Measures, markers, and mediators: Toward a staging system for clinical sepsis. A Report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25-26, 2000
Measures, markers, and mediators: Toward a staging system for clinical sepsis. A Report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25-26, 2000
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DOI：
10.1097/01.ccm.0000065186.67848.3a
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发表时间：
2003-05-01
影响因子：
8.8
通讯作者：
Reinhart, K
中科院分区：
文献类型：
--
作者：
Marshall, JC;Vincent, JL;Reinhart, K
背景：脓毒症不是一种单一的疾病，而是一个复杂的、异质性的过程。其表达是可变的，其严重程度受感染的性质、患者的遗传背景、临床干预的时间、临床医生提供的支持性护理以及许多未知因素的影响。有效疗法的评价一直受到限制，我们的能力，以表征的过程，并分层患者到更同质的组relations.Objectives：制定一个分类学的标志物相关的临床研究在败血症，并提出一个可测试的候选系统分层患者到更治疗同质组。数据来源：专家圆桌讨论和MEDLINE综述，使用检索词“标志物”和“脓毒症”。结果：标记物提供了三个领域中一个或多个领域的信息：诊断，预后和对治疗的反应。已经描述了超过80种假定的脓毒症标志物。所有这些都与死亡风险（预后）相关，但没有一个显示出在治疗（诊断）或滴定该治疗（反应）方面对患者进行分层的效用。它们的局限性来自于在复杂的疾病过程（如败血症）中建立因果关系以及将患者分层为更同质的人群的挑战。前一个限制可以通过修改科赫假设来区分因果关系和简单关联来解决。后者表明需要一个类似于用于其他复杂疾病过程（如癌症）的分期系统。这样一个系统的候选人框架，感染的基础上，主机的反应，和器官功能障碍的程度（IRO系统）的described.Conclusions：脓毒症患者的理解和管理的进展将需要更严格的方法来疾病的描述和分层。模型应该被开发、测试和修改！通过临床研究，而不是通过共识。
Background; Sepsis is not a single disease but a complex and heterogeneous process. Its expression is variable, and its severity is influenced by the nature of the infection, the genetic background of the patient, the time to clinical intervention, the supportive care provided by the clinician, and a number of factors as yet unknown. The evaluation of effective therapies has been hampered by limitations in our ability to characterize the process and to stratify patients into more homogeneous groups with respect to pathogenesis.Objectives: To develop a taxonomy of markers relevant to clinical research in sepsis and to propose a testable candidate system for stratifying patients into more therapeutically homogeneous groups.Data Source: An expert roundtable discussion and a MEDLINE review using search terms "marker" and "sepsis."Results: Markers provide information in one or more of three domains: diagnosis, prognosis, and response to therapy. More than 80 putative markers of sepsis have been described. All correlate with the risk of mortality (prognosis), yet none has shown utility in stratifying patients with respect to therapy (diagnosis) or in titrating that therapy (response). Their limitations arise from the challenges of establishing causality in a complex disease process such as sepsis and of stratifying patients into more homogeneous populations. The former limitation may be addressed through a modification of Koch's postulates to differentiate causality from simple association. The latter suggests the need for a staging system analogous to those used in other complex disease processes such as cancer. A candidate framework for such a system, based on, the infection, the host response, and the extent of organ dysfunction (the IRO system) is described.Conclusions: Advances in the understanding and management of patients with sepsis will necessitate more rigorous approaches to disease description and stratification. Models should be developed, tested, and modified! through clinical studies rather than through consensus.