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Biomarcadores y

Sepsis

Dr. Santiago Cruz Montesinos


HJM, Medicina de Emergencia y Cuidados Crticos.
@SimposiumSepsisMx
Objetivos

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

Diagnostico & Decisiones


Ideal. Rapido / Estratificar

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

>2.0 mmo/L E82 % S30%


>2. mmol/ L M: 14% Independiente
>20mmol/L M: 39%

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%

>10 mg/dl Infeccion =


M: 60.9% Incrementa

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

Polipeptido 16 a Virus IF gamma


Clulas T de la tiroides
Pulmones
TGI

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

Karlsson S, Heikkinen M, Pettil V et al.;Finnsepsis Study Group. Predictive value of procalcitonin


decrease in patients with severe sepsis: a prospective observationalstudy. Crit. Care 14(6), R205. 2010
Gua

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

Zheng J, Li Q, Fu W, et al. Procalcitonin as an early diagnostic and monitoring tool in urosepsis,


following.percutaneous.nephrolithotomy. Urolithiasis 2015
Post Qx niveles
altos. 48H. Infeccion.

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%

PCT>1 S:79 E:96

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

Tipo 1 < 5.5 ng/ml


Tipo 2 > 21.5 ng/ml

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

Sepsis es un problema de salud publica que


requiere, Biomarcadores que permitan evaluar la
enfermedad.

Existe una amplia literatura, sin embargo ningn


biomarcador tiene sensibilidad y especificidad.

Los mas utilizados son PCT y el PCR.


GRACIAS

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