Diagnostic Markers of Sepsis in the Emergency Department

Abstract

Sepsis is defined as the systemic inflammatory response to infection. However, changes in body temperature, heart and respiratory rate and white cell count (the "SIRS" criteria) are not specific enough to identify infected patients in the emergency department. Among many biological parameters, measurement of lactate, central venous oxygen saturation (ScvO2), C-reactive protein (CRP) and procalcitonin (PCT) are of particular interest. Early (within 6h) and goal-directed (ScvO2 > 70%) resuscitation increases survival in severe sepsis and septic shock, particularly in patients with high lactate clearances. CRP and PCT are both useful markers of sepsis but PCT increases earlier, better differentiates infective from non-infective causes of inflammation, more closely correlates with sepsis severity in terms of shock and organ dysfunction and better predicts outcome when followed in time. However, PCT measurement is more costly, time-consuming, and not widespread available. New markers for rapid diagnosis of sepsis (e.g. TREM-1) are under investigation.

Clinical and pulmonary thin-section CT findings in acute Klebsiella Pneumoniae pneumonia

“…Recently, Jong et al have also reported that alcoholics with Klebsiella pneumoniae pneumonia have a rapidly fatal clinical course with a mortality of 100%, even with adequate antibiotic therapy and intensive management [5]. Therefore, it is crucial to identify the risk factors associated with poor outcome and to evaluate the radiological findings as soon as possible, so as to lose no time in initiating appropriate management [6,7].…”

The value of biochemical markers in predicting a perforation in acute appendicitis

“…14 The use of a definitive WCC as a sign of appendicitis is difficult, as it is well known that the WCC can be either raised or lowered in sepsis. 15 As a result of this variation in WCC in sepsis, using 'raised WCC' as a marker for appendicitis is wrong as patients with a low WCC would cancel out those with a raised WCC in our analysis. This highlights the use of scoring mechanisms for identifying pathology, for example, the Alvarado scoring for appendicitis.…”

The Association Between Cellular Morphological Changes in Peripheral Blood Smear and Complications in Pediatric Burn Cases

“…Antibiyotik kullanımı, yavaş üreyen mikroorganizma varlığı ya da kültür ortamına konan kanda bakteri bulunmaması gibi nedenlerle yanlış negatif kan kültü-rü sonucuyla karşılaşılması, bakteriyemili yanık olgularında tedaviyi geciktiren önemli bir sorundur. [1][2][3][4] Bu sebeple, hiper-hipotermi, takipne, taşikardi, lökositoz-lökopeni ile kendini gösteren sistemik enflamatuvar cevap sendromu ile sepsis doğrudan ve aniden kendini gösterebilir.…”