Pancreatic Stone Protein Measurement to Screen and Diagnose Sepsis in the Context of the Surviving Sepsis Campaign Recommendations.
Main Article Content
Abstract
Sepsis occurs yearly in 48.9 million people worldwide of whom 11 million will die. Sepsis is defined as a life-threatening dysregulated reaction of the body in response to a bacterial infection, leading to organ dysfunction. The Surviving Sepsis Campaign made numerous recommendations for sepsis diagnosis and treatment using an evidence-based medicine approach. Frequently, levels of evidence of these recommendations are poor and lack clear clinical guidance. Interestingly, these guidelines strongly recommend, with a moderate quality of evidence, screening of nosocomial sepsis in acutely ill hospitalized high-risk patients. The definition of acutely ill and high-risk patients is not specified, nor it is indicated which tools should be used. The diagnosis of infection and the subsequent administration of antibiotics relies solely on rapid clinical assessment, as recommended by the Best Practice Statement. Again, the elements used for clinical assessment are poorly defined, encompassing patient history, clinical examination, and unspecified tests for both infectious and non-infectious causes of acute illness. In the real world and based on these recommendations, only 30 to 40% of empiric broad-spectrum antibiotic administrations are appropriate, contributing to the emergence of antimicrobial resistant bacteria, toxicity related to antibiotic administration, and costs. The aim of this review article is to show that the use of biomarkers, such as the Pancreatic Stone Protein, could be the specific tests and tools to help the clinician to diagnose and manage sepsis. Over 600 peer-reviewed publications have studied the physiology of Pancreatic Stone Protein and more than 50 evaluated its usefulness to screen for the development of nosocomial sepsis and diagnose sepsis.
Keywords:
Sepsis, Septic shock, infection, bacterial infection, biomarker, pancreatic stone protein, organ failure, antibiotics, antimicrobial resistance
Article Details
How to Cite
VENTURA, François et al.
Pancreatic Stone Protein Measurement to Screen and Diagnose Sepsis in the Context of the Surviving Sepsis Campaign Recommendations..
Medical Research Archives, [S.l.], v. 11, n. 12, jan. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4893>. Date accessed: 21 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i12.4893.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical care medicine. 2006;34(6):1589-1596.
4. Torio CM, Moore BJ. National inpatient hospital costs: the most expensive conditions by payer, 2013: statistical brief# 204. Healthcare cost and utilization project (HCUP) statistical briefs. 2006:2006-2016.
5. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Critical care medicine. 2021;49(11):e1063-e1143.
6. Ventura F. Diagnosis of Sepsis. Paper presented at: Presented at Area Critica2021; Bologna.
7. Klein Klouwenberg PM, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Critical care. 2015;19:1-8.
8. Murray CJ, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399(10325):629-655.
9. Sartelli M, Barie PS, Coccolini F, et al. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World Journal of Emergency Surgery. 2023;18(1):50.
10. Dyar O, Moran-Gilad J, Greub G, Pulcini C, Committee EE, Committee EE. Diagnostic stewardship: are we using the right term? Clinical Microbiology and Infection. 2019;25(3):272-273.
11. Swissnoso. Infections associées aux soins. Infections associées aux soins. https://swissnoso.ch/fr/de-quoi-sagit-il/infections-associees-aux-soins/. Accessed 23/11/2023.
12. Vincent J-L, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. Jama. 2020;323(15):1478-1487.
13. Dadgostar P. Antimicrobial resistance: implications and costs. Infection and drug resistance. 2019:3903-3910.
14. Markwart R, Saito H, Harder T, et al. Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive care medicine. 2020;46:1536-1551.
15. Farinas-Alvarez C, Farinas M, Fernandez-Mazarrasa C, Llorca J, Casanova D, Delgado-Rodríguez M. Analysis of risk factors for nosocomial sepsis in surgical patients. Journal of British Surgery. 2000;87(8):1076-1081.
16. Appelgren P, Hellström I, Weitzberg E, Söderlund V, Bindslev L, Ransjö U. Risk factors for nosocomial intensive care infection: a long‐term prospective analysis. Acta anaesthesiologica scandinavica. 2001;45(6):710-719.
17. Pierrakos C, Velissaris D, Bisdorff M, Marshall JC, Vincent J-L. Biomarkers of sepsis: time for a reappraisal. Critical Care. 2020;24(1):1-15.
18. Marshall JC, Reinhart K. Biomarkers of sepsis. Critical care medicine. 2009;37(7):2290-2298.
19. Graf R. Pancreatic stone protein–sepsis and the riddles of the exocrine pancreas. Pancreatology. 2020;20(3):301-304.
20. De Caro A, Lohse J, Sarles H. Characterization of a protein isolated from pancreatic calculi of men suffering from chronic calcifying pancreatitis. Biochemical and biophysical research communications. 1979;87(4):1176-1182.
21. Multigner L, De Caro A, Lombardo D, Campese D, Sarles H. Pancreatic stone protein, a phosphoprotein which inhibits calcium carbonate precipitation from human pancreatic juice. Biochemical and biophysical research communications. 1983;110(1):69-74.
22. De Reggi M, Gharib B, Patard L, Stoven V. Lithostathine, the presumed pancreatic stone inhibitor, does not interact specifically with calcium carbonate crystals. Journal of Biological Chemistry. 1998;273(9):4967-4971.
23. Terazono K, Yamamoto H, Takasawa S, et al. A novel gene activated in regenerating islets. Journal of Biological Chemistry. 1988;263(5):2111-2114.
24. Watanabe T, Yonekura H, Terazono K, Yamamoto H, Okamoto H. Complete nucleotide sequence of human reg gene and its expression in normal and tumoral tissues. The reg protein, pancreatic stone protein, and pancreatic thread protein are one and the same product of the gene. Journal of Biological Chemistry. 1990;265(13):7432-7439.
25. Jin CX, Hayakawa T, Ko SB, Ishiguro H, Kitagawa M. Pancreatic stone protein/regenerating protein family in pancreatic and gastrointestinal diseases. Internal Medicine. 2011;50(15):1507-1516.
26. Schiesser M, Bimmler D, Frick T, Graf R. Conformational changes of pancreatitis-associated protein (PAP) activated by trypsin lead to insoluble protein aggregates. Pancreas. 2001;22(2):186-192.
27. Iovanna J, Frigerio JM, Dusetti N, Ramare F, Raibaud P, Dagorn JC. Lithostathine, an inhibitor of CaCO3, crystal growth in pancreatic juice, induces bacterial aggregation. Pancreas. 1993;8(5):597-601.
28. Keel M, Härter L, Reding T, et al. Pancreatic stone protein is highly increased during posttraumatic sepsis and activates neutrophil granulocytes. Critical care medicine. 2009;37(5):1642-1648.
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