Biomarkeri u jedinici intenzivne medicine

Helena Ostović, Brankica Šimac, Jasminka Peršec

Biomarkeri su pokazatelji čije se koncentracije u biološkom uzorku mogu objektivno mjeriti i čije se razine koriste kao indikatori normalnog ili patološkog procesa u organizmu, kao i odgovora na primijenjenu terapiju. Imaju rastuću popularnost u jedinicama intenzivne medicine (JIM) kao alat za dijagnostiku i praćenje različitih bolesti. Od posebnog značenja su biomarkeri upale koji pomažu kliničarima u razlučivanju infektivne od neinfektivne etiologije upalnih stanja, koja su čest problem kod bolesnika u JIM-u. Rano prepoznavanje infekcije i pravovremeno postavljanje dijagnoze sepse ključan su preduvjet liječenja kojemu je primarni cilj što ranije započinjanje s odgovarajućom antimikrobnom terapijom. Unatoč rapidnom povećanju novootkrivenih biljega upale posljednjih godina, u kliničkoj praksi koristi ih se svega nekoliko i niti jedan nije idealan zbog granične osjetljivosti i nedostatne specifičnosti. Ovaj članak daje pregled rutinski korištenih biomarkera upale u JIM-u, ali daje i prikaz predstavnika nove generacije čija je namjena prvenstveno rano otkrivanje sepse. Biomarkerima upale, u klasičnom smislu, smatraju se broj leukocita, feritin, C-reaktivni protein (CRP), interleukin 6 (IL-6) i prokalcitonin (PCT), dok su širina distribucije monocita (MDW), presepsin i protein pankreasnog kamenca (PSP) relativno novijeg datuma. Kombinacija novih i tradicionalnih biomarkera upale kao ranih odnosno potvrdnih indikatora te njihova interpretacija u sklopu kliničkih pokazatelja čine temelj personaliziranog pristupa svakom kritično oboljelom bolesniku. Iako istraživanja na ovom području bilježe kontinuirani napredak uz obećavajuće rezultate, još uvijek ne postoji samostalni biomarker koji je validiran za definitivnu dijagnozu sepse.

Biomarkers are indicators whose concentrations in a biological sample can be objectively measured, and their levels are used as indicators of a normal or pathological process in the body, as well as the response to applied therapy. They are gaining increasing popularity in intensive care units (ICUs) as a tool for diagnosing and monitoring various diseases. Inflammatory biomarkers are of special significance as they help clinicians differentiate between infectious and non-infectious etiologies of inflammatory conditions, which are common problems in ICU patients. Early detection of infections and timely diagnosis of sepsis are crucial prerequisites for treatment, with the primary goal to start appropriate antimicrobial therapy as early as possible. Despite the rapid increase in newly
discovered inflammatory markers in recent years, only a few are used in clinical practice, and none are ideal due to borderline sensitivity and insufficient specificity. This article provides an overview of routinely used inflammatory biomarkers in ICUs and introduces representatives of the new generation, primarily intended for the early detection of sepsis. Classical inflammatory biomarkers include white blood cell count, ferritin, C-reactive protein (CRP), interleukin 6 (IL-6) and procalcitonin (PCT), while monocyte distribution width (MDW), presepsin, and pancreatic stone protein (PSP) are relatively new. The combination of new and traditional inflammatory biomarkers, as early or confirmatory indicators, and their interpretation in the context of clinical signs, forms the basis of a personalized
approach to each critically ill patient. Although research in this field is continuously advancing with promising results, there is still no standalone biomarker validated for the definitive diagnosis of sepsis.