الفهرس | Only 14 pages are availabe for public view |
Abstract Sepsis is a complex clinical syndrome which is multifactorial with many varying presentations. The pathophysiology of the syndrome is complex, involving inflammatory mediators, cell mediated immune response, Toll like receptor expression, and many cell surface receptors. In this study we tried to validate the efficacy of using a relatively new marker claiming it has better behaviour in the development of the septic syndrome and hence its potential to be used as a diagnostic marker for bacterial infection. The study included 74 patients divided on pathophysiological bases as Systemic inflammatory response syndrome (SIRS), sepsis, sever sepsis and septic shock groups, another group was derived from these and termed the non survivors group. Two endpoints were allocated in this study, the first was at day 6 and represented the first stage of measurements of the inflammatory markers proposed, the second endpoint was at day 28 and supposed to predict the 4 weeks morbidity and mortality nevertheless it could not be fulfilled as many of the subjects were expired somewhere between the 6 and the 28 day. Various groups of patients were used as for the medical conditions, e.g. multiple injuries vascular surgery patients, elective postoperative major surgery.... etc.. Samples were collected, stored and analysed, statistical analysis was done with significance, correlation, sensitivity and specificity analysis. To differentiate SIRS from sepsis we aimed at measuring Procalcitonin (PCT), Interleukin-6 (IL6), and soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) at day of enrolment which showed consistent significant difference between the SIRS and sepsis groups for sTREM-1, but did not show statistical significance for the PCT. The highest cutoff value for the the sTREM-1 was for day 2 compared to day 3 for the PCT. This is important and gives 24 hour earlier decision to be made. Correlation analysis showed stronger association between sTREM-1 and SOFA, which coincided well with the clinical evolution of the septic syndrome. The soluble triggering receptor expressed on myeloid cells-1 sTREM-1 has a high diagnostic power to differentiate SIRS from sepsis at a cutoff value of 116 pg/ml, in addition to differentiating sepsis from sever sepsis at a cutoff value of 187 pg/ ml, its highest value was at day 2 compared to PCT which was highest at day 3. It should be noted that the study design did not include specialised Intensive care settings e.g. cardiac surgery....etc. so the data presented here should be dealt with carefully not to be generalized unless a wider scale study is held and validated the results. |