Schuetz Philipp, Christ-Crain Mirjam, Müller Beat
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Curr Opin Crit Care. 2007 Oct;13(5):578-85. doi: 10.1097/MCC.0b013e3282c9ac2a.
We review the advantages and drawbacks of biomarkers in the diagnostic and prognostic assessment of systemic infections.
Since the signs and symptoms of severe infections can be ambiguous, biomarkers provide a more reliable tool in ascertaining the presence of a relevant bacterial infection, its severity and treatment response. Procalcitonin and, to a lesser extent, C-reactive protein and interleukin-8 can improve the diagnostic assessment of infections and guide antibiotic therapy. Promising prognostic biomarkers include cortisol, proadrenomedullin, copeptin and natriuretic peptides. The strengths and weaknesses of biomarkers must be recognized in order to use them rationally and safely. Cutoff ranges of biomarkers must be chosen according to the specific clinical context and they should be used as a complementary tool, to reinforce the clinical diagnostic workup. Biomarkers cannot determine the causative organisms and associated patterns of antibiotic susceptibility.
If used in the proper setting, serial measurements of diagnostic biomarkers may allow treatments to be adjusted at an early stage in patients with severe infections. This may involve either intensifying treatment when infection levels stay high or avoiding unnecessary prolonged courses of antibiotics when levels rapidly decrease, thereby improving the allocation of healthcare resources.
我们综述生物标志物在系统性感染诊断和预后评估中的优缺点。
由于严重感染的体征和症状可能不明确，生物标志物为确定是否存在相关细菌感染、其严重程度及治疗反应提供了更可靠的工具。降钙素原以及在较小程度上的C反应蛋白和白细胞介素-8可改善感染的诊断评估并指导抗生素治疗。有前景的预后生物标志物包括皮质醇、肾上腺髓质素原、 copeptin和利钠肽。必须认识到生物标志物的优点和缺点，以便合理、安全地使用它们。必须根据具体临床情况选择生物标志物的临界值范围，并且应将其用作辅助工具，以加强临床诊断检查。生物标志物无法确定病原体及相关的抗生素敏感性模式。
如果在适当的情况下使用，对诊断性生物标志物进行连续测量可能有助于在严重感染患者的早期阶段调整治疗。这可能包括在感染水平持续较高时加强治疗，或在水平迅速下降时避免不必要的长期抗生素疗程，从而改善医疗资源的分配。
