Author/Editor		Žargaj, Anja; Korošec, Peter; Šifrer, Franc; Košnik, Mitja
Title		Diagnostična vrednost označevalcev pri sepsi
Translated title		Biomarkers to diagnose sepsis
Type		članek
Vol. and No.		Letnik 86, št. 11/12
Publication year		2017
Volume		str. 481-492
ISSN		1581-0224 - Zdravniški vestnik
Language		slv
Abstract		Izhodišča: Sepsa je življenje ogrožajoče nedelovanje organov zaradi nezadostnega odgovora gostitelja na okužbo, kadar bakterije vstopijo v kri oz. se v krvi razmnožujejo. V zadnjih letih za prepoznavanje motenj v delovanju organov uporabljamo točkovanje lestvice SOFA. Zlati standard pri diagnosticiranju sepse je mikrobiološka preiskava krvi. Zanesljivi označevalci za odkrivanje sepse v zgodnji fazi bi bistveno pripomogli k hitremu in učinkovitemu zdravljenju sepse. Metode: V prospektivni neinterventni raziskavi smo proučevali uporabnost C-reaktivnega proteina (CRP), prokalcitonina, indeksa CD 64 na nevtrofilcih, koncentracijo nevtrofilcev in koncentracijo paličastih nevtrofilcev pri diagnosticiranju sepse. Vključenih je bilo zaporednih 46 bolnikov intenzivnega oddelka, ki so bili tja sprejeti zaradi težke okužbe, ter 10 zdravih oseb za kontrolno skupino. Bolnike so obravnavali rutinsko po načelih dobre klinične prakse. Rezultati: Statistično značilne razlike med skupinama smo ugotovili pri indeksu CD 64, prokalcitoninu in koncentraciji paličastih nevtrofilcev, medtem ko pri CRP in koncentraciji nevtrofilcev razlika ni bila statistično značilna. Najvišjo diagnostično vrednost sta imela koncentracija paličastih nevtrofilcev (AUC 0,91) in PCT (AUC 0,84). Kombinacija označevalcev pa ni imela boljše napovedne vrednost kot koncentracija paličastih nevtrofilcev oziroma PCT. Zaključki: Indeks CD64 je bil eden manj diskriminativnih za ločevanje med sepso in okužbo brez sepse pri bolnikih v enoti intenzivne interne medicine.Background: Sepsis is a life-threatening organ dysfunction that arises when a host responds insufficiently to an infection as bacteria enter the bloodstream. In recent years, SOFA scoring system has been used to identify poor organ functioning. Microbiological blood tests represent a gold standard in sepsis diagnostics. Reliable biomarkers for early detection of sepsis would greatly facilitate rapid and efficient treatment of sepsis. Methods: In a prospective non-interventional study we studied the diagnostic value of C-reactive protein (CRP), procalcitonin (PCT), neutrophil CD64 index, neutrophil granulocyte count and immature neutrophil count in patients with sepsis and patients with severe infection without sepsis. A total of 46 consecutive intensive-care-unit patients admitted for severe infection and 10 healthy controls were included. The patients were treated routinely according to the principles of good clinical practice. Results: Statistically significant differences between the two groups of patients have been established for the CD64 index, the PCT and the immature neutrophil count, whereas the differences in the CRP and the neutrophil granulocyte count are statistically non-significant. The highest diagnostic values were measured for the immature neutrophil count (AUC 0.91) and PCT (AUC 0.84). The combination of biomarkers has been shown to have same predictive values as the immature neutrophil count and the PCT. Conclusions: The CD64 index was one of the less discriminating for drawing distinction between sepsis and severe infection without sepsis in intensive-care-unit patients.
Keywords		sepsa indeks CD 64 CRP prokalcitonin nevtrofilci sepsis CD 64 antigen C-reactive protein procalcitonin neutrophil