Department of Internal Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Radboud University Medical Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
Department of Intensive Care Medicine, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands; Radboud University Medical Center for Infectious Diseases, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
J Crit Care. 2023 Dec;78:154360. doi: 10.1016/j.jcrc.2023.154360. Epub 2023 Jun 19.
Mortality in acute infections is mostly associated with sepsis, defined as 'life-threatening organ dysfunction caused by a dysregulated host response to infection'. It remains challenging to identify the patients with increased mortality risk due to the high heterogeneity in the dysregulated host immune response and disease progression. Biomarkers reflecting different pathways involved in the inflammatory response might improve prediction of mortality risk (prognostic enrichment) among patients with acute infections by reducing heterogeneity of the host response, as well as suggest novel strategies for patient stratification and treatment (predictive enrichment) through precision medicine approaches. The predictive value of inflammatory biomarkers has been extensively investigated in bacterial infections and the recent COVID-19 pandemic caused an increased interest in inflammatory biomarkers in this viral infection. However, limited research investigated whether the prognostic potential of these biomarkers differs between bacterial and viral infections. In this narrative review, we provide an overview of the value of various inflammatory biomarkers for the prediction of mortality in bacterial and viral infections.
急性感染的死亡率主要与败血症有关,败血症定义为“宿主对感染的失调反应导致危及生命的器官功能障碍”。由于宿主免疫反应和疾病进展的失调存在高度异质性,因此仍然难以识别具有更高死亡率风险的患者。通过减少宿主反应的异质性,反映炎症反应中不同途径的生物标志物可能通过精准医学方法改善急性感染患者的死亡率风险预测(预后富集),并通过精准医学方法为患者分层和治疗(预测富集)提供新策略。在细菌性感染中,炎症生物标志物的预测价值已经得到了广泛的研究,而最近 COVID-19 大流行也增加了人们对这种病毒感染中炎症生物标志物的兴趣。然而,关于这些生物标志物的预后潜力是否在细菌性和病毒性感染之间存在差异的研究有限。在这篇叙述性综述中,我们概述了各种炎症生物标志物在预测细菌性和病毒性感染患者死亡率方面的价值。