Background
To assess the ability of procalcitonin (PCT) to distinguish between bacterial and nonbacterial causes of patients with severe acute exacerbation of COPD (AECOPD) admitted to the ICU, we ...conducted a retrospective analysis of two prospective studies including 375 patients with severe AECOPD with suspected lower respiratory tract infections. PCT levels were sequentially assessed at the time of inclusion, 6 h after and at day 1, using a sensitive immunoassay. The patients were classified according to the presence of a documented bacterial infection (including bacterial and viral coinfection) (BAC + group), or the absence of a documented bacterial infection (i.e., a documented viral infection alone or absence of a documented pathogen) (BAC- group). The accuracy of PCT levels in predicting bacterial infection (BAC + group) vs no bacterial infection (BAC- group) at different time points was evaluated by receiver operating characteristic (ROC) analysis.
Results
Regarding the entire cohort (
n
= 375), at any time, the PCT levels significantly differed between groups (Kruskal–Wallis test,
p
< 0.001). A pairwise comparison showed that PCT levels were significantly higher in patients with bacterial infection (
n
= 94) than in patients without documented pathogens (
n =
218) (
p
< 0.001). No significant difference was observed between patients with bacterial and viral infection (
n
= 63). For example, the median PCT-H
0
levels were 0.64 ng/ml 0.22–0.87 in the bacterial group vs 0.24 ng/ml 0.15–0.37 in the viral group and 0.16 ng/mL 0.11–0.22 in the group without documented pathogens. With a c-index of 0.64 (95% CI; 0.58–0.71) at H
0
, 0.64 95% CI 0.57–0.70 at H
6
and 0.63 (95% CI; 0.56–0.69) at H
24
, PCT had a low accuracy for predicting bacterial infection (BAC + group).
Conclusion
Despite higher PCT levels in severe AECOPD caused by bacterial infection, PCT had a poor accuracy to distinguish between bacterial and nonbacterial infection. Procalcitonin might not be sufficient as a standalone marker for initiating antibiotic treatment in this setting.
Importance Blood transfusion is a mainstay of therapy for trauma-induced coagulopathy, but the optimal modalities for plasma transfusion in the prehospital setting remain to be defined. Objective To ...determine whether lyophilized plasma transfusion can reduce the incidence of trauma-induced coagulopathy compared with standard care consisting of normal saline infusion. Design, Setting, and Participants This randomized clinical trial was performed at multiple centers in France involving prehospital medical teams. Participants included 150 adults with trauma who were at risk for hemorrhagic shock and associated coagulopathy between April 1, 2016, and September 30, 2019, with a 28-day follow-up. Data were analyzed from November 1, 2019, to July 1, 2020. Intervention Patients were randomized in a 1:1 ratio to receive either plasma or standard care with normal saline infusion (control). Main Outcomes and Measures The primary outcome was the international normalized ratio (INR) on arrival at the hospital. Secondary outcomes included the need for massive transfusion and 30-day survival. As a safety outcome, prespecified adverse events included thrombosis, transfusion-related acute lung injury, and transfusion-associated circulatory overload. Results Among 150 randomized patients, 134 were included in the analysis (median age, 34 IQR, 26-49 years; 110 men 82.1%), with 68 in the plasma group and 66 in the control group. Median INR values were 1.21 (IQR, 1.12-1.49) in the plasma group and 1.20 (IQR, 1.10-1.39) in the control group (median difference, −0.01 IQR, −0.09 to 0.08;P = .88). The groups did not differ significantly in the need for massive transfusion (7 10.3% vs 4 6.1%; relative risk, 1.78 95% CI, 0.42-8.68;P = .37) or 30-day survival (hazard ratio for death, 1.07 95% CI, 0.44-2.61;P = .89). In the full intention-to-treat population (n = 150), the groups did not differ in the rates of any of the prespecified adverse events. Conclusions and Relevance In this randomized clinical trial including severely injured patients at risk for hemorrhagic shock and associated coagulopathy, prehospital transfusion of lyophilized plasma was not associated with significant differences in INR values vs standard care with normal saline infusion. Nevertheless, these findings show that lyophilized plasma transfusion is a feasible and safe procedure for this patient population. Trial Registration ClinicalTrials.gov Identifier:NCT02736812
IMPORTANCE Blood transfusion is a mainstay of therapy for trauma-induced coagulopathy, but the optimal modalities for plasma transfusion in the prehospital setting remain to be defined. OBJECTIVE To ...determine whether lyophilized plasma transfusion can reduce the incidence of trauma-induced coagulopathy compared with standard care consisting of normal saline infusion. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was performed at multiple centers in France involving prehospital medical teams. Participants included 150 adults with trauma who were at risk for hemorrhagic shock and associated coagulopathy between April 1, 2016, and
Sources d’énergie renouvelable, le solaire et l’éolien sont par nature intermittents. La gestion de leur production d’électricité est donc un problème à solutions multiples. Toutes ne sont cependant ...pas compatibles avec la nécessité de réduire les émissions de gaz à effet de serre et de prévenir ainsi la menace d’un changement climatique.
Malignancy is a possible cause of unexplained encephalitis.
We describe a 59-years-old woman with limbic encephalitis, not explained by other causes, preceding diagnosis of Hodgkin's disease. ...Successful treatment of Hodgkin's disease was effective against neurological disturbance.
This case provides evidence that Hodgkin's disease can be uncovered by paraneoplastic limbic encephalitis.
Introduction. –
En présence d’une encéphalite inexpliquée, une étiologie paranéoplasique doit être systématiquement envisagée.
Exégèse. –
Nous rapportons l’observation d’une femme de 59 ans qui a ...présenté un tableau d’encéphalite limbique. L’enquête a conduit à la découverte d’une maladie de Hodgkin. Le traitement de l’hémopathie s’est avéré efficace sur le tableau neurologique.
Conclusion. –
Cette observation rappelle que l’encéphalite limbique est une cause rare de syndrome neurologique paranéoplasique associé à la maladie de Hodgkin.
Introduction. –
Malignancy is a possible cause of unexplained encephalitis.
Exegesis. –
We describe a 59-years-old woman with limbic encephalitis, not explained by other causes, preceding diagnosis of Hodgkin’s disease. Successful treatment of Hodgkin’s disease was effective against neurological disturbance.
Conclusion. –
This case provides evidence that Hodgkin’s disease can be uncovered by paraneoplastic limbic encephalitis.
PDF
