RESUMEN
OBJECTIVE: To assess the potential role of procalcitonin and pro-inflammatory cytokines, TNF-alpha, and IL-6, in the diagnosis of spontaneous bacterial peritonitis (SBP). DESIGN: Prospective study. SETTING: The emergency unit of a teaching hospital. PATIENTS: We included 21 patients with SBP and 40 patients with sterile ascitic fluid. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For the diagnosis of SBP, the best markers were serum levels of procalcitonin with a cut-off value of 0.75 ng/ml, a sensitivity of 95%, a specificity of 98%, and ascitic fluid levels of IL-6 with a cut-off value of 5,000 ng/ml, a sensitivity of 100%, and a specificity of 88%. C-reactive protein and serum polymorphonuclear count have low sensitivity/specificity at 62/92% and 57/90%, respectively. From 21 patients with SBP, ascitic fluid to serum ratio of TNF-alpha and IL-6 was greater than to 2 in all cases with a mean at 6.2 +/- 6.5 and 34 +/- 31, respectively. By contrast, this ratio for procalcitonin was less than 1 in all cases with a mean at 0.31 +/- 0.25. We found no correlation between procalcitonin levels and cytokine levels in either ascitic fluid or serum. CONCLUSIONS: Serum procalcitonin level may become a useful marker for the diagnosis of SBP in cirrhotic patients. The low ratio of ascitic fluid to serum procalcitonin supports the hypothesis that procalcitonin is not produced intraperitoneally.
Asunto(s)
Calcitonina/metabolismo , Interleucina-6/sangre , Cirrosis Hepática/metabolismo , Peritonitis/diagnóstico , Precursores de Proteínas/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo , Líquido Ascítico/metabolismo , Líquido Ascítico/microbiología , Análisis Químico de la Sangre , Proteína C-Reactiva/metabolismo , Péptido Relacionado con Gen de Calcitonina , Estudios de Casos y Controles , Femenino , Humanos , Recuento de Leucocitos , Cirrosis Hepática/complicaciones , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neutrófilos/metabolismo , Peritonitis/microbiología , Estudios Prospectivos , Curva ROCRESUMEN
OBJECTIVE: It has been shown that serum procalcitonin (PCT) can be used to differentiate bacterial from viral meningitis in children in all cases. The aim of this study was to demonstrate the interest of PCT in the management of suspected meningitis in adults. PATIENTS AND METHODS: We conducted a prospective study including 179 consecutive patients admitted to the emergency department for suspected meningitis. All samples were taken at patient admission. The discriminant potential between bacterial and viral meningitis was studied for cerebrospinal fluid parameters (cytology, protein, glucose, lactate) and serum parameters (C reactive protein, PCT). RESULTS: Thirty-two patients had bacterial meningitis, 90 had viral meningitis and meningitis was ruled out in 57. Among all studied parameters, the most discriminant for distinguishing between bacterial and viral meningitis in 100% of the cases proved to be serum procalcitonin with a threshold value of 0.93 ng/ml. CONCLUSION: Serum procalcitonin is an interesting parameter in the emergency department for management of meningitis suspicion in adults.
Asunto(s)
Calcitonina/sangre , Glicoproteínas/sangre , Meningitis Bacterianas/diagnóstico , Meningitis Viral/diagnóstico , Precursores de Proteínas/sangre , Infecciones por Adenoviridae/sangre , Infecciones por Adenoviridae/líquido cefalorraquídeo , Infecciones por Adenoviridae/diagnóstico , Adulto , Calcitonina/líquido cefalorraquídeo , Péptido Relacionado con Gen de Calcitonina , Varicela/sangre , Varicela/líquido cefalorraquídeo , Varicela/diagnóstico , Interpretación Estadística de Datos , Diagnóstico Diferencial , Infecciones por Enterovirus/sangre , Infecciones por Enterovirus/líquido cefalorraquídeo , Infecciones por Enterovirus/diagnóstico , Femenino , Glicoproteínas/líquido cefalorraquídeo , Herpes Zóster/sangre , Herpes Zóster/líquido cefalorraquídeo , Herpes Zóster/diagnóstico , Infecciones por Herpesviridae/sangre , Infecciones por Herpesviridae/líquido cefalorraquídeo , Infecciones por Herpesviridae/diagnóstico , Humanos , Mediciones Luminiscentes , Masculino , Meningitis Bacterianas/sangre , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis por Haemophilus/sangre , Meningitis por Haemophilus/líquido cefalorraquídeo , Meningitis por Haemophilus/diagnóstico , Meningitis por Listeria/sangre , Meningitis por Listeria/líquido cefalorraquídeo , Meningitis por Listeria/diagnóstico , Meningitis Meningocócica/sangre , Meningitis Meningocócica/líquido cefalorraquídeo , Meningitis Meningocócica/diagnóstico , Meningitis Neumocócica/sangre , Meningitis Neumocócica/líquido cefalorraquídeo , Meningitis Neumocócica/diagnóstico , Meningitis Viral/sangre , Meningitis Viral/líquido cefalorraquídeo , Persona de Mediana Edad , Estudios Prospectivos , Precursores de Proteínas/líquido cefalorraquídeo , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Despite precise recommendations for prescription and monitoring, tosades de pointes is still observed with bepridil. The purpose of this study was to demonstrate the contribution of bepridil serum assay in therapeutic supervision. PATIENTS AND METHODS: Seventy-five patients over 70 years of age were included. Prolongation of the QT interval was observed in 23 patients. RESULTS: The potential prognostic factors for increased QT interval as demonstrated by univariate logistic regression were hypokaliemia, bradycardia, renal failure and bepridil serum level. After multivariate logistic regression, the persisting causal factors for increased QT interval were hypokaliemia, bradycardia and bepridil serum level. CONCLUSION: Prolongation of the QT interval remains dependent on several variables. Bepridil determination during treatment is insufficient alone.