Beruflich Dokumente
Kultur Dokumente
Sepsis
Clnica
Revision
Sepsis
Introduccin
Diagnstico temprano
Terapia
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther. 11(3),
265275 (2013)
Sepsis
Estudios Soporte
No Fcil
Dg. Crticos
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
Choque sptico:
Biomarcadores
Brit Long, Alex Koyfman. Ready for Prime Time? Biomarkers in Sepsis. Emerg Med Clin N Am 35 (2017)
Descartar Infeccion UCI
Fiebre
Antibioticos y estudios
Inecesarios
Hernando A. Guadania L. Sepsis biomarkers: A review. An Real Acad Farm Vol. 83, N 2 (2017)
Pronostico: DMO
Terapia - Respuesta
Procalcitonina
Biomarcadores Actuales de Sepsis
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
LACTATO
20 mmol/kg/d.
NADH
Metabolismo
anaerobio
T. Hepticos
Brit Long, Alex Koyfman. Ready for Prime Time? Biomarkers in Sepsis. Emerg Med Clin N Am 35 (2017)
Brit Long, Alex Koyfman. Ready for Prime Time? Biomarkers in Sepsis. Emerg Med Clin N Am 35 (2017)
LACTATO
10% = Objetivo
M : 60%
Brit Long, Alex Koyfman. Ready for Prime Time? Biomarkers in Sepsis. Emerg Med Clin N Am 35 (2017)
PROTEINA C REACTIVA
Inflamacin
Pavea et al.
no especifica
>8.7 mg/dl
S93 E81
Infeccin
>8.7 mg/dl
Fiebre 1930
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
PROTEINA C REACTIVA
4.1 mg/dl
I. Nosocomial
S 92 E74
48 H
M: 15,4%
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
Antibioticoterapia
Ineficaz
2,2 mg/dl
48H
NAV NAC
96H 60%
Eficaz 3D
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
Procalcitonina
Ramon Sager. Alexander Kutz. Beat Mueller. Philipp Schuetz. Procalcitonin-guided diagnosis and
antibiotic stewardship revisited. BMC Medicine. 2017
NAC 0,25 mcg/dl
S 95% y E 50%
>0.85 ng/ml M: 43.5%
No especifica
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
Tendencias
M 50%
72 h. 2010 Rol no
definido
Recognition IVF Antibiotics
Duracin
Cintica de la Procalcitonina
13% Incremental
Increase
Hernando A. Guadania L. Sepsis biomarkers: A review. An Real Acad Farm Vol. 83, N 2 (2017)
PCT en ER
Sobreutilizacin
Antibioticoterapia
Bronquitis y EPOC
TTO Cortos
Ramon Sager. Alexander Kutz. Beat Mueller. Philipp Schuetz. Procalcitonin-guided diagnosis and
antibiotic stewardship revisited. BMC Medicine. 2017
Consideraciones
A
PCT. 0,25 ng/ml
S > 0,50
Ramon Sager. Alexander Kutz. Beat Mueller. Philipp Schuetz. Procalcitonin-guided diagnosis and
antibiotic stewardship revisited. BMC Medicine. 2017
ITU
A B C
Pacientes 8.16 ng/ml
Procalcitonina quirrgicos.
1.16 ng/ ml QX percutnea
de rin
Qx cardiaca. 0.47
ng/ml
Ramon Sager. Alexander Kutz. Beat Mueller. Philipp Schuetz. Procalcitonin-guided diagnosis and
antibiotic stewardship revisited. BMC Medicine. 2017
La Neumonia nosocomial. La PCT no evidencia
capacidad diagnostica de forma aislada
CEPIS
Salluh J. Souza-Dantas V. Povoa P. The current status of biomarkers for the diagnosis
of nosocomial pneumonias. Curr Opin Crit Care 2017.
Niveles de Citocinas
Protenas IL6
IL8
Receptores FNT
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
Bozza et al.
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
IL 1 B
IL4
IL6
IL8
Mortalidad
MCP 1
Temprana
CSF
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
126 ER
Sepsis
IL2 RS
Severidad
IL8 y IL1B Choque
Sptico
Lvovschi V, Arnaud L, Parizot C et al. Cytokine profiles in sepsis have limited relevance for stratifying
patients in the emergency department: a prospective observational study. PLoS ONE 6(12), e28870 (2011).
Limitaciones.
Inespecfico
cintica
Hernando A. Guadania L. Sepsis biomarkers: A review. An Real Acad Farm Vol. 83, N 2 (2017)
Receptor soluble expresado en
clulas mieloides tipo 1(STREM 1)
INMUNOGLOBULINAS
S:60 E:59
NO SANOS
Hernando A. Guadania L. Sepsis biomarkers: A review. An Real Acad Farm Vol. 83, N 2 (2017)
CD 64
i> 2,3
SANOS
S:93 E:89
ONDA DEL COAGULO
Transmisin
ptica
59,3%
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
Protena C especifica de la
detencin del Crecimiento (Gas 6)
Protena Intracelular
Adhesion migracion y apoptosis
85 ng/ml
Gravedad
Vincent Jean-Louis. Diagnostic and prognostic markers in sepsis. Expert Rev. Anti Infect. Ther.
11(3), 265275 (2013)
Angiopoyetina
FCE
Brit Long, Alex Koyfman. Ready for Prime Time? Biomarkers in Sepsis. Emerg Med Clin N Am 35 (2017)
Proadrenomodulina (pro ADM)
Citoquinas
Vasodilatador e Inmunomodularor
Severidad de la NAC
Brit Long, Alex Koyfman. Ready for Prime Time? Biomarkers in Sepsis. Emerg Med Clin N Am 35 (2017)
Polimorfismo Gentico
Cambio de
Secuencia de AA
de un gen
Mas de 30 genes
IL 1
IL 6 < mortalidad G/G
IL 10 < m 1082 G/C
Otros Biomarcadores
PAMP
PRR
10
TLR C. DENDRITICAS
NEUTROFILOS
Lps
TLR 4 G-
.
Hernando A. Guadania L. Sepsis biomarkers: A review. An Real Acad Farm Vol. 83, N 2 (2017)
Preseptina
Macrfagos,
monocitos neutrfilos,
Selectinas Adhesion,
Rodamiento
DMO
Hernando A. Guadania L. Sepsis biomarkers: A review. An Real Acad Farm Vol. 83, N 2 (2017)
Conclusiones