الفهرس 
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Abstract
Participants in this prospective research had procedures in the medical ICU of Minia University Hospitals in Minia, Egypt, between December 2020 and November 2021.
Patients were divided into three groups based on whether or not they met criteria for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, or septic shock at the time of blood collection (group-I: 44 patients with negative blood culture; as control group); group-II: 26 patients with mild sepsis symptoms according to the Sequential Organ Failure Assessment (SOFA) score (2 without organ dysfunction); and group-III: 44 patients with severe sepsis symptoms
All participants had standard evaluations such a complete history and physical as well as an abdominal ultrasound. Standard hematologic and biochemical analyses were performed on them.
Patients must be 18 years or older to be considered, and they must be admitted to the intensive care unit, the internal medicine service, or the outpatient clinic.
Subjects who met any one of the following criteria were not included in the analysis: under the age of 18.
In-depth analyses in the lab:
Sample Collection Procedure for Blood
Each individual had around 5ml of venous blood collected via a sterile venipuncture and then split into three tubes in a completely aseptic environment: Blood was separated into three tubes: one with EDTA (0.5 ml) for a complete blood count (CBC) using an automated cell counter (SYSMEX KX-2iN, Japan); another with trisodium citrate (1.8 ml) for a prothrombin time, concentration, and international normalised ratio (INR) using an automated coagulometer (LABiTec-GmbH, Germany); and a plain tube (remaining blood, left until clotted (Thermo-Electron Incorporation, Finland). The rest of the serum was frozen at -20 degrees Celsius for further adrenomedullin ELISA testing (bioassay technology laboratory, China).
The mean concentration of bio-ADM in the sampled population was 158.53 176.30 pg/mL, our research shows. The bio-ADM levels in the control group were 48.3140.7% pg/mL, those in the mild sepsis group were 100.950.3% pg/mL, and those in the severe sepsis group were 302.7206.9% pg/mL, indicating a substantial step rise of bio-ADM with higher severity of sepsis (P 0.001). Bio-ADM quartile distributions also varied significantly across the groups.
Leukocytosis in sepsis may be attributed to a number of underlying conditions, including but not limited to infections, insulin insufficiency, dehydration, and the release of stress hormones, as this article has shown. The first step in diagnosing infection is a thorough evaluation of the patient’s history, physical, and laboratory parameters. The findings may help in determining the best time to start antibiotic treatment. In conclusion, it is not prudent to rely the choice to start antibiotic treatment on the presence of leukocytosis, CRP, or ESR.
In contrast to the standard assays, such as CRP and WBC, ESR, Bio ADM has shown to be a reliable and accurate diagnostic for ruling out bacterial infections, hence reducing unnecessary usage of antibiotics.
The early diagnosis and warning of sepsis is made possible by detecting bio ADM levels in the blood, which may be detectable within 1h of icu admission and rise quickly within 6 h, culminating at around 24 h.