The Contribution of Procalcitonin, C-Reactive Protein and Interleukin-6 in the Diagnosis and Prognosis of Surgical Sepsis: An Observational and Statistical Study

George Tocu,1,2,&ast; Raul Mihailov,3,4 Cristina Serban,4,5 Bogdan Ioan Stefanescu,5,6,&ast; Dana Tutunaru,1,2 Dorel Firescu4,5,&ast; 1Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galați, Romania; 2Clinical Laboratory of Medical Analysis, Emergency County Clinical Hospital “Sf. Ap. Andrei” Galati, Galați, Romania; 3Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galați, Romania; 4Department of Surgery, Emergency County Clinical Hospital “Sf. Ap. Andrei” Galati, Galați, Romania; 5Department of Clinical Surgery, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, Galați, Romania; 6Department of Obstetrics and Gynecology, Emergency County Clinical Hospital “Sf. Ap. Andrei” Galati, Galați, Romania&ast;These authors contributed equally to this workCorrespondence: Raul Mihailov, Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 47 Domneasca Street, Galați, 800008, Romania, Tel +40745250391, Email [email protected] Cristina Serban, Department of Clinical Surgery, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 47 Domneasca Street, Galați, 800008, Romania, Tel +40728249228, Email [email protected]: Sepsis affects over 30 million people worldwide each year, causing approximately 6 million deaths. Challenges in clinical diagnosis and the need for an early diagnosis to prevent mortality due to sepsis have led to dependence on inflammatory biomarkers like Procalcitonin (PCT), C-reactive protein (CRP), and Interleukin-6 (IL-6).Objective: This study was performed to observe the contribution of inflammatory biomarkers in the diagnosis and prognosis of patients with surgical sepsis.Methods: We performed a retrospective observational study in a Clinical Emergency Hospital, which included a number of 125 patients with surgical sepsis admitted between January 2020 and December 2021. The patients were included in the study based on the Sepsis-3 definition. PCT, CRP, IL-6, Sepsis-related Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), the time up to surgery, the days of treatment in Intensive Care Unit (ICU) and the total days of hospitalization had been statistically analyzed.Results: The mean age of all patients was 65.14 years. The mean value in all patients for PCT was 20.08 ng/mL, for CRP was 175.42 mg/l, and for IL-6 was 799.6 pg/mL. The strongest correlation between biomarkers was between CRP and IL-6 (r = 0.425; p < 0.0001). Of all biomarkers, the CRP correlated the strongest with patient outcomes (r = 0.544; p < 0.0001). The area under curve (AUC) for the mean values of the inflammatory biomarkers was calculated and the best diagnostic performance was for CRP with 0.816 (95% CI: 0.744– 0.887).Conclusion: CRP and IL-6 were the most efficient in sepsis diagnosis. The association of PCT, CRP and IL-6 has increased the range of certainty in sepsis diagnosis. CRP was the most efficient biomarker in the prognosis of sepsis.Keywords: inflammatory biomarkers, SOFA score, septic shock, surgical sepsis, postoperativel

Application of an intelligent study and research support system for clinical anatomy in a cooperation scenario

Scientific research and teaching are strongly interrelated. A student should be educated both to the fundamentals of a discipline and to the research tasks as the future development of a discipline is entrusted to the students of today. Computer based tutoring systems already showed useful in pursuing the former target while the Intelligent Study and Research Support System developed at DINFO may be used to fulfill both in an integrated manner. This paper introduces the possible application of the ISRSS to training of Clinical Anatomy in a scenario of international cooperation among academic institutions

The light chain IgLV3-21 defines a new poor prognostic subgroup in chronic lymphocytic leukemia: Results of a multicenter study

Purpose: Unmutated (UM) immunoglobulin heavy chain variable region (IgHV) status or IgHV3-21 gene usage is associated with poor prognosis in chronic lymphocytic leukemia (CLL) patients. Interestingly, IgHV3-21 is often co-expressed with light chain IgLV3-21, which is potentially able to trigger cell-autonomous BCR-mediated signaling. However, this light chain has never been characterized independently of the heavy chain IgHV3-21. Experimental Design: We performed total RNA sequencing in 32 patients and investigated IgLV3-21 prognostic impact in terms of treatment-free survival (TFS) and overall survival (OS) in 3 other independent cohorts for a total of 813 patients. IgLV3-21 presence was tested by real-time PCR and confirmed by Sanger sequencing. Results: Using total RNA sequencing to characterize 32 patients with high-risk CLL, we found a high frequency (28%) of IgLV3-21 rearrangements. Gene set enrichment analysis revealed that these patients express higher levels of genes responsible for ribosome biogenesis and translation initiation (P ≺ 0.0001) as well as MYC target genes (P = 0.0003). Patients with IgLV3-21 rearrangements displayed a significantly shorter TFS and OS (P ≺ 0.05), particularly those with IgHV mutation. In each of the three independent validation cohorts, we showed that IgLV3-21 rearrangements—similar to UM IgHV status—conferred poor prognosis compared with mutated IgHV (P ≺ 0.0001). Importantly, we confirmed by multivariate analysis that this was independent of IgHV mutational status or subset #2 stereotyped receptor (P ≺ 0.0001). Conclusions: We have demonstrated for the first time that a light chain can affect CLL prognosis and that IgLV3-21 light chain usage defines a new subgroup of CLL patients with poor prognosis.</p