Utilidad de la procalcitonina para el diagnóstico de infección en el paciente crítico con cirrosis hepática / Usefulness of procalcitonin for diagnosing infection in critically ill patients with liver cirrhosis

OBJETIVO: Analizar la utilidad de la procalcitonina (PCT) para el diagnóstico de infección en pacientes con cirrosis hepática ingresados en una unidad de cuidados intensivos. DISEÑO: Estudio observacional retrospectivo. ÁMBITO: unidad de cuidados intensivos. polivalente, 24 camas. PARTICIPANTES: Pacientes con cirrosis hepática ingresados en nuestra unidad de cuidados intensivos en los últimos 4 años con diagnóstico de sospecha de infección y determinación de PCT. RESULTADOS: Entre los 255 pacientes con cirrosis ingresados en nuestra unidad; se determinó la PCT para el diagnóstico diferencial de infección en 69 casos (27%). Tres pacientes fueron excluidos del análisis por falta de datos clínicos. La estancia media fue de 10,6 ± 9,2 días y la mortalidad del 65%. El origen de la cirrosis fue vírico (57%) o enólico (37%), con una puntuación de 9,5 ± 2 en la escala de Child-Pugh y 23±8 en la escala de MELD. En 54 pacientes (82%) se estableció el diagnóstico de infección. La infección más frecuente fue la neumonía (72%), seguida de la infección intraabdominal (18%), y la bacteriemia (5%). En los pacientes sin infección la mediana de PCT fue de 0,57 ng/ml (0,28-1,14) frente a 2,99 (1,31-9,4) p < 0,001 en aquellos con infección. La capacidad diagnóstica se mantuvo en los pacientes con infección intraabdominal. El punto de corte diagnóstico se estableció en 0,8ng/ml (sensibilidad 83%, especificidad 75%, AUC 0,82 [0,702-0,93]). CONCLUSIONES: En los pacientes con cirrosis hepática la PCT es útil para identificar la presencia de infecciones bacterianas incluyendo las intraabdominales

OBJECTIVE: To evaluate the usefulness of procalcitonin (PCT) for diagnosing infection in patients with liver cirrhosis admitted to an Intensive Care Unit. DESIGN: A retrospective study was carried out. SCOPE: Intensive Care Unit. Versatile, twenty-four beds. PARTICIPANTS: Patients with liver cirrhosis admitted to our Intensive Care Unit in the last four years with suspected infection and measurement of PCT. RESULTS: Among the 255 patients with cirrhosis admitted to our unit, PCT was determined for the differential diagnosis of infection in 69 cases (27%). Three patients were excluded from analysis due to a lack of clinical data. The average stay was 10.6 ± 9.2 days, with a mortality rate of 65%. The origin of cirrhosis was mainly viral (57%) or alcoholic (37%). The Child-Pugh and MELD scores were 9.5±2 and 23±8, respectively. Infection was diagnosed in 54 patients (82%). The most common infection was pneumonia (72%), followed by intraabdominal infections (18%) and bacteremia (5%). In patients without infection, the median PCT concentration was 0.57ng/ml (range 0.28 to 1.14) versus 2.99 (1.31 to 9.4) in those with infection (p <.001). Diagnostic capacity was maintained in patients with intraabdominal infections. The diagnostic cutoff point was set at 0.8ng/ml (sensitivity 83%, specificity 75%, AUC 0.82 [0.702-0.93]). CONCLUSIONS: In patients with liver cirrhosis, PCT is useful for identifying bacterial infections, including intraabdominal processes

[Usefulness of procalcitonin for diagnosing infection in critically ill patients with liver cirrhosis]. / Utilidad de la procalcitonina para el diagnóstico de infección en el paciente crítico con cirrosis hepatica.

OBJECTIVE: To evaluate the usefulness of procalcitonin (PCT) for diagnosing infection in patients with liver cirrhosis admitted to an Intensive Care Unit. DESIGN: A retrospective study was carried out. SCOPE: Intensive Care Unit. Versatile, twenty-four beds. Participants Patients with liver cirrhosis admitted to our Intensive Care Unit in the last four years with suspected infection and measurement of PCT. RESULTS: Among the 255 patients with cirrhosis admitted to our unit, PCT was determined for the differential diagnosis of infection in 69 cases (27%). Three patients were excluded from analysis due to a lack of clinical data. The average stay was 10.6 ± 9.2 days, with a mortality rate of 65%. The origin of cirrhosis was mainly viral (57%) or alcoholic (37%). The Child-Pugh and MELD scores were 9.5 ± 2 and 23 ± 8, respectively. Infection was diagnosed in 54 patients (82%). The most common infection was pneumonia (72%), followed by intraabdominal infections (18%) and bacteremia (5%). In patients without infection, the median PCT concentration was 0.57 ng/ml (range 0.28 to 1.14) versus 2.99 (1.31 to 9.4) in those with infection (p<.001). Diagnostic capacity was maintained in patients with intraabdominal infections. The diagnostic cutoff point was set at 0.8 ng/ml (sensitivity 83%, specificity 75%, AUC 0.82 [0.702-0.93]). CONCLUSIONS: In patients with liver cirrhosis, PCT is useful for identifying bacterial infections, including intraabdominal processes.

Human microglia cultures: a powerful model to study their origin and immunoreactive capacity.

In this paper, we report that pure cultures of human microglia were obtained from long-term astrocytic cultures of human fetal brain. After five to six months and repeated cell passages, macrophage-like cells started to spontaneously form in vitro, so that in two to three weeks the whole culture was populated by them. These cells were grown up to over 50 passages in culture and analyzed for morphology, specific marker positivity, growth rate and major histocompatibility complex (MHC) antigen expression with or without gamma-interferon (IFN) stimulation. We found that, regardless of embryonic age of original cultures (10-15 weeks of gestation), cultures showed a remarkable homogeneity and purity and over 90 stained for typical microglial markers. Under basal conditions, two cell subpopulations similar to those described in vivo, we observed: the reactive 'ameboid' type and the resting 'ramified' one, the latter increasing with time in vitro and cell passages. Both cell subpopulations were capable of active phagocytosis and of high-rate proliferation. They spontaneously expressed low levels of MHC class II antigens, but were negative for MHC class I. Stimulation with gamma-interferon lymphokine upregulated the MHC class II expression as well as the MHC class I heavy chain form in ameboid, 'reactive' cells but not in the ramified ones. We also found that beta 2 microglobulin, already expressed in basal conditions, was dissociated from HLA A-B-C molecules in lymphokine-stimulated cells at early passages. The physiological significance of these data, as well as the possible correlation with in vivo ontogenetic modifications, are also discussed.