Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Sepsis markers

10.073 Aufrufe

Veröffentlicht am

أستاذنا الدكتور سمير الأنصاري

Veröffentlicht in: Gesundheit & Medizin
  • Vitiligo Miracle Video - Heal Vitiligo In 7 Days ✔✔✔ http://tinyurl.com/y4d5dqxj
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • If u need a hand in making your writing assignments - visit ⇒ www.HelpWriting.net ⇐ for more detailed information.
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • 1 Weird Trick To Easily Cure Vitiligo For Good In As Little As 7 Days - Guaranteed! More Info.. ➤➤ https://bit.ly/3kTNHDZ
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Follow the link, new dating source: ❶❶❶ http://bit.ly/2Qu6Caa ❶❶❶
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Dating for everyone is here: ❤❤❤ http://bit.ly/2Qu6Caa ❤❤❤
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Sepsis markers

  1. 1. Sepsis markers
  2. 2. Introduction • Sepsis can occur suddenly and deteriorate rapidly • Timely diagnosis of sepsis is the key of success
  3. 3. How to improve the outcome of sepsis? • Early diagnosis and treatment • Surviving Sepsis Campaign .
  4. 4. Sepsis markers • Diagnostic – Useful for identifying or ruling out sepsis – Identifying patients who may benefit from specific therapies • Assessing the response to therapy • Prognostic
  5. 5. Ideal sepsis markers • High sensitivity (increase pathologically in the presence of disease) • High specificity (does not increase in the absence of disease) • Related to the disease burden and extent • Changes in accordance with the clinical evolution • Anticipates clinical changes before it happens
  6. 6. Ideal sepsis markers • Adds independent information about the risk or prognosis • Reproducible • Easy and cheap
  7. 7. What do we have now? • WCC • Lactate – Tissue perfusion variables • Biomarkers – C-reactive protein (CRP) – Procalcitonin (PCT) – Cytokines – New markers
  8. 8. What do we have now? • Large numbers of markers – Cytokines – Receptors biomarkers – Coagulation biomarkers – Biomarkers related to vascular endothelial damage – Markers related to organ dysfunction – Acute phase protein biomarkers – others
  9. 9. Sepsis markers • Lactate • C-reactive protein (CRP) • Procalcitonin (PCT) • Newer sepsis markers
  10. 10. Lactate production Critical illness leading to increased tissue oxygen extraction Oxygen delivery Oxygen consumption Oxygen debt Global tissue hypoxia Anaerobic metabolism Lactate production
  11. 11. Lactate • Raised in severe sepsis and septic shock – Hypoperfusion (secondary to anaerobic metabolism) – Cellular metabolic failure – Decrease clearance by the liver
  12. 12. Prognostic and predict mortality • It can be used as … – Monitoring response of septic patients to resuscitation – Stratification and prognosis • Serial lactate level monitoring is recommended – High lactate clearance: • less required vasopressors therapy, greater improvements in APACHE II scores and decreased mortality rates
  13. 13. Lactate clearance • In patients with septic shock – Survivors vs non-survivors • Initial lactate level did not differ much •Survivors had a significant decrease in lactate levels and less “lactate clearance time”
  14. 14. Lactate clearance • Lactate clearance – The percentage lactate decrease over the initial 6 hr ED evaluation and treatment period
  15. 15. Lactate clearance The higher the lactate clearance, the lower the mortality
  16. 16. CRP • Acute phase protein • Synthesized in liver • IL-6 (and IL-1 and TNFα) stimulate synthesis • Binds bacterial polysaccharide/ chromatin – Activates the classical complement pathway – Increase the immune inflammatory response • Esp. in bacteria infection (vs viral)
  17. 17. CRP • Level of CRP begins within 4-6hrs after stimulus • Doubles every 8hrs • Peaks at 36-50 hrs • Half-life 19hrs
  18. 18. CRP • A sensitive marker of inflammation and tissue damage • Other conditions result in raised in CRP – Rheumatological disease • SLE • Systemic sclerosis • Dermatomyositis • Sjogren’s disease – Inflammatory bowel disease – Haematological disease • E.g. leukaemia – Graft-versus-host disease
  19. 19. Procalcitonin • A peptide precursor of calcitonin • Produced by – parafollicular cells of the thyroid – neuroendocrine cells of the lung and the intestine (extrathyroidal) • It raises in a response to a proinflammatory stimulus – Esp of bacterial origin (mainly from the cells of lung and the intestine)
  20. 20. PCT- characteristics •Fast response (2-4hrs) •Peak values 8-24hr
  21. 21. PCT- characteristics • Short half-life (~24hrs) independent of renal function • Easy to measure in serum and plasma (stable in vivo and in vitro) • Plasma concentration ~ <0.05-1000ng/ml
  22. 22. • In systemic inflammation or in infection – Persists as long as inflammatory process continues • Mechanical trauma – Increase within 2-4hrs – Peak in 1st or 2nd day then diminish
  23. 23. Procalcitonin (PCT) • Reference values (except newborn) – Significantly lower in leukopenic patients < 0.05ng/ml Healthy individuals < 0.5ng/ml Probability of sepsis is low, local infection possible 0.5-2ng/ml Grey zone, recheck 6-12hrs later >2ng/ml Probability of sepsis is high
  24. 24. Use of PCT • Sepsis diagnosis • Antibiotic guidance • Patient prognosis
  25. 25. • Antibiotics were started/ stopped based on a predefined cut-off ranges of PCT value • Primary end point – 28 and 60 days mortality – No. of days without antibiotics
  26. 26. • PCT is also associated with other conditions – VAP – Severe acute pancreatitis – Acute exacerbation of COPD
  27. 27. Nonbacterial infection: Viruses, Fungi, Parasites • PCT tend to be low in viral infection – However, in systemic viral infection, PCT value can as high as 16 ng/ml • A low serum PCT cannot be used to exclude bacterial from viral infections but that a combination of PCT, CRP, white blood cell count, and clinical illness scoring might be more useful
  28. 28. Nonbacterial infection: Viruses, Fungi, Parasites • In patients with fungal infections, results have been variable • Infection with the malaria parasite often leads to very high levels of serum, as high as 662 ng/mL
  29. 29. Sepsis and PCT: The Pediatric Experience • Variable in sensitivity and specificity • Some authors recommended against the use of PCT in routine diagnosis of bacterial sepsis in neonates, because of more complicated PCT measurement and its expense in comparison with CRP.
  30. 30. Different features of CRP and PCT • CRP levels may not further increase during more severe stages of sepsis. • PCT rises in proportion to the severity of sepsis and reaches its highest levels in septic shock. Therefore, the diagnostic capacity of PCT isTherefore, the diagnostic capacity of PCT is superior to that of CRP due to the closesuperior to that of CRP due to the close correlation between PCT levels and thecorrelation between PCT levels and the severity of sepsis and outcome.severity of sepsis and outcome. Therefore, the diagnostic capacity of PCT isTherefore, the diagnostic capacity of PCT is superior to that of CRP due to the closesuperior to that of CRP due to the close correlation between PCT levels and thecorrelation between PCT levels and the severity of sepsis and outcome.severity of sepsis and outcome.
  31. 31. Different features of CRP and PCT • PCT reacted more quickly than CRP • PCT concentrations had their maximum levels prior to those of CRP Allows anticipation of a diagnosis of sepsis 24-48 hours before the CRP level would Allows anticipation of a diagnosis of sepsis 24-48 hours before the CRP level would
  32. 32. Different features of CRP and PCT • CRP concentrations were high already during the less severe stages of organ dysfunction and systemic inflammation – values were not much further increased during the more severe stages of disease. • PCT levels correlates with the stages of disease (especially increased in patients with organ dysfunction, severe sepsis or septic shock.) CRP less useful in distinguishing evolution of sepsis in severe sepsis and septic shock CRP less useful in distinguishing evolution of sepsis in severe sepsis and septic shock
  33. 33. Different features of CRP and PCT • PCT concentrations more rapidly declined as compared with CRP CRP remained high even in the late stage of disease CRP remained high even in the late stage of disease
  34. 34. Prognosis • PCT levels were significantly associated with – admission to a special care unit – duration of intravenous antibiotic use – total duration of antibiotic treatment – length of hospital stay, whereas CRP was related only to the latter two variables. • These data suggest that PCT may be a valuable addition to currently used markers of infection for diagnosis of infection and prognosis in patients with fever at the AED
  35. 35. New sepsis markers • Soluble CD14 subtype (Generic name- Presepsin) • Heparin-Binding protein • Others
  36. 36. Soluble CD14 subtype
  37. 37. Early diagnosis and prognosis { Presepsin }
  38. 38. Quick turn around time- for emergency and intensive care use Quick turn around time- for emergency and intensive care use
  39. 39. Heparin-binding protein • An early marker of circulatory failure in sepsis • Release from activated neutrophils –A potent inducer of vascular leakage –Resulted in extravasation of plasma and WBC to the focus of infection
  40. 40. How about other markers?
  41. 41. • TNF-a – The initiating factor in the activation of host response and subsequent cytokine release during infection – Concentration increase 24 times after LPS challenge during in vivo experimental endotoxemia
  42. 42. • Short half-life of 17 min – Short-term concentration in response to bacterial challenge However, the diagnostic utility of TNF is insufficient for distinguishing infectious inflammation Why?
  43. 43. • Interleukin-6 – Increased concentrations correlating to infection – Activation time: very short – Half-life time ~ 1hr – Sensitive early diagnosis of neonatal sepsis – Adult values • Sepsis 300-2700ng/L • SIRS 100ng/L – Usefulness in adult diagnosis has not well established.
  44. 44. THANK YOU SAMIR EL ANSARY

×