Pomen koncentracije prokalcitonina v serumu pri pacientih okuženih s SARS-CoV-2

Čižman, Nina (author), Osredkar, Joško (mentor)

Decembra 2019 se je na Kitajskem prvič pojavil nov sev koronavirusa, imenovan SARSCoV-2. Virus se je hitro razširil čez celoten svet ter povzročil več milijonov okužb in smrti. Bolezen COVID-19 je lahko asimptomatska ali simptomatska z najpogosteje izraženim kašljem, vročino, oteženim dihanjem ter izgubo vonja in okusa. Pojavi pa se lahko tudi težja oblika bolezni, kjer je potrebno zdravljenje na intenzivni enoti. Za prepoznavanje kritično bolnih, spremljanje poteka bolezni, napovedovanje izida bolezni ter ocenjevanje uspešnosti zdravljenja je pomembna uporaba rutinskih laboratorijskih testov. V okviru magistrske naloge smo želeli preučiti pomen prokalcitonina pri pacientih okuženih s SARS-CoV-2. Meritve PCT smo izvajali na analizatorju Pathfast in Advia Centaur XP na 112 vzorcih serumske krvi pacientov, hospitaliziranih na oddelku intenzivne enote diagnostično terapevtskega servisa. 71 % vzorcev je imelo koncentracijo PCT povišano nad referenčno območje (0,1 µg/L). Povprečna koncentracija PCT, izmerjena na analizatorju Pathfast je bila 2,3798 µg/L in 2,8446 µg/L na analizatorju Advia Centaur XP. Podrobneje smo preučili dva pacienta, kjer smo opazovali potek krvnih parametrov glede na datum odvzema vzorca. Vrednosti PCT so se spreminjale s potekom bolezni, ob zapletih so se poviševale, ob izboljšanju zdravstvenega stanja pa zniževale. Ob bakterijski okužbi sta bila povišana predvsem PCT in CRP, ki sta se ob ustreznem antibiotičnem zdravljenju zniževala. Pred dodajanjem kisika sta bili povišani predvsem vrednosti IL-6 in CRP. PCT najbolje korelira s CRP, sledi IL-6 in najslabše z D-dimerom (Spearmanov koeficient: 0,507, 0,437 in 0,194). Zaključimo lahko, da je PCT v kombinaciji z ostalimi v pomoč pri diagnosticiranju ter napovedovanju prognoze bolezni. Z napredovanjem tehnologije se je uveljavilo testiranje ob pacientu (POCT), ki je še posebej pomembno v enotah intenzivne medicine, saj omogoča takojšnjo razpoložljivost rezultata. Ujemanje rezultatov meritev PCT med POCT (analizator Pathfast) in klasično laboratorijsko metodo (analizator Advia Centaur XP) smo preverili s Passing-Bablok regresijsko analizo in Bland-Altmanovo analizo v programu MedCalc. Spearmanov korelacijski koeficient med metodama znaša 0,986, kar označuje odlično korelacijo. Analizator Pathfast izmeri povprečno za 0,3527 µg/L nižje rezultate, do razlik med meritvama prihaja predvsem ob višjih koncentracijah. Metodi sta medsebojno primerljivi in zamenljivi.

• Language: Slovenian
• Keywords: COVID-19, SARS-CoV-2, prokalcitonin, analizator Pathfast
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2022
• PID: 20.500.12556/RUL-134665
• Publication date in RUL: 25.01.2022

Secondary language

• Language: English
• Title: Significance of procalcitonin serum levels in patients with SARS-CoV-2 infection

Abstract

In December 2019, a new strain of coronavirus called SARS-CoV-2 first appeared in China. The virus has spread rapidly around the world, causing millions of infections and deaths. The COVID-19 disease can be asymptomatic or symptomatic, with the most common symptoms being cough, fever, shortness of breath, and loss of smell and taste. A more severe form of the disease may also occur, requiring treatment in an intensive care unit. The use of routine laboratory tests is important to identify critically ill patients, monitor the course of the disease, predict the outcome of the disease and evaluate the effectiveness of treatment. As part of the master's thesis, we aimed to study the significance of procalcitonin in patients infected with SARS-CoV-2. Procalcitonin measurements were performed using a Pathfast and Advia Centaur XP analyzer on 112 serum blood samples from patients hospitalized in the intensive care unit of the diagnostic and therapeutic service. In 71 % of the samples, the concentration of PCT was above the reference range (0.1 µg / L). The mean PCT concentration measured on the Pathfast analyzer was 2.3798 µg / L and 2.8446 µg / L on the Advia Centaur XP analyzer. We observed more closely two patients in whom we observed changes in blood parameters depending on the date of sampling. Values of the PCT changed with the progression of the disease, increasing as a result of complications and decreasing when the health condition improved. In the presence of bacterial infection, PCT and CRP were elevated, but decreased with appropriate antibiotic treatment. Elevated IL-6 and CRP levels indicated oxygen demands. The highest correlation is between PCT and CRP, followed by correlation with IL-6 and, finally, the lowest correlation with D-dimer (Spearman coefficient: 0.507, 0.437 and 0.194). We can conclude that PCT in combination with other blood parameters is helpful in diagnosis and prediction of the disease prognosis. POCT is especially important in intensive care units, where it allows immediate availability of the result. We have confirmed the agreement of PCT measurements between POCT and the classical laboratory method with the Passing-Bablok regression analysis and BlandAltman analysis. The Spearman's correlation coefficient between the methods is 0.986, indicating an excellent correlation. The Pathfast analyzer measures on average 0.3527 µg / L lower results, the differences between the measurements occur mainly at higher concentrations. The methods are comparable and interchangeable.

• Keywords: COVID-19, SARS-CoV-2, procalcitonin, Pathfast analyzer