Journal of critical care
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Journal of critical care · Feb 2018
Neutrophil CD64, C-reactive protein, and procalcitonin in the identification of sepsis in the ICU - Post-test probabilities.
We were interested in whether C-reactive protein (CRP) and procalcitonin (PCT) distinguish sepsis from non-septic controls and whether a combination of CRP, PCT, and neutrophil CD64 improves identification of sepsis in the intensive care unit (ICU). ⋯ Neutrophil CD64 expression was superior to PCT and CRP for the identification of sepsis in ICU. Positive post-test probability for any combinations of simultaneously analyzed CRP, PCT and CD64 showed improved diagnostic accuracy for sepsis. This approach may be useful for guiding antibiotic treatment in ICU.
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Journal of critical care · Feb 2018
Critical Care and Personalized or Precision Medicine: Who needs whom?
The current paradigm of modern healthcare is a reactive response to patient symptoms, subsequent diagnosis and corresponding treatment of the specific disease(s). This approach is predicated on methodologies first espoused by the Cnidean School of Medicine approximately 2500years ago. More recently escalating healthcare costs and relatively poor disease treatment outcomes have fermented a rethink in how we carry out medical practices. ⋯ Practitioners of CCM have been participating in Personalized Medicine unknowingly as it takes the protocols of sepsis, mechanical ventilation, and daily awakening trials and applies it to each individual patient. However, the immediate next step for CCM should be an active development of Precision Medicine. This developmental process should break down the silos of modern medicine and create a multidisciplinary approach between clinicians and basic/translational scientists.
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Journal of critical care · Feb 2018
The effect of early renal replacement therapy guided by plasma neutrophil gelatinase associated lipocalin on outcome of acute kidney injury: A feasibility study.
The optimal time and the parameter utilized for decision to initiate renal replacement therapy (RRT) in acute kidney injury (AKI) are still controversial. Recently, high levels of plasma NGAL (pNGAL) has been strongly correlated with poor AKI outcome. This is a feasibility study conducted to test whether early RRT initiation guided by pNGAL could improve AKI outcome. ⋯ Our finding suggested that it was feasible to use pNGAL to triage severe AKI patients. However, early initiation of RRT in this high risk group did not affect the 28-day mortality.