scholarly journals Invasive Monitoring of Intracranial Pressure After Decompressive Craniectomy in Malignant Stroke

Stroke ◽  
2020 ◽  
Author(s):  
Silvia Hernández-Durán ◽  
Leonie Meinen ◽  
Veit Rohde ◽  
Christian von der Brelie
Keyword(s):  
Intracranial Pressure ◽  
Mortality Rate ◽  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
High Specificity ◽  
Invasive Monitoring ◽  
Icp Monitoring ◽  
Characteristic Analysis ◽  
Decompressive Hemicraniectomy

Background and Purpose: The role of decompressive hemicraniectomy (DC) in malignant cerebral infarction (MCI) has clearly been established, but little is known about the course of intracranial pressure (ICP) in patients undergoing this surgical measure. In this study, we investigated the role of invasive ICP monitoring in patients after DC for MCI, postulating that postoperative ICP predicts mortality. Methods: In this retrospective observational study of MCI patients undergoing DC, ICP were recorded continuously in hourly intervals for the first 72 hours after DC. For every hour, mean ICP was calculated, pooling ICP of every patient. A receiver operating characteristic analysis was performed for hourly mean ICP. A subgroup analysis by age (≥60 years and <60 years) was also performed. Results: A total of 111 patients were analyzed, with 29% mortality rate in patients <60 years, and 41% in patients ≥60 years. A threshold of 10 mm Hg within the first 72 postoperative hours was a reliable predictor of mortality in MCI, with an acceptable sensitivity of 70% and high specificity of 97%. Established predictors of mortality failed to predict mortality. Conclusions: Our study suggests the need to reevaluate postoperative ICP after DC in MCI and calls for a redefinition of ICP thresholds in these patients to indicate further therapy.

scholarly journals Diagnostic utility of a Ferritin-to-Procalcitonin Ratio to differentiate patients with COVID-19 from those with Bacterial Pneumonia: A multicenter study

2021 ◽  
Author(s):  
Amal A Gharamti ◽  
Fei Mei ◽  
Katherine C Jankousky ◽  
Jin Huang ◽  
Peter Hyson ◽  
...  
Keyword(s):  
Bacterial Pneumonia ◽  
Operating Characteristic ◽  
Case Control Study ◽  
Receiver Operating Characteristic Analysis ◽  
Similar Proportion ◽  
Characteristic Analysis ◽  
Multivariable Analyses ◽  
Prevalence Of Diabetes Mellitus ◽  
Control Study

Abstract Background There is an urgent need for accurate, rapid, inexpensive biomarkers that can differentiate COVID-19 from bacterial pneumonia. We assess the role of the ferritin-to-procalcitonin (F/P) ratio to classify pneumonia cases into those due to COVID-19 or due to bacterial pathogens. Methods This multicenter case-control study compared patients with either COVID-19 and bacterial pneumonia, admitted between March 1 and May 31, 2020. Patients with COVID-19 and bacterial pneumonia co-infection were excluded. The F/P in patients with COVID-19 or with bacterial pneumonia were compared. Receiver operating characteristic analysis determined the sensitivity and specificity of various cut-off F/P values for COVID-19 versus bacterial pneumonia. Results A total of 242 COVID-19 pneumonia cases and 34 bacterial pneumonia controls were included. Patients with COVID-19 pneumonia had a lower mean age (57.11 vs 64.4 years, p=0.02) and a higher BMI (30.74 vs 27.15 kg/m 2, p=0.02) compared to patients with bacterial pneumonia. Cases and controls had a similar proportion of women (47% vs 53%, p=0.5) and COVID-19 patients had a higher prevalence of diabetes mellitus (32.6% vs 12%, p=0.01). The median F/P was significantly higher in patients with COVID-19 (4037.5) compared to the F/P in bacterial pneumonia (802, p&lt;0.001). An F/P ≥ 877 used to diagnose COVID-19 resulted in a sensitivity of 85% and a specificity of 56%, with a positive predictive value of 93.2%, and a likelihood ratio of 1.92. In multivariable analyses, an F/P ≥ 877 was associated with greater odds of identifying a COVID-19 case (OR: 11.27, CI: 4-31.2, p&lt;0.001). Conclusion An F/P ≥ 877 increases the likelihood of COVID-19 pneumonia compared to bacterial pneumonia.

scholarly journals The role of ICP monitoring in meningitis

2017 ◽  
Vol 43 (5) ◽  
pp. E7 ◽  
Author(s):  
Areej Tariq ◽  
Pedro Aguilar-Salinas ◽  
Ricardo A. Hanel ◽  
Neeraj Naval ◽  
Mohamad Chmayssani
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Mortality Rate ◽  
Intracranial Hypertension ◽  
Clinical Outcomes ◽  
Icp Monitoring ◽  
Review Of The Literature ◽  
Cns Infections

Intracranial pressure (ICP) monitoring has been widely accepted in the management of traumatic brain injury. However, its use in other pathologies that affect ICP has not been advocated as strongly, especially in CNS infections. Despite the most aggressive and novel antimicrobial therapies for meningitis, the mortality rate associated with this disease is far from satisfactory. Although intracranial hypertension and subsequent death have long been known to complicate meningitis, no specific guidelines targeting ICP monitoring are available. A review of the literature was performed to understand the pathophysiology of elevated ICP in meningitis, diagnostic challenges, and clinical outcomes in the use of ICP monitoring.

scholarly journals Intracranial pressure following decompressive hemicraniectomy for malignant cerebral infarction: clinical and treatment correlations

2018 ◽  
Vol 76 (12) ◽  
pp. 812-815 ◽  
Author(s):  
Bruno Ferreira Funchal ◽  
Maramélia Miranda Alves ◽  
Ítalo C. Suriano ◽  
Feres Eduardo Chaddad-Neto ◽  
Maria E. M. R. Ferraz ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Decompressive Craniectomy ◽  
Tertiary Hospital ◽  
National Institutes Of Health ◽  
Icp Monitoring ◽  
Decompressive Hemicraniectomy

ABSTRACT Decompressive craniectomy (DC) reduces mortality and improves outcome in patients with massive brain infarctions. The role of intracranial pressure (ICP) monitoring following DC for stroke has not been well established. Methods: We evaluated 14 patients admitted to a tertiary hospital with malignant middle cerebral artery infarctions, from October 2010 to February 2015, who underwent DC and had ICP monitoring. Patients with and without episodes of ICP elevation were compared. Results: Fourteen patients were submitted to DC and had ICP monitoring following the procedure during the period. Ten patients (71.4%) had at least one episode of sustained elevated ICP in the first seven days after surgery. Maximal ICP levels had no correlation with age, time to hemicraniectomy or Glasgow Coma Scores at admission, but had a trend toward correlation with the National Institutes of Health Stroke Scale score at admission (p = 0.1). Ventriculitis occurred in 21.4% of the patients. Conclusions: High ICP episodes and ventriculitis were common in patients following hemicraniectomy for malignant middle cerebral artery strokes. Therefore, the implications of ICP and benefits of the procedure should be firmly established.

scholarly journals 419. Diagnostic Utility of a Ferritin to Procalcitonin Ratio to Differentiate Patients with COVID-19 from Those with Bacterial Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S277-S277
Author(s):  
Katherine C Jankousky ◽  
Peter Hyson ◽  
Jin Huang ◽  
Daniel B Chastain ◽  
Carlos Franco-Paredes ◽  
...  
Keyword(s):  
Receiver Operating Characteristic ◽  
Host Response ◽  
Bacterial Pneumonia ◽  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
University Hospital ◽  
Characteristic Analysis ◽  
The Us ◽  
Test Probability ◽  
Receiver Operating

Abstract Background Accurate, rapid, inexpensive biomarkers are needed to differentiate COVID-19 from bacterial pneumonia, allowing effective treatment and antibiotic stewardship. We hypothesized that the ratio of ferritin to procalcitonin (F/P) reflects greater viral activity and host response with COVID-19 pneumonia, while bacterial pneumonia would be associated with less cytolysis (lower ferritin) and more inflammation (higher procalcitonin), thus a lower F/P ratio. Methods We conducted a retrospective study of adult patients admitted to a single University hospital in the US through May 2020, during the COVID-19 pandemic. We compared F/P ratio of patients diagnosed with COVID-19 or bacterial pneumonia, excluding patients with COVID-19 and bacterial co-infections. In a logistic regression, we controlled for age, sex, body mass index (BMI), diabetes (DM), and hypertension (HTN). We used a receiver operating characteristic analysis to calculate the sensitivity and specificity of F/P values for the diagnosis of COVID-19 versus bacterial pneumonia. Results Of 218 patients with COVID-19 and 17 with bacterial pneumonia, COVID-19 patients were younger (56 vs 66 years, p=0.04), male (66% vs 24%, p=0.009), had higher BMI (31 vs 27 kg/m2, p=0.03), and similar rates of HTN (59% vs 45%, p=0.3) and DM (32% vs 18%, p=0.2). The median F/P ratio was significantly higher in patients with COVID-19 (3195 vs 860, p=0.0003, Figure 1). An F/P ratio cut-off of ≥ 1250 generated a sensitivity of 78% and a specificity of 59% to correctly classify a COVID-19 case (Figure 2). When adjusted for age, gender, BMI, DM, and HTN, a ratio ≥ of 1250 was associated with significantly greater odds of COVID-19 versus bacterial pneumonia (OR: 4.9, CI: 1.5, 16.1, p=0.009). Figure 1. Ferritin to Procalcitonin Ratios of patients with COVID-19 and patients with Bacterial Pneumonia (controls). Figure 2. Receiver Operating Characteristic Analysis of Ferritin to Procalcitonin Ratio Cut-off Values Predicting COVID-19 Diagnosis. Conclusion We observed an elevated F/P ratio in patients with COVID-19 compared to those with bacterial pneumonia. A F/P ratio ≥ 1250 provides a clinically relevant increase in pre-test probability of COVID-19. Prospective studies evaluating the discriminatory characteristics of F/P ratio in larger cohorts is warranted. Disclosures All Authors: No reported disclosures

scholarly journals CXCL9 as a key biomarker of vitiligo activity and prediction of the success of cultured melanocyte transplantation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fuquan Lin ◽  
Wenting Hu ◽  
Wen Xu ◽  
Miaoni Zhou ◽  
Ai‑E. Xu
Keyword(s):  
Initial Treatment ◽  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
Healthy Controls ◽  
Blister Fluid ◽  
Characteristic Analysis ◽  
Curative Effect ◽  
Chemokine Ligand ◽  
Treatment Responses ◽  
Potential Biomarkers

AbstractThis study aimed to investigate the potential biomarkers of vitiligo by evaluating the disease activity and curative effect of autologous cultured pure melanocyte transplantation (CMT) on patients. Altogether, 36patients with stable vitiligo were treated with CMT. Blister fluid samples were collected from patients with stable vitiligo. Patients with active vitiligo were matched with healthy controls. The chemokine levels in the serum and blister fluid samples were measured using Luminex. The curative effect on patients with stable vitiligo was evaluated 6 months after treatment. Treatment responses were defined according to the extent of repigmentation as effective (if 50% or more repigmentation was achieved) or ineffective (if less than 50% or worse repigmentation was achieved). Patients received re-transplantation if the initial treatment was ineffective. The levels of C-X-C motif chemokine ligand (CXCL)9 and CXCL10 in blister fluid samples were significantly lower in stable patients than in active participants. Receiver operating characteristic analysis revealed that the levels of CXCL9 and CXCL10 were sensitive and specific in diagnosing active vitiligo. Further, 65.6% (21/32) of patients who received CMT had effective treatment responses. The high CXCL9 level in the blister fluid was a significant predictor of ineffective treatment responses. The treatment response was significantly enhanced after treatment. Four patients with ineffective treatment responses received anti-inflammatory treatment and re-transplantation. The CXCL9 and CXCL10 levels in the blister fluid were related to the presence of active vitiligo. Also, the CXCL9 level was a predictor of the effectiveness of CMT in treating vitiligo.

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