22 research outputs found
Performance of N-terminal-pro-B-type natriuretic peptide in critically ill patients: a prospective observational cohort study
Procalcitonin kinetics within the first days of sepsis: relationship with the appropriateness of antibiotic therapy and the outcome
Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report
<p>Abstract</p> <p>Background</p> <p>The usefulness of procalcitonin (PCT) measurement in critically ill medical patients with suspected nosocomial infection is unclear. The aim of the study was to assess PCT value for the early diagnosis of bacterial nosocomial infection in selected critically ill patients.</p> <p>Methods</p> <p>An observational cohort study in a 15-bed intensive care unit was performed. Seventy patients with either proven (n = 47) or clinically suspected but not confirmed (n = 23) nosocomial infection were included. Procalcitonin measurements were obtained the day when the infection was suspected (D0) and at least one time within the 3 previous days (D-3 to D0). Patients with proven infection were compared to those without. The diagnostic value of PCT on D0 was determined through the construction of the corresponding receiver operating characteristic (ROC) curve. In addition, the predictive value of PCT variations preceding the clinical suspicion of infection was assessed.</p> <p>Results</p> <p>PCT on D0 was the best predictor of proven infection in this population of ICU patients with a clinical suspicion of infection (AUROCC = 0.80; 95% CI, 0.68–0.91). Thus, a cut-off value of 0.44 ng/mL provides sensitivity and specificity of 65.2% and 83.0%, respectively. Procalcitonin variation between D-1 and D0 was calculated in 45 patients and was also found to be predictive of nosocomial infection (AUROCC = 0.89; 95% CI, 0.79–0.98) with a 100% positive predictive value if the +0.26 ng/mL threshold value was applied. Comparable results were obtained when PCT variation between D-2 and D0, or D-3 and D0 were considered. In contrast, CRP elevation, leukocyte count and fever had a poor predictive value in our population.</p> <p>Conclusion</p> <p>PCT monitoring could be helpful in the early diagnosis of nosocomial infection in the ICU. Both absolute values and variations should be considered and evaluated in further studies.</p
Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either gram negative or gram positive bacteria
<p>Abstract</p> <p>Background</p> <p>In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.</p> <p>Methods</p> <p>Review of the medical records of every patient treated between May, 2004 and December, 2006 who had bacteremia caused by either Gram positive (GP) or Gram negative (GN) bacteria, and whose PCT dosage at the onset of infection was available.</p> <p>Results</p> <p>97 episodes of either GN bacteremia (<it>n </it>= 52) or GP bacteremia (<it>n </it>= 45) were included. Procalcitonin levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia, whereas the SOFA score value in the two groups was similar. Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia. A PCT level of 16.0 ng/mL yielded an 83.0% positive predictive value and a 74.0% negative predictive value for GN-related bacteremia in the study cohort (AUROCC = 0.79; 95% CI, 0.71–0.88).</p> <p>Conclusion</p> <p>In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.</p
Impact of previous sepsis on the accuracy of procalcitonin for the early diagnosis of blood stream infection in critically ill patients
<p>Abstract</p> <p>Background</p> <p>Blood stream infections (BSI) are life-threatening infections in intensive care units (ICU), and prognosis is highly dependent on early detection. Procalcitonin levels have been shown to accurately and quickly distinguish between BSI and noninfectious inflammatory states in critically ill patients. It is, however, unknown to what extent a recent history of sepsis (namely, secondary sepsis) can affect diagnosis of BSI using PCT.</p> <p>Methods</p> <p>review of the medical records of every patient with BSI in whom PCT dosage at the onset of sepsis was available between 1<sup>st </sup>September, 2006 and 31<sup>st </sup>July, 2007.</p> <p>Results</p> <p>179 episodes of either primary (<it>n </it>= 117) or secondary (<it>n </it>= 62) sepsis were included. Procalcitonin levels were found to be markedly lower in patients with secondary sepsis than in those without (6.4 [9.5] vs. 55.6 [99.0] ng/mL, respectively; <it>p </it>< 0.001), whereas the SOFA score was similar in the two groups. Although patients in the former group were more likely to have received steroids and effective antibiotic therapy prior to the BSI episode, and despite a higher proportion of candidemia in this group, a low PCT value was found to be independently associated with secondary sepsis (Odd Ratio = 0.33, 95% Confidence Interval: 0.16–0.70; <it>p </it>= 0.004). Additional patients with suspected but unconfirmed sepsis were used as controls (<it>n </it>= 23). Thus, diagnostic accuracy of PCT as assessed by the area under the receiver-operating characteristic curves (AUROCC) measurement was decreased in the patients with secondary sepsis compared to those without (AUROCC = 0.805, 95% CI: 0.699–0.879, vs. 0.934, 95% CI: 0.881–0.970, respectively; <it>p </it>< 0.050).</p> <p>Conclusion</p> <p>In a critically ill patient with BSI, PCT elevation and diagnosis accuracy could be lower if sepsis is secondary than in those with a first episode of infection.</p
Accueil, orientation et prise en charge des urgences (une expérience originale au sein du service des urgences de l'Hôtel-Dieu du Creusot)
DIJON-BU MĂ©decine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Evolution de la prescription d'examens para cliniques par les internes au cours de leur semestre en réanimation médicale
Cette étude concerne une population de 200 patients hospitalisés dans le service de réanimation médicale du Centre Hospitalier Universitaire de Dijon. L'objectif était de quantifier rétrospectivement les prescriptions des examens para cliniques établies par les internes entre le début et la fin de leur semestre, de novembre 2001 à mai 2003. Dans le même temps, le volume des prescriptions des médecins seniors a été étudié. L'analyse statistique uni puis multivariée (ajustement sur la gravité du patient, la durée de ventilation mécanique et la durée du séjour en réanimation) a retrouvé une diminution significative des prescriptions d'examens biologiques (p=0,02) et de radiographies pulmonaires (p=0,03) faites par les internes au cours de leur semestre. A l'opposé, les médecins seniors ont une attitude de prescription stable dans le temps. La perspective de ce travail est l'amélioration de l'encadrement des internes en ce qui concerne ces prescriptions. L'extension à l'analyse des prescriptions de thérapeutiques pourrait faire l'objet d'autres travaux.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocNANCY1-Bib. numérique (543959902) / SudocSudocFranceF
Prise en charge et profil medico-social des patients en situation de précarité consultant à l'antenne d'accueil médical de Dijon
DIJON-BU MĂ©decine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Devenir des patients ventilés mécaniquement pour un accident vasculaire du tronc cérébral
DIJON-BU MĂ©decine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
PERFORMANCE DIAGNOSTIQUE AUX URGENCES DU CENTRE HOSPITALIER DE SENS (A PROPOS DE 243 CAS)
DIJON-BU MĂ©decine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF