110: 5th WSC – Novel Approaches to Pathogen Detection and Sepsis  Diagnostics

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5th World Sepsis Congress: Sepsis Research and Innovations 1h 17m 8 chapters transcribed 19 days ago
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What is the purpose of this session and who are the key speakers?

Unknown 0:02
Hello and thank you for joining us today. You're listening to the Fifth World Zepsis Congress, where we explore the latest research, innovations and solutions to fight Zepsis worldwide. Leading today's conversation is Konrad Reinhardt, founding president of the Global Sepsis Alliance and president of the Sepsis Stiftung, along with five renowned experts from all over the world. With that, let me turn it over to Konrad to kick off the session.
Konrad Reinhart 0:30
Dear colleagues, I am excited to chair this session on novel approaches to paddocken detection and biomarkers and diagnostics in sepsis. My name is Conrad Reinhardt, and it's my pleasure to announce our first speaker, which is Evdoxia Kiratsorupulu, who is trained in in in internal medicine and critical care medicine, and currently practicing in Athens. And she has an extensive track record also in the field of biomarkers in antimicrobial stewardship. Please get started.
Evdoxia Kyriazopoulou 1:14
So good morning, good evening, good afternoon to everyone. It's a great honor to be uh part of the year of this year's uh World Sepsis Congress and talk about biomarkers and sepsis diagnosis and microbial stewardship. Uh biomarkers are indicators that can be measured of a biological process either in normal or abnormal conditions. And in sepsis there is a great variety of biomarkers studied so far because the uh this the this Syndrome is quite complex. Insepsis biomarkers help us to diagnose the septic patient and also early recognize the patient with organ dysfunction. But also we use biomarkers to guide our treatment like antimicrobial stealcy. For the next ten minutes we will focus on diagnosis and antimicrobial stewardship using biomarkers in sepsis.
Evdoxia Kyriazopoulou 2:00
The current uh surviving sepsis campaign guidelines suggest that we should use uh intensively uh scores and programs to detect patients with sepsis to uh to early screen uh for sepsis. And although the sepsis three definitions uh have implemented uh sofa as the sofa score as the gold standard for sepsis uh diagnosis, the abbreviated score, the QSOFAS score, is not recommended for sepsis detection because the the QSOFA score is not sensitive enough. And of course biomarkers, when adding biomarkers to QSOFA, we can increase the sensitivity of the score, and such biomarkers may be lactate or arterial pH or prisepsin. Of course, there is no ideal biomarker to diagnose sepsis. And the most sad biomarker so far is procalcitonein, PCT.
Evdoxia Kyriazopoulou 2:51
In a large trial consisting of more than uh seventy five thousand patients in the US, procalcitonin levels of admission could not discriminate bacterial sepsis. Um PCD levels varied widely, uh dependent on the uh pathogen detected and also the origin of infection. And of course higher levels were uh shown uh in patients with septic socks and higher SOFA scores. And the overall sensitivity of the biomarker to detect sepsis was uh almost seventy percent. not uh w well enough. An interesting ongoing trial in the UK is conducted in emergency departments and combines procalcitonin, a biomarker, with a news to score, which is quite sensitive for sepsis diagnosis. Uh so patients are randomized either uh to be detected with a NUS two score or with a combination of procalcetonin and news two.
Evdoxia Kyriazopoulou 3:47
And the uh the two primary endpoints of the trial are uh the rate of uh patients that received antibiotics in the first three hours and also a safety signal of twenty eight day mortality. What is uh what really matters is not the initial value of procalcitonin, but the uh the kinetics of the biomarker. In an old trial of five hundred patients, there there were found uh three classes of PCT trajectory. The first class is the high value slow decrease with worse outcome, uh and there are two other uh classes with better outcomes the high value fast decrease and consistent slow procitone levels. So the current sepsis guidelines recommend that we do not use biomarkers for initiation of antimicrobials, as they are not ideal for the diagnosis, but uh in order to reduce the duration of antimicrobial treatment to five or uh seven days, which is a short period of antim antimicrobials, biomarkers can help us together with clinical judgment.

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