Biomarkers in the critically ill patient:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2011
|
| Schriftenreihe: | Critical care clinics
27,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XV S., S. [215]-428 graph. Darst. |
| ISBN: | 9781455704323 |
Internformat
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Datensatz im Suchindex
| _version_ | 1804145677060538368 |
|---|---|
| adam_text | Titel: Biomarkers in the critically ill patient
Autor: Levy, Mitchell M.
Jahr: 2011
Contents
Preface: Biomarkers in Critical Illness xiii
Mitchell M. Levy
Sensitive, Specific, Predictive... Statistical Basics: How to Use Biomarkers 215
Herwig Gerlach and Susanne Toussaint
Biomarkers are frequently used in critically ill patients, especially during in-
flammatory and/or infectious diseases such as severe sepsis and septic
shock. The rationale of when to measure laboratory parameters, which
marker may be useful, and how to interpret the results is not well defined.
Terms like sensitive, predictive, or significant to describe the capabilities of
specific markers are often mixed up or misused, which may have fatal con-
sequences regarding diagnosis and treatment. This review reflects some
statistical basics with clinical examples, showing possibilities as well as
limitations of how data for biomarkers may be used in critically ill patients.
Physiologic Parameters as Biomarkers: What Can We Learn from Physiologic
Variables and Variation? 229
Ricard Ferrer and Antonio Artigas
Sepsis generates an overwhelming host response characterized by
changes in physiologic parameters. Monitoring these parameters can
help identify and stratify septic patients. Recognizing sepsis early and
identifying septic patients at risk of worsening are keys to successful treat-
ment. Several studies have analyzed the independent physiologic param-
eters associated with the diagnosis of sepsis or bacteremia, with the
development of severe sepsis or septic shock, and with mortality. Physio-
logic variability of heart rate and body temperature is reduced in sepsis
and measuring the variability of these parameters can be useful for the di-
agnosis and prognosis of sepsis.
Biomarkers in the Critically III Patient: C-reactive Protein 241
Jean-Louis Vincent, Katia Donadello, and Xavier Schmit
Levels of C-reactive protein (CRP), an acute phase protein, are elevated in
many inflammatory conditions and are used to detect and follow disease in
many fields of medicine, including rheumatology, gastroenterology, and
cardiology. CRP concentrations are also used in critically ill patients, nota-
bly because they are increased during the inflammatory response to infec-
tion, that is, sepsis. However, CRP is not specific for sepsis, and serum
CRP concentrations need to be interpreted in the context of a full clinical
examination and the presence of other signs and symptoms of sepsis.
Biomarkers in the Critically III Patient: Procalcitonin 253
Konrad Reinhart and Michael Meisner
Infection and/or sepsis biomarkers should help to make the diagnosis and
thus initiate therapy earlier, help to differentiate between infectious and
sterile inflammation, allow the use of more-specific antimicrobials, shorten
the time of antimicrobial use, and ideally identify distinct phenotypes that
may benefit from specific adjunctive sepsis therapies. Procalcitonin (PCT)
was proposed as a sepsis and infection marker more than 15 years ago.
Meanwhile, PCT has been evaluated in various clinical settings. In this
review the present use of PCT on the ICU and in critically ill patients is
summarized, included it s role for diagnosis of severe sepsis and septic
shock and antibiotic stewardship with PCT.
Triggering Receptor Expressed on Myeloid Cell 1 265
Damien Barraud and Sébastien Gibot
Sepsis is a common cause of morbidity and mortality in intensive care
units. There is no gold standard for diagnosing sepsis because clinical
and laboratory signs are neither sensitive nor specific enough and micro-
biological studies often show negative results. The triggering receptor ex-
pressed on myeloid cell 1 (TREM-1) is a member of the immunoglobulin
superfamily. Its expression is upregulated on phagocytic cells in the pres-
ence of bacteria or fungi. This article reports on the potential usefulness of
the assessment of the soluble form of TREM-1 in biologic fluids in the di-
agnosis of infection.
Coagulation Biomarkers in Critically III Patients 281
Marcel Levi, Marcus Schultz, and Tom van der Poll
This article discusses coagulation biomarkers in critically ill patients where
coagulation abnormalities occur frequently and may have a major impact
on the outcome. An adequate explanation for the cause is important, since
many underlying disorders may require specific treatment and supportive
therapy directed at the underlying condition. Deficiencies in platelets and
coagulation factors in bleeding patients or patients at risk for bleeding
can be achieved by transfusion of platelet concentrate or plasma products,
respectively. Prohemostatic treatment may be beneficial in case of severe
bleeding, whereas restoring physiological anticoagulant pathways may be
helpful in patients with sepsis and disseminated intravascular coagulation.
Lactate: Biomarker and Potential Therapeutic Target 299
Okorie Nduka Okorie and Phil Dellinger
Lactate levels are frequently elevated in critically ill patients and correlate
well with disease severity. Elevated lactate levels are prognostic in preho-
spital, emergency department, and intensive care unit settings. This review
discusses the role of lactate as a biomarker in diagnosing and assessing
the severity of systemic hypoperfusion, as well as the role of serum lactate
measurements in guiding clinical care and enabling prognosis in critically ill
patients.
Cardiac Biomarkers in the Critically III 327
Corey E. Ventetuolo and Mitchell M. Levy
Cardiac biomarkers have well-established roles in acute coronary
syndrome and congestive heart failure. In many instances, the detection
of cardiac biomarkers may aid in the diagnosis and risk assessment of
critically ill patients. Despite increasing interest in the use of cardiac bio-
markers in noncardiac critical illness, no clear consensus exists on how
and in which settings markers should be measured. This article briefly
describes what constitutes an ideal biomarker and focuses on those that
have been most well studied in critical illness, specifically troponin, the
natriuretic peptides, and heart-type fatty acid-binding protein.
Sepsis Biomarkers in Polytrauma Patients 345
Charles A. Adams
Despite continual advances in medical care and injury prevention efforts,
traumatic injury remains a leading cause of death of Americans with these
deaths occurring in a tri-modal pattern. The early phases of this pattern are
characterized by immune activation whereas the last phase is marked by
profound immune dysfunction. It is during this last phase that many trauma
patients die of septic complications pointing to a dire need for a specific
biomarker for post-traumatic infection. This article discusses several
biomarkers, including emerging ones, for infection and sepsis following
trauma including inflammatory cytokines, intracellular proteins, and cellu-
lar biomarkers.
Biomarkers in Acute Lung Injury: Insights into the Pathogenesis of Acute
Lung Injury 355
L.J. Mark Cross and Michael A. Matthay
Studies of potential biomarkers of acute lung injury (ALI) have provided in-
formation relating to the pathophysiology of the mechanisms of lung injury
and repair. The utility of biomarkers remains solely among research tools
to investigate lung injury and repair mechanisms. Because of lack of sen-
sitivity and specificity, they cannot be used in decision making in patients
with ALI or acute respiratory distress syndrome. The authors reviewed
known biomarkers in context of their major biologic activity. The continued
interest in identifying and studying biomarkers is relevant, as it provides in-
formation regarding the mechanisms involved in lung injury and repair and
how this may be helpful in identifying and designing future therapeutic
targets and strategies and possibly identifying a sensitive and specific
biomarker.
Neutrophil Gelatinase-associated Lipocalin (NGAL) as a Biomarker for Early Acute
Kidney Injury 379
Douglas Shemin and Lance D. Dworkin
Based on information to date, although limitations in the accuracy of NGAL
in predicting AKI persist, the preponderance of published studies demon-
strate that NGAL, when measured in the plasma and in the urine, is a
reliable biomarker for the subsequent development of clinically apparent
AKI. If very early detection of AKI, via the measurement of plasma or
urinary NGAL, can be followed by effective treatment to abort the develop-
ment or limit the severity of AKI, and therefore decrease the rate of RRT,
length of hospitalization stay, and/or mortality risk, NGAL measurement
will become a critically important diagnostic tool in critical care medicine,
pediatrics, and surgery.
Multimarker Panels in Sepsis 391
Brian Casserly, Richard Read, and Mitchell M. Levy
Biomarkers differentiate between 2 or more biologic states. The complex-
ity of diseases like sepsis makes it unlikely that any single marker will allow
for precise disease specification. Combining several biomarkers into a sin-
gle classification rule should help to improve their accuracy and, therefore,
their usefulness. This article reviews several studies using multimarker
panels, and highlights the potential of more sophisticated diagnostic and
prognostic techniques in future multimarker panels. More complex
algorithms should accelerate the adoption of multimarker panels into the
routine management of patients with sepsis, provided that clinicians un-
derstand the multimarker approach.
Biomarkers: The Future 407
Steven P. La Rosa and Steven M. Opal
The future application of biomarkers in critical illness will be to select and
guide therapy. Specific biomarkers could identify a pathophysiologic per-
turbation or noxious mediator to counteract or the need to replete a
deficient protective protein. Functional genomics could identify patients
at risk for illness or at risk for a poor outcome in critical illness. Genetic
expression studies could help differentiate patients with sepsis from those
with noninfectious inflammation and could also help to monitor illnesses
over time. Expressional and functional proteomics could lead to the iden-
tification of new biomarkers and organ-specific therapies.
Index 421
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| title | Biomarkers in the critically ill patient |
| title_auth | Biomarkers in the critically ill patient |
| title_exact_search | Biomarkers in the critically ill patient |
| title_full | Biomarkers in the critically ill patient guest ed. Mitchell M. Levy |
| title_fullStr | Biomarkers in the critically ill patient guest ed. Mitchell M. Levy |
| title_full_unstemmed | Biomarkers in the critically ill patient guest ed. Mitchell M. Levy |
| title_short | Biomarkers in the critically ill patient |
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