Traditionelle Definitionen sind unscharf gefasst - Definition und Diagnose der Sepsis nach aktuellen Kriterien

Zusammenfassung

Die mikrobiologische Diagnose der Sepsis ist zeitintensiv und häufig nicht möglich. Auffällige Merkmale der meisten klinischen Studien sind die Unklarheit und Inkonstanz der verwendeten klinischen und mikrobiologischen Definitionen. Das Fehlen valider epidemiologischer Daten zu Inzidenz, Prävalenz, Letalität und Verlauf steht im Kontrast zu der großen gesundheitsökonomischen Bedeutung der Sepsis. Die Diagnose erfolgt in der Regel zu spät, weil es gegenwärtig keine angemessenen Mittel gibt, den Übergang einer lokal begrenzten Infektion zu einer schweren Sepsis vorherzusagen. Inflammatorische Marker spielen für die Diagnostik der Sepsis und deren Verlaufskontrolle eine zunehmende Rolle, da die Spezifität klinischer Symptome und klassischer Infektionszeichen (Temperaturerhöhung oder -erniedrigung, Leukozytose, Thrombozytenabfall) gering ist. Die Anzahl und das Ausmaß der assoziierten Organdysfunktion(en) beeinflussen den Verlauf und die Mortalität der Sepsis wesentlich. Neue Marker wie das Prohormon Procalcitonin korrelieren besser mit dem Schweregrad der Sepsis als bisher verfügbare Messgrößen. Sie erleichtern daher, neben den klinischen Zeichen des Syndroms, die Diagnose und Verlaufsbeurteilung der Sepsis.

Summary

The term „sepsis” has long been used interchangeably with bacteremia, septicemia or severe sepsis, thereby causing confusion in interpreting epidemiological data. Due to major weaknesses in the ICD-10 terminology, sepsis is mostly not accurately coded on hospital charts, which accounts to the low public awareness of this disease. Early diagnosis of the different severities of infectious-induced inflammation is important for early implementation of specific therapies. Sepsis and severe sepsis are accompanied by clinical and laboratory signs of systemic inflammation. However, patients suffering from non-infectious inflammation may present with similiar signs and symptoms making it difficult to diagnose infection based on clinical findings alone. Microbiological evidence of sepsis, though definitive and specific, may not be obtainable, is time-consuming and even may not occur concurrently with clinical signs of sepsis. It is therefore important to identify markers, which by enabling an early diagnosis of sepsis, would allow early therapeutic interventions. Whereas C-reactive protein is a more sensitive parameter for the diagnosis of localized infections outside the intensive care unit, procalcitonin is currently the most useful parameter to improve the diagnosis and monitoring of therapy in critically ill patients with severe sepsis and septic shock.

Key Words

sepsis - severe sepsis - septic shock - definition - diagnosis - ICD-10 - ACCP/SCCM consensus conference criteria - marker - procalcitonin

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1 Tumor, Nodi, Metastasen

2 monoclonal antibody improves survival and reduces organ dysfunction in human sepsis

3 recombinant human activated protein C worldwide evaluation in severe sepsis

Anschrift des Verfassers