Diagnostic and prognostic biomarkers of sepsis in critical care
Diagnostic and prognostic biomarkers of sepsis in critical care
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DOI：
10.1093/jac/dkq523
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发表时间：
2011-04-01
影响因子：
5.2
通讯作者：
Barlow, Gavin
中科院分区：
文献类型：
--
作者：
Kibe, Savitri;Adams, Kate;Barlow, Gavin
脓毒症是危重患者死亡的主要原因。延误诊断和开始使用抗生素已被证明会增加该队列的死亡率。然而，区分脓毒症与全身炎症反应综合征（SIRS）的非感染性触发因素是困难的，特别是在可能因其他原因而患有SIRS的危重患者中。正是这个难题主要推动了广谱抗菌药物的使用和重症监护环境中抗生素耐药性的相关演变。因此，寻找一种高度准确的脓毒症生物标志物已成为医学界的圣杯之一，这也许并不奇怪。降钙素原（PCT）已成为研究最多和最有前途的脓毒症生物标志物。对于重症监护中的诊断和预后目的，PCT是C-反应蛋白和其他传统脓毒症标志物的进步，但对于临床医生来说不够准确，无法免除临床判断。然而，有更强有力的证据表明，PCT的测量在减少重症监护患者的抗生素暴露方面具有作用。对于打算将PCT检测纳入常规临床实践的单位，其成本效益可能取决于平均抗生素疗程的实施前长度以及实施对新出现的抗生素耐药性的后续影响。在迄今为止的大多数试验中，抗生素疗程的平均基线持续时间长于英国许多重症监护病房目前的标准实践。目前正在研究许多其他生物标志物。为了在临床实践中高度有用，可能有必要将这些与其他新的生物标志物和/或脓毒症的传统标志物组合联合收割机。
Sepsis is a leading cause of mortality in critically ill patients. Delay in diagnosis and initiation of antibiotics have been shown to increase mortality in this cohort. However, differentiating sepsis from non-infectious triggers of the systemic inflammatory response syndrome (SIRS) is difficult, especially in critically ill patients who may have SIRS for other reasons. It is this conundrum that predominantly drives broad-spectrum antimicrobial use and the associated evolution of antibiotic resistance in critical care environments. It is perhaps unsurprising, therefore, that the search for a highly accurate biomarker of sepsis has become one of the holy grails of medicine. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. For diagnostic and prognostic purposes in critical care, PCT is an advance on C-reactive protein and other traditional markers of sepsis, but is not accurate enough for clinicians to dispense with clinical judgement. There is stronger evidence, however, that measurement of PCT has a role in reducing the antibiotic exposure of critical care patients. For units intending to incorporate PCT assays into routine clinical practice, the cost-effectiveness of this is likely to depend on the pre-implementation length of an average antibiotic course and the subsequent impact of implementation on emerging antibiotic resistance. In most of the trials to date, the average baseline duration of the antibiotic course was longer than is currently standard practice in many UK critical care units. Many other biomarkers are currently being investigated. To be highly useful in clinical practice, it may be necessary to combine these with other novel biomarkers and/or traditional markers of sepsis.