sepsis Dotaz Zobrazit nápovědu
Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Over the last decades, the approach to sepsis is evolving dramatically, mainly as a result of a rapid increase in the knowledge of its epidemiology, physiopathology, and management. In this context, the new international criteria and definition for sepsis, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), were introduced in 2016. The criteria were established consensually by the Task Force which consisted of experts from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. The main goal is the expansion of awareness of the professional public about this medical condition with a high fatality rate, particularly when not diagnosed and treated early. Sepsis-3 should also serve as a benchmark for future preclinical and clinical research, development of new diagnostic methods, and the terapy of patients with sepsis and septic shock.
- Klíčová slova
- sepsis - septic shock - organ dysfunction - definition - criteria.,
- MeSH
- konsensus MeSH
- lidé MeSH
- poradní výbory MeSH
- sepse * MeSH
- septický šok MeSH
- terminologie jako téma * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Sepsis is the most frequent cause of death in non-coronary intensive care units (ICUs). In the past 10 years, progress has been made in the early identification of septic patients and in their treatment and these improvements in support and therapy mean that the mortality is gradually decreasing but it still remains unacceptably high. Leaving clinical diagnosis aside, the laboratory diagnostics represent a complex range of investigations that can place significant demands on the system given the speed of response required. There are hundreds of biomarkers which could be potentially used for diagnosis and prognosis in septic patients. The main attributes of successful markers would be high sensitivity, specificity, possibility of bed-side monitoring, and financial accessibility. Only a fraction is used in routine clinical practice because many lack sufficient sensitivity or specificity. The following review gives a short overview of the current epidemiology of sepsis, its pathogenesis and state-of-the-art knowledge on the use of specific biochemical, hematological and immunological parameters in its diagnostics. Prospective approaches towards discovery of new diagnostic biomarkers have been shortly mentioned.
- Klíčová slova
- Biomarkers, SIRS, Sensitivity, Sepsis, Specificity,
- MeSH
- antigeny CD14 krev MeSH
- biologické markery analýza krev MeSH
- C-reaktivní protein analýza MeSH
- cytokiny krev MeSH
- fibrin-fibrinogen - produkty degradace analýza MeSH
- jednotky intenzivní péče MeSH
- kalcitonin krev MeSH
- leukocyty metabolismus MeSH
- lidé MeSH
- membránové glykoproteiny krev MeSH
- peptidové fragmenty krev MeSH
- proteinové prekurzory krev MeSH
- proteiny akutní fáze MeSH
- sepse diagnóza metabolismus MeSH
- syndrom systémové zánětlivé reakce diagnóza metabolismus MeSH
- transportní proteiny krev MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antigeny CD14 MeSH
- biologické markery MeSH
- C-reaktivní protein MeSH
- cytokiny MeSH
- fibrin fragment D MeSH Prohlížeč
- fibrin-fibrinogen - produkty degradace MeSH
- kalcitonin MeSH
- lipopolysaccharide-binding protein MeSH Prohlížeč
- membránové glykoproteiny MeSH
- peptidové fragmenty MeSH
- presepsin protein, human MeSH Prohlížeč
- proteinové prekurzory MeSH
- proteiny akutní fáze MeSH
- transportní proteiny MeSH
INTRODUCTION: Neonatal sepsis is a leading cause of infant mortality worldwide with non-specific and varied presentation. We aimed to catalogue the current definitions of neonatal sepsis in published randomised controlled trials (RCTs). METHOD: A systematic search of the Embase and Cochrane databases was performed for RCTs which explicitly stated a definition for neonatal sepsis. Definitions were sub-divided into five primary criteria for infection (culture, laboratory findings, clinical signs, radiological evidence and risk factors) and stratified by qualifiers (early/late-onset and likelihood of sepsis). RESULTS: Of 668 papers screened, 80 RCTs were included and 128 individual definitions identified. The single most common definition was neonatal sepsis defined by blood culture alone (n = 35), followed by culture and clinical signs (n = 29), and then laboratory tests/clinical signs (n = 25). Blood culture featured in 83 definitions, laboratory testing featured in 48 definitions while clinical signs and radiology featured in 80 and 8 definitions, respectively. DISCUSSION: A diverse range of definitions of neonatal sepsis are used and based on microbiological culture, laboratory tests and clinical signs in contrast to adult and paediatric sepsis which use organ dysfunction. An international consensus-based definition of neonatal sepsis could allow meta-analysis and translate results to improve outcomes.
- MeSH
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- kojenecká mortalita MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká sepse * diagnóza MeSH
- randomizované kontrolované studie jako téma MeSH
- sepse diagnóza terapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
OBJECTIVE: The purpose of this study was to identify a panel of biomarkers for distinguishing early stage sepsis patients from non-infected trauma patients. BACKGROUND: Accurate differentiation between trauma-induced sterile inflammation and real infective sepsis poses a complex life-threatening medical challenge because of their common symptoms albeit diverging clinical implications, namely different therapies. The timely and accurate identification of sepsis in trauma patients is therefore vital to ensure prompt and tailored medical interventions (provision of adequate antimicrobial agents and if possible eradication of infective foci) that can ultimately lead to improved therapeutic management and patient outcome. The adequate withholding of antimicrobials in trauma patients without sepsis is also important in aspects of both patient and environmental perspective. METHODS: In this proof-of-concept study, we employed advanced technologies, including Matrix-Assisted Laser Desorption/Ionization (MALDI) and multiplex antibody arrays (MAA) to identify a panel of biomarkers distinguishing actual sepsis from trauma-induced sterile inflammation. RESULTS: By comparing patient groups (controls, infected and non-infected trauma and septic shock patients under mechanical ventilation) at different time points, we uncovered distinct protein patterns associated with early trauma-induced sterile inflammation on the one hand and sepsis on the other hand. SYT13 and IL1F10 emerged as potential early sepsis biomarkers, while reduced levels of A2M were indicative of both trauma-induced inflammation and sepsis conditions. Additionally, higher levels of TREM1 were associated at a later stage in trauma patients. Furthermore, enrichment analyses revealed differences in the inflammatory response between trauma-induced inflammation and sepsis, with proteins related to complement and coagulation cascades being elevated whereas proteins relevant to focal adhesion were diminished in sepsis. CONCLUSIONS: Our findings, therefore, suggest that a combination of biomarkers is needed for the development of novel diagnostic approaches deciphering trauma-induced sterile inflammation from actual infective sepsis.
- Klíčová slova
- A2M, IL1F10, SYT13, bacteremia, biomarkers, sepsis, systemic inflammatory response syndrome, trauma,
- MeSH
- antiinfekční látky * MeSH
- biologické markery MeSH
- infekční nemoci * komplikace MeSH
- lidé MeSH
- sepse * komplikace diagnóza MeSH
- septický šok * komplikace MeSH
- synaptotagminy MeSH
- zánět MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- antiinfekční látky * MeSH
- biologické markery MeSH
- synaptotagminy MeSH
- SYT13 protein, human MeSH Prohlížeč
The article discusses new definitions for sepsis and septic shock called Sepsis-3. The definitions are put in the historical and factual context of the 1992 definition and their extended 2003 version. Also mentioned are potential impacts on clinical practice, with it-being clear that the new definition shifts the sepsis issues more to intensive care as it emphasizes organ failure. In prehospital care, emergency departments and general wards of hospitals where patients are triaged, a new scoring system, the so-called quick SOFA, may be used. In this approach, stress is placed on impaired consciousness, a drop in systolic pressure and tachypnea but its role in more precise identification is yet to be verified in common clinical practice.
Number of identical pathophysiological mechanisms is shared by sepsis and other clinical conditions and diseases. This could lead to their nearly similar clinical phenotype. However, the early discrimination of them is crucial - treatment of particular diseases differs significantly, and the mortality of the vast majority of them is considerable. The differential diagnostics possibilities together with brief description of selected clinical conditions are discussed within the review.
- Klíčová slova
- organ dysfunction, sepsis, sepsis mimics,
- MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- sepse * diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: This retrospective study examines the relationship between admission Blood Urea Nitrogen (BUN) levels and clinical outcomes in patients with sepsis from two separate cohorts in the Czech Republic and the United States. METHODS: The study included 9126 patients with sepsis between January 2014 and December 2018. Kaplan-Meier survival curves and Cox regression were used to analyse the data. An optimal cut-off was calculated by means of the Youden-Index. RESULTS: BUN at ICU admission was categorized as 10-20, 20-40 and >40 mg/dL. Comparing the group with the highest BUN levels to the one with lowest levels, we found HR for 28 days mortality 2.764 (CI 95% 2.37-3.20; P<0.001). We derived an optimal cut-off for prediction of 28 days mortality of 23 mg/dL. The association between BUN and 28 days mortality remained significant after adjusting for potential confounders - for APACHE IV (HR 1.374; 95%CI 1.20-1.58; P<0.001), SAPS2 (HR 1.545; 95%CI 1.35-1.77; P<0.001), eGFR (HR 1.851; 95%CI 1.59-2.16; P<0.001) and several other variables in an integrative model. CONCLUSIONS: Our findings support the BUN level as an independent and easily available predictor of 28 days mortality in septic critically ill patients admitted to an ICU.
AIM: Sepsis represents an increasingly frequent complication in the survival of the hospitalized persons. The nation-wide burden of the sepsis-related mortality in the Czech Republic has not yet been analysed. The present study aims to assess the trends and the disparities in the sepsis-related mortality in the Czech Republic for the period 1998-2011 using multiple causes of death reported on the death certificates. MATERIALS AND METHODS: Individual death records provided by the Institute for Health Information and Statistics were used to identify sepsis-related deaths based on the codes of the 10th revision of the International classification of the diseases (ICD-10). Frequencies, age-standardized rates and comorbidity patterns were studied. RESULTS: A total of 41,425 cases (3%) out of 1,456,539 deaths within the period 1998-2011 were associated with sepsis. In 2011, sepsis was reported in 8% of all in-hospital deaths. Sepsis is the most likely to be reported as immediate cause of death (66%), which results in its considerable underestimation in the underlying cause of death statistics. The sepsis-related mortality almost tripled between 1998 and 2011, and the most of the increase is attributable to persons aged 65 and over. In 44% of cases, circulatory disease or cancer was reported as the underlying cause of death. Significant associations with sepsis were however found for infectious diseases, diseases of skin, and metabolic or musculoskeletal disorders. CONCLUSION: Multiple cause of death analysis of sepsis-related mortality revealed that sepsis represents a growing burden related to the population ageing and increased prevalence of complications of chronic diseases. The observed upward trends, as well as the expected continuation of the ageing process, may result in further increase of sepsis-related mortality. Preventive measures in the clinical management of sepsis are recommended.
- Klíčová slova
- sepsis - septicaemia - mortality - comorbidity - ageing.,
- MeSH
- infekční nemoci * epidemiologie MeSH
- komorbidita MeSH
- lidé MeSH
- příčina smrti MeSH
- senioři MeSH
- sepse * epidemiologie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
Sepsis is associated with severe metabolic disturbances and progressive failure of utilization of carbohydrates, lipids and proteins to meet the energy requirements of peripheral tissue. The causes of this condition are analysed. The interrelation between malnutrition and sepsis is discussed. Current concepts regarding the meeting of water and ion requirements, indications for administration of colloid solutions and infusion of glucose, lipid emulsions and amino acid solutions in each stage of sepsis are presented. Various views on the amount and quality of necessary nutrients are discussed providing evidence that a number of problems have to be solved yet.
- MeSH
- energetický metabolismus * MeSH
- ionty MeSH
- koloidy MeSH
- lidé MeSH
- nutriční nároky MeSH
- sepse metabolismus MeSH
- tělesná voda metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- ionty MeSH
- koloidy MeSH
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
- Klíčová slova
- Infections, Organ dysfunction, Sepsis, Septic shock,
- MeSH
- arteriální tlak MeSH
- Glasgowská stupnice kómat MeSH
- konsensus MeSH
- lidé MeSH
- senzitivita a specificita MeSH
- sepse klasifikace mortalita MeSH
- správnost dat * MeSH
- stupeň závažnosti nemoci * MeSH
- vyhodnocení orgánové dysfunkce MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
