Biochemical analyze as indirect marker of sepsis
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GLAVAN, Danu. Biochemical analyze as indirect marker of sepsis. In: MedEspera, Ed. 1, 17 mai 2012, Chişinău. Chişinău: "Tipografia-Sirius" SRL, 2012, pp. 41-42. ISBN 978-9975-57-030-5.
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MedEspera 2012
Conferința "MedEspera"
1, Chişinău, Moldova, 17 mai 2012

Biochemical analyze as indirect marker of sepsis


Pag. 41-42

Glavan Danu
 
”Nicolae Testemițanu” State University of Medicine and Pharmacy
 
 
Disponibil în IBN: 10 noiembrie 2022


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Introduction: Sepsis is a complex pathophysiological disorder arising from systemic inflammatory response to infection. The inflammatory cascade has two limbs: one- inflammatory and one- pro-coagulant. Endothelium plays an important role in activation of clotting system and, simultaneous, in suppression of fibrinolitic system, that appears to be an essential component in the development of multi-organ failure (MOF). The objective of this study is analysing and describing clinical signs and biochemical values in adults with sepsis syndrome, which could allow the screening of indirect features of sepsis followed by early treatment as soon as possible. Methods: Thirty patients meeting the inclusion criteria who got admitted to the ICU at Municipal Clinical Hospital N3, Chisinau, between 2008-2010 were studied. Detailed history was taken and physical examination performed. Patients were investigated according to the clinical situation as defined by criteria set by the ACCP/SCCM Consensus Committee. Biochemical values were done on admission to detect metabolic derangements and organ dysfunction. The tests were repeated during 7 days depending on the severity of the derangement. Results: The patients were divided into two groups: the first group-20 patients with septic complications and the second group- 10 non-septic patients. The comparative analyze of biochemical profiles was performed between the groups. Thus, in the first group, on admission, the average level of fibrinogen is 5,102 g/l and the average level of indirect bilirubin is 20,14 mcmol/l. The correlation coefficient between prothrombin and ASAT is - 0,89434. In the second group, on admission, the average level of fibrinogen is 5,14 g/l and the average level of indirect bilirubin is 29,16 mcmol/l. The correlation coefficient between prothrombin and ASAT is 0,091. Conclusions: Biochemical profile analyze of patients from both groups reveals a multiple organ dysfunction (MOD) in first hours of septic process. Thus, the indirect relation between hepotocyte injury markers (ALAT/ASAT) and prothrombin reveals hepatic failure, triggered in first hours of sepsis. Fibrinogen elevated levels in first 24-72 h reveals the suppression of fibrinolysis and the activation of clotting system with the spread of microthrombi in the microcirculatory bed and perfusion disorders. Hyperbilirubinemia due to indirect bilirubin confirms hepatocyte affection with the involvement of microsomal enzyme systems, which are exhausted in hypercatabolism conditions and ATP deficiency.The study confirms the alteration of clotting system, even in the first hours of septic process installation and the necessity of early supervised thrombolytic therapy. In the absence of specific markers in sepsis diagnosis, we could sense the evolution of septic complications through indirect analyze of patient‘s biochemical profile with the early begining of resuscitation therapy.

Cuvinte-cheie
sepsis, systemic inflamatory response, clotting system, fibrinogen, prothrombin, hyperbilirubinemia