RESUMO
PURPOSE: Over 170 biomarkers are being investigated regarding their prognostic and diagnostic accuracy in sepsis in order to find new tools to reduce morbidity and mortality. Matrix metalloproteinases (MMPs) and their inhibitors have been recently studied as promising new prognostic biomarkers in patients with sepsis. This study is aimed at determining the utility of several cutoff points of these biomarkers to predict mortality in patients with sepsis. MATERIALS AND METHODS: A multicenter, prospective, analytic cohort study was performed in the metropolitan area of Bucaramanga, Colombia. A total of 289 patients with sepsis and septic shock were included. MMP-9, MMP-2, tissue inhibitor of metalloproteinase 1 (TIMP-1), TIMP-2, TIMP-1/MMP-9 ratio, and TIMP-2/MMP-2 ratio were determined in blood samples. Value ranges were correlated with mortality to estimate sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiving operating characteristic curve. RESULTS: Sensitivity ranged from 33.3% (MMP-9/TIMP-1 ratio) to 60.6% (TIMP-1) and specificity varied from 38.8% (MMP-2/TIMP-2 ratio) to 58.5% (TIMP-1). As for predictive values, positive predictive value range was from 17.5% (MMP-9/TIMP-1 ratio) to 70.4% (MMP-2/TIMP-2 ratio), whereas negative predictive values were between 23.2% (MMP-2/TIMP-2 ratio) and 80.9% (TIMP-1). Finally, area under the curve scores ranged from 0.31 (MMP-9/TIMP-1 ratio) to 0.623 (TIMP-1). CONCLUSION: Although TIMP-1 showed higher sensitivity, specificity, and negative predictive value, with a representative population sample, we conclude that none of the evaluated biomarkers had significant predictive value for mortality.
Assuntos
Sepse/sangue , Choque Séptico/sangue , Inibidor Tecidual de Metaloproteinase-1/sangue , Inibidores Teciduais de Metaloproteinases/sangue , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Metaloproteinases da Matriz , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Sepse/mortalidadeRESUMO
El signo de Pemberton, definido como la plétora facial ocasionada por compresión de la vasculatura a nivel del opérculo torácico cuando se elevan los miembros superiores, tiene un alto valor semiológico teniendo en cuenta la condición patológica subyacente. Este artículo busca presentar el caso de un hombre de 57 años en quien se documentó este hallazgo clínico secundario a un conglomerado ganglionar cervical de crecimiento progresivo, al punto de causar compresión de la médula espinal, provocando su muerte sin diagnóstico establecido. Se realiza una breve discusión basada en los reportes de casos publicados. [Niño-Vargas DC, Rojas-Castillo JC ,Wandurraga-Sánchez EA. Signo de Pemberton: Un hallazgo semiológico de gran importancia. Reporte de un caso.
The Pemberton sign is defined as a facial plethora caused by a compression of vasculature at thoracic operculum level. It happens when someone rises both arms. This finding has a high semiologic value because of its underlying pathological condition. We report a case of a 57-year-old man who presented this sign during a physical exploration. After getting some tests and images, huge neck lymph nodes were found with spinal cord compression. The man died before the diagnosis was established. A brief discussion is made based on cases reported. [Niño-Vargas DC, Rojas-Castillo JC, Wandurraga-Sánchez EA. A Signal of Pemberton: A physical diagnosis finding of great importance. A case report.
O sinal de Pemberton, definido como pletora ou edema facial é causado pela compressão da vasculatura ao nível toráxico no opérculo. Isso acontece quando ambos os membros superiores são elevados. Este achado tem um alto valor semiológico, devido à sua condição patológica subjacente. O artigo apresenta um caso de um homem de 57 anos de idade, que apresentou este sinal durante uma exploração física, cujo achado clínico foi documentado como secundário. Após a realização de alguns testes de imagem, enormes linfonodos cervicais foram encontrados com compressão da medula espinhal. O homem morreu antes que o diagnóstico fosse definido.Adiscussão feita no artigo tem por base outros informes similares de casos já publicados. [Niño-Vargas DC, Rojas-Castillo JC, Wandurraga-Sánchez EA. Sinais de Pemberton: Um achado diagnóstico de alto valor. Relato de caso.