Zusammenfassung
Sepsis stellt eine lebensbedrohliche Erkrankung dar, deren Pathogenese
durch ein komplexes Zusammenwirken von Infektionserregern und Immunsystem
charakterisiert ist. Das Monitoring immunologischer Parameter in
Sepsispatienten und Patienten mit erhöhtem Sepsisrisiko
kann helfen, prädisponierende Faktoren, den aktuellen Funktionszustand
des Immunsystems sowie infektionsspezifische Reaktionsmuster zu
erkennen und daraus personalisierte Therapiestrategien zu entwickeln.
Ausgehend von dem PIRO-Modell als pathophysiologisch ausgerichtetem
Konzept zur Entwicklung einer neuen Sepsis-Klassifikation fassen
wir einige der aktuell angewandten bzw. diskutierten Parameter zum Immunmonitoring
bei SIRS und Sepsis zusammen.
Summary
Sepsis is a life-threatening disease characterized by a complex
interaction between pathogens and the immune system. The analysis
of immune parameters in patients with sepsis or at risk for sepsis
may help to identify predisposing factors and infection-specific
reaction patterns, as well as to monitor the current functional
state of the immune system. This may lead to personalized therapeutic
strategies for improving outcome in sepsis. Based on the PIRO model
(predisposition, insult, response, organ dysfunction), a pathophysiologically-oriented
concept for the development of a new sepsis classification, this
article reviews currently used and new parameters for immunmonitoring
in SIRS (systemic inflammtory response syndrome) and sepsis.
Schlüsselwörter
SIRS - Sepsis - PIRO-Modell - Immunmonitoring - pro-inflammatorisch - anti-inflammatorisch - Immunparalyse
Keywords
systemic inflammatory response syndrom (SIRS) - sepsis - PIRO model - immune monitoring - pro-inflammatory - anti-inflammatory - immunoparalysis
Literatur
-
1
ACCP/SCCM .
American College of Chest Physicians/Society of Critical
Care Medicine Consensus Conference: definitions for sepsis and organ
failure and guidelines for the use of innovative therapies in sepsis.
Crit Care Med.
1992;
31
864-74
-
2
Becker K L, Snider R. et al .
Procalcitonin
assay in systemic inflammation, infection, and sepsis: clinical
utility and limitations.
Crit Care Med.
2008;
36
941-52
-
3
Bouwman L H, Roep B O, Roos A.
Mannose-binding lectin: clinical implications for infection,
transplantation, and autoimmunity.
Hum Immunol.
2006;
67
247-56
-
4
Brunkhorst F.
Definition und Diagnose der Sepsis nach aktuellen Kriterien.
Klinikarzt.
2004;
33
167-172
-
5
Cohen J.
The immunopathogenesis of sepsis.
Nature.
2002;
420
885-91
-
6
Docke W D, Hoflich C. et al .
Monitoring
temporary immunodepression by flow cytometric measurement of monocytic
HLA-DR expression: a multicenter standardized study.
Clin
Chem.
2005;
51
2341-7
-
7
Döcke W D, Randow F, Syrbe U. et al .
Monocyte deactivation in septic patients:
restoration by IFN-gamma treatment.
Nat Med.
1997;
3
678-81
-
8
Gerlach H.
Von Roger Bone to PIRO.
Anasthesiol Intensivmed Notfallmed Schmerzther.
2006;
41
32-4
-
9
Gibot S, Cravoisy A.
Soluble form of the triggering
receptor expressed on myeloid cells-1 as a marker of microbial infection.
Clin Med Res.
2004;
2
181-7
-
10
Harms H, Prass K, Meisel C. et
al .
Preventive antibacterial therapy in acute ischemic
stroke: a randomized controlled trial.
PLoS ONE.
2008;
14
e2158
-
11
Jensen J U, Lundgren B, Lundgren J D.
Meta-analysis of procalcitonin for sepsis detection.
Lancet
Infect Dis.
2007;
7
499-500
-
12
Kox W J, Volk T. et al .
Immunomodulatory
therapies in sepsis.
Intensive Care Med.
2000;
26
S124-8
-
13
Lam H S, Ng P C.
Biochemical markers
of neonatal sepsis.
Pathology.
2008;
40
141-8
-
14
Levy M M, Fink M P. et al .
2001
SCCM/ESICM/ACCP/ATS/SIS International Sepsis
Definitions Conference.
Crit Care Med.
2003;
31
1250-6
-
15
Lode H, Harnoss C M.
Infection from
the viewpoint of the infectiologist.
Beitr Infusionsther
Klin Ernahr.
1983;
10
17-24
-
16
Monneret G, Venet F. et al .
Monitoring
immune dysfunctions in the septic patient: a new skin for the old
ceremony.
Mol Med.
2008;
14
64-78
-
17
Moreno R P, Metnitz B, Adler L. et al .
Sepsis mortality prediction based on predisposition,
infection and response.
Intensive Care Med.
2008;
34
496-504
-
18
Müller B, Christ-Crain M, Schuetz P.
Meta-analysis of procalcitonin for sepsis detection.
Lancet
Infect Dis.
2007;
7
498-9
-
19
Nierhaus A, Montag B, Timmler N. et al .
Reversal of immunoparalysis by recombinant
human granulocyte-macrophage colony-stimulating factor in patients
with severe sepsis.
Intensive Care Med.
2003;
29
646-51
-
20
Reinhart K, Brunkhorst F M.
Meta-analysis
of procalcitonin for sepsis detection.
Lancet Infect Dis.
2007;
7
500-2
-
21
Reinhart K, Meisner M. et al .
Markers
for sepsis diagnosis: what is useful?.
Crit Care Clin.
2006;
22
503-19,
ix-x
-
22
Reinsberg J, Dembinski J. et al .
Determination
of total interleukin-8 in whole blood after cell lysis.
Clin
Chem.
2000;
46
1387-94
-
23
Strohmeyer J C, Blume C, Meisel C. et al .
Standardized immune monitoring for the
prediction of infections after cardiopulmonary bypass surgery in risk
patients.
Cytometry B Clin Cytom.
2003;
53
54-62
-
24
Sunden-Cullberg J, Norrby-Teglund A. et al .
The
role of high mobility group box-1 protein in severe sepsis.
Curr
Opin Infect Dis.
2006;
19
231-6
-
25
Tang B M, Eslick G D, Craig J C, McLean A S.
Accuracy
of procalcitonin for sepsis diagnosis in critically ill patients:
systematic review and meta-analysis.
Lancet Infect Dis.
2007;
7
210-7
-
26
Valdimarsson H.
Infusion of plasma-derived mannan-binding lectin (MBL) into
MBL-deficient humans.
Biochem Soc Trans.
2003;
31
768-9
-
27
Volk H D, Reinke P. et al .
Clinical
aspects: from systemic inflammation to ‘immunoparalysis’.
Chem Immunol.
2000;
74
162-77
-
28
Volk H D, Thieme M. et al .
Alterations
in function and phenotype of monocytes from patients with septic
disease – predictive value and new therapeutic strategies.
Behring Inst Mitt.
1991;
88
208-15
-
29
Winning J, Claus R A. et al .
Molecular
biology on the ICU. From understanding to treating sepsis.
Minerva
Anestesiol.
2006;
72
255-67
-
30
Yan S F, Ogawa S. et al .
Hypoxia-induced
modulation of endothelial cell properties: regulation of barrier
function and expression of interleukin-6.
Kidney Int.
1997;
51
41-25
Dr. med. Christian Meisel
Institut für Medizinische Immunologie, Charité Campus
Mitte
Charitéplatz 1
10117 Berlin
Phone: 030/450524-062
Fax: 030/450524-932
Email: chr.meisel@charite.de
