Prognostička vrednost presepsina (solubilnog CD 14-podtipa) u dijagnozi pneumonija povezanih sa mehaničkom ventilacijom i sepse kod traumatizovanih bolesnika

  • Bojan Jovanović Institute of Epidemiology, School of Medicine, University of Belgrade, Serbia
  • Olivera Đurić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Ljiljana Marković-Denić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Aleksandra Isaković University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Krstina Doklestić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Sanja Stanković Clinical Center of Serbia, Center for Medical Biochemistry, Belgrade, Serbia
  • Sašenka Vidičević University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Ivan Palibrk University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Janko Samardžić University of Belgrade, Clinical Pharmacology and Toxicology, Belgrade, Serbia
  • Vesna Bumbaširević University of Belgrade, Faculty of Medicine, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP161104027J
Ključne reči: presepsin protein, humani;, pneumonija, respiratorom uzrokovana;, sepsa;, šok, spetički;, biološki pokazatelji;, senzitivnost i specifičnost;, dijagnoza.

Sažetak


Uvod/Cilj. Persepsin (solubilni CD14-podtip) je fragment CD14 koji se produkuje kao odgovor na prisustvo bakterijske infekcije i predstavlja novi biomarker u dijagnostici pneumonije, sepse i spetičkog šoka. Cilj ove studije bio je da se uporedi senzitivnost i specifičnost presepsina (solubilnog CD14-podtipa) sa ostalim biomarkerima infekcije: prokalcitoninom (PCT), C-reaktivnim proteinom (CRP) i brojem leukocita (Le) kod povređenih bolesnika na mehaničkoj ventilaciji, kao markera pneumonije, sepse i septičkog šoka. Metode. Prospektivna studija sprovedena je u dve jedinice intenzivnog lečenja (JIL) (traumatološka i hirurška) Kliničkog centra Srbije u periodu od januara do aprila 2013. godine. U studiju je bilo uključeno 39 traumatizovanih bolesnika na mehaničkoj ventilaciji kod kojih se razvio neki od sledećih ishoda koji su bili i kriterijumi za uključivanje: sisemski inflamatorni odgovor (SIRS), pneumonija povezana sa mehaničkom ventilacijom (VAP), sepsa i/ili septički šok. Na prijemu u JIL Acute Physiology and Chronic Health Evaluation II (APACHE II) skor i Injury Severity Score (ISS) su računati za svakog bolesnika. Sedamdeset i dva merenja koncentracije četiri biomarkera (presepsin, PCT, CRP i Le) urađena su kod 39 bolesnika u trenutku postavljanja dijagnoze SIRS, VAP, sepse i/ili septičkog šoka. Sequential Organ Failure Assessment (SOFA) skor takođe je meren istovremeno. Rezultati. Većina bolesnika na prijemu bila je teško povređena (srednja vrednost ISS skora = 24.2) i bila je u srednje teškom stanju (srednja vrednost APACHE II skora = 14.5). Koncentracije presepsina značajno su se razlikovale između sve četiri grupe bolesnika, osim između grupa sa sepsom i septičkim šokom. Najsnažniju pozitivnu korelaciju presepsin je imao sa PCT (r = 0.741, p < 0.001). sCD14-ST pokazao je bolju prediktivnu vrednost u dijagnozi pneumonije (AUC = 0.909) i sepse (AUC = 0.899) u odnosu na PCT (AUCs: 0.863, 0.855), CRP (AUCs: 0.703, 0.677) i Le (AUCs: 0.688, 0.700). Zaključak. Ova studija je pokazala da je sCD14-ST pouzdan biomarker u određivanju težine sepse kao i da je u dobroj korelaciji sa nastankom infekcije i pogoršanjem stanja kod povređenih bolesnika.

Reference

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Objavljeno
2020/12/21
Broj časopisa
Vol. 75 Br. 10 (2018): Vojnosanit Pregl 2018; October Vol. 75 (No. 10)
Rubrika
Originalni članak