Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen road, Leicester LE5 4PW, UK.
Ir J Med Sci. 2011 Dec;180(4):793-8. doi: 10.1007/s11845-011-0741-1. Epub 2011 Jul 30.
Sepsis is a leading cause of death in the critically ill patient. It is a heterogeneous disease and it is frequently difficult to make an unequivocal and expeditious diagnosis. The current 'gold standard' in diagnosing sepsis is the blood culture but this is only available after a significant time delay. Mortality rates from sepsis remain high, however, the introduction of sepsis care bundles in its management has produced significant improvements in patient outcomes. Central to goal-directed resuscitation is the timely and accurate diagnosis of sepsis. The rapid diagnosis and commencement of the appropriate therapies has been shown to reduce the mortality.
Biomarkers are already used in clinical practice to aid other more traditional diagnostic tests. In the absence of an adequate gold standard to diagnose sepsis, there has been considerable and growing interest in trying to identify suitable biomarkers. There is currently an unmet need in the medical literature to communicate the importance of the challenges relating to the rapid diagnosis and implementation of goal-directed therapy in sepsis and the underlying concepts that are directing these investigations. This article reviews the more novel biomarkers investigated to differentiate systemic inflammatory response syndrome from sepsis.
The biomarkers described reflect the difficulties in making evidence-based recommendations particularly when interpreting studies where the methodology is of poor quality and the results are conflicting. We are reminded of our responsibilities to ensure high quality and standardised study design as articulated by the STAndards for the Reporting of Diagnostic accuracy studies (STARD) initiative.
败血症是危重病患者死亡的主要原因。它是一种异质性疾病，通常很难做出明确和迅速的诊断。目前诊断败血症的“金标准”是血培养，但只有在相当长的时间延迟后才能获得。然而，由于败血症护理包的引入，败血症的死亡率仍然很高，这对患者的预后产生了显著的改善。以目标为导向的复苏的核心是及时、准确地诊断败血症。快速诊断和开始适当的治疗已被证明可以降低死亡率。
生物标志物已在临床实践中用于辅助其他更传统的诊断测试。由于缺乏诊断败血症的充分金标准，因此人们对尝试识别合适的生物标志物产生了浓厚的兴趣。目前，医学文献中存在一个未满足的需求，即需要传达与败血症的快速诊断和目标导向治疗的实施相关的挑战以及指导这些研究的基本概念的重要性。本文综述了用于区分全身炎症反应综合征与败血症的更新型生物标志物。
所描述的生物标志物反映了在进行基于证据的推荐时所面临的困难，特别是在解释那些方法学质量差且结果相互矛盾的研究时。我们被提醒要承担责任，确保高质量和标准化的研究设计，正如诊断准确性研究报告标准（STARD）倡议所阐明的那样。
