Clinical Utility of Procalcitonin in the Diagnosis of Pneumonia Infectious Disease

BACKGROUND: The clinical utility of procalcitonin in the diagnosis and management of pneumonia remains controversial. METHODS: We assessed the clinical utility of procalcitonin in 2 prospective studies: first, a multicenter diagnostic study in patients presenting to the emergency department with acute dyspnea to directly compare the diagnostic accuracy of procalcitonin with that of interleukin 6 and C-reactive protein (CRP) in the diagnosis of pneumonia; second, a randomized management study of procalcitonin guidance in patients with acute heart failure and suspected pneumonia. Diagnostic accuracy for pneumonia as centrally adjudicated by 2 independent experts was quantified with the area under the ROC curve (AUC). RESULTS: Among 690 patients in the diagnostic study, 178 (25.8%) had an adjudicated final diagnosis of pneumonia. Procalcitonin, interleukin 6, and CRP were significantly higher in patients with pneumonia than in those without. When compared to procalcitonin (AUC = 0.75; 95% CI, 0.71–0.78), interleukin 6 (AUC = 0.80; 95% CI, 0.77–0.83) and CRP (AUC = 0.82; 95% CI, 0.79–0.85) had significantly higher diagnostic accuracy (P = 0.010 and P
Source: Clinical Chemistry - Category: Chemistry Authors: Tags: Infectious Disease Source Type: research

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Well, it’s been a really rough three weeks. The first thing that happened was on January 1, no kidding, when I came down with a case of the flu (much worse than the before-Xmas flu). It’s going around. A lot of people are sick with this thing. Anyway, it hit me with a very high fever and huge gastrointestinal issues. Terrible. Plus, one night, delirious with fever, I fell against the bathroom wall and injured my wrist. Ouch. Because my wrist was all swollen and hurt like the dickens, and I feared it might be fractured, Stefano took me to the emergency room at Florence’s university hospital, Careggi. We sp...
Source: Margaret's Corner - Category: Cancer & Oncology Authors: Tags: Blogroll cat Source Type: blogs
(Yale University) The Obamacare program intended to reduce the risk of patients being readmitted after hospitalizations for heart attacks, heart failure, and pneumonia has not caused an increase in mortality risk for patients in emergency departments or observational units, according to a new report.
Source: EurekAlert! - Medicine and Health - Category: International Medicine & Public Health Source Type: news
This observational time-trend study compares trends in 30-day mortality rates among veterans hospitalized with heart failure and pneumonia when claims-based vs clinical variables are used in risk-adjustment models.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research
The call for quality measurement to focus on outcomes rather than care processes is loud and persistent. However, robust consideration of problems with the validity of outcome measures is often lacking. In this issue of JAMA Internal Medicine, Silva and colleagues make an important contribution to that discussion. They used data from the Veterans Health Administration to examine trends in mortality 30 days following hospital admission for veterans with heart failure or pneumonia. Risk-adjustment models that used only comorbidity data to assess risk of death overestimated declines in risk-adjusted mortality compared with mo...
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research
AbstractA 71-year-old man undergoing hemodialysis (HD) was admitted to our hospital with congestive heart failure (CHF) and pneumonia. After admission, ultrafiltration with HD was urgently performed because of a lack of respiratory improvement despite the use of noninvasive positive pressure ventilation. During HD, cerebral regional saturation of oxygen (rSO2) was monitored by INVOS 5100c oxygen saturation monitor (Covidien Japan, Japan) to evaluate changes in tissue oxygenation. At HD initiation, cerebral rSO2 was very low at 34% under the fraction of inspiratory oxygen (FiO2) of 0.4. Ultrafiltration was performed at the ...
Source: Journal of Artificial Organs - Category: Transplant Surgery Source Type: research
ConclusionsIn patients with AHF, a strategy of PCT ‐guided initiation of ABX was not more effective than a standard care strategy in improving clinical outcomes.
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
Publication date: Available online 6 December 2019Source: American Journal of Kidney DiseasesAuthor(s): Junichi Ishigami, Yingying Sang, Morgan E. Grams, Josef Coresh, Alex Chang, Kunihiro MatsushitaRationale &ObjectiveInfluenza vaccination is recommended for all adults but particularly for older adults and those with high-risk conditions. Reduced kidney function is an important high-risk condition, but the effectiveness of influenza vaccination across kidney function is uncharacterized. We assessed the effectiveness of influenza vaccination among older adults with and without reduced kidney function.Study DesignObserv...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
CONCLUSIONS: The effect of PAP therapy on all-cause mortality was uncertain. In addition, although we found evidence that PAP therapy did not reduce the risk of cardiac-related mortality and rehospitalisation, there was some indication of an improvement in quality of life for heart failure patients with CSA. Furthermore, the evidence was insufficient to determine whether adverse events were more common with PAP than with usual care. These findings were limited by low- or very low-quality evidence. PAP therapy may be worth considering for individuals with heart failure to improve quality of life. PMID: 31797360 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
According to this study: A higher nursing skill mix (that is, one that includes more RNs) is associated with improvements in 12 patient outcomes.These 12 outcomes are length of stay; ulcer, gastritis, and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure to rescue; pneumonia; sepsis; urinary tract infection; mortality/30-day mortality; pressure injury; infections (other than urinary tract infection); and shock, cardiac arrest, or heart failure.
Source: AJN - Category: Nursing Tags: Journal Watch Source Type: research
The aim of this study was to determine the role of physiological measurements in the evaluation of postoperative risks before lung cancer surgery. Spirometry and ABG were performed for all patients with NSCLC before operation. Diffusion test and CPET were performed to patients with moderate-high risk for operation and the patient who required pneumonectomy. Postoperative complications, mortality and duration of stay in ICU and hospital were recorded.115 NSCLC patients who had limited lung capacity(22F,93M) with a mean age of 62.37±10.11 were included prospectively between Jan2015-Dec2018. 54(46.9%) patients were acc...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Thoracic surgery Source Type: research
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