الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Sepsis is a clinical syndrome that complicates severe infection, and is a leading cause of death in critically ill patients despite the use of modern antibiotics and resuscitation therapies. It is characterized by the cardinal signs of inflammation (vasodilatation, leukocyte accumulation, increased microvascular permeability) occurring in tissues which are remote from the infection. Severe sepsis and septic shock are the end result of complex interactions between infecting organisms and several elements of the host response, and reflect a primarily inappropriate response by the host to a microbial pathogenic insult. The key term that describes the pathophysiologic events in septic shock at any point in time is the ‘‘mismatch’’ of the host response to the intensity of the pathogenic stimuli ultimately leading to organ injury or dysfunction The challenges of diagnosing and treating sepsis seem more difficult as incidence increases, patients become older and sicker, and pathogenic organisms evolve. Early recognition of sepsis is not always straightforward and clinical signs themselves can be misleading especially in patients with several co-morbidities or variable demographic characteristics. These complexities have led to the search for a biomarker or set of biomarkers with compelling sensitivity and specificity for effectively identifying the disease, patients at risk for untoward outcomes, and reliably guiding treatment.
Among different molecules that have been suggested as sepsis
biomarkers, presepsin or soluble CD14 subtype (sCD14- ST),
procalcitonin (PCT), Creactive protein (CRP) and cytokines.
Procalcitonin has the advantage of rapid induction (2h), high
biostability, half-life 24h, and wide biologic range. However, it has the
disadvantage of low sensitivity for local infection and expensive.
C reactive protein (CRP) is not expensive, However, it has low
specificity, slow induction period (peak 24h), low biologic range, and
does not correlate with the severity of inflammation.
Cytokines have high sensitivity and rapid induction (minutes).
However, they have high variability, low biostability, they have low
correlation with the severity of inflammation, and they are expensive.
Presepsin concentrations in blood were increased faster than PCT
and CRP in sepsis patients. Additionally, the measurement of presepsin
concentrations is useful for evaluating the severity of sepsis and also for
monitoring the clinical responses to therapeutic interventions.
Presepsin is thought to be an applicable biomarker for prediction of
poor outcome, more organ failure, and subsequently, mortality prediction.
More evaluation of the use of presepsin in sepsis is required with the
evaluation of the use of a combined panel of several biomarkers.