The Dynamical Assessment of Inflammatory Biomarkers in Predicting the Outcome of Septic Patients and the Response to Antimicrobial Therapy

Abstract

Aims:To evaluate the kinetics of inflammatory biomarkers in septic patients in order to identify the most reliable predictor of unfavorable outcome. Methods: A prospective analysis of septic patients was performed. Median levels of neutrophil/lymphocyte count ratio, fibrinogen, C-reactive protein and procalcitonin were dynamically assessed and comparatively analyzed. Results: Seventy-seven patients were included. Descendent kinetic patterns were registered for all biomarkers, except C-reactive protein. At 24 hours, neutrophil/lymphocyte count ratio significantly decreased in 42.85% of cases, procalcitonin in 37.33%, C-reactive protein in 16.12% and fibrinogen in 1.58% of cases. At 72 hours, procalcitonin decreased to one-half in 70% of cases and neutrophil/lymphocyte count ratio in 67.53% of cases. Conclusions: Neutrophil/lymphocyte count ratio and procalcitonin significantly decreased in the first 72 hours, while C-reactive protein increased in the first 24 hours. The proportions of patients with major decrease of baseline values were higher for neutrophil/lymphocyte count ratio and procalcitonin.

Fibrinogen reflects severity and predicts outcomes in patients with sepsis and septic shock

“…However, the dynamics of fibrinogen were not investigated within these studies, although decrease of fibrinogen levels may be observed in patients with progression of sepsis or septic shock. The present study demonstrated decrease of fibrinogen levels in patients admitted with septic shock (median decrease 41% from day 1 to day 3), whereas fibrinogen levels remained stable in patients with sepsis without shock (median increase 7.5% from day 1 to day 3), which may be attributed to SIC-related fibrinogen consumption in patients with more advanced stages of sepsis [29]. The prognostic impact of fibrinogen dynamics was investigated within 60 septic patients with increased CRP levels (i.e.…”

The value of sepsis biomarkers and their kinetics in the prognosis of septic shock due to bacterial infections

“…Leaving clinical diagnosis away, in many situations the laboratory diagnostics (sepsis biomarkers) may represent a helpful tool to predict the positive diagnosis of sepsis and/or septic shock [2,3,6]. There are hundreds of biomarkers that could be potentially used for diagnosis and prognosis in septic patients [3]. However, few studies have evaluated the discriminative power of PCT, CRP, and SChE activity kinetics as predictors of survival outcome in patients admitted to the ICU with septic shock [2][3][4][5][10][11][12].…”

“…There are hundreds of biomarkers that could be potentially used for diagnosis and prognosis in septic patients [3]. However, few studies have evaluated the discriminative power of PCT, CRP, and SChE activity kinetics as predictors of survival outcome in patients admitted to the ICU with septic shock [2][3][4][5][10][11][12].…”

“…Given the significance of timely beginning of appropriate antibiotics to optimise septic shock outcomes [1, 2], clinicians must quickly achieve a diagnosis of infection. In fact, it is now accepted that starting an early effective antibiotic therapy in the course of an infection decreases morbidity and mortality in this specific condition [2,3]. Moreover, apart from…”

“…So far, many biomarkers have the potential to play a decisive role by providing adjunctive information to guide clinicians to a rapid diagnosis and to adjust a treatment. There are hundreds of biomarkers that could be potentially used for diagnosis and prognosis in septic patients [3][4][5]. To the best our knowledge, procalcitonin (PCT) and C-reactive protein (CRP) have been the most widely investigated [1,2].…”