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重症监护病房的“神奇数字”:生物标志物在支持临床决策中的作用

ICU 'Magic Numbers': The Role of Biomarkers in Supporting Clinical Decision-Making.

作者信息

Cipulli Francesco, Balzani Eleonora, Marini Giuseppe, Lassola Sergio, De Rosa Silvia, Bellani Giacomo

机构信息

Anesthesia and Intensive Care 1, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Largo Medaglie d'Oro 9, 38112 Trento, Italy.

Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy.

出版信息

Diagnostics (Basel). 2025 Apr 11;15(8):975. doi: 10.3390/diagnostics15080975.

Abstract

Critical care medicine is a highly complex field where diagnosing diseases and selecting effective therapies pose daily challenges for clinicians. In critically ill patients, biomarkers can play a crucial role in identifying and addressing clinical problems. Selecting the right biomarkers and utilizing them effectively can lead to more informed decisions, ultimately impacting patient outcomes. However, each biomarker has its strengths and limitations, making a thorough understanding essential for accurate diagnosis and treatment management. For instance, neuron-specific enolase (NSE) is commonly used to predict outcomes in out-of-hospital cardiac arrest (OHCA), procalcitonin (PCT) levels strongly correlate with bacterial infections, and NT-proBNP serves as a reliable indicator of cardiac stress. Additionally, serum creatinine (SCr) remains fundamental in renal diagnostics, while prealbumin helps differentiate catabolic and anabolic phases in critically ill patients. This narrative review highlights a carefully selected set of biomarkers known for their clinical utility and reliability in guiding critical care decisions. Further refining the application of biomarkers-especially by integrating them into a multimodal approach-will enhance clinicians' ability to navigate the challenges of critical care, always striving to improve patient outcomes.

摘要

重症医学是一个高度复杂的领域,对临床医生来说,诊断疾病和选择有效的治疗方法是日常面临的挑战。在重症患者中,生物标志物在识别和解决临床问题方面可以发挥关键作用。选择合适的生物标志物并有效利用它们可以做出更明智的决策,最终影响患者的治疗结果。然而,每种生物标志物都有其优点和局限性,因此全面了解对于准确诊断和治疗管理至关重要。例如,神经元特异性烯醇化酶(NSE)常用于预测院外心脏骤停(OHCA)的预后,降钙素原(PCT)水平与细菌感染密切相关,而N末端脑钠肽前体(NT-proBNP)是心脏应激的可靠指标。此外,血清肌酐(SCr)在肾脏诊断中仍然是基础指标,而前白蛋白有助于区分重症患者的分解代谢和合成代谢阶段。这篇叙述性综述重点介绍了一组精心挑选的生物标志物,它们在指导重症监护决策方面具有临床实用性和可靠性。进一步优化生物标志物的应用——特别是通过将它们整合到多模式方法中——将提高临床医生应对重症监护挑战的能力,始终努力改善患者的治疗结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6bea/12025389/0ee4b78510ac/diagnostics-15-00975-g001.jpg

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