tailieunhanh - Báo cáo y học: "Meningococcal disease: identifying high-risk cases"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Meningococcal disease: identifying high-risk cases. | Available online http content 10 2 129 Commentary Meningococcal disease identifying high-risk cases David Inwald1 and Mark Peters2 1 Paediatric Intensive Care Unit St Mary s Hospital London UK 2Portex Unit Institute of Child Health London UK Corresponding author David Inwald Published 16 March 2006 This article is online at http content 10 2 129 2006 BioMed Central Ltd Critical Care 2006 10 129 doi cc4873 See related research by Vermont et al. in issue http content 10 1 R33 Abstract In the previous issue of Critical Care Vermont and colleagues presented a simple but well-executed observational study describing the levels of chemokines in the serum of 58 children with meningococcal sepsis. The chemokine levels correlated with disease severity and outcome. Significant correlations were demonstrated between admission chemokine levels and the Paediatric Risk of Mortality score the Disseminated Intravascular Coagulopathy score the Sequential Organ Failure Assessment score and laboratory parameters of disease severity. Additionally nonsurvivors had much higher levels of chemokines compared with survivors and the chemokine levels predicted mortality with a high degree of sensitivity and specificity. The findings are important as they indicate a possible mechanism for risk stratification in future trials of novel therapies in human sepsis which as yet have not been successful. Injection of lipopolysaccharide into volunteers is followed by acute rises of monocyte-derived proinflammatory cytokines including tumour necrosis factor 1 IL-1 and IL-6 2 . Although the concentration of these cytokines falls to normal within a few hours the secondary effects of their release can be devastating. These effects include fever leukocyte and endothelial activation leukocyte margination and transmigration leukocyte maturation metabolic and endocrine effects and enhanced procoagulant activity at the endothelial .