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Parameter der frühen Prädiktion des Sepsisverlaufs

Indicators for early prediction of outcome in sepsis

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Zusammenfassung

Nach wie vor ist die Sepsis eine Hauptursache postoperativer Morbidität und Mortalität. Eine Vielzahl biochemischer Indikatoren wurde bezüglich ihres prognostischen Stellenwertes in der Sepsis evaluiert. Prinzipiell gilt es, zwischen Indikatoren zur präoperativen Erkennung von Risikopatienten für die Entwicklung einer letalen Sepsis und solchen zur frühzeitigen Prädiktion eines letalen Verlaufs bei bestehender Sepsis zu unterscheiden. Zu den ersteren zählt die Messung der IL-12-Synthesekapazität mononukleärer Phagozyten, wobei eine erniedrigte IL-12-Synthesekapazität mit einer höheren Letalität assoziiert war. Auch Genpolymorphismen, wie der Verlust der monozytären HLA-DR-Expression sowie der Homozygotismus für das TNFB2-Allel, haben ihren Stellenwert in der präoperativen Risikoabschätzung und waren in der Sepsis mit einer schlechten Prognose assoziiert.

Zu den wichtigsten Indikatoren zur Prädiktion eines letalen Verlaufs bei Sepsisbeginn zählen erniedrigte L-Selectin-, erhöhte IL-18-, IL-6- sowie PCT-Plasmaspiegel. Auch erwiesen sich eine erhöhte NF-κB-Aktivität in mononukleären Phagozyten sowie persistierend erhöhte CGRP-Plasmaspiegel als prognostisch ungünstig.

Abstract

Sepsis is still a major cause of postoperative morbidity and mortality. Numerous biochemical indicators have been evaluated regarding their potential in predicting prognosis in sepsis. Generally, one must differentiate between indicators: those for preoperative detection of patients at risk for lethal sepsis and those for early prediction of lethal outcome of septic complications. The first include the analysis of mononuclear phagocyte interleukin (IL)-12-synthesizing capability. Reduced IL-12 levels were associated with higher lethality. Cytokine-associated gene polymorphisms such as the loss of monocyte HLA-DR expression and homozygotism for the tumor necrosis factor B2 allele have a place in preoperative risk evaluation, as they were associated with worse prognosis in sepsis. Among the most important biochemical indicators for early prediction of lethal outcome in sepsis are decreased L-selectin and elevated IL-18, IL-6, and PCT plasma concentrations. Increased nuclear factor κB activity in mononuclear phagocytes and elevated calcitonin gene-related protein plasma concentrations were associated with unfavourable prognosis.

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  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München

    A. Novotny, K. Emmanuel, H. Bartels, J.-R. Siewert &  B. Holzmann

  2. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 , München

    B. Holzmann

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  1. A. Novotny
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  2. K. Emmanuel
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Novotny, A., Emmanuel, K., Bartels, H. et al. Parameter der frühen Prädiktion des Sepsisverlaufs. Chirurg 76, 837–844 (2005). https://doi.org/10.1007/s00104-005-1077-z

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