الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Sepsis is a complex clinical syndrome which is multifactorial
with many varying presentations. The
pathophysiology of the syndrome is complex, involving
inflammatory mediators, cell mediated immune response, Toll
like receptor expression, and many cell surface receptors.
In this study we tried to validate the efficacy of using a
relatively new marker claiming it has better behaviour in the
development of the septic syndrome and hence its potential to
be used as a diagnostic marker for bacterial infection.
The study included 74 patients divided on
pathophysiological bases as Systemic inflammatory response
syndrome (SIRS), sepsis, sever sepsis and septic shock groups,
another group was derived from these and termed the non
survivors group.
Two endpoints were allocated in this study, the first was at
day 6 and represented the first stage of measurements of the
inflammatory markers proposed, the second endpoint was at
day 28 and supposed to predict the 4 weeks morbidity and
mortality nevertheless it could not be fulfilled as many of the
subjects were expired somewhere between the 6 and the 28 day.
Various groups of patients were used as for the medical
conditions, e.g. multiple injuries vascular surgery patients,
elective postoperative major surgery.... etc.. Samples were collected, stored and analysed, statistical
analysis was done with significance, correlation, sensitivity and
specificity analysis.
To differentiate SIRS from sepsis we aimed at measuring
Procalcitonin (PCT), Interleukin-6 (IL6), and soluble
Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1)
at day of enrolment which showed consistent significant
difference between the SIRS and sepsis groups for sTREM-1,
but did not show statistical significance for the PCT.
The highest cutoff value for the the sTREM-1 was for day
2 compared to day 3 for the PCT. This is important and gives
24 hour earlier decision to be made.
Correlation analysis showed stronger association between
sTREM-1 and SOFA, which coincided well with the clinical
evolution of the septic syndrome.
The soluble triggering receptor expressed on myeloid
cells-1 sTREM-1 has a high diagnostic power to differentiate
SIRS from sepsis at a cutoff value of 116 pg/ml, in addition to
differentiating sepsis from sever sepsis at a cutoff value of 187
pg/ ml, its highest value was at day 2 compared to PCT which
was highest at day 3. It should be noted that the study design
did not include specialised Intensive care settings e.g. cardiac
surgery....etc. so the data presented here should be dealt with
carefully not to be generalized unless a wider scale study is held
and validated the results.