【文摘发布】脓毒症目前的诊断方法
发布于 2007-08-21 · 浏览 1232 · IP 海南海南
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Current Diagnostic Methods
Shawn D. Carrigan,1 George Scott,et ca,Toward Resolving the Challenges of Sepsis Diagnosis,[J],Clinical Chemistry,1301–1314
Traditional sepsis diagnostics include culturing techniques and symptom classification systems. A positive culture from blood, urine, cerebrospinal fluid, or bronchial fluid represents the most certain method of diagnosis.
Unfortunately, clinical symptoms frequently manifest themselves in the absence of a positive culture; among the studies we reviewed, positive cultures ranged from 8% to 73% in neonatal diagnoses and from 8% to 88% in
adult diagnoses. An additional drawback of culture based diagnosis is the 24- to 48-h assay time. How-ever, culture-based pathogen identification remains anessential part of diagnosis to verify the efficacy of antimicrobial
treatment, whether rendered before or after culturing.Automated culturing systems detect bacteria based on solution pH or the presence of CO2, with
detection times of 11–31 h and false-positive and -negative diagnoses in the 2–3% range.Classification systems are intended to aid clinical diagnosis
in the absence of a positive culture. Systems such as Acute Physiology Age and Chronic Health Examination(APACHE), Simplified Acute Physiology Score (SAPS),and SIRS represent existing attempts to stratify patients according to various physiologic indices. Although diagnostic usefulness has been demonstrated by the APACHE II score, a majority of studies revealed no diagnostic differentiation of sepsis from SIRS by APACHE II or SAPS II .
Biomarker quantification by immunoassay is limited almost exclusively to commercially available ELISAs. Similar in principle to ELISA, PCT is measured by an immunoluminometric assay. Alternatively, reports of flow cytometric measurement of PCT and other biomarkers exist, although application is limited.Common among these methods is the need for incubation,which leads to a 2–3 h delay in subsequent diagnosis.The catalog of proteic molecules associated with sepsis is extensive and includes cytokines, chemokines, adhesion mediators, soluble receptors, and acute-phase proteins. Initial identification of the proteins to monitor generally stems from animal models of sepsis. Although caution is needed in extrapolating the conclusions of
animal studies to humans, results from these studies contribute considerable to understanding septic inflammation and host response [for reviews of animal studies,see Refs. Current proteic biomarker research focuses primarily on PCT and several interleukins in continued pursuit of a diagnostic magic bullet biomarker for infection. The standard method for characterizing
diagnostic utility is the ROC curve, which plots the sensitivity (true-positive diagnoses) of the diagnostic marker(s) at a specified cutoff value against the specificity (false-positive diagnoses). Table 1 compares sensitivity and specificity values among the surveyed studies for
delineating infectious from noninfectious illness by use of the most commonly reported biomarkers.Tumor necrosis factor- (TNF) is considered the
likely initiating factor in the activation of host response and subsequent cytokine release during infection, with concentrations increasing to 24 times (828 ng/L) their preinfection concentrations at 2 h post-lipopolysaccharide
(LPS) challenge during in vivo experimental endotoxemia. However, the diagnostic utility of TNF is insufficient for distinguishing infectious inflammation, with ROC analyses indicating poor sensitivity and specificity
for differentiating sepsis from lack of infection in adults and neonates . Furthermore, published values are generally 100 ng/L during sepsis in studies of both adults and neonates , which is well below peak concentrations found during experimental endotoxemia. Difficulties in using TNF for sepsis
diagnosis arise from the central role this cytokine plays in the inflammatory response, its short-term concentration in response to bacterial challenge, its short half-life of 17 min , and from excessive concentrations of soluble
receptors p55 (sTNF-RI) and p75 (sTNF-RII) during sepsis
Shawn D. Carrigan,1 George Scott,et ca,Toward Resolving the Challenges of Sepsis Diagnosis,[J],Clinical Chemistry,1301–1314
Traditional sepsis diagnostics include culturing techniques and symptom classification systems. A positive culture from blood, urine, cerebrospinal fluid, or bronchial fluid represents the most certain method of diagnosis.
Unfortunately, clinical symptoms frequently manifest themselves in the absence of a positive culture; among the studies we reviewed, positive cultures ranged from 8% to 73% in neonatal diagnoses and from 8% to 88% in
adult diagnoses. An additional drawback of culture based diagnosis is the 24- to 48-h assay time. How-ever, culture-based pathogen identification remains anessential part of diagnosis to verify the efficacy of antimicrobial
treatment, whether rendered before or after culturing.Automated culturing systems detect bacteria based on solution pH or the presence of CO2, with
detection times of 11–31 h and false-positive and -negative diagnoses in the 2–3% range.Classification systems are intended to aid clinical diagnosis
in the absence of a positive culture. Systems such as Acute Physiology Age and Chronic Health Examination(APACHE), Simplified Acute Physiology Score (SAPS),and SIRS represent existing attempts to stratify patients according to various physiologic indices. Although diagnostic usefulness has been demonstrated by the APACHE II score, a majority of studies revealed no diagnostic differentiation of sepsis from SIRS by APACHE II or SAPS II .
Biomarker quantification by immunoassay is limited almost exclusively to commercially available ELISAs. Similar in principle to ELISA, PCT is measured by an immunoluminometric assay. Alternatively, reports of flow cytometric measurement of PCT and other biomarkers exist, although application is limited.Common among these methods is the need for incubation,which leads to a 2–3 h delay in subsequent diagnosis.The catalog of proteic molecules associated with sepsis is extensive and includes cytokines, chemokines, adhesion mediators, soluble receptors, and acute-phase proteins. Initial identification of the proteins to monitor generally stems from animal models of sepsis. Although caution is needed in extrapolating the conclusions of
animal studies to humans, results from these studies contribute considerable to understanding septic inflammation and host response [for reviews of animal studies,see Refs. Current proteic biomarker research focuses primarily on PCT and several interleukins in continued pursuit of a diagnostic magic bullet biomarker for infection. The standard method for characterizing
diagnostic utility is the ROC curve, which plots the sensitivity (true-positive diagnoses) of the diagnostic marker(s) at a specified cutoff value against the specificity (false-positive diagnoses). Table 1 compares sensitivity and specificity values among the surveyed studies for
delineating infectious from noninfectious illness by use of the most commonly reported biomarkers.Tumor necrosis factor- (TNF) is considered the
likely initiating factor in the activation of host response and subsequent cytokine release during infection, with concentrations increasing to 24 times (828 ng/L) their preinfection concentrations at 2 h post-lipopolysaccharide
(LPS) challenge during in vivo experimental endotoxemia. However, the diagnostic utility of TNF is insufficient for distinguishing infectious inflammation, with ROC analyses indicating poor sensitivity and specificity
for differentiating sepsis from lack of infection in adults and neonates . Furthermore, published values are generally 100 ng/L during sepsis in studies of both adults and neonates , which is well below peak concentrations found during experimental endotoxemia. Difficulties in using TNF for sepsis
diagnosis arise from the central role this cytokine plays in the inflammatory response, its short-term concentration in response to bacterial challenge, its short half-life of 17 min , and from excessive concentrations of soluble
receptors p55 (sTNF-RI) and p75 (sTNF-RII) during sepsis
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