Biomarkers In Sepsis | Clinical Nursing Classroom – Makeupclass

Updated: July 11, 2023
Posted by: NMM Editorial

If you missed the last edition of Clinical Nursing Classroom, we have compiled a summary of the class. To never miss another class, join us today.

Sepsis is considered a global health burden with a significant economic impact.

Overall, sepsis is associated with substantial hospital mortality of 25%-30% globally, which increases to 40%-50% in patients with complications and in lower-income countries.

An estimated 30 million cases of sepsis each year result in more than 8 million deaths.

In the United States alone, spending on sepsis was estimated at US $20 billion (5.2% of hospital costs) in 2011 (Canadian Medical Association, 2017).

Infection prevention and control, early detection and immediate infection treatment are crucial in tackling sepsis.

Sepsis can be defined as a dysregulated systemic host response to the presence of infection which could result in life-threatening organ dysfunction.

“Lactate levels should be kept below 2mmol/L in sick patients, especially the critically ill.”

Therefore, it is imperative to identify infection early and initiate treatment immediately to prevent the negative progression of sepsis to severe sepsis and eventually septic shock.

Sepsis biomarkers are tools or characteristics that help to pick and measure ongoing infectious processes in the body and their severity, even when the host has not yet presented obvious signs and symptoms of infection.

They also help to evaluate the effectiveness of pharmacological intervention and guide the initiation, continuation or termination of antibiotics therapy.

Procalcitonin-based algorithm used in the PRORATA trial to initiate, pursue or discontinue antibiotics [46]. * Excludes situations requiring immediate antibiotic treatment (e.g. septic shock, purulent meningitis).

Lactate

Lactate is an end product of anaerobic respiration.

High blood lactate is due to an imbalance between lactate production and clearance.

The liver and kidneys are primarily responsible for lactate clearance in the body.

So any damage to these organs will cause lactate build-up in the body system.

In times of stress, the oxygen requirement of body tissues outweighs the oxygen delivery, which can lead to tissue hypoperfusion.

This process induces a switch from aerobic to anaerobic metabolism, causing lactate to build up.

Since sepsis poses oxidative stress on the body, a high lactate level can also be a pointer to determining the presence of infection, provided other factors that can cause elevated lactate (such as dehydration, malignancy, liver disease, mitochondria disorder, etc.) have been ruled out.

Monitoring lactate levels can also provide valuable information regarding a patient’s response to therapy.

Lactate levels should be kept below 2mmol/L in sick patients, especially the critically ill.

Several studies have associated high lactate levels with increased mortality.

C-Reactive Protein (CRP)

CRP is a protein produced majorly in the liver.

Its level increases significantly during acute inflammation, hence its use as a well-established biomarker of infection (bacterial or viral) and inflammation.

Although its low specificity may be a primary drawback as a biomarker of sepsis in adults, it is commonly used to screen for early-onset sepsis (occurring during 24 hours of life) because its sensitivity is generally considered very high in this period. Target CRP level <10mg/dl.

Procalcitonin (PCT)

PCT is normally produced by the parafollicular cells of the thyroid but can also be produced by the neuroendocrine cells of the lung and the intestine in response to proinflammatory stimuli.

PCT is a biomarker used to predict the likelihood of a patient having a bacterial infection and how severe that infection might be.

Its specificity makes it more reliable than CRP.

There is a need to balance the urgency of initiating antibiotic therapy with the imperative of avoiding injudicious antibiotic use (antibiotic stewardship).

Monitoring PCT levels shortens the patient’s exposure to antibiotic therapy and, consequently, the length of hospital stay.

References

Kang HE and Park DW. Lactate as a Biomarker of Sepsis. Infection and Chemotherapy Journal. 2016; 48(3): 252-253.

Dugani S, Veillard J and Kissoon N. Reducing the global burden of sepsis. Canadian Medical Journal. 2017; 189(1): E2-E3.

Clinical Nursing Classroom is a community of nurses dedicated to improving clinical nursing practice among nurses. Become part of our community and improve your clinical nursing skills and stand out. Join us here.