BJA -- E-letters for Mokart et al., 0 (2005) 2571

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Clinical Investigation:
D. Mokart, M. Leone, A. Sannini, J. P. Brun, A. Tison, J. R. Delpero, G. Houvenaeghel, J. L. Blache, and C. Martin
Predictive perioperative factors for developing severe sepsis after major surgery
Br. J. Anaesth. 2005; 0: aei257v1 [Abstract] [PDF]

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Electronic letters published:

Predicting infection and sepsis: A clinician's dilemma.: Sumit Kumar Jha (2 December 2005)

Predicting infection and sepsis: A clinician's dilemma. 2 December 2005

Sumit Kumar Jha,
Senior House Officer.
Addenbrooke's Hospital NHS Trust. Cambridge.
Send letter to journal:
Re: Predicting infection and sepsis: A clinician's dilemma.

I read with interest article of D. Mokart and colleagues on ‘Predictive perioperative factors for developing severe sepsis after major surgery’.
The well-written article seeks to identify the predictive risk factors for developing postoperative severe sepsis. I would agree with them that some of the markers that can be easily collected in the preoperative or postoperative visits can be used to screen the patients at high risk for developing severe sepsis after major surgery. I would like to share my experiences in a similar and ongoing project we are conducting this year at the Neurosciences Critical care Unit, Addenbrooke’s Hospital, Cambridge.
We are studying patients admitted to the unit and whether CRP in association with other biochemical markers can be predictive of infection in a tertiary ITU setting of a teaching University Hospital. We are looking at C-reactive protein, clinical markers of infection, cell counts and correlating these with the SAPS and APACHE scores. The clinical use of Procalcitonin, as marker of severity of infection in critically ill patients is another aspect to be looked at in coming studies. Procalcitonin (PCT) has recently been proposed as a marker of bacterial infection in critically ill patients.
The suggestions are:
1.There is a need for an effective and accurate biochemical marker to support, or exclude, the diagnosis of infection.
2.Upsurge of MRSA and drug resistant microbes should propel clinicians into novel strategies aimed at predicting infection. This is especially relevant in the critical care setting where infection is difficult to control and has a significant bearing on patient outcome.
3.C-Reactive protein is a non-specific marker of inflammation anywhere in the body. In retrospect, a normal CRP is very reassuring.
References:
1.Predictive perioperative factors for developing severe sepsis after major surgery. D. Mokart, M. Leone2, A. Sannini, J. P. Brun, A. Tison, J. R. Delpero, G. Houvenaeghel3, J. L. Blache and C. Martin. British Journal of Anaesthesia 2005 95(6): 776-781; doi: 10.1093/bja/aei257
2.Procalcitonin as a marker of bacterial infection in the emergency department: an observational study. Yi-Ling Chan, Ching-Ping Tseng, Pei- Kuei Tsay, Shy-Shin Chang1, Te-Fa Chiu and Jih-Chang Chen. Critical Care 2004, 8:R12-R20 doi: 10.1186/cc239
3.Ugarte H, Silva E, Mercan D, De Mendonca A, Vincent JL: Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 1999, 27:498-504
4.Muller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, Ritz R: Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000, 28:977-983.
Conflict of Interest:
None declared