Raised PCT levels have also BAY 87-2243? been reported in other conditions associated with inflammatory response, such as trauma [23], major surgery [24] and cardiac surgery [25]. Although CRP is often reported as inferior compared with PCT in terms of sepsis diagnosis, it is frequently used in clinical practice because of its greater availability. Elevated concentrations of serum CRP are correlated with an increased risk of organ failure and death [26], and the study of its time course may be helpful to evaluate the response to therapy in septic patients [11].Another group of compounds that has been widely assessed as potential biomarkers are the cytokines. These are important mediators in the pathophysiology of sepsis, and most are produced fairly rapidly after sepsis onset.
In a clinical study, levels of TNF and IL-10 were increased within the first 24 hours after admission of the patient [27]. However, blood cytokine concentrations are rather erratic and their time course is not clearly in concert with the course of sepsis [27,28], making interpretation difficult.The diagnosis of sepsis is a challenge. Clinical and standard laboratory tests are not very helpful because most critically ill patients develop some degree of inflammatory response, whether or not they have sepsis. Even microbiological assessment is unreliable because many culture samples do not yield microorganisms in these patients. However, biomarkers have also not been shown to be a great asset in the diagnosis of sepsis. Indeed, relatively few biomarkers have been evaluated as diagnostic markers (Table (Table10).
10). Our search retrieved only 10 biomarkers that have been assessed for their ability to distinguish septic patients from non-septic patients with systemic immune response syndrome. However, none of these biomarkers has been tested for both sensitivity and specificity, and there is therefore no biomarker clearly identified as being able to differentiate sepsis syndrome from an inflammatory response due to other causes.Early diagnosis of sepsis is also an important issue as early institution of appropriate therapy, including antibiotics, is associated with improved outcomes. We identified 16 factors that have been evaluated specifically for the early diagnosis of sepsis; five of these had reported sensitivity and specificity of more than 90%.
IL-12 was measured in newborns at the time when sepsis was first suspected clinically and was higher in patients with sepsis than in those without [29]. Interferon-induced protein 10 (IP-10) was higher in neonates Batimastat with sepsis and necrotizing enterocolitis than in neonates who had only necrotizing enterocolitis [30]. These two biomarkers have not been evaluated for this purpose in adults. Group II phospholipase 2 (PLA2-II) was reported to have high sensitivity and specificity for the diagnosis of bacteremia in critically ill adult patients within 24 hours after admission [31].