全身性感染血清标记物文献

1.Janković B, Veljković D, Pasić S, Rakonjac Z, Jevtić D, Martić J.C-reactive protein and cytokines in the diagnosis of neonatal sepsis.Med Pregl. 2006 Nov-Dec;59(11-12):545-9.SourceInstitut za zdravstvenu zastitu majke i deteta, Srbije "Dr Vukan Cupić", Beograd.jankovicb@beotel.yuAbstractINTRODUCTION: Accurate evaluation and correct treatment of neonates for possible sepsis still represent the most challenging clinical tasks. Early diagnosis of neonatal sepsis is largely based on the measurement of serum concentrations of different mediators of systemic inflammation, as well as, on a group of proteins named acute phase reactants. Among acute phase reactants, C-reactive protein (CRP) has been the most extensively used and investigated so far. SYNTHESIS AND BIOLOGICAL ROLE OF CRP: This article reviews current knowledge on the synthesis, structure and biologic roles of CRP. Also, we present our original results in regard to the kinetics of serum CRP concentration during the first 24 hours of systemic injection, as well as different patterns of CRP dynamics associated with the initial choice of antibiotics, complications and the final outcome of systemic injection. INTERLEUKINS AND PROCALCITONIN IN DIAGNOSIS OF SEPSIS: Because CRP is specific, but somewhat late marker of neonatal sepsis, possible diagnostic use of other indicators of inflammation, i.e. interleukins 6 and 8, and procalcitonin during neonatal sepsis is also considered. The theoretical advantage of these early indicators is discussed in comparative analysis of the time of their activation after initial infections stimuli. CONCLUSION: In conclusion, we point to the diagnostic accuracy of serial measurements of serum CRP levels. As an alternative, simultaneous measurement of CRP and serum levels using a faster marker, such as procalcitonin, is recommended.2.Jean-Louis Vincent, Elena Carrasco Serrano and Aikaterina DimoulaCurrent management of sepsis in critically ill adult patients.Expert Rev Anti Infect Ther. 2011 Jul;9(7):847-56.Severe sepsis is a common occurrence in critically ill patients and a major cause of morbidity and mortality in this population. Management relies on the early identification and treatment of the underlying causative infection, adequate and rapid hemodynamic resuscitation, support of associated organ failure and modulation of the immune response with drotrecogin alfa (activated) when it is not contraindicated, and corticosteroids in severe septic shock. We will review current approaches to each of these categories.3.Predicting bacteremia by procalcitonin levels in patients evaluated for sepsis in the emergency departmentAlbrich WC, Mueller B.Expert Rev Anti Infect Ther. 2011 Jun;9(6):653-6.Evaluation of: Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am. J. Clin. Pathol. 135(2), 182–189 (2011).In a recent report, Riedel et al. proposed a procalcitonin cutoff of 0.1 ng/ml to rule out bacteremia in adult patients presenting to the emergency department with systemic infections. Procalcitoninlevels were higher in patients with true bacteremia than in patients with negative blood cultures or bacteremia due to possible contaminants. For prediction of bacteremia, a procalcitonin level of 0.1 ng/ml had an excellent negative predictive value of 96.3%, and a good sensitivity of 75%, specificity of 70.6% and area under the curve of 0.73, but poor positive predictive value of 12.8%. Based on the results in this study, we propose that a procalcitonin value of 0.1 ng/ml or less could be used to rule out bacteremia (NPV: 96.3%).4.Chan T, Gu F.Early diagnosis of sepsis using serum biomarkersExpert Rev Mol Diagn. 2011 Jun;11(5):487-96. doi: 10.1586/ERM.11.26.Sepsis, an innate immunological response of systemic inflammation to infection, is a growing problem worldwide with a relatively high mortality rate. Immediate treatment is required, necessitating quick, early and accurate diagnosis. Rapid molecular-based tests have been developed to address this need, but still suffer some disadvantages. The most commonly studied biomarkers of sepsis are reviewed for their current uses and diagnostic accuracies, includingC-reactive protein, procalcitonin, serum amyloid A, mannan and IFN-γ-inducible protein 10, as well as other potentially useful biomarkers. A singular ideal biomarker has not yet been identified; an alternative approach is to shift research focus to determine the diagnostic relevancy of multiple biomarkers when used in concert. Challenges facing biomarker research, including lack of methodology standardization and assays with better detection limits, are discussed. The ongoing efforts in the development of a multiplex point-of-care testing kit, enabling quick and reliable detection of serum biomarkers, may have great potential for early diagnosis of sepsis.5.Ann Emerg Med. 2007 Jul;50(1):34-41. Epub 2006 Dec 11.Procalcitonin test in the diagnosis of bacteremia: a meta-analysis.Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA.SourceDepartment of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861, USA. alan.jones@AbstractSTUDY OBJECTIVE:We seek to evaluate the diagnostic performance of the procalcitonin test for the diagnosis of bacteremia in the emergency department (ED) population.METHODS:We conducted a search of MEDLINE, bibliographies of previous systemic reviews, and pertinent national meeting research abstracts. We included studies that assessed the diagnostic accuracy of procalcitonin for bacteremia, with blood culture as the reference standard. We included prospective investigations of adults and children with suspected infection studied in the ED or at admission. Two authors independently extracted data and assessed study quality; consensus was reached by conference. The analysis was based on the I2 statistic for heterogeneity, unweighted summary receiver-operating characteristic curve, and random-effects pooled sensitivity and specificity across studies using the same test threshold.RESULTS:The search yielded 348 publications and 1 unpublished study. Seventeen studies met the inclusion criteria and provided a sample of 2,008 subjects. There was a substantial degree of inconsistency (I2=64%). The unweighted summary receiver-operating characteristic curve provided the best overall estimate of test performance, with an area under the curve of 0.84 (95% confidence interval [CI] 0.75 to 0.90). Sensitivity analysis based on study quality did not significantly change the results. Subgroup analysis including only studies that used a test threshold of 0.5 or 0.4 ng/mL yielded pooled estimates for sensitivity and specificity of 76% (95% CI 0.66 to 0.84) and 70% (95% CI 0.60 to 0.79), respectively.CONCLUSION:We found the diagnostic performance of the procalcitonin test for identifying bacteremia in ED patients to be moderate. Future research designed to determine the utility of the procalcitonin test as a diagnostic tool used in isolation for detecting bacteremia in ambulatory patients is needed before widespread clinical use.6.Med Pregl. 2006 Nov-Dec;59(11-12):545-9.[C-reactive protein and cytokines in the diagnosis of neonatal sepsis].[Article in Serbian]Janković B, Veljković D, Pasić S, Rakonjac Z, Jevtić D, Martić J.SourceInstitut za zdravstvenu zastitu majke i deteta, Srbije "Dr Vukan Cupić", Beograd.jankovicb@beotel.yuAbstractINTRODUCTION: Accurate evaluation and correct treatment of neonates for possible sepsis still represent the most challenging clinical tasks. Early diagnosis of neonatal sepsis is largely based on the measurement of serum concentrations of different mediators of systemic inflammation, as well as, on a group of proteins named acute phase reactants. Among acute phase reactants, C-reactive protein (CRP) has been the most extensively used and investigated so far. SYNTHESIS AND BIOLOGICAL ROLE OF CRP: This article reviews current knowledge on the synthesis, structure and biologic roles of CRP. Also, we present our original results in regard to the kinetics of serum CRP concentration during the first 24 hours of systemic injection, as well as different patterns of CRP dynamics associated with the initial choice of antibiotics, complications and the final outcome of systemic injection. INTERLEUKINS AND PROCALCITONIN IN DIAGNOSIS OF SEPSIS: Because CRP is specific, but somewhat late marker of neonatal sepsis, possible diagnostic use of other indicators of inflammation, i.e. interleukins 6 and 8, and procalcitonin during neonatal sepsis is also considered. The theoretical advantage of these early indicators is discussed in comparative analysis of the time of their activation after initial infections stimuli. CONCLUSION: In conclusion, we point to the diagnostic accuracy of serial measurements of serum CRP levels. As an alternative, simultaneous measurement of CRP and serum levels using a faster marker, such as procalcitonin, is recommended.7.J Perinatol. 2009 Mar;29(3):225-31. Epub 2008 Dec 11.Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants. Cetinkaya M, Ozkan H, Köksal N, Celebi S, Hacimustafaoğlu M.SourceDivision of Neonatology, Department of Pediatrics, Uludag University, Bursa, Turkey.drmerih@AbstractOBJECTIVE:The purpose of this study was to determine the role of serum amyloid A (SAA) in diagnosis of neonatal sepsis and evaluation of clinical response to antibiotic therapy. We also aimed to compare the efficiency of SAA with that of C-reactive protein (CRP) and procalcitonin (PCT) in diagnosis and follow-up of neonatal sepsis in preterm infants.STUDY DESIGN:A total of 163 infants were enrolled in this prospective study. The infants were classified into four groups: group 1 (high probable sepsis), group 2 (probable sepsis), group 3 (possible sepsis) and group 4 (no sepsis, control group). Blood samples for whole blood count, CRP, PCT, SAA and culture were obtained before initiating antibiotic treatment. This procedure was repeated three times at 48 h, 7 and 10 days.RESULT:Initial CRP, PCT and SAA levels were found to be positive in 73.2, 75.6 and 77.2% of all infants, respectively. Sensitivities of CRP, PCT and SAA at 0 h were 72.3, 74.8 and 76.4%, respectively. Although it was not statistically significant, SAA was found to be more sensitive than CRP and PCT in diagnosis of neonatal sepsis. The area under the curve (AUC) for CRP, PCT and SAA at 0 h were 0.870, 0.870 and 0.875, respectively. Although the AUC for SAA at 0 h was higher than PCT and CRP, the difference was not statistically significant.CONCLUSION:SAA is an accurate and reliable marker for diagnosis and follow-up of neonatal sepsis. It is especially useful at the onset of inflammation for rapid diagnosis of neonatal sepsis and can be safely and accurately used in combination with other sepsis markers such as CRP and PCT in diagnosis and follow-up of neonatal sepsis in preterm infants.8.Eur J Clin Microbiol Infect Dis. 2005 Apr;24(4):272-5.Value of measuring serum procalcitonin, C-reactive protein, and mannan antigens to distinguish fungal from bacterial infections.Petrikkos GL, Christofilopoulou SA, Tentolouris NK, Charvalos EA, Kosmidis CJ, Daikos GL. SourceLaboratory of Infectious Diseases and Antimicrobial Chemotherapy, Athens University School of Medicine, Laiko General Hospital, 17 Agiou Thoma street, 115 27 Athens, Greece.AbstractThe study presented here was conducted to determine the diagnostic value of measuring procalcitonin, C-reactive protein, and mannan antigens to distinguish fungal from bacterial infections. The sensitivity and specificity of these measurements ranged from 35% to 97%. On days 1 and 3 following the onset of fever, both serum procalcitonin and C-reactive protein levelswere lower in patients with fungal infections than in those with bacterial infections (p<0.0001). The presence of mannan antigens combined with a procalcitonin level <0.5 ng/ml provided higher specificity for distinguishing fungal from bacterial infections than each result alone.。