Pemeriksaan Laboratorium sebagai Indikator Sepsis dan Syok Septik

Abstract: The complexity of the pathogenesis and pathophysiology of sepsis involves almost all types of cells, tissues, and organ systems. Therefore, there are numbers of laboratory tests that can be used as biomarkers of sepsis and septic shock. Some widely used biomarkers are divided into groups of bacterial products, acute phase proteins, tissue hypoperfusion, coagulation mediators, cell surfaces, and cytokines.Keywords: sepsis, septic shock, biomarkersAbstrak: Kompleksnya patogenesis dan patofisiologi sepsis melibatkan hampir semua jenis sel, jaringan, dan sistem organ. Oleh karena itu, terdapat banyak parameter laboratorik yang dapat dijadikan biomarker sepsis dan syok septik. Berbagai biomarker yang banyak digunakan terbagi dalam kelompokan produk bakteri, protein fase akut, hipoperfusi jaringan, mediator koagulasi, permukaan sel, dan sitokin.Kata kunci: sepsis, syok septik, biomarker

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Endotoxemia and hepatic injury in a rodent model of hindlimb unloading

Journal of Applied Physiology ◽

10.1152/japplphysiol.00302.2003 ◽

2003 ◽

Vol 95 (4) ◽

pp. 1656-1663 ◽

Cited By ~ 17

Author(s):

C. A. Rivera ◽

M. H. Tcharmtchi ◽

L. Mendoza ◽

C. W. Smith

Keyword(s):

Acute Phase ◽

Hepatic Injury ◽

Acute Phase Proteins ◽

Elevated Serum ◽

Hindlimb Unloading ◽

Low Grade ◽

Systemic Blood ◽

Blood Samples ◽

Amyloid A ◽

Organ Systems

Hindlimb unloading (HU) is known to induce physiological alterations in various organ systems that mimic some responses observed after exposure to microgravity. In the present study, the effects of up to 4 wk of HU on the liver were assessed in male Wistar rats and two mouse strains: endotoxin-sensitive C57BL/6 mice and endotoxin-resistant C3H/HEJ mice. Plasma levels of endotoxin, a known stimulator of hepatic injury, were measured in portal and systemic blood samples. Endotoxin was elevated by ∼50% in portal blood samples of mice and rats but was not detectable in systemic blood. This low-grade portal endotoxemia was associated with hepatic injury in rats and C57BL/6 mice as indicated by inflammation and elevated serum transaminase activities. Blood levels of the cytokine TNF-α were increased by ∼50% in C57BL/6 mice; no significant elevation of this cytokine was detected in rats. Messenger RNA levels of the acute-phase proteins serum amyloid A, haptoglobin, and lipopolysaccharide binding protein were significantly enhanced after 3 wk of HU in endotoxin-sensitive rodents. In contrast, no histological changes or significant increases in serum enzyme activity were detected after HU in C3H/HEJ mice despite portal endotoxin levels of 222 ± 83.4 pg/ml. At the 3-wk time point, expression of acute-phase proteins was not elevated in C3H/HEJ mice; however, expression after 4 wk of HU was similar to endotoxin-sensitive rodents. In conclusion, these findings indicate that HU induced mild portal endotoxemia, which contributed to the observed hepatic injury in endotoxin-sensitive rodents.

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Continuing chronic beta-blockade in the acute phase of severe sepsis and septic shock is associated with decreased mortality rates up to 90 days

British Journal of Anaesthesia ◽

10.1093/bja/aex231 ◽

2017 ◽

Vol 119 (4) ◽

pp. 616-625 ◽

Cited By ~ 22

Author(s):

C. Fuchs ◽

S. Wauschkuhn ◽

C. Scheer ◽

M. Vollmer ◽

K. Meissner ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Acute Phase ◽

Mortality Rates ◽

Beta Blockade ◽

Sepsis And Septic Shock

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Interactions of Endotoxin with Cortisol and Acute Phase Proteins in Septic Shock Neonates

Acta Paediatrica ◽

10.1111/j.1651-2227.1986.tb10159.x ◽

1986 ◽

Vol 75 (1) ◽

pp. 69-74 ◽

Cited By ~ 8

Author(s):

H. TOGARI ◽

S. SUGIYAMA ◽

T. OGINO ◽

S. SUZUKI ◽

T. ITO ◽

...

Keyword(s):

Septic Shock ◽

Acute Phase ◽

Acute Phase Proteins

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Faculty Opinions recommendation of Continuing chronic beta-blockade in the acute phase of severe sepsis and septic shock is associated with decreased mortality rates up to 90 days.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732225452.793540010 ◽

2017 ◽

Author(s):

André Coetzee

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Acute Phase ◽

Mortality Rates ◽

Beta Blockade ◽

Sepsis And Septic Shock

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Integrated Multiorgan Bedside Ultrasound for the Diagnosis and Management of Sepsis and Septic Shock

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0041-1733896 ◽

2021 ◽

Vol 42 (05) ◽

pp. 641-649

Author(s):

Daniel A. Sweeney ◽

Brandon M. Wiley

Keyword(s):

Septic Shock ◽

Point Of Care ◽

Bedside Ultrasound ◽

Multiple Point ◽

Point Of Care Ultrasound ◽

Suspected Sepsis ◽

Source Of Infection ◽

Organ Systems ◽

Sepsis And Septic Shock ◽

Delays In Diagnosis

AbstractDespite decades of research, the mortality rate of sepsis and septic shock remains unacceptably high. Delays in diagnosis, identification of an infectious source, and the challenge of providing patient-tailored resuscitation measures routinely result in suboptimal patient outcomes. Bedside ultrasound improves a clinician's ability to both diagnose and manage the patient with sepsis. Indeed, multiple point-of-care ultrasound (POCUS) protocols have been developed to evaluate and treat various subsets of critically ill patients. These protocols mostly target patients with undifferentiated shock and have been shown to improve clinical outcomes. Other studies have shown that POCUS can improve a clinician's ability to identify a source of infection. Once a diagnosis of septic shock has been made, serial POCUS exams can be used to continuously guide resuscitative efforts. In this review, we advocate that the patient with suspected sepsis or septic shock undergo a comprehensive POCUS exam in which sonographic information across organ systems is synthesized and used in conjunction with traditional data gleaned from the patient's history, physical exam, and laboratory studies. This harmonization of information will hasten an accurate diagnosis and assist with hemodynamic management.

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1443: EARLY MOBILIZATION IN THE ACUTE PHASE OF SEPSIS AND SEPTIC SHOCK IMPROVES PATIENT OUTCOMES

Critical Care Medicine ◽

10.1097/01.ccm.0000529445.19370.06 ◽

2018 ◽

Vol 46 (1) ◽

pp. 705-705

Author(s):

Liu Keibun ◽

Takayuki Ogura ◽

Mitsunobu Nakamura ◽

Dai Miyazaki ◽

Hiroyuki Suzuki ◽

...

Keyword(s):

Septic Shock ◽

Patient Outcomes ◽

Acute Phase ◽

Early Mobilization ◽

Sepsis And Septic Shock

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Mekanisme Kompleks Sepsis dan Syok Septik

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.10.3.2018.21979 ◽

2018 ◽

Vol 10 (3) ◽

pp. 143

Author(s):

Diana S. Purwanto ◽

Dalima A.W. Astrawinata

Keyword(s):

Septic Shock ◽

Inflammatory Response ◽

Host Response ◽

Coagulation System ◽

Complex Mechanism ◽

Medical Problems ◽

Risk Of Death ◽

Infectious Pathogen ◽

Almost All ◽

Sepsis And Septic Shock

Abstract: Sepsis and septic shock are still important medical problems. As sepsis progresses to septic shock, the risk of death increases significantly. Sepsis is a complex mechanism which can include infectious pathogen with its virulence factors, host response, inflammatory response, impaired coagulation system, and organ dysfunction. The complexity of the pathogenesis and pathophysiology of sepsis involves almost all types of cells, tissues, and organ systems.Keywords: sepsis, septic shockAbstrak: Sepsis dan syok septik masih merupakan masalah medis yang penting. Seiring penjalanan sepsis menjadi syok septik, risiko kematian meningkat secara signifikan. Sepsis ialah mekanisme kompleks yang dapat meliputi patogen penyebab infeksi dengan faktor virulensinya, respon pejamu, respon inflamasi, sistem koagulasi yang terganggu, dan disfungsi organ. Kompleksnya patogenesis dan patofisiologi sepsis melibatkan hampir semua jenis sel, jaringan, dan sistem organ.Kata kunci: sepsis, syok septik

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Laboratory Tests in Rheumatic Disorders

The Brigham Intensive Review of Internal Medicine ◽

10.1093/med/9780199358274.003.0028 ◽

2014 ◽

pp. 286-298

Author(s):

Peter H. Schur

Keyword(s):

Acute Phase ◽

Acute Phase Response ◽

Laboratory Tests ◽

Acute Phase Proteins ◽

Plasma Concentrations ◽

Phase Response

Chapter 28 discusses acute-phase response, which is a major pathophysiological phenomenon that accompanies inflammation. The acute-phase response accompanies both acute and chronic inflammatory states. It can occur in association with a wide variety of disorders, including infection, trauma, infarction, inflammatory arthritides, and various neoplasms. Acute-phase proteins are defined as those proteins whose plasma concentrations change by at least 25% during inflammatory states. These changes largely reflect their production by hepatocytes.

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A Critical Analysis of the Literature on Time-to-Antibiotics in Suspected Sepsis

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa146 ◽

2020 ◽

Vol 222 (Supplement_2) ◽

pp. S110-S118

Author(s):

Jeremy Weinberger ◽

Chanu Rhee ◽

Michael Klompas

Keyword(s):

Septic Shock ◽

Severity Of Illness ◽

Signs And Symptoms ◽

Suspected Sepsis ◽

Antibiotic Overuse ◽

Time To Antibiotics ◽

Precise Relationship ◽

Inflated Estimate ◽

Almost All ◽

Sepsis And Septic Shock

Abstract The Surviving Sepsis Campaign recommends immediate antibiotics for all patients with suspected sepsis and septic shock, ideally within 1 hour of recognition. Immediate antibiotic treatment is lifesaving for some patients, but a substantial fraction of patients initially diagnosed with sepsis have noninfectious conditions. Aggressive time-to-antibiotic targets risk promoting antibiotic overuse and antibiotic-associated harms for this subset of the population. An accurate understanding of the precise relationship between time-to-antibiotics and mortality for patients with possible sepsis is therefore critical to finding the best balance between assuring immediate antibiotics for those patients who truly need them versus allowing clinicians some time for rapid investigation to minimize the risk of overtreatment and antibiotic-associated harms for patients who are not infected. More than 30 papers have been published assessing the relationship between time-to-antibiotics and outcomes, almost all of which are observational cohort studies. Most report significant associations but all have important limitations. Key limitations include focusing just on the sickest subset of patients (only patients requiring intensive care and/or patients with septic shock), blending together mortality estimates from patients with very long intervals until antibiotics with patients with shorter intervals and reporting a single blended (and thus inflated) estimate for the average increase in mortality associated with each hour until antibiotics, and failure to control for large potential confounders including patients’ presenting signs and symptoms and granular measures of comorbidities and severity of illness. In this study, we elaborate on these potential sources of bias and try to distill a better understanding of what the true relationship between time-to-antibiotics and mortality may be for patients with suspected sepsis or septic shock.

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