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Parámetros importantes en respuestas inflamatorias

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cataataca's version from 2015-04-19 21:13

Parámetros importantes en respuestas inflamatorias

 

Question Answer
Qué es el índice cardiacoparámetro hemodinámico que relaciona el gasto cardiaco del ventrículo izquierdo con el área de superficie corporal. Es igual a CO/BSA es decir SVXHR/BSA
Valor normal del IC2.6–4.2 L/min/m2
Cuándo se define shock cardiogénico a partir del ICcuando está <2.2 L/min/m2
Cómo se calcula el área de superficie corporalusando fórmulas de medición indirecta como la fórmula de Du Bois: 0.007184 X peso 0,425 X Altura 0,725
Qué es la Procalcitoninapéptido de 116 aa, precursos de la calcitonina, producida por células C parafoliculares tiroidea. También producida por células neuroendocrinas del pulmón y del intestino como un reactante de fase aguda de infamación, especialmente ante estímulos bacterianos. El aumento en procalcitonina se relaciona con endotoxinas bacterianas y con citoquinas inflamatorias. Procalcitonina liberada como reactante de fase aguda no resulta en aumentos de calcitonina.
Limitaciones procalcitoninaProcalcitonin, although useful in bacterial sepsis, has no value in the assessment of fungal or viral infections and shows no response to intracellular microorganisms (ie, Mycoplasma) or in local infections with no systemic response. Similar to CRP, clinical conditions associated with high baseline procalcitonin levels include burns, major surgery, and systemic inflammatory processes.
Correlaciones clínicas con altos niveles de procalcitoninain patients with sepsis, higher procalcitonin levels are associated with a greater risk of progression to severe sepsis and septic shock, worsening the survival prognosis. Local bacterial infections and abscesses do not significantly raise procalcitonin levels. Procalcitonin levels fall with successful treatment of severe bacterial infection and severe noninfectious inflammatory stimuli. Persistent or recurrent procalcitonin elevation in the latter setting should prompt suspicion of secondary infection.
Rangos normales procalcitoninaThe reference value of procalcitonin in adults and children older than 72 hours is 0.15 ng/mL or less.
Conditions associated with mildly elevated serum procalcitonin (PCT) levels (0.15-2 ng/mL)infex bacterianas localizadas leves a moderadas, rta inflame no infecciosa, falla renal en estadío terminal no tratada.
Conditions associated with elevated serum procalcitonin levels (>2 ng/mL)sepsis bacteriana, infección bacteriana localizada severa (ej neumonia severa, meningitis, peritonitis), estímulo inflame no infeccioso severo (quemaduras mayors, trauma severo, falla multiorgánica agua, Qx mayor abdominal o cardiotorácica), carcinoma medular tiroideo (puede llegar a exceeder 10,000 ng/ml)
Vida media procalcitonina en sangre30 h
Indicaciones para la medición de procalcitonina séricaTo aid in the diagnosis and risk stratification of bacterial sepsis.To aid in the diagnosis of renal involvement in children with urinary tract infection. To aid in distinguishing bacterial from viral infections, including meningitis. To monitor therapeutic response to antibacterial therapy and reduce antibiotic exposure .To aid in the diagnosis of systemic secondary infection after surgery and in severe trauma, burns, and multiorgan failure .To aid diagnosis of infected necrosis and associated systemic complications in acute pancreatitis
Valores de referencia para CRPCRP: 0-10 mg/dL. High-sensitivity CRP (hs-CRP): < 3 mg/L
CRP en IAMHs CRP appears within one to two days of acute myocardial infarction, peaks at 3 days and becomes negative after seven days. Failure of CRP to return to normal signifies tissue damage in the cardiac or other tissues. The absence of a CRP increase raises the question of necrosis in prior to 2 to 10 days. CRP does not usually increase in patients with unstable angina. Hs CRP correlates with peak CKMB following acute myocardial infarction. CRP may remain high for at least three months following acute myocardial infarction.
En qué situaciones se aumenta la CRPAcute or chronic inflammatory conditions, Tissue necrosis or tissue injury, Ischemia or infarction of issues, Infection, inflammation, Metabolic syndrome, Malignant tumors especially of breast, lung and gastrointestinal tract, Acute pancreatitis, Post-surgery, Burn, Leukemia, Tobacco smoking, Hormone replacement therapy, Obesity
Qué situaciones disminuyen la CRPExercise, weight loss, moderate alcohol consumption, medications like statins, niacin and fibrates
Qué es la CRPuna proteína sérica de fase aguda sintetizada por el hígado en mayor medida y también por células de la pared vas cular como endoteliales, SMC y tejido adiposo.
Indicaciones CRPSuspected inflammatory state (vasculitis, autoimmune disorders, SLE, psoriasis, infection), CRP may sometimes be ordered along with erythrocyte sedimentation rate (ESR), CRP may be ordered, for example, when a newborn shows signs of infection or when an individual has symptoms of sepsis, such as fever, chills, and rapid breathing and heart rate. CRP may also be ordered to monitor conditions such as rheumatoid arthritis and lupus and is often repeated at intervals to determine effectiveness of treatment. hs-CRP can be ordered for patients with some established risk factors of coronary heart disease to determine strategy for prevention of cardiovascular events and for follow-up of patients with acute coronary syndromes.
Funciones inmunológicas de la CRP it activates complement, binds to Fc receptors and acts as an opsonin for various pathogens. Interaction of CRP with Fc receptors leads to the generation of proinflammatory cytokines that enhance the inflammatory response. Unlike IgG, which specifically recognizes distinct antigenic epitopes, CRP recognizes altered self and foreign molecules based on pattern recognition. Thus, CRP is though to act as a surveillance molecule for altered self and certain pathogens.
Vida media CRP19 dias
CRP como marcador de riesgo cardiovascular, consideraciones medicioens e interpretaciónCRP, being a marker of acute inflammation, is elevated 100-1000 fold after infection or trauma and, thus, for its utility as a cardiovascular risk marker, it needs to be measured 2 times at least 2 weeks apart, in a metabolically stable state, post-infection or illness, since its half-life is 19 days.
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