Rozanovic Martin, Csontos Csaba, Bogár Lajos, Szélig Lívia, Bocskai Tímea, Kovács Patrícia, Matancic Marianna, Miseta Attila, Loibl Csaba
Department of Anesthesiology and Intensive Care, University of Pécs, Hungary.
1st Department of Internal Medicine, University of Pécs, Hungary.
Clin Hemorheol Microcirc. 2016;64(4):875-885. doi: 10.3233/CH-168024.
In polytrauma and burn injury Systemic Inflammatory Response Syndrome (SIRS) develops. SIRS is presented in many hospitalized patients, including those who never develop infection or sepsis. Both in SIRS and sepsis the leukocyte activation occurs. In acute phase reaction leukocytes' upward flotation i.e. leukocyte antisedimentation rate (LAR) can indicate infectious origin.
To evaluate the predictive power of LAR, serum C-reactive protein (CRP) and procalcitonin (PCT) levels regarding mortality risk and development of septic complications.
In a prospective, observational study, 36 patients were followed for 5 days (T1-T5) after admission to a critical care unit immediately with severe polytrauma or burn injury. Eleven patients developed septic complications, their LAR, CRP and PCT levels were analyzed before and after 3 days of sepsis was declared.
Ten patients died due to septic complications. In survivors LAR at T1 (p < 0.001) and T2 (p < 0.001) as well as CRP at T1 (p < 0.05) were significantly higher compared to controls and non survivors. In septic patients LAR (p < 0.05) and CRP (p < 0.05) showed a significant drop one day before sepsis was declared. PCT levels failed to predict this.
Drop in LAR and CRP levels may be warning signs regarding the onset of septic complications after severe polytrauma and burn injury.
在多发伤和烧伤中会发生全身炎症反应综合征（SIRS）。许多住院患者都会出现SIRS，包括那些从未发生感染或脓毒症的患者。在SIRS和脓毒症中都会发生白细胞激活。在急性期反应中，白细胞上浮，即白细胞抗沉降率（LAR）可提示感染源。
评估LAR、血清C反应蛋白（CRP）和降钙素原（PCT）水平对死亡风险和脓毒症并发症发生的预测能力。
在一项前瞻性观察研究中，对36例因严重多发伤或烧伤而立即入住重症监护病房的患者进行了5天（T1 - T5）的随访。11例患者发生了脓毒症并发症，在宣布脓毒症发生3天前后分析了他们的LAR、CRP和PCT水平。
10例患者因脓毒症并发症死亡。与对照组和非幸存者相比，幸存者在T1（p＜0.001）和T2（p＜0.001）时的LAR以及在T1时的CRP（p＜0.05）显著更高。在脓毒症患者中，LAR（p＜0.05）和CRP（p＜0.05）在宣布脓毒症发生前一天显著下降。PCT水平未能预测到这一点。
LAR和CRP水平下降可能是严重多发伤和烧伤后脓毒症并发症发生的警示信号。
