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Article ; Online: One biomarker does not fit all: tailoring anti-infective therapy through utilization of procalcitonin and other specific biomarkers.

Essmann, Lennart / Wirz, Yannick / Gregoriano, Claudia / Schuetz, Philipp

2023 Volume 23, Issue 9, Page(s) 739–752

Abstract: Introduction: Considering the ongoing increase in antibiotic resistance, the importance of judicious use of antibiotics through reduction of exposure is crucial. Adding procalcitonin (PCT) and other biomarkers to pathogen-specific tests may help to ... ...

Abstract	Introduction: Considering the ongoing increase in antibiotic resistance, the importance of judicious use of antibiotics through reduction of exposure is crucial. Adding procalcitonin (PCT) and other biomarkers to pathogen-specific tests may help to further improve antibiotic therapy algorithms and advance antibiotic stewardship programs to achieve these goals. Areas covered: In recent years, several trials have investigated the inclusion of biomarkers such as PCT into clinical decision-making algorithms. For adult patients, findings demonstrated improvements in the individualization of antibiotic treatment, particularly for patients with respiratory tract infections and sepsis. While most trials were performed in hospitals with central laboratories, point-of-care testing might further advance the field by providing a cost-effective and rapid diagnostic tool in upcoming years. Furthermore, novel biomarkers including CD-64, presepsin, Pancreatic stone and sTREM-1, have all shown promising results for increased accuracy of sepsis diagnosis. Availability of these markers however is currently still limited and there is insufficient evidence for their routine use in clinical care. Expert opinion: In addition to new host-response markers, combining such biomarkers with pathogen-directed diagnostics present a promising strategy to increase algorithm accuracy in differentiating between bacterial and viral infections. Recent advances in microbiologic testing using PCR or nucleic amplification tests may further improve the diagnostic yield and promote more targeted pathogen-specific antibiotic therapy.
MeSH term(s)	Adult ; Humans ; Procalcitonin ; Sepsis/diagnosis ; Sepsis/drug therapy ; Biomarkers ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship/methods ; Peptide Fragments ; Lipopolysaccharide Receptors/therapeutic use
Chemical Substances	Procalcitonin ; Biomarkers ; Anti-Bacterial Agents ; presepsin protein, human ; Peptide Fragments ; Lipopolysaccharide Receptors
Language	English
Publishing date	2023-07-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2112530-2
ISSN	1744-8352 ; 1473-7159
ISSN (online)	1744-8352
ISSN	1473-7159
DOI	10.1080/14737159.2023.2242782
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Article ; Online: Hospital Outcomes in Medical Patients With Alcohol-Related and Non-Alcohol-Related Wernicke Encephalopathy.

Rasiah, Roshaani / Gregoriano, Claudia / Mueller, Beat / Kutz, Alexander / Schuetz, Philipp

Mayo Clinic proceedings

2023

Abstract: Objective: To conduct a nationwide retrospective cohort study to assess trends and hospitalization-associated outcomes in patients with Wernicke encephalopathy.: Patients and methods: In this nationwide retrospective cohort study, we used in-hospital ...

Abstract	Objective: To conduct a nationwide retrospective cohort study to assess trends and hospitalization-associated outcomes in patients with Wernicke encephalopathy. Patients and methods: In this nationwide retrospective cohort study, we used in-hospital claims data of patients hospitalized with Wernicke encephalopathy in Switzerland from January 1, 2012, to December 31, 2020. We estimated incidence rates per 100,000 person-years among the overall Swiss population stratified by alcohol and non-alcohol-induced Wernicke encephalopathy. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included progression to Korsakoff syndrome and 1-year hospital readmission. We estimated odds ratios (ORs) for binary outcomes. Results: It was found that 4098 of 4393 hospitalizations (93.3%) for Wernicke encephalopathy during the 8-year study were alcohol-related. Incidence rates for hospitalizations were 14-fold higher in alcohol-related compared with non-alcohol-related Wernicke encephalopathy (5.43 vs 0.39 per 100,000 person-years). The risk for in-hospital mortality was significantly lower in patients with alcohol-related vs non-alcohol-related Wernicke encephalopathy (3.2% vs 8.5%; adjusted OR, 0.38; 95% CI, 0.23 to 0.62). Patients with alcohol-related Wernicke encephalopathy had higher risk for development of Korsakoff syndrome (16.9% vs 1.7%; adjusted OR, 10.64; 95% CI, 4.37 to 25.92) and 1-year hospital readmission (31.6% vs 18.7%; adjusted OR, 1.4; 95% CI, 1.04 to 1.88). Conclusion: In this Swiss nationwide cohort study, Wernicke encephalopathy was a rare but serious cause for hospitalization and mainly alcohol-related. Patients with alcohol-related Wernicke encephalopathy had lower risks of in-hospital mortality but were more likely to develop Korsakoff syndrome and be readmitted to the hospital.
Language	English
Publishing date	2023-12-08
Publishing country	England
Document type	Journal Article
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2023.07.021
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Article ; Online: Rate of cardiovascular events up to 8 years after uncomplicated myocarditis: A nationwide cohort study.

Schelldorfer, Andreas / Gregoriano, Claudia / Hauser, Stephanie / Fuchs, Tobias A / Mueller, Beat / Schuetz, Philipp / Kutz, Alexander

European heart journal. Acute cardiovascular care

2024

Abstract: Background: While prognosis of acute myocarditis with uncomplicated presentation is perceived as benign, data on long-term outcomes is scarce. We evaluated rates of myocarditis-associated cardiovascular events after a first-time hospitalization with ... ...

Abstract	Background: While prognosis of acute myocarditis with uncomplicated presentation is perceived as benign, data on long-term outcomes is scarce. We evaluated rates of myocarditis-associated cardiovascular events after a first-time hospitalization with uncomplicated acute myocarditis in patients without known heart disease. Methods: In this retrospective nationwide population-based cohort study from 2013 to 2020, hospitalized patients with uncomplicated acute myocarditis but without known heart disease were 1:1 propensity score-matched with surgical controls hospitalized for laparoscopic appendectomy. As assessed in time-to-event analyses, the primary outcome was a composite of rehospitalization for myocarditis, pericardial disease, heart failure and its complications, arrhythmias, implantation of cardiac devices, and heart transplant. Results: After matching, we identified 1,439 patients with uncomplicated acute myocarditis (median age of 35 years, 74.0% male) and 1,439 surgical controls (median age of 36 years, 74.4% male). Over a median follow-up of 39 months, compared with surgical controls, the hazard ratio (HR) for the primary composite outcome was 42.3 (95% confidence interval [CI], 17.4 to 102.8), corresponding to an incidence rate (IR) of 43.7 vs. 0.9 per 1,000 patient-years (py) and an incidence rate difference (IRD) of 42.7 (95% CI, 36.7 to 48.8) per 1,000 py. Conclusion: Patients hospitalized with uncomplicated acute myocarditis and no known prior heart disease were associated with substantial risk for cardiovascular events over a follow-up of up to 8 years. This calls for a more efficient therapeutic management of this population of patients.
Language	English
Publishing date	2024-02-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2663340-1
ISSN	2048-8734 ; 2048-8726
ISSN (online)	2048-8734
ISSN	2048-8726
DOI	10.1093/ehjacc/zuae021
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Article ; Online: Supplementation of the population during the COVID-19 pandemic with vitamins and micronutrients - how much evidence is needed?

Schuetz, Philipp / Gregoriano, Claudia / Keller, Ulrich

Swiss medical weekly

2021 Volume 151, Page(s) w20522

MeSH term(s)	Ascorbic Acid Deficiency/epidemiology ; Ascorbic Acid Deficiency/immunology ; Ascorbic Acid Deficiency/prevention & control ; Ascorbic Acid Deficiency/therapy ; COVID-19/epidemiology ; COVID-19/immunology ; COVID-19/prevention & control ; COVID-19/therapy ; Deficiency Diseases/epidemiology ; Deficiency Diseases/immunology ; Deficiency Diseases/prevention & control ; Deficiency Diseases/therapy ; Dietary Supplements ; Evidence-Based Medicine ; Humans ; Magnesium Deficiency/epidemiology ; Magnesium Deficiency/immunology ; Magnesium Deficiency/prevention & control ; Magnesium Deficiency/therapy ; Micronutrients/therapeutic use ; Risk Factors ; SARS-CoV-2 ; Switzerland ; Trace Elements/therapeutic use ; Treatment Outcome ; Vitamin B 12 Deficiency/epidemiology ; Vitamin B 12 Deficiency/immunology ; Vitamin B 12 Deficiency/prevention & control ; Vitamin B 12 Deficiency/therapy ; Vitamin D Deficiency/epidemiology ; Vitamin D Deficiency/immunology ; Vitamin D Deficiency/prevention & control ; Vitamin D Deficiency/therapy ; Vitamins/therapeutic use ; Zinc/deficiency
Chemical Substances	Micronutrients ; Trace Elements ; Vitamins ; Zinc (J41CSQ7QDS)
Language	English
Publishing date	2021-05-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.4414/smw.2021.20522
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Article ; Online: Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19.

Wolfisberg, Selina / Gregoriano, Claudia / Schuetz, Philipp

Critical reviews in clinical laboratory sciences

2021 Volume 59, Issue 1, Page(s) 54–65

Abstract: Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches "alarming" levels according to the World Health Organization, ... ...

Abstract	Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches "alarming" levels according to the World Health Organization, the importance of using biomarkers, such as PCT to limit unnecessary antibiotic exposure has further increased. Randomized trials in patients with respiratory tract infections have shown that PCT has prognostic implications and its use, embedded in stewardship protocols, leads to reductions in the use of antibiotics in different clinical settings without compromising clinical outcomes. However, available data are heterogeneous and recent trials found no significant benefit. Still, from these trials, we have learned several key considerations for the optimal use of PCT, which depend on the clinical setting, severity of presentation, and pretest probability for bacterial infection. For patients with respiratory infections and sepsis, PCT can be used to determine whether to initiate antimicrobial therapy in low-risk settings and, together with clinical data, whether to discontinue antimicrobial therapy in certain high-risk settings. There is also increasing evidence regarding PCT-guided therapy in patients with coronavirus disease 2019 (COVID-19). This review provides an up-to-date overview of the use of PCT in different clinical settings and diseases, including a discussion about its potential to improve the care of patients with COVID-19.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/diagnosis ; Bacterial Infections/drug therapy ; Biomarkers ; COVID-19 ; Humans ; Procalcitonin ; SARS-CoV-2 ; Sepsis/drug therapy
Chemical Substances	Anti-Bacterial Agents ; Biomarkers ; Procalcitonin
Language	English
Publishing date	2021-09-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	280641-1
ISSN	1549-781X ; 1040-8363 ; 0590-8191
ISSN (online)	1549-781X
ISSN	1040-8363 ; 0590-8191
DOI	10.1080/10408363.2021.1975637
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Article: Role of procalcitonin use in the management of sepsis.

Gregoriano, Claudia / Heilmann, Eva / Molitor, Alexandra / Schuetz, Philipp

Journal of thoracic disease

2020 Volume 12, Issue Suppl 1, Page(s) S5–S15

Abstract: Important aspects of sepsis management include early diagnosis as well as timely and specific treatment in the first few hours of triage. However, diagnosis and differentiation from non-infectious causes often cause uncertainties and potential time ... ...

Abstract	Important aspects of sepsis management include early diagnosis as well as timely and specific treatment in the first few hours of triage. However, diagnosis and differentiation from non-infectious causes often cause uncertainties and potential time delays. Correct use of antibiotics still represents a major challenge, leading to increased risk for opportunistic infections, resistances to multiple antimicrobial agents and toxic side effects, which in turn increase mortality and healthcare costs. Optimized procedures for reliable diagnosis and management of antibiotic therapy has great potential to improve patient care. Herein, biomarkers have been shown to improve infection diagnosis, help in early risk stratification and provide prognostic information which helps optimizing therapeutic decisions ("antibiotic stewardship"). In this context, the use of the blood infection marker procalcitonin (PCT) has gained much attention. There is still no gold standard for the detection of sepsis and use of conventional diagnostic approaches are restricted by some limitations. Therefore, additional tests are necessary to enable early and reliable diagnosis. PCT has good discriminatory properties to differentiate between bacterial and viral inflammations with rapidly available results. Further, PCT adds to risk stratification and prognostication, which may influence appropriate use of health-care resources and therapeutic options. PCT kinetics over time also improves the monitoring of critically ill patients with sepsis and thus influences decisions regarding de-escalation of antibiotics. Most importantly, PCT helps in guiding antibiotic use in patients with respiratory infection and sepsis by limiting initiation and by shortening treatment duration. To date, PCT is the best studied biomarker regarding antibiotic stewardship. Still, further research is needed to understand optimal use of PCT, also in combination with other remerging diagnostic tests for most efficient sepsis care.
Language	English
Publishing date	2020-02-28
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2019.11.63
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Article ; Online: Burden of disease in patients hospitalised with COVID-19 during the first and second pandemic wave in Switzerland: a nationwide cohort study.

Gregoriano, Claudia / Rafaisz, Kris / Schuetz, Philipp / Mueller, Beat / Fux, Christoph A / Conen, Anna / Kutz, Alexander

Swiss medical weekly

2023 Volume 153, Page(s) 40068

Abstract: Aim of the study: The first and second waves of the COVID-19 pandemic led to a tremendous burden of disease and influenced several policy directives, prevention and treatment strategies as well as lifestyle and social behaviours. We aimed to describe ... ...

Abstract	Aim of the study: The first and second waves of the COVID-19 pandemic led to a tremendous burden of disease and influenced several policy directives, prevention and treatment strategies as well as lifestyle and social behaviours. We aimed to describe trends of hospitalisations with COVID-19 and hospital-associated outcomes in these patients during the first two pandemic waves in Switzerland. Methods: In this nationwide retrospective cohort study, we used in-hospital claims data of patients hospitalised with COVID-19 in Switzerland between January 1st and December 31st, 2020. First, stratified by wave (first wave: January to May, second wave: June to December), we estimated incidence rates (IR) and rate differences (RD) per 10,000 person-years of COVID-19-related hospitalisations across different age groups (0-9, 10-19, 20-49, 50-69, and ≥70 years). IR was calculated by counting the number of COVID-19 hospitalisations for each patient age stratum paired with the number of persons living in Switzerland during the specific wave period. Second, adjusted odds ratios (aOR) of outcomes among COVID-19 hospitalisations were calculated to assess the association between COVID-19 wave and outcomes, adjusted for potential confounders. Results: Of 36,517 hospitalisations with COVID-19, 8,862 (24.3%) were identified during the first and 27,655 (75.7%) during the second wave. IR for hospitalisations with COVID-19 was highest during the second wave and among patients above 50 years (50-69 years: first wave: 31.49 per 10,000 person-years; second wave: 62.81 per 10,000 person-years; RD 31.32 [95% confidence interval [CI]: 29.56 to 33.08] per 10,000 person-years; IRR 1.99 [95% CI: 1.91 to 2.08]; ≥70 years: first wave: 88.59 per 10,000 person-years; second wave: 228.41 per 10,000 person-years; RD 139.83 [95% CI: 135.42 to 144.23] per 10,000 person-years; IRR 2.58 [95% CI: 2.49 to 2.67]). While there was no difference in hospital readmission, when compared with the first wave, patients hospitalised during the second wave had a lower probability of death (aOR 0.88 [95% CI: 0.81 to 0.95], ARDS (aOR 0.56 [95% CI: 0.51 to 0.61]), ICU admission (aOR 0.66 [95% CI: 0.61 to 0.70]), and need for ECMO (aOR 0.60 [95% CI: 0.38 to 0.92]). LOS was -16.1 % (95% CI: -17.8 to -14.2) shorter during the second wave. Conclusion: In this nationwide cohort study, rates of hospitalisations with COVID-19 were highest among adults older than 50 years and during the second wave. Except for hospital readmission, the likelihood of adverse outcomes was lower during the second pandemic wave, which may be explained by advances in the understanding of the disease and improved treatment options.
MeSH term(s)	Adult ; Humans ; Aged ; Switzerland/epidemiology ; COVID-19/epidemiology ; Cohort Studies ; Pandemics ; Retrospective Studies ; Cost of Illness
Language	English
Publishing date	2023-05-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2036179-8
ISSN	1424-3997 ; 1424-7860
ISSN (online)	1424-3997
ISSN	1424-7860
DOI	10.57187/smw.2023.40068
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Article: Inhalative Therapie bei COPD und Asthma.

Gregoriano, Claudia / Tschacher, Anne / Grendelmeier, Peter / Cadus, Cordula

Therapeutische Umschau. Revue therapeutique

2019 Volume 76, Issue 6, Page(s) 301–310

Abstract: Development of inhaled therapies for COPD and ... ...

Title translation	Development of inhaled therapies for COPD and asthma.
Abstract	Development of inhaled therapies for COPD and asthma
MeSH term(s)	Administration, Inhalation ; Adrenal Cortex Hormones ; Asthma/drug therapy ; Bronchodilator Agents/administration & dosage ; Bronchodilator Agents/therapeutic use ; Female ; Humans ; Male ; Medication Adherence ; Pulmonary Disease, Chronic Obstructive/drug therapy
Chemical Substances	Adrenal Cortex Hormones ; Bronchodilator Agents
Language	German
Publishing date	2019-11-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	82044-1
ISSN	1664-2864 ; 0040-5930
ISSN (online)	1664-2864
ISSN	0040-5930
DOI	10.1024/0040-5930/a001103
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Article: Inhalative Therapie bei COPD und Asthma

Gregoriano, Claudia / Tschacher, Anne / Grendelmeier, Peter / Cadus, Cordula

Therapeutische Umschau

2019 Volume 76, Issue 6, Page(s) 301–310

Abstract: Die inhalative Therapie ist nach wie vor sowohl bei der COPD als auch beim Asthma eine wichtige Säule der Behandlung. ...

Abstract	Die inhalative Therapie ist nach wie vor sowohl bei der COPD als auch beim Asthma eine wichtige Säule der Behandlung.
Keywords	Behandlung ; Biomarker ; individueller Patientennutzen
Language	German
Document type	Article
ZDB-ID	82044-1
ISSN	1664-2864 ; 0040-5930
ISSN (online)	1664-2864
ISSN	0040-5930
Database	bibnet.org

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Article ; Online: Biomarkers of Infection: Are They Useful in the ICU?

Heilmann, Eva / Gregoriano, Claudia / Schuetz, Philipp

Seminars in respiratory and critical care medicine

2019 Volume 40, Issue 4, Page(s) 465–475

Abstract: Biomarkers are increasingly used in patients with serious infections in the critical care setting to complement clinical judgment and interpretation of other diagnostic and prognostic tests. The main purposes of such blood markers are (1) to improve ... ...

Abstract	Biomarkers are increasingly used in patients with serious infections in the critical care setting to complement clinical judgment and interpretation of other diagnostic and prognostic tests. The main purposes of such blood markers are (1) to improve infection diagnosis (i.e., differentiation between bacterial vs. viral vs. fungal vs. noninfectious), (2) to help in the early risk stratification and thus provide prognostic information regarding the risk for mortality and other adverse outcomes, and (3) to optimize antibiotic tailoring to individual needs of patients ("antibiotic stewardship").Especially in critically ill patients, in whom sepsis is a major cause of morbidity and mortality, rapid diagnosis is desirable to start timely and specific treatment.Besides some biomarkers, such as procalcitonin, which is well established and has shown positive effects in regard to utilization of antimicrobials and clinical outcomes, there is a growing number of novel markers from different pathophysiological pathways, where the final proof of an added value to clinical judgment and ultimately clinical benefit to patients is still lacking.Without a doubt, the addition of blood biomarkers to clinical medicine has had a strong impact on the way we care for patients today. Recent trials show that as an adjunct to other clinical and laboratory parameters these markers provide important information about risks for bacterial infection and resolution of infection. Moreover, biomarkers can help to optimize management of patients with serious illness in the intensive care unit, thereby offering more individualized treatment courses with overall improvements in clinical outcomes.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship ; Biomarkers/blood ; Critical Care/methods ; Critical Illness ; Humans ; Intensive Care Units ; Randomized Controlled Trials as Topic ; Sepsis/diagnosis ; Sepsis/drug therapy
Chemical Substances	Anti-Bacterial Agents ; Biomarkers
Keywords	covid19
Language	English
Publishing date	2019-10-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1183617-9
ISSN	1098-9048 ; 1069-3424
ISSN (online)	1098-9048
ISSN	1069-3424
DOI	10.1055/s-0039-1696689
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