Estudo dos biomarcadores procalcitonina e proteína c reativa em doentes com infeções bacterianas
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2018-12-20
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Os avanços promovidos pela investigação científica têm vindo a solucionar ou a melhorar a resposta a diversos problemas relativos à saúde pública. Uma das patologias mais graves em todo mundo, responsável pela ocorrência de elevada mortalidade nos doentes afetados, é a sepsis. A deteção e diagnóstico precoce da sepsis representam um desafio diário no ambiente médico hospitalar devido à complexidade da doença e à falta de métodos específicos. Um dos métodos da deteção da sepsis consiste na realização de análises aos níveis séricos de biomarcadores que mostram alteração na presença de agentes patogénicos. A procalcitonina (PCT) e a proteína C reativa (CRP) são os biomarcadores mais utilizados para a deteção da sepsis. Estes biomarcadores permitem uma resposta rápida contribuindo positivamente para o diagnóstico precoce desta doença. Neste trabalho, realizou-se um estudo dos doentes com idade superior a 65 anos internados na UCIP com infeção bacteriana, nos anos 2016 e 2017, que efetuaram análises aos níveis séricos da PCT e CRP. O objetivo principal deste trabalho foi verificar o nível de concordância na utilização dos biomarcadores, PCT e CRP, para o diagnóstico da sepsis através de um estudo pormenorizado dos dados dos doentes que deram entrada no CHTMAD. Verificou-se que apesar de CRP ter sido descoberta e utilizada no âmbito hospitalar antes da PCT, este biomarcador não apresenta especificidade suficiente para a deteção da sepsis. Em contrapartida, tem uma sensibilidade considerável na presença de agentes patogénicos no organismo. A PCT manifesta uma especificidade superior e, por isso, é o biomarcador mais utilizado para diagnóstico da sepsis, apesar de mais dispendioso. Como complemento a este trabalho foi também calculado o intervalo de cut-off prático e o índice de concordância de utilização simultânea dos biomarcadores, PCT e CRP, para o diagnóstico da sepsis, definido como índice kappa (IK). O intervalo de cut-off prático foi concordante com o intervalo dado pela ROCHE®, para o ano de 2016 e 2017. Desta forma, verificou-se que existe coerência entre o método considerado e o obtido na prática laboratorial. Após a realização do cálculo do IK, o grau de concordância foi classificado como “Muito Bom”, valorizando a utilização da PCT e CRP em simultâneo para a deteção da sepsis.
Abstract The Advances promoted by scientific research haveM coming to solve Or to improve the response to various Problems related to public health. One of the most serious pathologies in the world, responsible the occurrence of high mortality in the affected patients is sepsis. Early detection and diagnosis of sepsis represent a daily challenge in the hospital medical environment due to the complexity of the disease and the lack of specific methods. One of the methods of the detection of sepsis is to perform analyses on the serum levels of biomarkers that show alterations in the presence of pathogenic agents. Procalcitonin (PCT) and C-reactive protein (CRP) are the most widely used biomarkers for the detection of sepsis. These biomarkers allow a rapid response contributing positively to the early diagnosis of this disease. In this work, we conducted a study of patients older than 65 years hospitalized in the UCIP with bacterial infection in the years 2016 and 2017, who performed analyses at the serum levels of PCT and CRP. The main objective of this work was to verify the level of agreement in the use of biomarkers, PCT and CRP, for the diagnosis of sepsis Through a detailed study of the data of patients who entered the Chtmad. It was found that although CRP was discovered and used in the hospital context before PCT, this biomarker does not present sufficient specificity for the detection of sepsis. On the other hand, it has considerable sensitivity in the presence of pathogenic agents in the body. PCT manifests a higher specificity and, therefore, is the most widely used biomarker for diagnosis of sepsis, although it is more costly. As a complement to this work, we also calculated the interval of cut-off and the concordance rate of simultaneous use of biomarkers, PCT and CRP, for the diagnosis of sepsis, defined as Kappa Index (IK). The range of cut-off Agreement was consistent with the interval given by ROCHE®, for the year 2016 and 2017. Thus, it was verified that there is coherence between the method considered and that obtained in laboratory practice. After the performance of the IK calculation, the degree of agreement was classified as "very good", The use of PCT and CRP simultaneously for the detection of sepsis.
Abstract The Advances promoted by scientific research haveM coming to solve Or to improve the response to various Problems related to public health. One of the most serious pathologies in the world, responsible the occurrence of high mortality in the affected patients is sepsis. Early detection and diagnosis of sepsis represent a daily challenge in the hospital medical environment due to the complexity of the disease and the lack of specific methods. One of the methods of the detection of sepsis is to perform analyses on the serum levels of biomarkers that show alterations in the presence of pathogenic agents. Procalcitonin (PCT) and C-reactive protein (CRP) are the most widely used biomarkers for the detection of sepsis. These biomarkers allow a rapid response contributing positively to the early diagnosis of this disease. In this work, we conducted a study of patients older than 65 years hospitalized in the UCIP with bacterial infection in the years 2016 and 2017, who performed analyses at the serum levels of PCT and CRP. The main objective of this work was to verify the level of agreement in the use of biomarkers, PCT and CRP, for the diagnosis of sepsis Through a detailed study of the data of patients who entered the Chtmad. It was found that although CRP was discovered and used in the hospital context before PCT, this biomarker does not present sufficient specificity for the detection of sepsis. On the other hand, it has considerable sensitivity in the presence of pathogenic agents in the body. PCT manifests a higher specificity and, therefore, is the most widely used biomarker for diagnosis of sepsis, although it is more costly. As a complement to this work, we also calculated the interval of cut-off and the concordance rate of simultaneous use of biomarkers, PCT and CRP, for the diagnosis of sepsis, defined as Kappa Index (IK). The range of cut-off Agreement was consistent with the interval given by ROCHE®, for the year 2016 and 2017. Thus, it was verified that there is coherence between the method considered and that obtained in laboratory practice. After the performance of the IK calculation, the degree of agreement was classified as "very good", The use of PCT and CRP simultaneously for the detection of sepsis.
Descrição
Dissertação de Mestrado em Biologia Clínica Laboratorial apresentada à Universidade de Trás-os-Montes e Alto Douro
Palavras-chave
sepsis , procalcitonina , proteína C reativa , intervalo de cut-off prático , índice kappa