Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis

Sepsis und ihre unmittelbaren Folgen stellen weltweit einen häufigen Grund für Krankheit und Tod dar. Erste klinische Zeichen der Sepsis sind unspezifisch und decken sich häufig mit Symptomen eines systemischen inflammatorischen Response-Syndroms (SIRS) nicht bakterieller Genese. Ziel dieser Arbeit war es, die diagnostische Wertigkeit von Procalcitonin bei kritisch kranken Patienten mit Sepsis zu ermitteln und anhand dieser, eine Schlussfolgerung über dessen Nutzen im klinischen Alltag zu ziehen. Hierfür wurden die Datenbanken Medline, Embase, ISI Web of Knowledge, the Cochrane Library, Scopus, BioMed Central und Science Direct von deren Entstehung an bis zum 21.02.2012 nach Studien durchsucht, die die Fähigkeit des Procalcitonins eruieren, zwischen septischen Patienten und Patienten mit SIRS nicht bakterieller Genese zu unterscheiden. Zwei voneinander unabhängige Untersucher extrahierten Patienten- und Studiencharakteristiken und führten diese tabellarisch auf. Es konnten insgesamt 3487 relevante Studien identifiziert werden, wovon 30 den Einschlusskriterien entsprachen. In der durchgeführten bivariaten Analyse wurde eine Gesamtsensitivität von 0,77 (95% CI 0,72-0,81) und eine Gesamtspezifität von 0,79 (95% CI 0,74-0,84) ermittelt. Die Area under the revceiver operating characteristic curve (ROC AUC) betrug 0,85 (95% CI 0,81-0,88). Zwischen den Studien wurde eine erhebliche Heterogenität (I²=96%, 95% CI 94-99) festgestellt. Keine der durch Meta-Regression untersuchten Studiencharakteristiken konnte jedoch für die gefundene Heterogenität verantwortlich gemacht werden. Zusammenfassend lässt sich sagen, dass Procalcitonin ein hilfreicher Marker für die frühzeitige Diagnose der Sepsis bei kritisch kranken Patienten ist. Nichtsdestotrotz sollte es nicht uneingeschränkt als alleiniger und endgültiger Test verwendet werden, sondern immer in Zusammenhang mit Anamnese, klinischer Untersuchung und, wenn möglich, mit mikrobiologischen Ergebnissen interpretiert werden

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock – a systematic review and meta-analysis

INTRODUCTION: Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients from primary care, emergency department, and intensive care unit (ICU) settings, suggesting that procalcitonin-guided therapy may reduce antibiotic exposure without increasing the mortality rate. However, information on the efficacy and safety of this approach in the most vulnerable population of critically ill patients with severe sepsis and septic shock is missing. METHOD: Two reviewers independently performed a systematic search in PubMed, Embase, ISI Web of Knowledge, BioMed Central, ScienceDirect, Cochrane Central Register of Controlled Trials, http://www.ClinicalTrials.gov and http://www.ISRCTN.org. Eligible studies had to be randomized controlled clinical trials or cohort studies which compare procalcitonin-guided therapy with standard care in severe sepsis patients and report at least one of the following outcomes: hospital mortality, 28-day mortality, duration of antimicrobial therapy, length of stay in the intensive care unit or length of hospital stay. Disagreements about inclusion of studies and judgment of bias were solved by consensus. RESULTS: Finally seven studies comprising a total of 1,075 patients with severe sepsis or septic shock were included in the meta-analysis. Both hospital mortality (RR [relative risk]: 0.91, 95%CI [confidence interval]: 0.61; 1.36) and 28-day mortality (RR: 1.02, 95%CI: 0.85; 1.23) were not different between procalcitonin-guided therapy and standard treatment groups. Duration of antimicrobial therapy was significantly reduced in favor of procalcitonin-guided therapy (HR [hazard ratio]: 1.27, 95%CI: 1.01; 1.53). Combined estimates of the length of stay in the ICU and in hospital did not differ between groups. CONCLUSION: Procalcitonin-guided therapy is a helpful approach to guide antibiotic therapy and surgical interventions without a beneficial effect on mortality. The major benefit of PCT-guided therapy consists of a shorter duration of antibiotic treatment compared to standard care. Trials are needed to investigate the effect of PCT-guided therapy on mortality, length of ICU and in-hospital stay in severe sepsis patients

Gestational Diabetes: Physical Activity Before Pregnancy and Its Influence on the Cardiovascular System

Objectives:Gestational diabetes mellitus (GDM) is a common complication in pregnancy, affecting around 14% of all pregnancies each year. It will likely further increase, as obesity becomes more prevalent. The impact of GDM on cardiovascular changes in pregnant women and her child is still unclear. The aim of the study was to measure the effects of physical activity before pregnancy on the cardiovascular system in patients with GDM in pregnancy. Methods:Two hundred and six pregnant women were included in this observational study. All participants were recruited at the tertiary level teaching University Hospital "Klinikum rechts der Isar" between 28 and 32 weeks gestation. Questionnaires dealing with pre-pregnancy daily and physical activity (PA) were evaluated. The cardiovascular status of the mothers included measurements of the intima-media thickness (IMT) of the carotid arteries. PA level was performed with a standardized 6-min-walking-test. Results:Ninety-nine women with GDM with a mean age of 33.84 (+/- 4.7) years were examined. One hundred seven healthy pregnant women aged 32.6 (+/- 4.2) years served as controls. The mean weight in the study group was 73.0 (+/- 20.3) kg and 61.7 (+/- 9.5) kg in the control group. Based on the higher weight in the study group, the Body Mass Index (BMI) was also significantly higher than in the control group (26.3 +/- 7.1 vs. 21.6 +/- 3;p< 0.001). The frequency of PA was significantly higher in the control group (p< 0.001). The objective fitness level was worse in pregnant women with GDM compared to healthy controls (472 vs. 523 m,p< 0.001). PA before and during pregnancy was less performed in the study group (86 vs. 64.5%,p= 0.002;69 vs. 45.7%,p= 0.003). Women who were physically inactive before pregnancy had a 3-times higher risk to develop GDM compared to active women (OR = 2.67). The IMT was significantly thicker in the study group (0.48 +/- 0.042 mm vs. 0.45 +/- 0.042) mm;p= 0.006). Conclusion:Physical activity before pregnancy and a lower initial weight reduces the risk of developing GDM and cardiovascular risk factors in pregnancy. The development of prevention programs is certainly necessary

Is the beck anxiety inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands study of depression and anxiety (NESDA)

<p>Abstract</p> <p>Background</p> <p>Appropriate management of anxiety disorders in primary care requires clinical assessment and monitoring of the severity of the anxiety. This study focuses on the Beck Anxiety Inventory (BAI) as a severity indicator for anxiety in primary care patients with different anxiety disorders (social phobia, panic disorder with or without agoraphobia, agoraphobia or generalized anxiety disorder), depressive disorders or no disorder (controls).</p> <p>Methods</p> <p>Participants were 1601 primary care patients participating in the Netherlands Study of Depression and Anxiety (NESDA). Regression analyses were used to compare the mean BAI scores of the different diagnostic groups and to correct for age and gender.</p> <p>Results</p> <p>Patients with any anxiety disorder had a significantly higher mean score than the controls. A significantly higher score was found for patients with panic disorder and agoraphobia compared to patients with agoraphobia only or social phobia only. BAI scores in patients with an anxiety disorder with a co-morbid anxiety disorder and in patients with an anxiety disorder with a co-morbid depressive disorder were significantly higher than BAI scores in patients with an anxiety disorder alone or patients with a depressive disorder alone. Depressed and anxious patients did not differ significantly in their mean scores.</p> <p>Conclusions</p> <p>The results suggest that the BAI may be used as a severity indicator of anxiety in primary care patients with different anxiety disorders. However, because the instrument seems to reflect the severity of depression as well, it is not a suitable instrument to discriminate between anxiety and depression in a primary care population.</p

Physical Activity in High-Risk Pregnancies

It is known that physical activity before and during pregnancy is associated with health benefits for both the mother and fetus. The WHO recommends a minimum of 150 min per week of moderate-intensity aerobic physical activity for pregnant women. However, the majority of pregnant woman seem not to be physically active in pregnancy as recommended. In addition, the WHO recommendations do not include information on physical activity (PA) for specific target groups. This might be particularly problematic in women with assisted reproduction technologies (ART) or those who have received the fetal diagnosis of congenital heart defects (CHD). The aim of our study was to elaborate on whether assisted reproduction technologies (ART) and/or the diagnosis of fetal congenital heart defects (CHD) influence the level of PA in pregnant women, and to determine if there is a difference between PA behavior before and during pregnancy. In addition, we will evaluate whether high-risk pregnant women also reach the WHO recommendations. A non-interventional, cross-sectional, monocentric study based on two standardized questionnaires on physical activity was conducted. In total, n = 158 pregnant women were included. All of the participants were recruited from the outpatient clinics of the German Heart Center, Munich, and the Klinikverbund Kempten-Oberallg&auml;u, Germany. Pregnant women after ART (n = 18), with fetal CHD (n = 25) and with both ART and CHD (n = 8) could be included. A total of 107 pregnant women served as healthy controls. Women, after ART, showed a significantly reduced level of physical activity (p = 0.014) during pregnancy compared to women who became pregnant naturally. Additionally, less (p &lt; 0.001) and lighter (p = 0.002) physical activity was observed in all groups during pregnancy compared to those before pregnancy. An increase in maternal age increases the likelihood of CHD (p &lt; 0.001) and decreases the level of physical activity before pregnancy (p = 0.012). The overall level of physical activity decreased in healthy and high-risk pregnancies, and only a quarter (26.49%) of all pregnant women reached the WHO recommendations. Further research for the specific target groups is highly recommended in order to promote and increase physical activity in ART and CHD pregnancies