Introduction: This study was conducted to assess the efficacy of point-of-care (POC) procalcitonin (PCT) serial measurement in determining the antibiotic treatment duration in patients with ventilator-associated pneumonia (VAP).Material and methods: One hundred patients were randomly recruited and then further randomly divided into two groups of 50 patients each. The first group used the POC PCT test along with the standard sepsis parameter monitoring, while the second group had the standard monitoring only (C-reactive protein [CRP] level, total white count, temperature and tracheal aspirate culture). Serial PCT test results and CRP levels were monitored on days 1, 3, 7 and 9. The patients were followed up for 28-day mortality.Results: Eighty-five patients completed the trial, of whom 43 were in the PCT group and 42 were in the control group. The PCT group had a significantly lower mean (SD) antibiotic treatment duration (10.28 [2.68] days) than the control group (11.52 [3.06]). The mean (SD) difference was −1.25 (95% confidence interval [CI], −2.48 to 0.01; t-statistic [df] = −1.997 [83]; P = 0.049). The PCT group also had a higher number of antibiotic-free days alive during the 28 days after VAP onset than the control group (mean [SD], 10.79 [7.61] vs. 8.72 [6.41]). The Sequential Organ Failure Assessment score was the sole factor for the decrease in duration after VAP onset (regression coefficient β [95% CI], −0.70 [−1.19 to −0.20]; P = 0.006).Conclusions: The POC procalcitonin test can reduce the antibiotic treatment duration in patients with VAP.

Sepsis is a major cause of mortality and morbidity in intensive care units. This case–control study aimed to investigate the haematology cell population data and extended inflammatory parameters for sepsis management. The study included three groups of patients: sepsis, non-sepsis, and healthy controls. Patients suspected of having sepsis underwent a Sequential Organ Failure Assessment (SOFA) evaluation and had blood drawn for blood cultures, complete peripheral blood counts (CBC), and measurements of various markers such as C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). We observed significant changes in numerous CBC parameters and extended inflammation parameters (EIPs), in addition to significant biochemical analysis markers CRP and IL-6 in sepsis cohorts. Multiple logistic regression analyses showed that combining different CBC parameters and EIPs were effective to profile these patients. Two different models have been developed using white blood cell counts and their extended parameters. Our findings indicate that the absolute counts of white blood cells, and the EIPs which reflect their activation states, are important for the prediction and assessment of sepsis, as the body responds to an insult that triggers an immune response. In an emergency situation, having timely updates on patient conditions becomes crucial for guiding the management process. Identifying trends in these specific patient groups will aid early diagnosis, complementing clinical signs and symptoms, especially as CBC is the most commonly ordered test in a diagnostic workup.

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient’s hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient’s condition worsened, and she succumbed to death on day 7 of hospitalization.

Background: Sepsis and septic shock are the leading causes of critical care-related mortality worldwide. This study aimed to determine the prevalence of sepsis, its intensive care unit (ICU) mortality rate and the factors associated with both ICU mortality and prolonged stay. Methods: A prospective cohort study was conducted from January 2019 to December 2019 with adult patients presenting evidence of sepsis who were admitted to the ICU. Parameters were assessed in the ICU to determine the association with all-cause ICU mortality and prolonged stay. Results: Out of 607 adults, 292 with sepsis were admitted to the ICU in 2019, with a mean age of 50.98 (standard deviation [SD] = 17.75) years old. There was, thus, a 48% incidence of sepsis. Mortality was observed in 78 patients (mortality rate = 26.7%) (95% confidence interval [CI]: 21.7, 32.2). Patients with higher Glasgow coma scale (GCS) scores had lower odds of ICU mortality (adjusted odds ratio [OR] = 0.90; 95% CI: 0.82, 0.98; P = 0.019), while patients with higher sequential organ failure assessment (SOFA) scores had higher odds (adjusted OR = 1.22; 95% CI: 1.11, 1.35; P < 0.001). Eighty patients (37.4%) who survived had prolonged ICU stays (95% CI: 30.9, 44.2). Patients with higher albumin levels had lower odds of a prolonged ICU stay (adjusted OR = 0.94; 95% CI: 0.90, 0.98; P = 0.006) and patients on renal replacement therapy had higher odds of a prolonged ICU stay (adjusted OR = 1.25; 95% CI: 1.74, 7.12; P < 0.001). Conclusion: Our study identified a sepsis prevalence of 48% and an ICU mortality rate of 26.7% among adult patients admitted to the ICU. GCS and SOFA scores were the most important factors associated with ICU mortality.

Non-invasive ventilation (NIV) is not proven to be effective in treating respiratory failure in severe pneumonia. However, some clinicians nevertheless attempt NIV to indirectly deliver adequate oxygenation and avoid unnecessary endotracheal intubation. In this article, we report the case of a 24-year-old woman at 32 weeks' gestation who presented with hypoxemic respiratory failure requiring mechanical ventilation. She was successfully managed by NIV. However, NIV must be managed by providers who are trained in mechanical ventilation. This is of the utmost importance in avoiding any delay should the patient's condition worsen and require endotracheal intubation. Moreover, in pregnant women, the severity of illness may progress quickly due to the immunosuppression inherent in these patients. Special attention should be given to the choices of invasive ventilation and NIV to manage community acquired pneumonia patients in third trimester.

Introduction: Procalcitonin (PCT) has attracted significant attention as a novel biomarker of sepsis. This study aimed to assess the agreement between blood results of PCT, obtained using the Finecare™ FIA Meter Plus (FS113), a point-of-care (POC) procalcitonin testing device, and the automated Elecsys® BRAHMS PCT assay on the Cobas e411, among critically ill septic patients. Methodology: This observational study was conducted in the intensive care unit of Hospital Universiti Sains Malaysia, in 2021. Whole blood samples were collected and tested with the Finecare™ FIA Meter Plus (FS113) (Wondfo, China) for PCT measurement. Additionally, the same whole blood samples were centrifuged to produce plasma samples, which were then analyzed using the automated Elecsys® BRAHMS PCT assay on the Cobas e411 (Roche Diagnostics, Germany). Results: A total of 40 samples were analyzed in this study. Both PCT measurement techniques demonstrated a significant correlation, with a correlation coefficient of 0.96. Regression analysis revealed the following results: an Ordinary Least Square (OLS) slope of 0.91 (95% CI 0.83, 1.00) with an intercept of 1.27 (95% CI -0.75, 3.29); a Deming slope of 0.95 (95% CI 0.80, 1.10) with an intercept of 0.77 (95% CI -0.44, 1.85); and a Passing-Bablok slope of 1.16 (95% CI 0.99, 1.36) with an intercept of 0.22 (95% CI 0.08, 0.58). Conclusion: The point-of-care procalcitonin measurement provided by the Finecare™ FIA Meter Plus presents a viable alternative for assessing procalcitonin levels among septic patients in the intensive care unit (ICU). Abbreviations: CLIA- chemiluminescence immunoassays; PCT- Procalcitonin; POC- Point-of-care Key words: procalcitonin, point of care, sepsis, Intensive care unit Citation: Ismail MA, Mazlan MZ, Hassan SK, Azman WNW, Koon TS, Yaacob NM, Omar M, Mohamad NAN. Evaluation of agreement between point-of-care and laboratory automated immunoassay in procalcitonin measurement among critically ill patients. Anaesth. pain intensive care 2023;27(4):470−477; DOI: 10.35975/apic.v27i4.2277 Received: November 27, 2022; Reviewed: July 11, 2023; Accepted: July 11, 2023