Proteínas nucleares y otros mediadores de inflamación en pacientes en shock séptico sometidos a terapias de remplazo renal

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Sepsis, a life-threatening organ dysfunction caused by an uncontrolled host response to infection, has been on the rise in recent years worldwide and can account for 50% of admissions to intensive care units, being one of the main causes of morbidity and mortality in critically ill patients. To achieve an early diagnosis and define a prognostic stratification, the clinician has diagnostic biomarkers that monitor treatment, such as procalcitonin (PCT), C-reactive protein (CRP) and interleukin 6 (IL-6). The study of nucleoproteins and HMGB1 in blood, resulting from the initial tissue damage, have been related to the pathogenesis of sepsis and have been postulated as diagnostic and prognostic biomarkers. Acute septic kidney failure may require continuous renal replacement techniques (RCRT), which will allow inflammatory molecules such as interleukins, among others, to be removed from the bloodstream. Our working hypothesis was whether TCRR could nucleoproteins and HMGB1 in patients in septic shock with acute renal failure who underwent TCRR during the first 24 hours. The primary objective was to know the evolution of PCT, CRP, IL-6, nucleoproteins and HMGB1. The secondary ones analyze said biomarkers according to the time of evolution of sepsis and the control of the septic focus; evaluate its relationship with organic dysfunctions; and finally to evaluate mortality based on them. We designed a longitudinal prospective observational study in the Intensive Medicine Service of the Dr Peset Hospital in Valencia, in which we included patients over 18 years of age who met diagnostic criteria for septic shock with renal replacement therapies, excluding polytraumatized immunosuppressed patients with neoplasms and previous chronic kidney failure. We define different times to measure biomarkers: before starting dialysis (T0), at the start time: pre-filter (T1pre) post-filter (T1post) and in effluent, and at 24 hours. For nucleoprotein analysis, a “home-made” ELISA was used using capture and detection antibodies, for HMGB1 the IBL ELISA kit was used. 30 patients were recruited. The mean age was 67 years, the APACHE II and SOFA scales at admission were 2810 and 113. Control of the previous septic focus was achieved in 72% of the patients. Among organic dysfunctions, the SOFA score, cardiovascular and renal failure, and acid-base balance improved significantly. The initial concentrations of nucleoproteins and HMGB1 were high and were not modified by the TCRRs. PCT and IL-6 decreased globally. Nucleoproteins and HMGB1 had higher values ​​in earlier sepsis. There was a positive correlation between PCT, IL-6, nucleoproteins and HMGB1 with organic dysfunctions, in addition nucleoproteins and classical biomarkers were also correlated. Those who died in the ICU had higher concentrations of HMGB1 24 hours after initiating CRRT. The development of a diagnostic algorithm based on the set of results presented, associated with the clinical assessment scales and microbiological information could lead to a new paradigm when diagnosing the septic patient. As well as improving the criteria for administering the TCRR
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