EAJAIC
Eurasian Journal of Anesthesiology and Intensive Care

The Eurasian Journal of Anesthesiology and Intensive Care (EAJAIC) is an independent-unbiased, peer-reviewed, "double-blind", and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, differential diagnoses, editorial opinions, letters to the editor, and educational papers in anesthesiology, algology, and intensive care medicine.

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eISSN: 3023-6738
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Original Article
The process of biochemical parameters in the transition from sepsis to septic shock
Abstract
Aims: Sepsis and septic shock are critical conditions that contribute significantly to morbidity and mortality in intensive care units worldwide. Early diagnosis and treatment are crucial for improving survival, yet traditional diagnostic methods lack sensitivity. Biomarkers like C-reactive protein and procalcitonin, along with disease severity scores such as APACHE II, SOFA, and MODS, are increasingly used to assess patient status and predict outcomes. This study aims to explore the relationship between inflammatory biomarkers and disease severity scores in critically ill patients with septic shock.
Methods: This prospective study included 20 patients with septic shock admitted to the intensive care unit between July and September 2009. C-reactive protein, procalcitonin, cortisol, brain natriuretic peptide, lactate, and other physiological parameters were monitored over a three-day period. Disease severity was assessed using APACHE II, SOFA, and MODS scores, with mortality outcomes recorded. Data was analyzed using Spearman’s correlation analysis.
Results: The study found no significant correlation between APACHE II scores at admission and 28-day mortality. However, both SOFA and MODS scores showed significant correlations with 28-day mortality when measured on the second and third days of intensive care unit admission. C-reactive protein and procalcitonin levels were elevated in all patients, yet no direct correlation with 28-day mortality was identified. Sequential monitoring of SOFA and MODS scores was more predictive of patient outcomes than single-day measurements.
Conclusion: Sequential assessments of disease severity scores provide valuable insights into the progression of septic shock. While C-reactive protein and procalcitonin are useful in monitoring infection, they alone may not be sufficient to predict mortality. In contrast, dynamic measurements of SOFA and MODS scores are better indicators of patient prognosis, particularly when combined with biomarker data. Continuous monitoring of disease severity scores, particularly SOFA and MODS, alongside biomarkers such as C-reactive protein and procalcitonin, enhances the prediction of mortality in septic shock patients. These tools, when used together, offer a comprehensive approach to managing critically ill patients in the intensive care unit, allowing for timely and effective interventions.

Keywords : Apache, biomarkers, organ dysfunction scores, sepsis, septic shock

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1. Annane D, Aegerter P, Jars-Guincestre MC, Guidet B, CUB-R&eacute;a Network. Current epidemiology of septic shock: the CUB-R&eacute;a Network. <em>Am J Respir Crit Care Med</em>. 2003;168(2):165-172.
2. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. <em>Crit Care Med</em>. 2017;45(3):486-552.
3. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. <em>Lancet</em>. 2020;395(10219):200-211.
4. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. <em>JAMA</em>. 2014;311(13):1308-1316.
5. Phua J, Ngerng W, See K, et al. Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. <em>Crit Care</em>. 2013;17(5):R202.
6. Vincent JL, Sakr Y, Singer M, et al. Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. <em>JAMA</em>. 2020; 323(15):1478.
7. P&oacute;voa P, Coelho L, Dal-Pizzol F, et al. How to use biomarkers of infection or sepsis at the bedside: guide to clinicians. <em>Intensive Care Med</em>. 2023; 49(2):142-53.
8. Garvik OS, P&oacute;voa P, Magnussen B, et al. C-reactive protein and albumin kinetics before community-acquired bloodstream infections - a Danish population-based cohort study. <em>Epidemiol Infect</em>. 2020;148:e38.
9. Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. <em>Crit Care Med</em>. 2003;31(6):1737-1741.
10. Kennis B, Ali A, Lasoff D, Sweeney DA, Wardi G. The diagnostic utility of procalcitonin is limited in the setting of methamphetamine toxicity. <em>Am J Emerg Med</em>. 2022;54:36-40.
11. Christ-Crain M, Opal SM. Clinical review: The role of biomarkers in the diagnosis and management of community-acquired pneumonia. <em>Crit Care</em>. 2010;14(1):203.
12. Higgins TL. Chapter: 222. Severity of illness indices and outcome prediction: development and evaluation. in: vincent jl, eds. textbook of critical care. 6th Edition. WB Saunders Company Philadelphia, Pa; 2000; 2011:1604-1614
13. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. <em>Crit Care Med</em>. 1985;13(10):818-829.
14. Marshall JC, Cook DJ, Christou NV., Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score. <em>Crit Care Med</em>. 1995;23(10):1638-1652.
15. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. <em>Intensive Care Med</em>. 1996;22(7):707-710.
16. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. <em>Intensive Care Med</em>. 2013;39(2):165-228.
17. Zhu Y, Zhang R, Ye X, Liu H, Wei J. SAPS III is superior to SOFA for predicting 28-day mortality in sepsis patients based on Sepsis 3.0 criteria. <em>Int J Infect Diseases</em>. 2022;114:135-141.
18. P&oacute;voa P, Almeida E, Moreira P, et al. C-reactive protein as an indicator of sepsis. <em>Intensive Care Med</em>. 1998;24(10):1052-56.
19. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. <em>Clin Infect Diseases. </em>2004;39(2):206-217.
20. Tan M, Lu Y, Jiang H, Zhang L. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: a systematic review and meta-analysis. <em>J Cell Biochem</em>. 2019;120(4):5852-5859.
21. Lobo SMA, Lobo FRM, Bota DP, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. <em>Chest. </em>2003;123(6):2043-2049.
22. Ventetuolo CE, Levy MM. Biomarkers: diagnosis and risk assessment in sepsis. <em>Clin Chest Med</em>. 2008;29(4):591-603.
23. Giamarellos-Bourboulis EJ, Tsangaris I, Kanni Th, et al. Procalcitonin as an early indicator of outcome in sepsis: a prospective observational study. <em>J Hospital Infect</em>. 2011;77(1):58-63.
24. Kataria Y, Remick D. Sepsis biomarkers. <em>Methods Mol Biol. </em>2021;2321:177-189.
25. Malko&ccedil; M, Kural B. Presepsin: sepsis tespiti i&ccedil;in umut verici yeni bir biyobelirte&ccedil;. <em>Celal Bayar &Uuml;niversitesi Sağlık Bil Ens Derg</em>. 2021;8(3):553-557.
26. Hoeboer SH, Groeneveld ABJ. Changes in circulating procalcitonin versus C-reactive protein in predicting evolution of infectious disease in febrile, critically ill patients. <em>PLoS One</em>. 2013;8(6):e65564.
27. Rapsang A, Shyam DC. Scoring systems in the intensive care unit: a compendium. <em>Indian J Critical Care Med</em>. 2014;18(4):220-228.
28. Arefian H, Heublein S, Scherag A, et al. Hospital-related cost of sepsis: a systematic review. <em>J Infect</em>. 2017;74(2):107-117.
29. Xu Z, Huang M. A dynamic nomogram for predicting 28-day mortality in septic shock: a Chinese retrospective cohort study. <em>PeerJ</em>. 2024;12:e16723.
Article available in :
Volume 1, Issue 4, 2024
Page : 86-91
https://doi.org/10.51271/EAJAIC-0018
Article Information
Received : 19 Eyl 2024
Accepted : 01 Eki 2024
Published : 15 Eki 2024
Corresponding Author :

Arif Timuroğlu: Department of Anesthesiology and Reanimation, Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital, Ankara, Turkiye

[email protected]
Citation : Timuroğlu A, Yılmaz AA, Tulunay M. The progression of biochemical parameters and disease severity scores in patients with septic shock: a study of sequential measurements. Eur J Anesthesiol Intensive Care. 2024;1(4):86-91.

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