Critical care clinics
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This article discusses coagulation biomarkers in critically ill patients where coagulation abnormalities occur frequently and may have a major impact on the outcome. An adequate explanation for the cause is important, since many underlying disorders may require specific treatment and supportive therapy directed at the underlying condition. Deficiencies in platelets and coagulation factors in bleeding patients or patients at risk for bleeding can be achieved by transfusion of platelet concentrate or plasma products, respectively. Prohemostatic treatment may be beneficial in case of severe bleeding, whereas restoring physiological anticoagulant pathways may be helpful in patients with sepsis and disseminated intravascular coagulation.
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Despite continual advances in medical care and injury prevention efforts, traumatic injury remains a leading cause of death of Americans with these deaths occurring in a tri-modal pattern. The early phases of this pattern are characterized by immune activation whereas the last phase is marked by profound immune dysfunction. It is during this last phase that many trauma patients die of septic complications pointing to a dire need for a specific biomarker for post-traumatic infection. This article discusses several biomarkers, including emerging ones, for infection and sepsis following trauma including inflammatory cytokines, intracellular proteins, and cellular biomarkers.
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Sepsis is a common cause of morbidity and mortality in intensive care units. There is no gold standard for diagnosing sepsis because clinical and laboratory signs are neither sensitive nor specific enough and microbiological studies often show negative results. ⋯ Its expression is upregulated on phagocytic cells in the presence of bacteria or fungi. This article reports on the potential usefulness of the assessment of the soluble form of TREM-1 in biologic fluids in the diagnosis of infection.