[Evaluation of lymphocyte activation in patients in intensive care units by using flow cytometry for determining expression of early activation antigen CD69]. / Hodnocení aktivace lymfocytu sledováním exprese casného aktivacního antigenu CD69 prutokovou cytometrií u pacientu na JIP.

Disorders in immune reactions represent one of the main pathogenetic mechanisms in patients of Intensive Care Units who suffer from sepsis or syndrome of systemic inflammatory response. The determination of early activation sign CD69 on T lymphocytes makes it possible to evaluate functional capacity of this cell population. The determination of other selected immunological parameters contributes to differential diagnosis of infectious and non-infectious etiology of systemic inflammatory response. The authors demonstrated lower expression of CD69 on CD3+ CD8+ lymphocytes after stimulation with phytohemagglutinin in patients with sepsis as well as patients with the syndrome of systemic inflammatory response of non-infections etiology. No statistically significant differences were proved in the concentrations of IgG, IgA and IgM, number of leukocytes, percentual representation of lymphocytes, TNF alpha production and the expression of surface sign of CD64 in both groups of patients. There were statistically significant differences in the concentrations of C3 and C4 components of complement, prealbumin and procalcitonin. The study did not show correlation between the expression of CD69 and selected immunological parameters (IgA, IgM, IgG, C3, C4, leukocytes, lymphocytes, prealbumin, procalcitonin, TNF alpha and CD64).

[Comparison of procalcitonin, interleukin-6 and C-reactive protein in the differential diagnosis of patients with sepsis syndrome in intensive care units]. / Srovnání prokalcitoninu, interleukinu-6 a C-reaktivního proteinu v diferenciální diagnostice pacientu JIP se syndromem sepse.

UNLABELLED: One of the most difficult tasks in differential diagnosis of patients with septic syndrome at the Intensive Care Units is to differentiate between infection and non-infection etiology of this syndrome. In the last years, new parameters have played an important role in this area--C-reactive protein, Interleukin-6 and procalcitonin. THE AIM: Of the investigation was to compare these three parameters in differential diagnosis of the septic syndrome. THE COHORT AND METHODS: The authors examined 56 patients (17 women and 39 men, mean age being 43 and 51 years, respectively) hospitalized at the Intensive Care Units who corresponded to the criteria of the syndrome of inflammatory response, sepsis or septic shock. A total of 99 examinations were done. The samples were taken up to 24 hours after the beginning of clinical symptomatology and submitted to the laboratory within four hours. Immediately afterwards the determination of concentrations of all three parameters--C-reactive protein, interlaukin-6 and procalcitonin, were done. The results of the examinations were compared to each other as well as to the diagnosis of sepsis--the confirmed infection etiology. RESULTS: In all the evaluated parameters the authors detected significant differences between the values of entry examination and all measurements between the patients with the syndrome of systemic inflammatory response and septic shock as well as among patients with sepsis and the septic shock. Likewise, the authors confirmed significant differences between concentrations of all three parameters in comparing the patients with sepsis and those with the septic shock. Only in the case of procalcitonin there was a significant difference in concentration between patients with the syndrome of systemic inflammatory response of non-infectious etiology and those with sepsis. The concentration of procalcitonin was the only predictive marker of diagnosis with the correlation coefficient r = 0.7263, r2 = 0.5275, P < 0.00005. CONCLUSION: Calcitonin proved to be the most specific parameter in demonstrating infection etiology in patients with the septic syndrome, its predictive value being higher than that of C-reactive protein and Interleukin-6. Monitoring of calcitonin dynamism provides important information on efficiency of the applied antibiotic treatment. In patients with diagnostic uncertainties as far as the etiology of the septic syndrome is concerned; procalcitonin is the parameter of choice, while it may be supplemented with the examination of C-reactive protein.