Procalcitonin and C-reactive protein during systemic inflammatory response syndrome,sepsis and organ dysfunction

Introduction  

Both C-reactive protein (CRP) and procalcitonin (PCT) are accepted sepsis markers. However, there is still some debate concerning the correlation between their serum concentrations and sepsis severity. We hypothesised that PCT and CRP concentrations are different in patients with infection or with no infection at a similar severity of organ dysfunction or of systemic inflammatory response.     

Oxidative stress in critically ill patients with systemic inflammatory response syndrome

OBJECTIVE: To evaluate whether critically ill patients with systemic inflammatory response syndrome, on admission to an intensive care unit, had more severe oxidative stress than those without this syndrome. DESIGN: A prospective, cohort study. SETTING: A mixed medical and surgical adult intensive care unit with 12 beds. PATIENTS: A total of 68 consecutive patients admitted to the intensive care unit. INTERVENTIONS: Venous blood samples were routinely obtained within 24 hrs of admission. MEASUREMENTS AND MAIN RESULTS: Patients' plasma total antioxidant capacity, the lipid peroxidation products malondialdehyde and 4-hydroxynonenal, reduced sulfhydryl groups, and nitrites/nitrates were measured by spectrophotometric technique at admission to the intensive care unit. Myeloperoxidase (enzyme-linked immunosorbent assay) and polymorphonuclear elastase (immuno-activation assay) were also measured on admission to the intensive care unit. The patients with criteria of systemic inflammatory response syndrome (n = 20) had higher Acute Physiology and Chronic health Evaluation III scores (determined by collecting the worst value within 24 hrs after admission to the intensive care unit) and plasma concentrations of lipid peroxidation products and nitrites/nitrates and lower plasma concentration of reduced sulfhydryl groups and plasma total antioxidant capacity than patients without the syndrome (n = 48). Moreover, the markers for leukocyte activation, myeloperoxidase and polymorphonuclear elastase, presented higher concentrations in the plasma of patients with systemic inflammatory response syndrome. CONCLUSIONS: Patients admitted to the intensive care unit with criteria of systemic inflammatory response syndrome had a more severe oxidative stress than patients without this syndrome.     

全身炎症反应综合征评分应用于产科急危重症患者中的效果评价

目的 探究全身炎症反应综合征(systemic inflammatory response syndrome, SIRS)评分应用于产科急危重症患者中的效果。方法 选取我院 2016年10月-2018年10月收治的产科急危重症患者134 例,按照随机数表法将其分为对照组和观察组,各67例,对照组给予常规干预,观察组采用SIRS评分干预。比较2组不良妊娠结局、并发症发生率及围生儿死亡率。结果 干 预后观察组不良妊娠结局发生率及并发症发生率均低于对照组(X₂=4.968,P=0.026;X₂= 3.890,P=0.049);2组围生儿死亡率比较,差异无统计学意义(X₂=3.890,P=0.049)。结论 SIRS评分应用于产科急危重症患者中,可改善患者的不良妊娠结局,降低并发症发生率,值得推广。     

血小板在危重病患者全身炎症反应监测中的意义

目的 :研究血小板在危重病全身炎症反应监测中的意义 ,为全身炎症反应综合征 (SIRS)提供敏感而简易的临床监测指标。方法 :ICU内各种原因所致的 SIRS、脓毒症和多器官功能障碍综合征 (MODS)患者 2 13例 ,按临床结局将患者分为死亡组 (n=6 2 )和存活组 (n=15 1)。入院后当天和第 3d、7d、10 d进行急性生理学和慢性健康状况评分 (APACHE )、血常规和外周血中肿瘤坏死因子α(TNFα)检测。结果 :入 ICU时存活组和死亡组 APACHE 评分明显增高 ,但无显著差异 ;治疗 7d和 10 d后 ,存活组下降至 10分以下 ,而死亡组上升至 2 0分以上 (P<0 .0 1)。血小板计数在入院时两组均降低 ,治疗 3d后有明显回升 ,但在治疗后 7d和 10 d时死亡组患者血小板再度进行性下降 ,而存活组上升至正常范围 (P<0 .0 0 1) ;白细胞总数和分类两组间无显著差异。入院时两组患者外周血中 TNFα的浓度无显著差异 ,3d后两组 TNFα均升高 ;治疗 7d和 10 d后存活组 TNFα水平显著下降 ,而死亡组患者仍维持在相对高的水平 ,两组间有显著性差异 (P均 <0 .0 0 1)。结论 :血小板进行性下降能较正确、敏感地反映全身炎症反应的强弱 ,且其检查快速、简单、易行 ,在临床上有较大的实用价值。     

Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients

Introduction  

Non-intensive care unit (ICU) cohorts have shown an association between inflammatory disturbances and delirium, though these relationships have not been studied in critically ill patients. This study sought to investigate the relationship between two inflammatory biomarkers, procalcitonin and C-reactive protein (CRP), and duration of acute brain dysfunction in ventilated patients.     

C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome

Objective To assess the diagnostic value of a single determination of serum C-reactive protein as a marker of sepsis in critically ill patients.Design Prospective, observational study.Setting Intensive care unit of a university hospital.Patients and participants One hundred twenty-five adult patients with systemic inflammatory response syndrome (SIRS) (55 patients without evidence of infection and 70 patients with the diagnosis of sepsis confirmed by documented infection). Twenty-five patients with non-complicated acute myocardial infarctions (AMI) and 50 healthy volunteers were used as controls.Interventions None.Measurements and results Serum C-reactive protein concentration was measured within the first 24 h of SIRS onset. Healthy subjects, AMI and non-infectious SIRS patients showed lower C-reactive protein median values ([(0.21 [95% confidence intervals (95% CI), 0.21–0.4] mg/dl, 2.2 [95% CI, 2.1–4.9] mg/dl and 1.7 [95% CI, 2.4–5.5] mg/dl, respectively) than patients with sepsis (18.9 [95% CI, 17.1–21.8]), p<0.001. The presence of severe sepsis (r_s=0.27; p=0.03), SOFA score (r_s=0.25; p=0.03) and arterial lactate (r_s=0.24; p=0.04) correlated significantly with C-reactive protein concentrations in sepsis cases. The best threshold value for C-reactive protein for predicting sepsis was 8 mg/dl (sensitivity 94.3%, specificity 87.3%). The area under the receiver-operating characteristic curve for C-reactive protein was 0.94 (95% CI, 0.89–0.98).Conclusions Determination of serum C-reactive protein can be used as an early indicator of infection in patients with SIRS.Supported in part by Red Respira (isciii-RTIC C03/11), CIRIT SGR 2001/414 and Distinció a la Recerca Universitaria (JR).     

全身炎性反应综合征患者血清C反应蛋白、白细胞介素6和D-二聚体的变化

目的探讨神经科并发全身炎性反应综合征(SIRS)的危重症患者血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)和D-二聚体(D-Di)水平变化及其与多器官功能障碍综合征(MODS)和病死率的关系。方法将120例神经科危重症患者根据是否并发SIRS分为SIRS组(48例)和非SIRS组(72例),分别于发病24 h内及3 d、7 d晨起空腹抽取静脉血5 mL,测定血清CRP、IL-6、D-Di水平,并观察两组患者的MODS发生率和病死率。结果发病24 h内、3 d、7 d不同时间血清CRP,非SIRS组内比较差异无统计学意义(P0.05),但SIRS组内比较差异有统计学意义(P0.05);各时间点SIRS组血清CRP水平明显高于非SIRS组(P0.01)。SIRS组发病24 h内、3 d、7 d时血清IL-6明显高于非SIRS组(P0.05)。非SIRS组发病24 h内、3 d、7 d不同时间D-Di水平比较差异无统计学意义(P0.05),SIRS组内比较差异有统计学意义(P0.05);各时间点SIRS组D-Di水平明显高于非SIRS组(P0.01)。SIRS组MODS发生率明显高于非SIRS组(χ2=5.042,P0.05),SIRS组病死率明显高于非SIRS组(χ2=7.879,P0.05)。结论血清CRP、IL-6及D-Di可作为预测MODS的早期指标。     

Diagnostic accuracy of sTREM-1 to identify infection in critically ill patients with systemic inflammatory response syndrome

ObjectivesTo assess the accuracy of plasma levels of soluble Triggering Receptor Expressed on Myeloid cells (sTREM)-1 to diagnose infection in critical patients with systemic inflammatory response syndrome (SIRS).Design and methodsWe prospectively studied 114 patients with SIRS criteria. The patients’ plasma levels of sTREM-1 were measured within 24 h of admission to the intensive care unit. The final diagnosis of infection was made independently by two investigators, who were blinded to the levels of sTREM-1.ResultsThe area under the ROC curve of sTREM-1 for the diagnosis of sepsis was 0.62 (95% confidence interval [95% CI] 0.51–0.72). The diagnostic odds ratio of sTREM-1 after adjusting for the Infection Probability Score and procalcitonin plasma levels was 1.81 (95% CI 0.66–4.98; p = 0.2508).ConclusionsIn critical patients admitted with SIRS, sTREM-1 has poor discriminative power to identify patients with infection, and sTREM-1 levels do not add diagnostic information to that provided by other routinely available clinical tests.     

Endotoxin immunity and the developmentof the systemic inflammatory responsesyndrome in critically ill children

Background The systemic inflammatory response syndrome (SIRS) may be triggered by endotoxin. Humans have antibodies directed against the core of endotoxin (endotoxin core antibodies, EndoCAb) that appear to be protective following surgery and in sepsis. We hypothesised that children with elevated antibodies to endotoxin core would be less likely to develop SIRS in their initial period on intensive care. Because of the existing literature we defined two sub-groups according to the primary reason for ICU admission: infection and non-infection. Methods We recruited 139 consecutive patients admitted to a paediatric intensive care unit (PICU) with more than one organ failure for longer than 12 h as part of another study. Patients were classified on admission to PICU as having an infectious or a non-infections diagnosis. The occurrence of SIRS within 48 h of admission was recorded along with detailed clinical and demographic data, EndoCAb concentration and the potential confounding variables C-reactive protein and mannose-binding lectin. Results In the 71 patients admitted without infection (primarily post-operative and head injured) IgG EndoCAb was significantly lower in patients who developed SIRS than those who did not (72 vs. 131 MU/ml), independent of potential confounding variables. In patients with infection there was no significant difference in IgG EndoCAb between children developing SIRS and those who did not (111 vs. 80 MU/ml). Conclusion Head injured and post-operative patients admitted to PICU who develop early SIRS have significantly lower serum IgG EndoCAb levels than those who do not. M.W.T. and N.J.K. both act as scientific consultants for NatImmune, a Danish company exploring the therapeutic potential of MBL. M.G.M. is involved in the development of an anti-endotoxin vaccine This article refers to the editorial .     

老年全身炎症反应综合征患者血清D-二聚体和C反应蛋白检测的意义

目的 研究D-二聚体、C反应蛋白（CRP）检测在老年全身炎症反应综合征（SIRS）向多器官功能障碍综合征（MODS）转化中的临床意义。方法 老年患者240例分为SIRS组和非SIRS组，SIRS组190例再分为MODS组与非MODS组，常规测定各组患者APACHEⅡ评分，分别用ELISA法测定血清D-二聚体水平，全自动生化分析仪免疫比浊法测定CRP水平。结果 发病后24h内SIRS组D-二聚体和CRP水平明显高于非SIRS组（P〈0．01）。MODS组患者血D-二聚体和CRP水平明显高于非MODS组（P〈0．05）。D-二聚体与预后呈负相关（r=-0．2879，P〈0．01）。结论 检测SIRS患者血清CRP和D-二聚体水平有助于早期诊断MODS并判断预后。     

Evaluation of oxygen consumption and resting energy expenditure in critically ill patients with systemic inflammatory response syndrome.

OBJECTIVE: To determine whether oxygen consumption VO2), CO2 production, and resting energy expenditure (REE) in critically ill patients differ in varying grades of systemic inflammatory response syndrome (SIRS). DESIGN: Prospective, clinical study. SETTING: Intensive care unit at a university hospital. PATIENTS: Twenty-six critically ill patients requiring mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 100 metabolic measurements were performed. The grade of SIRS and the Acute Physiology and Chronic Health Evaluation II score were evaluated at the time of the metabolic cart study. VO2 and REE differed among the groups inadequate for SIRS (non-SIRS), with SIRS without infection (nonseptic SIRS), and with SIRS with infection (septic SIRS) (125 +/- 37 mL/min/m2 and 855 +/- 204 kcal/day/m2, 135 +/- 33 mL/min/m2 and 948 +/- 214 kcal/day/m2, and 166 +/- 55 mL/min/m2 and 1149 +/- 339 kcal/day/m2, respectively; p < .005). Patients with septic SIRS had higher VO2 and REE than patients with non-SIRS and nonseptic SIRS. CONCLUSION: VO2 and REE differ among groups of patients with non-SIRS, nonseptic SIRS, and septic SIRS. Patients with septic SIRS have higher VO2 and REE than patients with non-SIRS or nonseptic SIRS. The present study shows that classifying patients into three grades (non-SIRS, nonseptic SIRS, and septic SIRS) is a valid predictor of metabolic stress in critically ill patients.     

Evaluation of severity for systemic inflammatory response syndrome and sepsis

Systemic inflammatory response syndrome (SIRS) is defined by four simple clinical and laboratory indices and now widely accepted for diagnosing sepsis. However, since the SIRS criteria include patients with a wide range of severity, other parameters are necessary to evaluate the severity and outcome of the patients. In this review, we discussed several methods to estimate the severity of SIRS, such as number of positive SIRS indices among four, duration of SIRS, plasma IL-6 and procalcitonin, etc.     

Hypermetabolism syndrome in critically ill children

The paper focuses on the developmental mechanisms and triggers of hypermetabolism, by describing the specific features of pathophysiological reactions occurring in the child's body. It also shows the leading role of artificial therapeutic feeding included into the multimodality therapy of children under stresses in restoring plastic and energy demands and in preventing the development of multiple organ dysfunction.     

Biomarkers in the critically ill patient: C-reactive protein

Levels of C-reactive protein (CRP), an acute phase protein, are elevated in many inflammatory conditions and are used to detect and follow disease in many fields of medicine, including rheumatology, gastroenterology, and cardiology. CRP concentrations are also used in critically ill patients, notably because they are increased during the inflammatory response to infection, that is, sepsis. However, CRP is not specific for sepsis, and serum CRP concentrations need to be interpreted in the context of a full clinical examination and the presence of other signs and symptoms of sepsis.