Sepsis neonatal: aspectos fisiopatológicos y biomarcadores

Abstract

La sepsis neonatal es una causa importante de morbilidad y mortalidad en recién nacidos a nivel mundial. Su diagnóstico es difícil por sus manifestaciones clínicas inespecíficas y la poca disponibilidad de métodos diagnósticos eficientes. En la fisiopatología de la sepsis se ha descrito una respuesta inmune excesiva o suprimida que puede conducir a desenlaces potencialmente fatales. Se ha estudiado la utilidad pronóstica, diagnóstica y de seguimiento de factores solubles que se alteran en la sepsis neonatal y se han agrupado bajo el término biomarcadores de sepsis neonatal. Aquí se describen los principios fisiopatológicos de la sepsis neonatal y las características de los biomarcadores más usados para su diagnóstico, además, se mencionan detalles de otros marcadores que también han sido estudiados recientemente. Actualmente, se recomienda el uso de un biomarcador temprano en combinación con uno tardío para lograr un mejor rendimiento, sin embargo, aún no se ha identificado un biomarcador ideal para la sepsis neonatal. MÉD.UIS.2019;32(3):35-47

A dosagem de biomarcadores no diagnóstico e prognóstico de sepse neonatal: uma revisão de literatura

“…According to data from the World Health Organization (WHO), SN is responsible for about five million deaths annually. In view of the possible absence of symptoms or signs that guide the conduct and accurate analysis of the condition, NS ends up having a difficult diagnosis and the severity of the disease underestimated 1 .…”

“…And in patients with effective antibiotic therapy and good therapeutic response, it declines within 24 hours. Thus, this cytokine is useful as an early marker contributing to an assertive evolutionary analysis of the disease and its treatment 1,13 .…”

“…N eonatal sepsis (NS) is the most important cause of morbidity and mortality in newborns despite advances in the diagnostic technology selected for this function. According to data from the World Health Organization (WHO), this dysfunction represents a relevant health problem in newborns (NB) hospitalized in Neonatal or mixed Intensive Care Units (neonatal and pediatric) and is one of the main causes of neonatal death in the world, accounting for 60% to 80% of lost lives in childhood [1][2][3] . The incidence of SN is increasing every year, which raises an alert in the medical community, as this fact contrasts with evident advances in the area of antibiotic therapy, microbiology and life support techniques 4 .…”

“…On the other hand, when analyzing the pathophysiology of SN, it is known that, after the identification of a signal originating from the pathogen or some damage caused by it, there is an increase in the generation of inflammatory and anti-inflammatory mediators of the most diverse classes, which can be acute or not, interleukins (IL), markers, among other mediating molecules, making it possible to strategically measure these substances and use them in a more accurate analysis of the development of SN 4.5 . This analysis is extremely important, because the biomarkers related to it are shown as important parameters for a better and faster diagnosis, stratification, screening, rational use of antibiotics and monitoring of prognosis, causing a significant reduction in mortality, since its variations indicate the levels of inflammatory response to infectious injury of the most diverse forms and evolutionary stages of the dysfunction 1,4,5 . These biomarkers are still relevant in this process as they can help to estimate the severity of the condition and allow the differentiation and characterization of viral, bacterial and fungal infections; in addition to identifying the spread or not of the dysfunctional infectious process 6 .…”

“…Considering the relevance of this information and its prompt availability when using biomarkers, the search for these molecules in the assessment of sepsis led to the identification of a little more than 170 biomarkers; including procalcitonin (PCT), C-reactive protein (PCR), cytokines such as interleukin (IL) 1β, IL-8, IL-6, interferon (IFN-γ), tumor necrosis factor (TNF-α), chemokines and markers for cell surface 1,4 . In this sense, several studies were recently published analyzing the role of the most varied biomarkers in septic patients, and these discoveries are a great advance for science [7][8][9] .…”