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Advisor(s)
Abstract(s)
No amplo espectro das patologias infecciosas, a pneumonia é uma das
causas mais frequentes de consulta; a taxa de incidência anual de pneumonia
adquirida na comunidade (PAC) varia de 2,6 a 13,4 casos por 1000 habitantes,
sendo a taxa maior nos extremos de idade e as taxas de mortalidade variam entre 1
e 50% consoante o local de tratamento.
O doente com PAC pode apresentar-se com um quadro localizado, de
pouca gravidade, respondendo eficazmente à terapêutica, ou com envolvimento
sistémico, de prognóstico potencialmente fatal caso não seja instituída a
antibioterapia rapidamente. Na abordagem inicial, o clínico deve obter todos os
dados que lhe permitam tomar uma das decisões com maior influência no
prognóstico, ou seja o local de tratamento – ambulatório, enfermaria ou unidade
de cuidados intensivos.
Actualmente os testes diagnósticos rápidos constituem uma das
ferramentas mais importantes para a instituição precoce da antibioterapia,
idealmente dentro de 4 horas após entrada no hospital. Os métodos de diagnóstico
clássicos não permitem obter resultados nesse período, e apesar de sensíveis, são
pouco específicos para infecção. O uso de biomarcadores mais específicos
providencia uma nova abordagem das infecções, nomeadamente na estimativa da
gravidade, necessidade de instituir tratamento e no prognóstico. A procalcitonina
(PCT) é um dos biomarcadores mais recentes, estando elevada nos processos
inflamatórios sistémicos de etiologia bacteriana, e apresentando uma cinética com
implicações prognósticas.
Este trabalho é uma análise de alguns estudos que avaliaram a
aplicabilidade da determinação da PCT na PAC, a nível do diagnóstico, do
tratamento e do prognóstico. Foi feita uma revisão bibliográfica de artigos em
inglês, português e espanhol, publicados entre 1990 e 2008, através de motores de
busca (Google e Pubmed), complementando com o recurso a tratados de
medicina.
A análise da informação recolhida revela que a utilidade da PCT como
guia da antibioterapia e marcador do prognóstico e da gravidade na PAC está bem
estabelecida; no entanto para o seu diagnóstico os dados não estabelecem com
segurança a sua importância. Para o futuro aguardam-se novos estudos que
incidam em outros marcadores, e na associação dos já existentes, de forma a
aumentar a especificidade diagnóstica dos processos infecciosos, nomeadamente
da PAC.
Pneumonia is one of the most frequent causes of medical consultation within the scope of infectious pathologies. It is estimated that the annual incidence rate of community-acquired pneumonia (CAP) varies from 2.6 to 13.4 cases per thousand inhabitants, being even higher in the age extremes, and mortality rate ranging from less than 1% to 50% according to treatment setting. A CAP patient can present mild localized symptoms with an effective response to therapeutics, or a systemic condition with a potentially fatal prognosis unless antibiotherapy is rapidly administered. In the first approach, the clinician must collect all the data that will allow him to make one of the decisions with the most impact on the prognosis, i.e. the treatment setting – ambulatory, ward or ICU. Currently, the rapid diagnostic tests are one of the most important tools for early antibiotherapy prescription, ideally within four hours from hospital admission. The classical diagnostic methods do not afford results in such a period of time and despite being sensitive they are unspecific for infection. The use of specific surrogate markers provides a new approach of infection, in particular to the prediction of severity, to the need to prescribe treatment, and to the prognosis. Procalcitonin (PCT) is one of the most recent surrogate markers that is high in systemic inflammatory processes of bacterial etiology and that shows a kinetics with prognostic implications. This work is an analysis of previous studies that assessed the applicability of PCT determination in the diagnosis, treatment and prognosis of CAP. Information for the literature review included English, French and Spanish papers published from 1990 to 2008, obtained via web search engines (Google and Pubmed), that were complemented with medical compendia. The analysis of the collected information shows that PCT utility is well established both as an antibiotherapy guide and as prognostic and severity marker in CAP. However, the data are not as certain of its importance in the diagnosis of CAP. Future studies will be expected to focus not only on other markers but also on the association of already existing markers likely to increase the diagnostic specificity of infectious processes, namely of CAP.
Pneumonia is one of the most frequent causes of medical consultation within the scope of infectious pathologies. It is estimated that the annual incidence rate of community-acquired pneumonia (CAP) varies from 2.6 to 13.4 cases per thousand inhabitants, being even higher in the age extremes, and mortality rate ranging from less than 1% to 50% according to treatment setting. A CAP patient can present mild localized symptoms with an effective response to therapeutics, or a systemic condition with a potentially fatal prognosis unless antibiotherapy is rapidly administered. In the first approach, the clinician must collect all the data that will allow him to make one of the decisions with the most impact on the prognosis, i.e. the treatment setting – ambulatory, ward or ICU. Currently, the rapid diagnostic tests are one of the most important tools for early antibiotherapy prescription, ideally within four hours from hospital admission. The classical diagnostic methods do not afford results in such a period of time and despite being sensitive they are unspecific for infection. The use of specific surrogate markers provides a new approach of infection, in particular to the prediction of severity, to the need to prescribe treatment, and to the prognosis. Procalcitonin (PCT) is one of the most recent surrogate markers that is high in systemic inflammatory processes of bacterial etiology and that shows a kinetics with prognostic implications. This work is an analysis of previous studies that assessed the applicability of PCT determination in the diagnosis, treatment and prognosis of CAP. Information for the literature review included English, French and Spanish papers published from 1990 to 2008, obtained via web search engines (Google and Pubmed), that were complemented with medical compendia. The analysis of the collected information shows that PCT utility is well established both as an antibiotherapy guide and as prognostic and severity marker in CAP. However, the data are not as certain of its importance in the diagnosis of CAP. Future studies will be expected to focus not only on other markers but also on the association of already existing markers likely to increase the diagnostic specificity of infectious processes, namely of CAP.
Description
Keywords
Biomarcadores Pneumonia - Biomarcadores Biomarcadores - Procalcitonina - Sépsis
Citation
Publisher
Universidade da Beira Interior