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入院时的首发体征:初始促炎标志物对ICU患者脓毒症及死亡率的预后价值

First Signs at Admission: Prognostic Value of Initial Proinflammatory Markers for Sepsis and Mortality in ICU Patients.

作者信息

Aktaş Fatma, Zer Yasemin, Elay Gülseren, Erinmez Mehmet

机构信息

Department of Medical Microbiology, Ersin Arslan Education and Research Hospital, Gaziantep 27090, Türkiye.

Department of Medical Microbiology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Türkiye.

出版信息

Pathogens. 2025 Sep 10;14(9):907. doi: 10.3390/pathogens14090907.

DOI:10.3390/pathogens14090907
PMID:41011807
Abstract

Sepsis is a life-threatening condition and due to its non-specific symptoms, diagnosing sepsis and determining its severity remains difficult. Delays in recognizing sepsis can significantly increase mortality despite advances in antimicrobial therapy and resuscitation procedures. Biomarkers can help detect the presence and severity of sepsis, distinguish between types of infections, and evaluate treatment response. This prospective study aims to determine whether biomarker levels measured at the time of intensive care unit (ICU) admission can assist in the early prediction, diagnosis, and prognosis of sepsis and bacteremia. Blood samples were collected from 132 ICU patients upon admission and analyzed for CRP, IL-6, PCT, SAA, and endotoxin levels. Patients were monitored for sepsis development, blood culture results, and mortality. IL-6 levels demonstrated a significant association with prognosis and identified as an independent risk factor. CRP and PCT levels exhibit a significant effect on the development of sepsis in both univariate and multivariate analyses. Also, our study demonstrated that the presence of bacteremia in the initial blood sample taken from intensive care patients holds significant diagnostic and prognostic value even without waiting for species-level identification when combined with markers such as PCT, CRP, and IL-6.

摘要

脓毒症是一种危及生命的病症,由于其症状不具有特异性,诊断脓毒症并确定其严重程度仍然很困难。尽管抗菌治疗和复苏程序有所进展,但脓毒症识别的延迟会显著增加死亡率。生物标志物有助于检测脓毒症的存在和严重程度,区分感染类型,并评估治疗反应。这项前瞻性研究旨在确定在重症监护病房(ICU)入院时测量的生物标志物水平是否有助于脓毒症和菌血症的早期预测、诊断及预后评估。在132例ICU患者入院时采集血样,分析其CRP、IL-6、PCT、SAA和内毒素水平。对患者进行脓毒症发展、血培养结果及死亡率监测。IL-6水平与预后显著相关,并被确定为独立危险因素。在单变量和多变量分析中,CRP和PCT水平对脓毒症的发展均有显著影响。此外,我们的研究表明,即使不等待菌种鉴定,重症监护患者初始血样中的菌血症与PCT、CRP和IL-6等标志物联合时仍具有显著的诊断和预后价值。

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本文引用的文献

1
Artificial Intelligence in Sepsis Management: An Overview for Clinicians.脓毒症管理中的人工智能:临床医生概述
J Clin Med. 2025 Jan 6;14(1):286. doi: 10.3390/jcm14010286.
2
Sepsis Biomarkers: Advancements and Clinical Applications-A Narrative Review.脓毒症生物标志物:进展与临床应用——叙述性综述。
Int J Mol Sci. 2024 Aug 19;25(16):9010. doi: 10.3390/ijms25169010.
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Validation of SeptiCyte RAPID to Discriminate Sepsis from Non-Infectious Systemic Inflammation.验证SeptiCyte RAPID以区分脓毒症与非感染性全身炎症。
J Clin Med. 2024 Feb 20;13(5):1194. doi: 10.3390/jcm13051194.
4
Study on the correlation and clinical significance of T-lymphocyte Subsets, IL-6 and PCT in the severity of patients with sepsis.脓毒症患者病情严重程度与T淋巴细胞亚群、IL-6及PCT的相关性及临床意义研究
Pak J Med Sci. 2023 Jan-Feb;39(1):227-231. doi: 10.12669/pjms.39.1.5711.
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Clinical usefulness of biomarkers for diagnosis and prediction of prognosis in sepsis and septic shock.生物标志物在脓毒症和感染性休克的诊断和预后预测中的临床应用价值。
Medicine (Baltimore). 2022 Dec 2;101(48):e31895. doi: 10.1097/MD.0000000000031895.
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A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis.qSOFA、SIRS 和 NEWS 在预测疑似脓毒症患者死亡率准确性方面的比较:一项荟萃分析。
PLoS One. 2022 Apr 15;17(4):e0266755. doi: 10.1371/journal.pone.0266755. eCollection 2022.
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Biomarkers of sepsis: time for a reappraisal.脓毒症的生物标志物:重新评估的时候到了。
Crit Care. 2020 Jun 5;24(1):287. doi: 10.1186/s13054-020-02993-5.
8
Bloodstream infections in critically ill patients: an expert statement.危重症患者血流感染:专家声明。
Intensive Care Med. 2020 Feb;46(2):266-284. doi: 10.1007/s00134-020-05950-6. Epub 2020 Feb 11.
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Pathologic Difference between Sepsis and Bloodstream Infections.脓毒症与血流感染之间的病理差异。
J Appl Lab Med. 2019 Jan;3(4):654-663. doi: 10.1373/jalm.2018.026245. Epub 2018 Nov 20.
10
Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study.抗菌药物治疗前和治疗后严重脓毒症表现患者的血培养结果:一项诊断研究。
Ann Intern Med. 2019 Oct 15;171(8):547-554. doi: 10.7326/M19-1696. Epub 2019 Sep 17.