Diagnostic markers of sepsis in the emergency department.

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Samenvatting

Sepsis is a complex and heterogenous disease with variable presentation, severity and evolution. Consequently, the list of putative markers of sepsis is long, including ample determinants of both infection and the immuno-inflammatory host response. Sepsis has been defined as the systemic inflammatory response to a documented or suspected infection. Unfortunately this response which embraces numerical deviations in core temperature, heart and respiratory rate and white blood cell count (the so-called SIRS criteria) is too sensitive and not specific enough to identify infected patients in the emergency department (ED).
Extended diagnostic criteria for sepsis have recently been published. They confirm the SIRS criteria as a useful concept but also add important clinical signs and symptoms as well as biological variables that better reflect the clinical response to infection. Among the biological variables, measurement of lactate, central venous oxygen saturation (ScvO2), C-reactive protein (CRP) and prolactin (PCT) are particular interest for the ED specialist.
Early (within GR) and aggressive (ScvO2 > 70%) resuscitation (early goal-directed therapy, EGDT) as compared to standard therapy significantly increased survival in patients with severe sepsis and septic shock. EGDT patients were given more intravenous fluids (including transfusion) and more inotropic support in the ED but had less need for vasopressors, ventilation and invasive hemodynamic monitoring in the ICU. The best outcome was noted in patients with higher lactate clearance, indicating better resolution of global tissue hypoxia. CRP and PCT are both useful markers of sepsis. As compared to CRP, PCT increases earlier, has higher sensitivity and specificity for differentiating infective from non-infective causes of inflammation, more closely correlates with sepsis severity in terms of shock and organ dysfunction and better predicts outcome when followed in time. However, PCT measurement is more costly, time-consuming, and still not routinely available in many hospitals.
Promising new markers for rapid diagnosis of sepsis (e.g. TREM-1) are under investigation and await clinical introduction.
Originele taal-2English
Pagina's (van-tot)138-142
Aantal pagina's5
TijdschriftActa Clinica Belgica: International Journal of Clinical and Laboratory Medicine
Volume61
Nummer van het tijdschriftActa clinica Belgica
DOI's
StatusPublished - 2006

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