The laboratory plays a fundamental role in sepsis and septic shock. Clinical signs must always be integrated with laboratory tests to define the picture and immediate treatment. In addition to the laboratory investigations helpful in assessing the patient’s overall clinical condition (blood count, creatinine, blood glucose, aminotransferase, bilirubin, cardiac troponins, coagulation tests D-dimer) (Table 1), lactic acid determination and blood culture play a critical role. Lactic acid levels represent the expression of peripheral tissue dis tress, and the concentration and kinetics correlate with the patient prognosis. Moreover, in preserved hemodynamic parameters, an important lactate increase (>4 mmol/L) could detect cryptic shock. Finally, lactate measurement is used to assess the clinical evolution of sepsis. The blood culture rep resents the fundamental test for correctly identifying the pathogenic species responsible for sepsis. However, the literature reports varying percentages of sepsis with negative blood cultures from 20% to 40%. Moreover, although blood culture remains the reference method for the etiological diagnosis of sepsis, it should be remembered that its execution usually requires 24 to 72 hours, depending on the investigation's complexity. The recent introduction of molecular techniques that allow the identification of pathogens from culture directly on blood samples could shorten the etiological diagnosis by several hours. They are essentially based on the following: (1) DNA strip technology, a method characterized by high diagnostic efficiency, whereby DNA is isolated, amplified, and detected by strip hybridization and (2) polymerase chain reaction (PCR) and microarray-based microbiology, which allow DNA extraction, multiplex PCR, detection, and identification of multiple bacterial species simultaneously in less than 3 hours. Today, direct molecular tests would allow obtaining a precise etiological diagnosis (on average) in less than 6 hours, would not require dedicated personnel, and could be available at all times, even in emergencies. It is important to remember that blood cultures should be collected before antibiotic therapy in patients with suspected sepsis or septic shock because antibiotic therapy may alter the results.

Table1. Laboratory tests in sepsis

In addition to common laboratory investigations, many biomarkers are used in clinical practice for managing patients with suspected or confirmed sepsis and septic

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مواضيع ذات صلة

Biomarkers of Sepsis

potassium, urine (K)

porphyrins and porphobilinogens

platelet function assay (Platelet closure time, PCT, Aspirin resistance tests, Bleeding time [BT], 11-Dehydro-thromboxane B2)

Laboratory Diagnosis of Rabies Virus

Procalcitonin

Erythrocyte Sedimentation Rate

C-Reactive Protein

plasminogen (Fibrinolysin)

placental growth factor (PGF)

PI-linked antigen (Phosphatidylinositol antigen)

Pre-implantation Diagnosis