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Separating signal from noise: the challenge of identifying useful biomarkers in sepsis

机译:从噪声中分离信号:在脓毒症中鉴定有用的生物标志物的挑战

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摘要

Abstract Sepsis diagnosis remains based largely on clinical presentation despite significant advances in the understanding of underlying pathophysiology and host-pathogen interactions. The systematic review article by Zonneveld and colleagues in the previous issue of Critical Care describes another potential avenue of study for using biomarkers for sepsis diagnosis and prognostication. Soluble leukocyte adhesion molecules and their associated sheddase enzymes vary in detectable levels and activity in patients in relation to immunologic status, age, and systemic inflammation, including in the setting of sepsis. Unfortunately, studies of these molecules as diagnostic or prognostic aids (or both) in sepsis have thus far been disappointing. Zonneveld and colleagues propose two potential avenues to enhance the performance characteristics of soluble adhesion molecules and their sheddases in sepsis diagnosis and prognosis: (a) identifying age-adjusted normal values for soluble leukocyte adhesion molecules and their sheddases and (b) investigating simultaneous measurement of both soluble adhesion molecules and sheddases in integrated sepsis evaluation schema. This commentary discusses the proposed solutions of Zonneveld and colleagues in more detail and outlines additional considerations that should be addressed in order to develop robust and valid diagnostic and prognostic tools for clinicians managing patients with sepsis.
机译:摘要尽管对潜在的病理生理学和宿主-病原体相互作用的理解取得了重大进展,败血症的诊断仍主要基于临床表现。 Zonneveld及其同事在上一期《重症监护》中发表的系统评价文章描述了使用生物标志物进行败血症诊断和预后的另一种潜在研究途径。可溶性白细胞粘附分子及其相关的脱氢酶在患者的可检测水平和活性方面与免疫状态,年龄和全身性炎症有关,包括败血症的发生率也有所不同。不幸的是,迄今为止,对这些分子作为败血症的诊断或预后辅助手段(或两者)的研究令人失望。 Zonneveld及其同事提出了两种可能的途径,以增强可溶性粘附分子及其棚酶在败血症诊断和预后中的性能特征:(a)确定年龄调整后的可溶性白细胞粘附分子及其棚酶的正常值,以及(b)研究同时测量可溶性白细胞粘附分子及其棚酶的正常值。脓毒症综合评估方案中的可溶性粘附分子和脱氢酶均如此。该评论更详细地讨论了Zonneveld及其同事提出的解决方案,并概述了其他一些需要考虑的因素,以便为管理败血症患者的临床医生开发健壮有效的诊断和预后工具。

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