Abstract:In the surgical ICU, LBP moderately discriminated patients without infection from patients with severe sepsis but not from patients with sepsis without organ dysfunction. LBP concentrations did not distinguish between gram-positive and gram-negative infections. The correlation of LBP concentrations with disease severity and outcome is weak compared with other markers and its use as a biomarker is not warranted in this patient population.
“…LBP levels increase in patients with septicemia from Gram-positive, Gram-negative and fungal infections [14][15][16][17][18][19]. This molecule is constitutively synthesized in hepatocytes after being induced by IL-1 and IL-6 during the acute phase response.…”
The use of the cut-off values for LBP and CRP determined here would have avoided unnecessary antibiotic therapy in 14 and 11%, of patients respectively. CRP and LBP appear to be superior to IL-6 and WBC as diagnostic markers of bacterial gastrointestinal infection. Cut-off values may be a useful tool to support clinical decision-making on whether or not to initiate empiric antibiotic therapy.
“…LBP levels increase in patients with septicemia from Gram-positive, Gram-negative and fungal infections [14][15][16][17][18][19]. This molecule is constitutively synthesized in hepatocytes after being induced by IL-1 and IL-6 during the acute phase response.…”
The use of the cut-off values for LBP and CRP determined here would have avoided unnecessary antibiotic therapy in 14 and 11%, of patients respectively. CRP and LBP appear to be superior to IL-6 and WBC as diagnostic markers of bacterial gastrointestinal infection. Cut-off values may be a useful tool to support clinical decision-making on whether or not to initiate empiric antibiotic therapy.
“…The acutephase protein LBP is a 60-kDa serum glycosylated protein, forming high-affinity complexes with bacterial endotoxins (lipopolysaccharide), functioning as an opsonin, that is produced and secreted by hepatocytes. The reference limit of LBP in healthy individuals is less than 10 μg/ml [83][84][85]. The results of this study showed increased sIL-2R and LBP postmortem serum levels over the clinical reference limits in sepsis-related fatalities, suggesting that these markers could be an appropriate diagnostic tool, in combination with other biochemical markers, in the postmortem diagnosis of sepsis in forensic autopsy practice.…”
Section: Acute-phase Proteins and Cytokinesmentioning
As a continuation of "Postmortem Chemistry Update Part I," Part II deals with molecules linked to liver and cardiac functions, alcohol intake and alcohol misuse, myocardial ischemia, inflammation, sepsis, anaphylaxis, and hormonal disturbances. A very important array of new material concerning these situations had appeared in the forensic literature over the last two decades. Some molecules, such as procalcitonin and C-reactive protein, are currently researched in cases of suspected sepsis and inflammation, whereas many other analytes are not integrated into routine casework. As in part I, a literature review concerning a large panel of molecules of forensic interest is presented, as well as the results of our own observations, where possible.
“…Keiner ist als alleiniger laborchemischer Parameter geeignet, die Diagnose "Sepsis" zu stellen. Gleichwohl kann die Bestimmung hilfreich sein, um früher als allein klinisch die richtige Diagnose zu stellen (IL-6), um zwischen bakterieller Sepsis und SIRS zu differenzieren (PCT, LBP), um die antibiotische Therapiedauer zu verkürzen (PCT) oder für das Monitoring der Entzündungsaktivi-tät im längeren Verlauf (CRP) [7][8][9][10][11][12][13][14]. Am besten etabliert ist dabei das PCT, das sogar ein Kandidat als "offizielles" Definitionskriterium der Sepsis ist [15].…”
unclassified
“…Laborwerte wie das CRP helfen nur im Verlauf. Routinescreening mit PCT oder LBP konnte die Erwartungen nicht ganz erfüllen und ist ausgesprochen kostspielig [10]. Das Entscheidende ist ein hoher Grad an Aufmerksamkeit und das unverzügliche Einleiten adä-quater Untersuchungen, um eine Sepsis durch z.…”
A high level of suspicion is necessary to detect postoperative sepsis in good time. It may be difficult to differentiate sepsis from normal SIRS in the postoperative setting. Early signs and symptoms include delirium and respiratory compromise. These should trigger the search for a septic focus aggressively with special attention to the original site of surgery. Key recommendations include early goal-directed resuscitation of the septic patient, administration of broad-spectrum antibiotic therapy within 1 hour of diagnosis, and source control with attention to the balance of risks and benefits of the chosen method. In cases of severe abdominal sepsis the concept of relaparotomy on-demand has become most popular.
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