Креативная хирургия и онкология

Расширенный поиск


Полный текст:


Introduction. Laboratory indicators of endotoxinemia in conjunction with the clinical picture have been used as the criteria to diagnosticate sepsis for quite a long time. The objective of the study is to analyze the prognostic significance of endotoxin activity indicator in patients with sepsis that undergo treatment in conditions of surgical resuscitation and intensive care at multidisciplinary hospital.

Materials and methods. One-center prospective study on the basis of ICU department of the Republic Clinical Hospital (Ufa, Russia) during the period of 2015- 2016. We have performed screening of 60 patients with sepsis and 15 healthy volunteers.

Results. The median of the value of endotoxin activity in group of patients with sepsis amounted to 0.42 vs. 0.1 of group of healthy volunteers. It was found that the level of endotoxin activity correlates with the severity of the disease: low scores on the scale of the APACHE II severity are consistent with low endotoxin activity (r=0.985, r2=0.971, p=0.0001). Findings show that the median of sensitivity of the medical test corresponds to 87.5% and that of specificity - to 32.6%. The prognostic value of a positive result amounted to 27.5%, and the prognostic value of a negative result - 97.8%. The area under the ROC-curve for the level of endotoxin activity is equal to 0.749±0.084, 95% confidence interval (CI) 0.620-0.852. Sensitivity-61.5% (54.8-86.0), specificity is 93.6% (82.4-98.6). The optimum point of separation was 0.88. Positive predictive level amounted to 72.7%, negative one - 89.8%.

Conclusions. The test to determine the level of endotoxin activity of blood has high sensitivity and negative prognostic value, allowing you to use it as an effective screening method to assess the probable invasion of gram-negative flora, days before the results of bacteriological research are available. 

Об авторах

Konstantin N. Zolotukhin
G.G. Kuvatov Republican Clinical Hospital.

Zolotukhin Konstantin Nikolaevich - Candidate of Medical Sciences, Chief of ICU & Anesthesiology Department, G.G. Kuvatov Republican Clinical Hospital.

132 Dostoevsky st., Ufa, 450005.

Helmut Kronfeldner
University Hospital Regensburg.

Kronfeldner Helmut - Dr. med., Physician of the Department of Anesthesiology at University Hospital Regensburg.

Franz-Josef-Strauss-Allee 11, 93051 Regensburg.

Aleksandr Samorodov
G.G. Kuvatov Republican Clinical Hospital.

Samorodov Aleksandr Vladimirovich – Candidate of Medical Sciences, Physician of the Department of ICU & Anesthesiology, G.G. Kuvatov Republican Clinical Hospital.

132 Dostoevsky st., Ufa, 450005.

Список литературы

1. Hartman M.E., Saeed M.J., Powell K.N., Olsen M.A. The comparative epidemiology of pediatric severe sepsis. J Intensive Care Med. 2017. 1:885066617735783. DOI: 10.1177/0885066617735783.

2. Angus D.C., Linde-Zwirble W.T., Lidicker J., Clermont G., Carcillo J., Pinsky M.R. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-10. PMID: 11445675.

3. Yusef D., Shalakhti T., Awad S., Algharaibeh H., Khasawneh W. Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: a retrospective review. Pediatr Neonatol. 2017; Jun 9. pii:S1875-9572(16)30157-7. DOI: 10.1016/j.pedneo.2017.06.001.

4. Chatterjee S., Bhattacharya M., Todi SK. Epidemiology of adult-population sepsis in India: a single center 5 year experience. Indian J Crit Care Med. 2017;21(9):573-577. DOI: 10.4103/ijccm.IJCCM_240_17.

5. Wang J., Li Y., Sun H. Lipopolysaccharide. A target for the development of novel drugs being aimed at gram-negative bacteria. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2015;32(4):910-3. PMID: 26710468.

6. Wang H., Wang T., Yuan Z., Cao Y., Zhou Y., He J., et al. Role of receptor for advanced glycation and products in regulating lung fluid balance in lipopolysaccharide-induced acute lung injury and infection-related acute respiratory distress syndrome. Shock. 2017; Oct. 16. DOI: 10.1097/SHK.0000000000001032.

7. Mai N., Prifti L., Rininger A., Bazarian H., Halterman M.W. Endotoxemia induces lung-brain coupling and multi-organ injury following cerebral ischemia-reperfusion. Exp Neurol. 2017;297:82-91. DOI: 10.1016/j.expneurol.2017.07.016.

8. Marshall J.C., Foster D., Vincent J.L., Cook D.J., Dellinger R.P., Opal S., et al. Diagnostics and prognostic implications of endotoxemia in critically illness: results of the MEDIC study. J Infect Dis. 2004;190(3):527-34. DOI: 10.1086/422254.

9. Peters A.L., Gerritsen M.G., Brinkman P., Zwinderman K.A.H., Vlaar A.P.J., Bos LD. Volatile organic compounds in exhaled breath are independent of systemic inflammatory syndrome caused by intravenous lipopolysaccharide infusion in humans: results from an experiment in healthy volunteers. J Breath Res. 2017;11(2):026003. DOI: 10.1088/17527163/aa6545.

10. Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., et al. The Third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10. DOI: 10.1001/jama.2016.0287.

Для цитирования:

Zolotukhin K.N., Kronfeldner H., Samorodov A. EVALUATION OF PROGNOSTIC SIGNIFICANCE OF BLOOD ENDOTOXIN ACTIVITY INDICATOR IN PATIENTS WITH SEPSIS. Креативная хирургия и онкология. 2017;7(4):43-47.

For citation:

Zolotukhin K.N., Kronfeldner H., Samorodov A. EVALUATION OF PROGNOSTIC SIGNIFICANCE OF BLOOD ENDOTOXIN ACTIVITY INDICATOR IN PATIENTS WITH SEPSIS. Creative surgery and oncology. 2017;7(4):43-47.

Просмотров: 197

Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.

ISSN 2307-0501 (Print)
ISSN 2076-3093 (Online)