The document discusses several markers that can be used to evaluate patients for systemic inflammatory response syndrome (SIRS). It notes that a complete blood count with differential can detect leukocytosis or leukopenia. Procalcitonin levels may help distinguish between infectious and non-infectious causes of SIRS. Interleukin-6 and interleukin-8 are inflammatory cytokines that provide information on the body's immune response. Several other potential biomarkers are mentioned, including C-reactive protein, leucocyte count, and leptin levels, but it is noted that none are perfectly sensitive or specific on their own. The document outlines some limitations in diagnosing sepsis/SIRS in different patient populations and challenges in determining the cause. Trans

1. BY
DR.VIJAYANAND PALANISAMY

4.  complete blood cell count with differential to
evaluate for leukocytosis or leucopenia
 Sedimentation rates and C-reactive proteins are
not sensitive in distinguishing between causes
of SIRS but may be helpful in certain
circumstances
 Lung receives whole output of right side of
heart . Hence lungs is more susceptable to
injury than other organs

5.  Ref value <0.5ng/ml
 In an observational, prospective study in a
pediatric ICU, Arkader et al showed that PCT
levels could be used to differentiate between
infectious and noninfectious SIRS, while C-
reactive protein (CRP) levels could not
 Raise in bacterial infection
 Their lack of routine availability in most
hospitals limits their usefulness.

7.  produced by monocytes, lymphocytes, and
endothelial cells
 stimulates an adhesive neutrophil-cardiac
myocyte interaction and induces myocardial
damage following CPB surgery
 normal value <28 pg/ml and >300pg/ml – sirs
 In addition, a decrease in IL-6 by the second
day of antibiotic treatment has been shown to
be a marker of effectiveness of therapy and a
positive prognostic sign in those patients with
an infectious etiology for their SIRS

8. Interleukin 8
 monocytes, polymorphonuclear (PMN) leukocytes,
macrophages, fibroblasts, and vascular endothelial
cells
 induces the amplification of neutrophils and
macrophages
 regulate neutrophil transendothelial migration,
and potentially to control neutrophil-mediated
tissue injury
Interleukin 10
counter antiinflammatory response syndrome
(CARS)

9.  NEOPTERIN - Ref value <12.5nM
 Serum phosphate level – hypophosphatemia
(inversely correlates with proinflammatory
cytokines level )

10.  Leucocyte count - Ref value 4000-12000
 C-reactive protein - Ref value <5mg/l
 Leucocyte elastase - Ref value <32mcg/l
 sL-selectin - Ref value 1250 ng/ml
 sCD-14-Ref value <4.5mcg/ml
 Leptin - cutoff of 38 µg/L (correlates well with
serum IL-6 and tumor necrosis factor–alpha
(TNF- α ) levels)

12.  The aPTT wave form analysis was performed
with the MDA II analyzer. In the aPTT assay,
the slope of the initial phase of the light
transmission profile quantifies an abnormal
BPW. BPW signal unit is transmittance
percentage per second (%T/s).
 The BPW is caused by calcium-dependent
formation between VLDL and CRP .
 independent of the aPTT clotting
 Statin therapy reduce chance of developing
BPW

16.  fever and other SIRS criteria have a low
specificity (e.g. burns, pancreatitis, transfusion)
 elderly, immunocompromised and
malnourished patients do not manifest typical
signs of sepsis or SIRS
 both infective and noninfective SIRS can
co-exist in same patient

17.  some of the clinical criteria applies to adult
physiological variables
 early administration of antibiotics is important in
management but decreases diagnostic yield
 delay in diagnosis (time until culture results
available)
 specimens are easily contaminated
 PCR tests are not universally available
 biomarkers such as CRP, IL-6 and procalcitonin
have limited sensitivity & specificity and cannot be
used in isolation

18.  Transient rise in Heart rate ,breathing
frequency , and signs of hyperventilation
results from suctioning and inadequate
sedation and analgesia
 Transient raise in heart rate in case of pain,
change in inotropic support , alteration in
preload or afterload , or as patient getting
awake.
 Heart rate will be low because of betablocking
in postop period.

19.  Temperature of patient is influenced by
ICU/OR temperature , Blood transfusion ,
cardiac status , thyroid status ,
vasodilators/constrictors and so on

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