The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

OBJECTIVES: During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection. METHODS: The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs. RESULTS: Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1b were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients. CONCLUSION: Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes

Avaliação da utilidade diagnóstica da procalcitonina e da proteína C reativa em pacientes críticos com síndrome respiratória aguda grave e suspeita de infecção pelo vírus influenza H1N1 2009

Exportado OPUSMade available in DSpace on 2019-08-13T19:47:46Z (GMT). No. of bitstreams: 1 dissertacao_mariana_benevides_s._paiva_final.pdf: 1826500 bytes, checksum: 24b4e26f313aa3e118475c06d75c26ff (MD5) Previous issue date: 29Na vigência de uma pandemia de gripe, existe dificuldade em se diferenciar, à admissão do paciente no centro de terapia intensiva, se o quadro de insuficiência respiratória aguda é causado pelo vírus influenza ou por outros agentes infecciosos, ou ainda se se trata de um processo não infeccioso. O objetivo do presente estudo foi avaliar a utilidade da procalcitonina e da proteína C reativa na identificação etiológica e na caracterização da gravidade em pacientes internados no CTI com síndrome gripal aguda grave e suspeita de infecção pelo vírus influenza A H1N1 pândemico. Adicionalmente, avaliou-se o comportamento de quatro citocinas (fator de necrose tumoral-, interferon-, interleucina-1 e interleucina-10) nesse pacientes. Todos os biomarcadores foram dosados à admissão, e nos dia 3, 5 e 7 da internação em 35 pacientes internados no centro de terapia intensiva de dois hospitais universitários, com infecção suspeita pelo vírus 2009 influenza A H1N1. Três grupos foram constituídos: (i) 12 (34.3%) pacientes com infecção confirmada pelo 2009 influenza A H1N1; (ii) 6 (17.1%) pacientes com influenza sazonal; e (iii) 17 (48.6%) pacientes com swabs negativos para vírus influenza. Os níveis de procalcitonina à admissão (p=0,005) e no terceiro dia (p=0,015), e de proteína C reativa no terceiro dia (0,024), encontravam-se elevados nos pacientes com infecção confirmada pelo 2009 influenza A H1N1 comparados aos dois outros grupos estudados. Considerando-se as citocinas avaliadas, o nível sérico de interleucina-1 à admissão mostrou-se mais elevado nos pacientes com infecção pelo 2009 influenza A H1N1 em relação aos outros grupos (p=0,014). A proteína C reativa nos dias 3, 5 e 7 (p= 0,047, p=0,012 e p=0,008, respectivamente) e a procalcitonina nos dias 5 e 7 (p=0,019 e p=0,001, respectivamente) apresentaram níveis mais baixos nos pacientes que sobreviveram. Em conclusão, observou-se níveis mais altos de procalcitonina, proteína C reativa e interleucina 1 nos pacientes críticos com síndrome respiratória aguda grave causada pelo influenza A H1N1 em comparação aos pacientes com insuficiência respiratória por outra etiologia. Considerando-se toda a população estudada, os níveis de procalcitonina nos dias 5 e 7, e de proteína C reativa nos dias 3, 5 e 7 após a admissão associaram-se à mortalidade intra-hospitalar.During the 2009 influenza A H1N1 pandemic it became difficult to differentiate viral infection from other conditions in patients admitted to the Intensive Care Unit. We sought to evaluate the utility of circulating serum levels of procalcitonin and C-reactive protein to differentiate the 2009 influenza A H1N1 infection from other conditions in patients admitted to the intensive care unit with severe acute respiratory illness during the pandemic; and to investigate the behavior of circulating levels of four cytokines (tumor necrosis factor-, interferon-, interleukin-1 and interleukin-10) in those patients. To this, we performed prospective measurements of these molecules in 35 consecutive patients admitted to two University Hospitals intensive care units with suspected 2009 influenza A H1N1 pneumonia on admission and on days 3, 5 and 7. Three groups were constituted: (i) 12 (34.3%) patients with confirmed 2009 influenza A H1N1 infection; (ii) 6 (17.1%) patients with seasonal influenza infection; (iii) 17 (48.6%) patients with negative swabs for influenza virus. Circulating levels of PCT at inclusion and on day 3, and CRP on day 3, were significantly higher among subjects with confirmed 2009 influenza A H1N1 infection compared the other two groups of critically ill patients, p=0.005, p=0.015 and p=0.024, respectively. Regarding the tested cytokines, baseline levels of interleukin-1 were significantly higher among patients of 2009 influenza A H1N1 group compared to the other groups (p=0.014). CRP levels on day 3, 5 and 7 (p= 0.047, p=0.012 and p=0.008, respectively) and PCT levels on days 5 and 7 (p=0.019 and p=0.001, respectively), were significantly higher in non-surviving patients. In conclusion, we found higher levels of procalcitonin, C-reactive protein and interleukin-1 among critically ill patients with severe acute respiratory illness due to 2009 influenza A H1N1 compared to those cases related to seasonal influenza infection and non-influenza diagnoses. In the analysis including the 35 patients, procalcitonin on days 5 and on day 7, and C-reactive protein on days 3, day 5 and day 7 following admission were associated with all-cause hospital mortality