指南共识注册编号：PREPARE-2024CN491
Expert consensus on the emergency application of sepsis-related inflammatory markers
-
-
Key words:
- sepsis /
- emergency /
- expert consensus
-
-
表 1 证据水平分级标准
证据水平 描述 高水平证据 多个随机对照试验的荟萃分析或系统评价；随机对照试验 中等水平证据 设计良好的非随机性病例对照研究；队列研究；观察性研究；横断面研究 低水平证据 非随机性回顾性研究；病例报告；专家共识 
下载: 导出CSV
表 2 炎症标志物在脓毒症早期诊断中的应用——开展建议
开展建议 炎症标志物(推荐意见强度) 建议急诊常规开展 白细胞计数与分类(强)、C反应蛋白(强)、降钙素原(强) 建议有条件开展 MDW(强)、肝素结合蛋白(强)、白介素6(强) PSEP(中)、CD64(中)、可溶性髓样细胞触发受体-1(中)、多种指标联合应用(中) 血清淀粉样蛋白A(低)、白介素1β(低)、白介素8(低)、白介素10(低) 注：MDW: 单核细胞分布宽度。
下载: 导出CSV
-
[1] Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J]. JAMA, 2016, 315(8): 762-774. doi: 10.1001/jama.2016.0288
[2] 降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识[J]. 中华急诊医学杂志, 2012, 19(9): 944-951. doi: 10.3760/cma.j.issn.1671-0282.2012.09.005
[3] 中国中西医结合学会检验医学专业委员会. 血清淀粉样蛋白A在感染性疾病中临床应用的专家共识[J]. 中华检验医学杂志, 2019, 42(3): 186-192.
[4] 中国医药教育协会感染疾病专业委员会. 感染相关生物标志物临床意义解读专家共识[J]. 中华结核和呼吸杂志, 2017, 40(4): 243-257. doi: 10.3760/cma.j.issn.1001-0939.2017.04.002
[5] Russell CD, Parajuli A, Gale HJ, et al. The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: a systematic review and meta-analysis[J]. J Infect, 2019, 78(5): 339-348. doi: 10.1016/j.jinf.2019.02.006
[6] Huang YH, Chen CJ, Shao SC, et al. Comparison of the diagnostic accuracies of monocyte distribution width, procalcitonin, and C-reactive protein for sepsis: a systematic review and meta-analysis[J]. Crit Care Med, 2023, 51(5): e106-e114. doi: 10.1097/CCM.0000000000005820
[7] Hausfater P, Robert Boter N, Morales Indiano C, et al. Monocyte distribution width(MDW)performance as an early sepsis indicator in the emergency department: comparison with CRP and procalcitonin in a multicenter international European prospective study[J]. Crit Care, 2021, 25(1): 227. doi: 10.1186/s13054-021-03622-5
[8] Olson ME, Hornick MG, Stefanski A, et al. A biofunctional review of C-reactive protein(CRP)as a mediator of inflammatory and immune responses: differentiating pentameric and modified CRP isoform effects[J]. Front Immunol, 2023, 14: 1264383. doi: 10.3389/fimmu.2023.1264383
[9] Volanakis JE. Human C-reactive protein: expression, structure, and function[J]. Mol Immunol, 2001, 38(2-3): 189-197. doi: 10.1016/S0161-5890(01)00042-6
[10] Hsieh IN, White M, Hoeksema M, et al. Histone H4 potentiates neutrophil inflammatory responses to influenza A virus: Down-modulation by H4 binding to C-reactive protein and Surfactant protein D[J]. PLoS One, 2021, 16(2): e0247605. doi: 10.1371/journal.pone.0247605
[11] Gershov D, Kim S, Brot N, et al. C-Reactive protein binds to apoptotic cells, protects the cells from assembly of the terminal complement components, and sustains an antiinflammatory innate immune response: implications for systemic autoimmunity[J]. J Exp Med, 2000, 192(9): 1353-1364. doi: 10.1084/jem.192.9.1353
[12] Meisner M. Pathobiochemistry and clinical use of procalcitonin[J]. Clin Chim Acta, 2002, 323(1-2): 17-29. doi: 10.1016/S0009-8981(02)00101-8
[13] Tan M, Lu Y, Jiang H, et al. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: a systematic review and meta-analysis[J]. J Cell Biochem, 2019, 120(4): 5852-5859. doi: 10.1002/jcb.27870
[14] Paudel R, Dogra P, Montgomery-Yates AA, et al. Procalcitonin: a promising tool or just another overhyped test?[J]. Int J Med Sci, 2020, 17(3): 332-337. doi: 10.7150/ijms.39367
[15] Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection[J]. Lancet, 1993, 341(8844): 515-518. doi: 10.1016/0140-6736(93)90277-N
[16] Zhang Y, Zhang J, Sheng H, et al. Acute phase reactant serum amyloid A in inflammation and other diseases[J]. Adv Clin Chem, 2019, 90: 25-80.
[17] Sui YD, Xin WN, Feng LL. Comparison of the clinical application values of PCT, hs-CRP and SAA detection in the early diagnosis of sepsis[J]. Pak J Med Sci, 2020, 36(7): 1683-1687.
[18] Yuan HN, Huang J, Lv BK, et al. Diagnosis value of the serum amyloid A test in neonatal sepsis: a meta-analysis[J]. Biomed Res Int, 2013, 2013: 520294.
[19] Bentzer P, Fisher J, Kong HJ, et al. Heparin-binding protein is important for vascular leak in sepsis[J]. Intensive Care Med Exp, 2016, 4(1): 33. doi: 10.1186/s40635-016-0104-3
[20] Fisher J, Russell JA, Bentzer P, et al. Heparin-binding protein(HBP): a causative marker and potential target for heparin treatment of human sepsis-induced acute kidney injury[J]. Shock, 2017, 48(3): 313-320. doi: 10.1097/SHK.0000000000000862
[21] 吴凯, 李霖, 江华, 等. 肝素结合蛋白的特性及在临床诊断中的应用[J]. 细胞与分子免疫学杂志, 2013, 29(11): 1226-1228, 1231.
[22] Bateman RM, Sharpe MD, Jagger JE, et al. 36th international symposium on intensive care and emergency medicine: Brussels, Belgium. 15-18 March 2016[J]. Crit Care, 2016, 20(suppl 2): 94.
[23] Mao Z, Yang W, Gao J, et al. Accuracy of blood heparin-binding protein(HBP)for diagnosis bacteremia in patients with sepsis[J]. Sci Rep, 2025, 15(1): 5702. doi: 10.1038/s41598-025-89241-4
[24] 陈琼娜, 李翊卫, 王晔恺, 等. 肝素结合蛋白等炎性因子在脓毒症患者早期诊断中的价值对比研究[J]. 中国卫生检验杂志, 2016, 26(11): 1610-1613.
[25] 邹艳花, 杨录波, 邱淑妍, 等. 肝素结合蛋白在脓毒症诊断及分级中的应用[J]. 深圳中西医结合杂志, 2018, 28(20): 58-59.
[26] Hagan P, Poole S, Bristow AF. Endotoxin-stimulated production of rat hypothalamic interleukin-1βin vivo and in vitro, measured by specific immunoradiometric assay[J]. J Mol Endocrinol, 1993, 11(1): 31-36. doi: 10.1677/jme.0.0110031
[27] Matsukawa A, Yoshimura T, Miyamoto K, et al. Analysis of the inflammatory cytokine network among TNF alpha, IL-1 beta, IL-1 receptor antagonist, and IL-8 in LPS-induced rabbit arthritis[J]. Lab Invest, 1997, 76(5): 629-638.
[28] Schulte W, Bernhagen J, Bucala R. Cytokines in sepsis: potent immunoregulators and potential therapeutic targets: an updated view[J]. Mediators Inflamm, 2013, 2013: 165974.
[29] Pinsky MR, Vincent JL, Deviere J, et al. Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality[J]. Chest, 1993, 103(2): 565-575. doi: 10.1378/chest.103.2.565
[30] Simon C, Schröder H, Beyer C, et al. Neonatal sepsis in an intensive care unit and results of treatment[J]. Infection, 1991, 19(3): 146-149. doi: 10.1007/BF01643234
[31] Calandra T, Baumgartner JD, Grau GE, et al. Prognostic values of tumor necrosis factor/cachectin, interleukin-l, interferon-, and interferon-in the serum of patients with septic shock[J]. J Infect Dis, 1990, 161(5): 982-987. doi: 10.1093/infdis/161.5.982
[32] Iwase S, Nakada TA, Hattori N, et al. Interleukin-6 as a diagnostic marker for infection in critically ill patients: a systematic review and meta-analysis[J]. Am J Emerg Med, 2019, 37(2): 260-265. doi: 10.1016/j.ajem.2018.05.040
[33] Wakabayashi A, Sawada K, Nakayama M, et al. Targeting interleukin-6 receptor inhibits preterm delivery induced by inflammation[J]. Mol Hum Reprod, 2013, 19(11): 718-726. doi: 10.1093/molehr/gat057
[34] Chawla LS, Seneff MG, Nelson DR, et al. Elevated plasma concentrations of IL-6 and elevated APACHE Ⅱ score predict acute kidney injury in patients with severe sepsis[J]. Clin J Am Soc Nephrol, 2007, 2(1): 22-30. doi: 10.2215/CJN.02510706
[35] Maskin B, Fontán PA, Spinedi EG, et al. Evaluation of endotoxin release and cytokine production induced by antibiotics in patients with Gram-negative nosocomial pneumonia[J]. Crit Care Med, 2002, 30(2): 349-354. doi: 10.1097/00003246-200202000-00014
[36] Oberholzer A, Souza SM, Tschoeke SK, et al. Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis[J]. Shock, 2005, 23(6): 488-493.
[37] Baggiolini M, Walz A, Kunkel SL. Neutrophil-activating peptide-1/interleukin 8, a novel cytokine that activates neutrophils[J]. J Clin Invest, 1989, 84(4): 1045-1049. doi: 10.1172/JCI114265
[38] Van Zee KJ, DeForge LE, Fischer E, et al. IL-8 in septic shock, endotoxemia, and after IL-1 administration[J]. J Immunol, 1991, 146(10): 3478-3482. doi: 10.4049/jimmunol.146.10.3478
[39] Huber AR, Kunkel SL, Todd RF 3rd, et al. Regulation of transendothelial neutrophil migration by endogenous interleukin-8[J]. Science, 1991, 254(5028): 99-102. doi: 10.1126/science.1718038
[40] Marty C, Misset B, Tamion F, et al. Circulating interleukin-8 concentrations in patients with multiple organ failure of septic and nonseptic origin[J]. Crit Care Med, 1994, 22(4): 673-679. doi: 10.1097/00003246-199404000-00025
[41] Calfee CS, Thompson BT, Parsons PE, et al. Plasma interleukin-8 is not an effective risk stratification tool for adults with vasopressor-dependent septic shock[J]. Crit Care Med, 2010, 38(6): 1436-1441. doi: 10.1097/CCM.0b013e3181de42ad
[42] Liu XW, Ma T, Cai Q, et al. Elevation of serum PARK7 and IL-8 levels is associated with acute lung injury in patients with severe sepsis/septic shock[J]. J Intensive Care Med, 2019, 34(8): 662-668. doi: 10.1177/0885066617709689
[43] Oberholzer A, Oberholzer C, Moldawer LL. Interleukin-10: a complex role in the pathogenesis of sepsis syndromes and its potential as an anti-inflammatory drug[J]. Crit Care Med, 2002, 30(1 suppl): S58-S63.
[44] 孙荣青, 张少雷. 脓毒症早期血清白细胞介素-18和10在疾病严重程度及预后评估中的价值研究[J]. 中国危重病急救医学, 2011, 23(5): 299-301.
[45] Memar MY, Baghi HB. Presepsin: a promising biomarker for the detection of bacterial infections[J]. Biomed Pharmacother, 2019, 111: 649-656. doi: 10.1016/j.biopha.2018.12.124
[46] Paraskevas T, Chourpiliadi C, Demiri S, et al. Presepsin in the diagnosis of sepsis[J]. Clin Chim Acta, 2023, 550: 117588. doi: 10.1016/j.cca.2023.117588
[47] Zhang J, Hu ZD, Song J, et al. Diagnostic value of presepsin for sepsis[J]. Medicine, 2015, 94(47): e2158. doi: 10.1097/MD.0000000000002158
[48] Velissaris D, Zareifopoulos N, Karamouzos V, et al. Presepsin as a diagnostic and prognostic biomarker in sepsis[J]. Cureus, 2021, 13(5): e15019.
[49] Patnaik R, Azim A, Agarwal V. Neutrophil CD64 a Diagnostic and Prognostic Marker of Sepsis in Adult Critically Ill Patients: A Brief Review[J]. Indian J Crit Care Med, 2020, 24(12): 1242-1250. doi: 10.5005/jp-journals-10071-23558
[50] Li S, Huang XM, Chen ZP, et al. Neutrophil CD64 expression as a biomarker in the early diagnosis of bacterial infection: a meta-analysis[J]. Int J Infect Dis, 2013, 17(1): e12-e23. doi: 10.1016/j.ijid.2012.07.017
[51] Wang X, Li ZY, Zeng L, et al. Neutrophil CD64 expression as a diagnostic marker for sepsis in adult patients: a meta-analysis[J]. Crit Care, 2015, 19(1): 245. doi: 10.1186/s13054-015-0972-z
[52] Yang Y, Griffin K, Li X, et al. Combined CD25, CD64, and CD69 biomarker in 3D-printed multizone millifluidic device for sepsis detection in clinical samples[J]. Anal Chem, 2023, 95(34): 12819-12825. doi: 10.1021/acs.analchem.3c01797
[53] Giannakopoulos K, Hoffmann U, Ansari U, et al. The use of biomarkers in sepsis: a systematic review[J]. Curr Pharm Biotechnol, 2017, 18(6): 499-507.
[54] Gibot S, Béné MC, Noel R, et al. Combination biomarkers to diagnose sepsis in the critically ill patient[J]. Am J Respir Crit Care Med, 2012, 186(1): 65-71. doi: 10.1164/rccm.201201-0037OC
[55] Dimoula A, Pradier O, Kassengera Z, et al. Serial determinations of neutrophil CD64 expression for the diagnosis and monitoring of sepsis in critically ill patients[J]. Clin Infect Dis, 2014, 58(6): 820-829. doi: 10.1093/cid/cit936
[56] Bauer P, Kashyap R, League S, et al. Diagnostic accuracy and clinical relevance of an inflammatory biomarker panel in early sepsis in adult critical care patients[J]. Crit Care, 2015, 19(S1): P55. doi: 10.1186/cc14135
[57] Jämsä J, Ala-Kokko T, Huotari V, et al. Neutrophil CD64, C-reactive protein, and procalcitonin in the identification of sepsis in the ICU: Post-test probabilities[J]. J Crit Care, 2018, 43: 139-142. doi: 10.1016/j.jcrc.2017.08.038
[58] Jiyong J, Tiancha H, Wei C, et al. Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in bacterial infection: a meta-analysis[J]. Intensive Care Med, 2009, 35(4): 587-595. doi: 10.1007/s00134-008-1333-z
[59] Gibot S, Kolopp-Sarda MN, Béné MC, et al. Plasma level of a triggering receptor expressed on myeloid cells-1: its diagnostic accuracy in patients with suspected sepsis[J]. Ann Intern Med, 2004, 141(1): 9-15. doi: 10.7326/0003-4819-141-1-200407060-00009
[60] Su LX, Han BC, Liu CT, et al. Value of soluble TREM-1, procalcitonin, and C-reactive protein serum levels as biomarkers for detecting bacteremia among sepsis patients with new fever in intensive care units: a prospective cohort study[J]. BMC Infect Dis, 2012, 12: 157. doi: 10.1186/1471-2334-12-157
[61] Zhang J, She D, Feng D, et al. Dynamic changes of serum soluble triggering receptor expressed on myeloid cells-1(sTREM-1) reflect sepsis severity and can predict prognosis: a prospective study[J]. BMC Infect Dis, 2011, 11: 53. doi: 10.1186/1471-2334-11-53
[62] de Nooijer AH, Grondman I, Lambden S, et al. Increased sTREM-1 plasma concentrations are associated with poor clinical outcomes in patients with COVID-19[J]. Biosci Rep, 2021, 41(7): BSR20210940. doi: 10.1042/BSR20210940
[63] Jedynak M, Siemiatkowski A, Mroczko B, et al. Soluble TREM-1 serum level can early predict mortality of patients with sepsis, severe sepsis and septic shock[J]. Arch Immunol Ther Exp, 2018, 66(4): 299-306. doi: 10.1007/s00005-017-0499-x
[64] Chen MK, Zhu Y. Utility of sTREM-1 and presepsin(sCD14-ST)as diagnostic and prognostic markers of sepsis[J]. Clin Lab, 2020, 66(4).
[65] Wei Y, Xiao P, Wu B, et al. Significance of sTREM-1 and sST2 combined diagnosis for sepsis detection and prognosis prediction[J]. Open Life Sci, 2023, 18(1): 20220639. doi: 10.1515/biol-2022-0639
[66] Pierrakos C, Velissaris D, Bisdorff M, et al. Biomarkers of sepsis: time for a reappraisal[J]. Crit Care, 2020, 24(1): 287. doi: 10.1186/s13054-020-02993-5
[67] Ng PC. Diagnostic markers of infection in neonates[J]. Arch Dis Child Fetal Neonatal Ed, 2004, 89(3): F229-F235. doi: 10.1136/adc.2002.023838
[68] Bengnér J, Quttineh M, Gäddlin PO, et al. Serum amyloid A-A prime candidate for identification of neonatal sepsis[J]. Clin Immunol, 2021, 229: 108787. doi: 10.1016/j.clim.2021.108787
[69] Tong-Minh K, Welten I, Endeman H, et al. Predicting mortality in adult patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review[J]. BMC Emerg Med, 2021, 21: 70. doi: 10.1186/s12873-021-00461-z
[70] Mearelli F, Fiotti N, Giansante C, et al. Derivation and validation of a biomarker-based clinical algorithm to rule out sepsis from noninfectious systemic inflammatory response syndrome at emergency department admission: a multicenter prospective study[J]. Crit Care Med, 2018, 46(9): 1421-1429. doi: 10.1097/CCM.0000000000003206
[71] Song Y, Chen Y, Dong X, et al. Diagnostic value of neutrophil CD64 combined with CRP for neonatal sepsis: a meta-analysis[J]. Am J Emerg Med, 2019, 37(8): 1571-1576. doi: 10.1016/j.ajem.2019.05.001
-
计量
- 文章访问数: 357
- 施引文献: 0