The objective of this study was to evaluate the prognostic value of C-reactive protein (CRP), procalcitonin (PCT), and their combination for mortality in patients with septic shock. This multicenter, prospective, observational study was conducted between November 2015 and December 2017. A total of 1,772 septic shock patients were included, and the overall 28-day mortality was 20.7%. Although both CRP and PCT were elevated in the non-survivor group, only CRP had statistical significance (11.9 mg/dL vs. 14.7 mg/dL, p = 0.003, 6.4 ng/mL vs. 8.2 ng/mL, p = 0.508). Multivariate analysis showed that CRP and PCT were not independent prognostic markers. In the subgroup analysis of the CRP and PCT combination matrix using their optimal cut-off values (CRP 14.0 mg/dL, PCT 17.0 ng/dL), both CRP and PCT elevated showed significantly higher mortality (Odds ratio 1.552 [95% Confidence intervals 1.184–2.035]) than both CRP and PCT not elevated (p = 0.001) and only PCT elevated (p = 0.007). However, both CRP and PCT elevated was also not an independent predictor in multivariate analysis. Initial levels of CRP and PCT alone and their combinations in septic shock patients had a limitation to predict 28-day mortality. Future research is needed to determine new biomarkers for early prognostication in patients with septic shock.

We performed a meta-analysis to seek evidence for the usefulness of the delta neutrophil index (DNI) as a prognostic blood biomarker for mortality in the early stage of sepsis in adults. A literature search was performed using criteria set forth in a predefined protocol. Studies of adults with sepsis that provided a DNI measurement and that had mortality as the outcome, were included. Review articles, editorials, and non-human studies were excluded. The methodological quality of identified studies was assessed independently by two authors using the Quality in Prognosis Studies (QUIPS) tool. A total of 1,822 patients from eleven studies were ultimately included. Standardized mean differences between non-survivors and survivors were compared. An elevated DNI was associated with mortality in patients with sepsis (standardized mean difference [SMD] 1.22; 95% confidence interval 0.73–1.71; I² = 91%). After excluding two studies—one that included paediatric patients and one with a disproportionately low mortality rate—heterogeneity was minimized (SMD 0.74, 95% confidence interval 0.53–0.94; I² = 43%). Overall, the findings suggest that high DNI values are associated with mortality in septic patients.

Worldwide, an estimated 6 million patients seek medical attention for burns annually. Various treatment methods and materials have been investigated and developed to enhance burn wound healing. Recently, a new technology, plasma medicine, has emerged to offer new solutions in wound care. As the development of plasma medicine has shown benefit in wound healing, we aimed to assess the effects of plasma medicine on burn wounds. To investigate the effectiveness of a nonthermal atmospheric pressure plasma jet (NAPPJ) for burn wound treatment on a brass comb burn wound rat model. Burn wounds were made by applying a preheated brass comb (100°C) for 2 minutes, which resulted in four full-thickness burn wounds separated by three interspaces. Interspaces were exposed to NAPPJ treatment for 2 minutes and morphological changes and neutrophil infiltration were monitored at 0, 4, and 7 days post-wounding. The percentage of necrotic interspace was higher in the control group than in the plasma-treated group (51.8 ± 20.5% vs 31.5 ± 19.0%, P < .001). Moreover, the exposure of interspace to NAPPJ greatly reduced the number of infiltrating neutrophils. In addition, the percentage of interspace that underwent full-thickness necrosis in the plasma-treated group was smaller than that in the control group (28% vs 67%). NAPPJ exposure on interspaces has a positive effect on burn wounds leading to wound healing by reducing burn injury progression.