Avaliação seriada da proteína C reativa e do lactato em canídeos, doentes críticos, durante a sua hospitalização
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2021
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Ao longo dos anos a definição de sepsis e SIRS (do inglês, Systemic Inflammatory Response Syndrome) permaneceram ligadas. O conceito de sepsis foi descrito pela primeira vez, no primeiro consenso, em 1991. No terceiro consenso, publicado em 2016 (sepsis – 3), o conceito de SIRS foi retirado da nova definição de sepsis, permitindo assim excluir doentes com alterações inespecíficas nos critérios inflamatórios. Neste consenso, foi ainda introduzida a escala quick Sequential Organ Failure Assessment (qSOFA).
Atualmente, existem inúmeros biomarcadores de sepsis, capazes de auxiliar no diagnóstico, monitorizar e melhorar a resposta ao tratamento pelo paciente, melhorando assim a precisão do prognóstico.
A presente dissertação de mestrado, pretendeu estabelecer uma melhor ligação entre escalas de avaliação de prognóstico adaptadas a medicina veterinária, como a Modified quick sepsis-related organ failure assessment (MqSOFA), em doentes críticos com sinais de SIRS, recorrendo-se a biomarcadores, como o lactato e a Proteína C-Reativa (PCR), associados a tempos de coagulação. O estudo concentrou-se numa amostra de 32 cães, que deram entrada em situação de urgência, segundo os critérios Veterinay Triage List (VTL), no Hospital Veterinário da Arrábida (HVA), que tinham pelo menos 2 critérios de SIRS positivos, tendo sido posteriormente avaliados com recurso à MqSOFA de modo a avaliar o risco de mortalidade, associado a biomarcadores de sepsis (lactato e PCR) e a tempos de coagulação, sendo que todos os parâmetros séricos foram avaliados pelo menos cada 24h.
Com os resultados obtidos, foi possível verificar-se que a PCR tem um aumento exponencial nas primeiras 24h após, sendo de extrema importância a sua monitorização durante as primeiras 72h. Verificou-se ainda que nas primeiras 24h os valores séricos de lactato diminuíram significativamente, devido ao fenómeno de clearance do lactato.
Em suma, concluiu-se que a PCR e o lactato apresentam um interesse significativo quando usados para monitorização e avaliação de prognóstico de doentes críticos com sinais de SIRS, permitindo diminuir a taxa de mortalidade quando associada a uma boa terapêutica durante o internamento em unidade de cuidados intensivos.
Palavras-chave: Cães, SIRS, Sepsis, MqSOFA, Proteína C-Reativa (PCR), Lactato, Tempos de coagulação.
Over the years, the definition of sepsis and SIRS (Systemic Inflammatory Response Syndrome) have been linked. The first consensus of sepsis was published in 1991. In the third consensus, published in 2016 (sepsis - 3), the concept of SIRS was removed from the new definition of sepsis, thus allowing the exclusion of patients with nonspecific changes in inflammatory criteria. In this consensus, the quick Sequential Organ Failure Assessment (qSOFA) scale was also introduced. Currently, there are numerous biomarkers of sepsis, capable of assisting in the diagnosis, monitoring and improving the response to treatment by the patient, thus improving the accuracy of the prognosis. This master's thesis aimed to establish a better connection between prognostic assessment scales adapted to veterinary medicine, such as the Modified quick sepsis-related organ failure assessment (MqSOFA), in critically ill patients with signs of SIRS, using biomarkers, such as lactate and C-Reactive Protein (CRP), associated with clotting times. The study focused on a sample of 32 dogs, admitted to the emergency room, (according to the Veterinay Triage List (VTL) criteria), at the Arrábida Veterinary Hospital (HVA), with least 2 positive SIRS criteria, and subsequently evaluated using MqSOFA in order to assess the risk of mortality. Each patient had sepsis biomarkers (lactate and CRP) and clotting times, assessed at least every 24 hours. It was possible to verify that the CRP increases exponentially in the first 24 hours, making it extremely important to monitor during the first 72 hours. It was also found that in the first 24h the serum lactate values decreased significantly, presumably due to the phenomenon of lactate clearance. CRP and lactate are of significant interest when used for monitoring and assessing the prognosis of critically ill patients with signs of SIRS, allowing for a decrease mortality rate when associated with appropriate therapy during hospitalization in intensive care units. Keywords: Dogs, SIRS, Sepsis, MqSOFA, C- Reactive Protein (CRP), Lactate, Clotting Times.
Over the years, the definition of sepsis and SIRS (Systemic Inflammatory Response Syndrome) have been linked. The first consensus of sepsis was published in 1991. In the third consensus, published in 2016 (sepsis - 3), the concept of SIRS was removed from the new definition of sepsis, thus allowing the exclusion of patients with nonspecific changes in inflammatory criteria. In this consensus, the quick Sequential Organ Failure Assessment (qSOFA) scale was also introduced. Currently, there are numerous biomarkers of sepsis, capable of assisting in the diagnosis, monitoring and improving the response to treatment by the patient, thus improving the accuracy of the prognosis. This master's thesis aimed to establish a better connection between prognostic assessment scales adapted to veterinary medicine, such as the Modified quick sepsis-related organ failure assessment (MqSOFA), in critically ill patients with signs of SIRS, using biomarkers, such as lactate and C-Reactive Protein (CRP), associated with clotting times. The study focused on a sample of 32 dogs, admitted to the emergency room, (according to the Veterinay Triage List (VTL) criteria), at the Arrábida Veterinary Hospital (HVA), with least 2 positive SIRS criteria, and subsequently evaluated using MqSOFA in order to assess the risk of mortality. Each patient had sepsis biomarkers (lactate and CRP) and clotting times, assessed at least every 24 hours. It was possible to verify that the CRP increases exponentially in the first 24 hours, making it extremely important to monitor during the first 72 hours. It was also found that in the first 24h the serum lactate values decreased significantly, presumably due to the phenomenon of lactate clearance. CRP and lactate are of significant interest when used for monitoring and assessing the prognosis of critically ill patients with signs of SIRS, allowing for a decrease mortality rate when associated with appropriate therapy during hospitalization in intensive care units. Keywords: Dogs, SIRS, Sepsis, MqSOFA, C- Reactive Protein (CRP), Lactate, Clotting Times.
Descrição
Orientação: Rute Teixeira ; co-orientação: Ângela Martins
Palavras-chave
MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, MEDICINA VETERINÁRIA, VETERINÁRIA, CANÍDEOS, CÃES, SÍNDROME DE RESPOSTA INFLAMATÓRIA SISTÉMICA, LACTATO, COAGULAÇÃO SANGUÍNEA, SÉPSIS, VETERINARY MEDICINE, CANIDS, DOGS, LACTATE, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME, BLOOD COAGULATION, SEPSIS, C-REACTIVE PROTEIN, PROTEÍNA C-REATIVA