Early diagnostic markers of sepsis after oesophagectomy (including thromboelastography)

BMC Anesthesiology

Miroslav Durila⁴  J Bronský³  T Haruštiak²  Alexander Pazdro²  Marta Pechová¹  Karel Cvachovec⁴ 

[1] Department of Clinical Biochemistry and Pathobiochemistry, Second Faculty of Medicine, Charles University, Prague, Czech Republic

[2] Third Department of Surgery, First Faculty of Medicine, Prague, Czech Republic

[3] Department of Paediatrics, Charles University, Second Faculty of Medicine, Prague, Czech Republic

[4] Department of Anesthesiology and Critical Care Medicine, Second Faculty of Medicine and Institute for Postgraduate Medical Education, Charles University in Prague, V Úvalu 84, 150 06, Prague 5, Czech Republic

关键词: Thromboelastography;    Hematological;    Biochemical;    Sepsis;   

Others  :  817046
DOI  :  10.1186/1471-2253-12-12

 received in 2011-10-11, accepted in 2012-06-26,  发布年份 2012

【 摘 要 】

Background

Early diagnosis of sepsis and its differentiation from the noninfective SIRS is very important in order that treatment can be initiated in a timely and appropriate way. In this study we investigated standard haematological and biochemical parameters and thromboelastography (TEG) in patients who had undergone surgical resection of the oesophagus to find out if changes in any of these parameters could help in early differentiation between SIRS and sepsis development.

Methods

We enrolled 43 patients (aged 41–74 years) of whom 38 were evaluable. Blood samples were obtained on the morning of surgery and then at 24-hour intervals for the next 6 days. Samples were analysed for procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL- 6), aspartate transaminase (AST), alanine transaminase (ALT) , lactate, white blood count (WBC), D-dimers, antithrombin (AT), international normalised ratio (INR), activated partial thromboplastin time (APTT) and parameters of TEG.

Results

Significant differences between patients who developed sepsis during this period (9 patients) and SIRS were found in ALT on Day 1, in AST on Days 1–4, in PCT on Days 2–6; in CRP on Days 3–6; in IL-6 on Days 2–5; in leucocytes on Days 2, 3 and 6; and in D-dimers on Days 2 and 4. Significance values ranged from p < 0.0001 to p < 0.05.

Conclusions

Sequential measurements of ALT, AST, PCT and IL-6 during the early postoperative period can be used for early differentiation of sepsis and postoperative SIRS after oesophagectomy. Among the coagulation parameters measured, only D-dimer concentrations appeared to be helpful in this process. TEG does not seem to be a useful early predictor of sepsis development; however it can be used to differentiate sepsis and SIRS from Day 5 after surgery.

【 授权许可】

   
2012 Durila et al.;licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Angus DC, Wax RS: Epidemiology of sepsis: an update. Crit Care Med 2001, 29(7 Suppl):S109-116.
• [2]Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP: The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 1995, 273(2):117-123.
• [3]Amaral A, Opal SM, Vincent JL: Coagulation in sepsis. Intensive Care Med 2004, 30(6):1032-1040.
• [4]Dixon B: The role of microvascular thrombosis in sepsis. Anaesth Intensive Care 2004, 32(5):619-629.
• [5]Diaz NL, Finol HJ, Torres SH, Zambrano CI, Adjounian H: Histochemical and ultrastructural study of skeletal muscle in patients with sepsis and multiple organ failure syndrome (MOFS). Histol Histopathol 1998, 13(1):121-128.
• [6]Iapichino G, Marzorati S, Umbrello M, Baccalini R, Barassi A, Cainarca M, Colombo Pavini F, Mantovani E, Mauri A, Moroni B, et al.: Daily monitoring of biomarkers of sepsis in complicated long-term ICU-patients: can it support treatment decisions? Minerva Anestesiol 2010, 76(10):814-823.
• [7]Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, Moutardier V, Blache JL: Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth 2005, 94(6):767-773.
• [8]Mahla E, Lang T, Vicenzi MN, Werkgartner G, Maier R, Probst C, Metzler H: Thromboelastography for monitoring prolonged hypercoagulability after major abdominal surgery. Anesth Analg. 2001, 92:572-577.
• [9]Hawker F: Liver dysfunction in critical illness. Anaesth Intensive Care 1991, 19(2):165-181.
• [10]Pastor CM, Billiar TR, Losser MR, Payen DM: Liver injury during sepsis. J Crit Care 1995, 10(4):183-197.
• [11]Chand N, Sanyal AJ: Sepsis-induced cholestasis. Hepatology 2007, 45(1):230-241.
• [12]Szabo G, Romics L, Frendl G: Liver in sepsis and systemic inflammatory response syndrome. Clin Liver Dis 2002, 6(4):1045-1066.
• [13]Trauner M, Fickert P, Stauber RE: Inflammation-induced cholestasis. J Gastroenterol Hepatol 1999, 14(10):946-959.
• [14]Verhage RJ, Hazebroek EJ, Boone J, Van Hillegersberg R: Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir 2009, 64(2):135-146.
• [15]Daudel F, Kessler U, Folly H, Lienert JS, Takala J, Jakob SM: Thromboelastometry for the assessment of coagulation abnormalities in early and established adult sepsis: a prospective cohort study. Crit Care 2009, 13(2):R42. BioMed Central Full Text
• [16]Spiel AO, Mayr FB, Firbas C, Quehenberger P, Jilma B: Validation of rotation thrombelastography in a model of systemic activation of fibrinolysis and coagulation in humans. J Thromb Haemost 2006, 4(2):411-416.
• [17]Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992, 101(6):1644-1655.
• [18]Velasco E, Thuler LC, Martins CA, Dias LM, Conalves VM: Risk factors for infectious complications after abdominal surgery for malignant disease. Am J Infect Control 1996, 24(1):1-6.
• [19]Capdevila JA, Martinez-Vazquez JM, Almirante B, Hernandez A: Liver alterations in acute pneumonia. Arch Intern Med 1990, 150(10):2206-2209.
• [20]Campos J, Alende R, Gonzalez-Quintela A: Abnormalities in aminotransferase levels during acute pyelonephritis. Eur J Intern Med 2009, 20(3):e53-56.
• [21]Sinha A, Clatch RJ, Stuck G, Blumenthal SA, Patel SA: Isoflurane hepatotoxicity: a case report and review of the literature. Am J Gastroenterol 1996, 91(11):2406-2409.
• [22]Ito S, Sato N, Kojika M, Yaegashi Y, Suzuki Y, Suzuki K, Endo S: Serum procalcitonin levels are elevated in esophageal cancer patients with postoperative infectious complications. Eur Surg Res 2005, 37(1):22-28.
• [23]Adamzik M, Eggmann M, Frey UH, Gorlinger K, Brocker-Preuss M, Marggraf G, Saner F, Eggebrecht H, Peters J, Hartmann M: Comparison of thromboelastometry with procalcitonin, interleukin 6, and C-reactive protein as diagnostic tests for severe sepsis in critically ill adults. Crit Care 2010, 14(5):R178. BioMed Central Full Text