods. RESULTS: The MALDI chip method was optimized using recombinant PCT spiked into the human serum. The PCT detection limit was 10 ng/mL. The optimized method was used to analyze 13 sera from patients suffering sepsis. The PCT results were confirmed by LC-MS/MS. The measurement of the intact PCT by the MALDI chip method revealed that sera of patients with severe sepsis have other forms of PCT present, which show post-processing of the primary sequence by cleavage of PCT, resulting in the formation of N and C termini fragments. CONCLUSIONS: Procalcitonin from human serum was successfully enriched and detected using immunoaffinity MALDI chips. The intact PCT was characterized in 13 septic patients. The method is more specific compared to non-MS-based immunoaffinity techniques and allows observation of different variants of PCT in septic patients.
- Publikační typ
- časopisecké články MeSH
- MeSH
- chronická obstrukční plicní nemoc diagnóza farmakoterapie komplikace MeSH
- chronická renální insuficience diagnóza komplikace terapie MeSH
- delirium etiologie MeSH
- diabetes mellitus diagnóza terapie MeSH
- komorbidita MeSH
- komplikace diabetu MeSH
- lidé MeSH
- management péče o pacienta MeSH
- nádory komplikace MeSH
- nemoci jater komplikace terapie MeSH
- obezita komplikace terapie MeSH
- péče o pacienty v kritickém stavu * MeSH
- sepse diagnóza etiologie terapie MeSH
- srdeční selhání diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Netuberkulózní mykobakteriózy jsou vzácná onemocnění, jejichž incidence spolu s narůstajícím počtem imunokompromitovaných nemocných a lepšími diagnostickými možnostmi pozvolna narůstá. Článek stručně shrnuje problematiku netuberkulózních mykobakterióz na podkladě reálné kazuistiky.
Nontuberculous mycobacterial infections are rare diseases. However, as number of immunocompromised patients is growing and modern diagnostic tools are available, both the importance and incidence of nontuberculous mycobacterial infections are gaining clinical importance. Based on a clinical case, this article briefly summarizes the current knowledge on this issue.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- imunosupresivní léčba škodlivé účinky MeSH
- klinické laboratorní techniky metody MeSH
- lidé MeSH
- Mycobacterium avium MeSH
- mykobakteriózy * diagnóza terapie MeSH
- senioři MeSH
- smrt MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
