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Markers of Sepsis

  • Heinz Redl
  • Andreas Spittler
  • Wolfgang Strohmaier
Chapter

Conclusion

Considering the range of options available, one must be aware of the fact that the increase in parameters and compartments included in diagnosis, is directly proportional to the uncertainties arising [78]. Therefore, on the one hand, more prospective studies on sepsis markers are required to identify the most relevant and predictive markers (not to mention the financial aspects of costly analysis). On the other, the use of new approaches of data mining to identify specific patterns in specific patient groups is warranted. These efforts need the support of extensive pathophysiological research, since more extensive knowledge regarding patients' underlying diseases may facilitate the finding and choice of an appropriate marker (or set of markers). In conclusion we suggest improved monitoring of sepsis patients to enable a better selection of the appropriate cases and more precise timing for therapeutic interventions; much as vasopressors are not administered without pressure monitoring. We recommend the measurement of IL-6, PCT, and neopterin in plasma, particularly to determine the hyper-inflammatory phase. The most suitable marker for the immunoparalytic phase seems to be a combination of HLA-DR measurement on peripheral blood monocytes and the determination of the capacity of whole blood to secrete pro-inflammatory cytokines after stimulation. The fact that the use of sepsis markers for monitoring — though the actual parameter may ultimately be different — can be beneficial for the therapeutic regimen has recently been nicely demonstrated within the MONARCS, IL-6 monitored anti-TNF study. Furthermore, the active approach using the ACTH response test with monitoring of cortisol in plasma to identify specific sepsis patients [79] is a promising step for the future of sepsis trials.

The most recent research results raise hopes that sepsis markers in combination with increasing knowledge on the influence of polymorphisms and gender may enable us to identify patients at high risk of infectious complications. These patients may be those who will profit most from immune/biochemical monitoring, since individualized therapeutic interventions supporting the immune and humoral systems are within reach.

Keywords

Septic Shock Severe Sepsis Systemic Inflammatory Response Syndrome Peripheral Blood Monocyte Sepsis Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Heinz Redl
  • Andreas Spittler
  • Wolfgang Strohmaier

There are no affiliations available

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