Uloga prokalcitonina u dijagnosticiranju i liječenju akutno teško bolesnih osoba različitih dobnih skupina

master's thesis

• Title (english): The role of procalcitonin in the diagnosis and treatment of critically ill patients in different age groups
• Author: Marta Grgat
• Mentor: Ana Vujaklija Brajković (mentor)
• Committee member: Luka Bielen (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Ana Vujaklija Brajković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Akutno teško bolesne osobe zahtijevaju posebnu liječničku skrb zbog teško narušenih vitalnih funkcija. Osnovu procjene stanja bolesnika čine klinički pregled, stalni nadzor i reevaluacija stanja. Važnu dodatnu pomoć daju dijagnostičke pretrage, u koje spada i određivanje različitih biomarkera. Biomarkeri predstavljaju široku skupinu kliničkih znakova koji se mogu točno izmjeriti, a jedan od njih je i prokalcitonin (PCT). U fiziološkim uvjetima on je prekursor kalcitonina, hormona ključnog za regulaciju kalcija. Tijekom bakterijske infekcije, razina PCT-a u krvi raste zbog utjecaja mikrobioloških endotoksina i upalnih medijatora. Razina PCT-a počinje rasti već za 2-6 sati od početka bolesti, dostiže svoju najveću vrijednost u prvih 6 do 24 sata te se brzo snižava s rezolucijom infekcije. U skupini akutno teško bolesnih pacijenata svih dobnih skupina, PCT se najčešće koristi kao biomarker bakterijske infekcije. Brojna istraživanja u odrasloj populaciji pokazala su dobru točnost PCT-a kao dijagnostičkog i prognostičkog biomarkera sepse. Također ima ulogu u provođenju antibiotskog liječenja, odnosno kao pomoć pri odluci o deeskalaciji i/ili prekidu antimikrobne terapije. Olakšava razlikovanje upale izazvane bakterijom od upalnih stanja virusnog i drugog uzroka. U pedijatrijskoj populaciji, PCT se uglavnom koristi kao dodatni dijagnostički biomarker sepse, uključujući ranu i kasnu novorođenačku sepsu, a manje kao dio strategija za antibiotsko liječenje. Relativno često područje primjene također su uroinfekcije u djece, gdje se PCT koristi kao pokazatelj zahvaćenosti gornjeg dijela mokraćnog sustava. Iako postoji mnogo podataka o korisnosti PCT-a u navedenim područjima primjene, potrebno je provesti još istraživanja, pogotovo u pedijatrijskoj populaciji. Također, važno je naglasiti da svi biomarkeri, pa tako i PCT, mogu predstavljati pomoć pri kliničkom odlučivanju, ali da su unatoč napretku dijagnostike, temeljit klinički pregled i stalni nadzor bolesnika osnove dobre liječničke skrbi.

Abstract (english)

Critically ill patients require special medical care due to severely impaired vital functions. The basis for assessing the patient's condition is a clinical examination, constant monitoring and re-evaluation of the condition. Important additional help is provided by diagnostic tests, including biomarkers. Biomarkers represent a broad group of clinical signs that can be accurately measured, and one of them is procalcitonin (PCT). Under physiological conditions, PCT is a precursor of calcitonin, a hormone crucial for calcium regulation. During a bacterial infection, the blood level of PCT rises due to the influence of microbiological endotoxins and inflammatory mediators. PCT levels begin to rise as early as 2-6 hours after the onset of the disease, reach their maximum value in the first 6 to 24 hours, and decrease rapidly with the resolution of the infection. In the group of acutely ill patients of all ages, PCT is most commonly used as a biomarker of bacterial infection. Numerous studies in the adult population have demonstrated good accuracy of PCT as a diagnostic and prognostic biomarker of sepsis. It also has a role in the implementation of antibiotic treatment, i.e. as an aid in deciding on the de-escalation of antimicrobial therapy. Additionally, PCT helps to distinguish inflammation caused by bacteria from other causes, including viruses. In the pediatric population, PCT is mainly used as an additional diagnostic biomarker of sepsis, including early and late onset neonatal sepsis, and less as part of antibiotic treatment strategies. A relatively common area of application is also urinary tract infections in children, where PCT is used as an indicator of upper urinary tract involvement. Although there is a lot of data on the usefulness of PCT in these areas of application, more research is needed, especially in the pediatric population. Also, it is important to emphasize that all biomarkers, including PCT, can be an aid in clinical decision-making, but that despite the progress in diagnostics, thorough clinical examination and constant monitoring of patients still are the basis of good medical care.

• Keywords: prokalcitonin; biomarker; sepsa; infekcija
• Keywords (english): procalcitonin; biomarker; sepsis; infection
• Language: croatian
• URN:NBN: urn:nbn:hr:105:384609
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-03 12:58:27