Etiological and prognostic values of procalcitonin in hospital-acquired pneumonia

Biological markers such as procalcitonin, may be helpful for the diagnosis of HAP. Procalcitonin has greater diagnostic accuracy than most commonly used clinical parameters and other biomarkers of infection, such as C-reactive protein and ESR. The aim of the study was to assess the etiological and prognostic values of procalcitonin in adult patients with hospital acquired pneumonia [HAP]. 15 Patients with a strong suspicion of hospital acquired pneumonia. The diagnosis of HAP depends on the clinical criteria of pulmonary infection and presence of radiological findings. Complete blood picture, sputum culture and sensitivity, ESR, CRP and PCT were obtained at admission and repeated after 2 weeks. PCT was determined with Elecsys BRAHMS PCT in serum >f studied patients. Serum PCT above 0.5 microg/L was considered highly positive for diagnosis of HAP. It was significantly higher at admission [2.72 +/- 1.72 microg/L] than after two weeks [1.0 +/- 1.91 microg/L]. There was a statistical significant decrease in serup levels of procalcitonin [P = 0.002] in response to antibiotic therapy. Also the PCX was significantly higher in patients with bad outcome [2.11-6.0 microg/L] than patients with good outcome [1.76 +/- 0.69 microg/L]. Procalcitonin was significantly higher among patients with pseudomonas [5.53 +/- 0.50 microg/L] and acinetobacter [2.67 +/- 0.49 microg/L] and lesser among patients with Escherichia coli [1.38 +/- 0.06 microg/L] and MRSA [1.09 +/- 0.13 microg/L]. Procalcitonin was a good etiological and prognostic marker in hospital acquired pneumonia. PCX is the most specific biomarker and has a number of advantages over previous markers

Diagnostic and therapeutic implications of hypomagnesemia in respiratory intensive care unit

The present study aimed at determining: the frequency of serum Mg2 + abnormalities in respiratory ICU patients and its possible association with other electrolyte abnormalities or ECG changes; the possible effect of commonly used drugs in ICU on serum Mg2+ level and the impact of I.V. administration of MgSO4 in hypomagnesaemic patients on the course of severe asthma or COPD [chronic obstructive pulmonary diseases]. This study included 75 Patients divided into five groups: group I stable state of a] COPD [7 patients] and b] bronchial asthma [8 patients], group II acute exacerbation a] COPD [6 patients] and b] bronchial asthma [9 patients], group III [respiratory failure under mechanical ventilation], group IV [difficult weaning] and group V [status asthmaticus]. The following parameters were assessed: serum electrolytes [Mg[2] +, Na+, K+ and Ca[2] +],ECG, respiratory functions when possible [FEVI, FVC and PEFR] and arterial blood gases [PaO2 and PaCO2]. 77.33% of studied patients were normomagnesaemic, 16% were hypomagnesaemic and 6.6% were hypermagnesaemic. The incidences of hyponatraemia, hypokalaemia and hypocalcaemia in hypomagnesaemic patients were 25%, 33.33% and 25% respectively. ECG changes seemed to be more frequent in hypomagnesemia than in normomagnesaemic patient however, these differences were statistically insignificant. beta2 -agonists, diuretics, corticosteroids and parenteral glucose were accompanied with significantly lower serum Mg[2] + level as compared to an adjusted mean of normal range. Magnesium replacement therapy significantly improved serum Mg[2] + deficiency, ECG abnormalities and arterial blood gases in 4 out of 12 hypomagnesaemic patients as compared to their baseline. On the other hand, a single infusion of 2 gm MgSO4 over 20 minutes significantly improved clinical signs and symptoms as well as PaO2 and PaCO2 in 4 patients with severe acute asthma but not in COPD as compared to their baseline measurements. [1] A 16% incidence of hypomagnesemia was found, along with other electrolyte abnormalities in the respiratory ICU patients. [2] Because of its potential negative pathophysiologic effects on cardiac and respiratory functions, serum Mg2] + determination is recommended in such patients especially in those taking beta2 -agonists, diuretics, corticosteroids and parenteral glucose. [3] Mg[2] + replacement therapy significantly improved the clinical outcome in some hypomagnesaemic patients. [4] A single I.V. infusion of MgSO4 improved clinical outcome and arterial blood gases in some severe asthmatic patients but not in COPD