tailieunhanh - Báo cáo y học: "Clinical review: The role of biomarkers in the diagnosis and management of communityacquired pneumonia"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: The role of biomarkers in the diagnosis and management of communityacquired pneumonia. | Christ-Crain and Opal Critical Care 2010 14 203 http content 14 1 203 CRITICAL CARE REVIEW L. Clinical review The role of biomarkers in the diagnosis and management of community-acquired pneumonia Mirjam Christ-Crain 1 and Steven M Opal2 Abstract In patients with community-acquired pneumonia traditional criteria of infection based on clinical signs and symptoms clinical scoring systems and general inflammatory indicators for example leukocytosis fever C-reactive protein and blood cultures are often of limited clinical value and remain an unreliable guide to etiology optimal therapy and prognosis. Procalcitonin is superior to other commonly used markers in its specificity for bacterial infection allowing alternative diagnoses to be excluded as an indicator of disease severity and risk of death and mainly as a guide to the necessity for antibiotic therapy. It can therefore be viewed as a diagnostic prognostic and perhaps even theragnostic test. It more closely matches the criteria for usefulness than other candidate biomarkers such as C-reactive protein which is rather a nonspecific marker of acute phase inflammation and proinflammatory cytokines such as plasma IL-6 levels that are highly variable cumbersome to measure and lack specificity for systemic infection. Elevated levels of pro-adrenomedullin copeptin which is produced in equimolar amounts to vasopressin natriuretic peptides and cortisol are significantly related to mortality in community-acquired pneumonia as are other prohormones such as pro-atrial natriuretic peptide coagulation markers and other combinations of inflammatory cytokine profiles. However all biomarkers have weaknesses as well as strengths. None should be used on its own and none is anything more than an aid in the exercise of clinical judgment based upon a synthesis of available clinical physiologic and laboratory features in each patient. Correspondence Division of Endocrinology Diabetes and Clinical