Naslov
Is There An Additional Clinical Value Of Lipopolysaccharide-Binding Protein In Identification And Outcome Prediction Of Patients With Severe Sepsis? – A Case Report

Autori
Žarak, Marko ; Starčić, Jelena ; Stančin, Nevenka ; Bradić, Nikola ; Šimac, Brankica ; Jovanović, Marijana ; Škorvaga, Sanja ; Živković, Marcela

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Clinical Chemistry and Laboratory Medicine (CCLM), 56, 11 / - : Walter de Gruyter, 2018, EA306-eA306

Skup
5th EFLM-UEMS European Joint Congress in Laboratory Medicine

Mjesto i datum
Antalya, Turska, 10.10.2018. - 13.10.2018

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
sepsis ; lipopolysaccharide-binding protein ; procalcitonin ; intensive care unit

Sažetak
AIM: Sepsis is still the main cause of death in surgical intensive care unit (ICU) with continuously increasing incidence and mortality rate. Therefore, both early diagnosis and prognosis of sepsis are of great importance. In addition to procalcitonin (PCT), C-reactive protein (CRP), leukocytes an lactate, novel studies propose lipopolysaccharide-binding protein (LBP) as a sensitive marker for bacterial infection and possibly useful follow-up parameter of sepsis. The aim of this report is to investigate the additional clinical value of LBP to PCT, CRP, leukocytes and lactate in identification and outcome prediction of a patient with severe sepsis. PATIENT AND METHODS: A 74-year old male patient was admitted to ICU after major open-heart surgery. Seventeen days after surgery, severe sepsis with Pseudomonas aeruginosa infection was diagnosed. In the 10 following days before patients’ death concentrations of PCT (CLIA, Siemens Advia Centaur XP), CRP (immunoturbidimetry, Beckman Coulter AU680), leukocytes (optical count, Siemens Advia 2120i), lactate (photometry, Beckman Coulter AU680) and LBP (CLIA, Siemens Advia Centaur XP) were measured. The results were compared using the Reference Change Value (RCV), Z = 1.96. Obtained RCVs for PCT, CRP, leukocytes, lactate and LBP were 49%, 138%, 32%, 76% and 42%, respectively. These values were considered clinically significant. Sepsis-related Organ Failure Assesment (SOFA) score was calculated on the day of diagnosis. RESULTS: Measured values of all analytes on the first day of diagnosis were: CRP (138.8 mg/L), PCT (14.7 ng/mL), leukocytes (4.6x109/L), lactate (2.32 mmol/L) and LBP (45.9 μg/mL). Calculated SOFA score was 17 with estimation of mortality higher than 90%. The highest levels of CRP (298.6 mg/L), lactate (17.9 mmol/L) and leukocytes (16.6x109/L) were measured on the 3rd day showing clinically significant difference for leukocytes and lactate compared to the 1st day. CRP showed no significant difference within all 10 days. The highest values of PCT (32.85 ng/mL and 26.77 ng/mL) were on 2nd and 3rd day showing significant change and an expected continuous decrease in the following days, whereas LBP did not change significantly. CONCLUSION: Values for PCT, CRP and lactate remained within their patophysiological dynamics as was expected due to the patients’ condition and performed therapy. However, as leukocytes increased after the 5th day and LBP did not significantly decrease in all 10 days, these two parameters could be considered as predictors of fatal outcome in this case report. Also, as an increase of LBP was not observed, it is to presume that LBP starts to increase before PCT and CRP, and can help in identifying patients that are likely to develope severe sepsis days before other mentioned parameters. These results are in agreement with several studies but further research in this field is needed.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti, Kliničke medicinske znanosti

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