Clinica chimica acta; international journal of clinical chemistry
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We compared the diagnostic utilities of procalcitonin (PCT) and C-reactive protein (CRP) for predicting bacteremia diagnosed by blood cultures. PCT was also evaluated as a parameter for differentiating true bacteremia from culture contamination. ⋯ PCT concentration by single testing was more useful for predicting bacteremia than CRP. PCT also exhibited diagnostic utility for ruling out blood culture contamination. Thus, PCT could be helpful in the accurate diagnosis of bacteremia.
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Concomitant use of opioids and benzodiazepines can result in significant untoward effects. Point of care (POC) urine testing devices are commonly used tools to monitor patient use of medications. These useful devices are relatively inexpensive and yield immediate results that can be acted upon at the time of the appointment, although numerous limitations have been identified for specific medications or medication classes. We established the diagnostic accuracy of a commonly used POC testing method for benzodiazepines. ⋯ POC immunoassay for benzodiazepines could fail to provide accurate information regarding patient specific medication use. The false positive and false negative rates of the immunoassay were particularly high for clonazepam and lorazepam. Further testing of patient specimens using more accurate methods such as LC-MS/MS is necessary to provide definitive data that can assist in clinical decision making, and potentially protect these patients from untoward effects, morbidity and mortality.
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Point-of-care devices for performing a prothrombin time/international normalized ratio (PT/INR) using capillary blood samples are being increasingly used to monitor patients receiving anticoagulation therapy. However, the performance of some devices has been shown to be suboptimal and there are only limited published data comparing specific devices to various central laboratory coagulation analyzers. We report an evaluation of the iSTAT PT/INR with a comparison to the Tcoag MDA II analyzer. ⋯ The iSTAT PT/INR compares well to the MDA II when performed by phlebotomists or nurses.
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Red blood cell distribution width (RDW) has been shown to predict clinical outcomes in cardiovascular diseases. We studied whether RDW is useful to predict early mortality in patients with acute dyspnea at an emergency department (ED). ⋯ Our findings suggest that RDW measured at ED is an independent and additive predictor of early mortality in patients with acute dyspnea.
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Comparative Study
Prognostic value of combining high sensitive troponin T and N-terminal pro B-type natriuretic peptide in chest pain patients with no persistent ST-elevation.
The aim was to examine whether high sensitive troponin T (Hs-TnT) is better than conventional troponins to risk stratify chest pain patients, in particular when applying early serial measurements or combining with natriuretic peptides. Samples were obtained on admission and after 2 h in 231 chest pain patients who were followed for a median time of 22 months. Troponin levels were determined by Hs-TnT, conventional TnT (Roche Diagnostics) and troponin I (Beckman Coulter) assays. ⋯ In those with negative TnI, Hs-TnT identified 26 patients of whom 23% had subsequent events. After adjusting for differences in baseline characteristics, both Hs-TnT and NT-proBNP were independently associated with short-term (3 months) risk of combined endpoint and long-term risk of death or MI. By combining Hs-TnT and NT-proBNP patients could be divided into low-, intermediate- and high-risk groups.